Welcome to Advance Physical Therapy, Inc. Newsletter

Welcome to our August newsletter! If you've had physical therapy treatment, you may have heard the saying, "Movement is life" and "motion is lotion."  As physical therapists, we feel that these are two essential principles to healing. Our bodies depend on movement to keep everything inside and outside of us balanced. We think we know this concept pretty well but yet it's so hard to put it to practice. We're so busy and work life consumes so much of our time and priority.

Any type of aerobic activity contributes to cardiovascular fitness. In fact, even divided "doses" of activity - such as three 10-minute walks spread throughout the day - offer aerobic benefits. What's most important is making regular physical activity part of our lifestyle. As a general goal, aim for at least 30 minutes of physical activity every day.

Many of you have asked us to discuss how sleep is affected by athletic performance and why don't knee injuries heal well. Here are some insights to these great questions.

To Your Health,
Advance Physical Therapy, Inc.

Sleep and Athletic Performance

In any sport, successful performance requires a planned approach to training and recovery. Whereas healthy adults are recommended 7-9 hours of sleep each night, some athletes, under circumstances of need, are taught to aim for 9-10 hours of sleep. Coaches and athletes rate sleep as critical to optimal performance, but the reality is that athletes are not getting it. Poor or inadequate sleep affects athletic performance, recovery, and may have systemic effects. The effects of sleep on athletes are complex due to multiple mechanisms of action, as well as individual variations to required or perceived need of sleep and resilience to sleep restriction. Many studies have evaluated sleep deprivation, a prolonged period of sleep loss such as a whole night or longer; however, sleep restriction, the partial disturbance of the sleep-wake cycle, is more akin to real world experiences of athletes. The following is a sample of the evidence of sleep restriction in athletes that can help decision-making regarding the use of sleep support habits and/ or agents.
The amount of sleep an elite athlete obtains is influenced by their training schedule.
Seventy nationally ranked athletes from seven different sports were monitored using wrist activity monitors and asked to complete sleep/training diaries for 2 weeks during normal training. Fatigue levels were recorded prior to each training session using a 7-point scale. Athletes, on average, awoke at 6:48 am, fell asleep at 11:06 pm, spent 8 hours and 18 minutes in bed, and obtained 6 hours and 30 minutes of sleep per night. Of particular interest is that on nights prior to training days, time spent in bed was significantly shorter, sleep onset, as well as awakening times were significantly earlier, and the amount of sleep obtained was significantly less. It is not surprising that shorter sleep durations were associated with higher levels of pre-training fatigue. Timing of training also plays a role, in that, early morning training start times reduce sleep duration and increase pre-training fatigue levels.
Athletes from individual sports went to bed earlier, woke up earlier, and obtained, on average, 30 minutes less sleep than athletes from team sports.
The same research group followed 124 elite athletes from five individual sports and four team sports for 7-28 nights. Wrist activity monitor data and sleep diaries were assessed. Averages of sleep markers were similar to the previous study, but significant variances were seen in the individual sport athletes.
Increasing intensity of training in elite athletes negatively affects sleep quality, mood, and performance.
In one study 13 highly-trained male cyclists participated in two 9-day periods of intensified training. Sleep was measured each night via wristwatch actigraphy. Mood state questionnaires were completed daily. Performance was assessed with maximal oxygen uptake. Percentage sleep time fell during intensified training despite an increase in time in bed. Sleep efficiency decreased during intensified training. Mood disturbance increased during intensified training. Performance in the exercise protocol fell significantly with intensified training.
Overtraining of trained endurance athletes leads to poor sleep and illness.
In one study, 27 trained male triathletes were either randomized into a 3 weeks period of “overload” training or normal training, both with a week of moderate training preceding the variable training and a two-week taper following the variable training. Researchers measured maximal aerobic power and oxygen uptake (VO2max) from incremental cycle ergometry. After each phase questionnaires measured mood states, and incidences of illness and sleep were monitored using wristwatch actigraphy. Half of the individuals in the overload group were categorized as functionally overreached. This group demonstrated decreases in sleep duration, sleep efficiency, immobile time, and a higher prevalence of upper respiratory tract incidences.
Some athletes report trouble sleeping the night prior to a competition.
Competitive Sport and Sleep questionnaire and the Pittsburgh Sleep Quality Index were given to 283 elite Australian athletes. 64.0% of athletes indicated worse sleep on at least one occasion in the nights prior to an important competition over the past 12 months. 82.1% reported the main sleep problem was falling asleep. 83.5% attributed this problem to thoughts about the competition and 43.8% reported nervousness. 59.1% of team sport athletes reported having no strategy to overcome poor sleep. 32.7% of individual athletes reported the same.
Elite athletes sleep less after a game.
Ten elite male rugby players were monitored over a twelve night period for sleep quantity and efficiency. There was a statistically significant difference in sleep quantity on game nights compared to non-game nights, with players sleeping less on game nights. Athletes went to sleep later on game nights.
Night games, in elite athletes, results in reduced sleep duration and perceived recovery.
Sixteen elite soccer players completed a subjective online questionnaire twice a day for 21 days during the season. Players were asked about sleep duration, how long it took to fall asleep, time that they fell asleep and awoke, and how long it took to fully wake up. Players were also asked about how they felt they were recovering, mood, and performance. Subjects reported, on average, 24 minutes less sleep per night after night games. Perceived recovery on a 7-point scale dropped by -2.6 points which were not seen in training days or in day matches.
Individual needs of athletes should be considered which makes guidelines and even team schedules difficult. While researchers seek to elucidate exact mechanisms of sleep and effects of sleep restriction in athletes, they are hesitant to provide practical recommendations. Current athletes may benefit from the knowledge and web of evidence that has thus far been understood.

At Advance Physical Therapy, Inc., it is our focus to make sure that a comprehensive assessment includes understanding the patient's sleep pattern and cycle as it relates to achieving optimal performance and recovery from injury.

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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Females Under Age 25 May Have Higher Incidence of ACL Re-tears Post Surgery

According to recent research, the odds of an ACL re-tear post-reconstruction could be high for females younger than age 25 with a graft size of less than 8 mm.

Other contributing factors to the increased odds of a re-tear include estrogen levels, anatomical differences, and decreased knee strength, according to the study’s lead author Duong Nguyen, MD, in a media release from the American Orthopedic Society of Sports Medicine (AOSSM). 

In the study, Nguyen and his team studied a group of 503 athletes who underwent primary, autograft hamstring ACL reconstruction—the same surgical technique, performed at the same hospital, by the same surgeon—between September and December 2012. Altogether, there were 235 females and 268 males, and their average ages were 27. Postsurgery, the participants were followed for 2 years.

The patients were allowed to return to sports participation between 6 and 12 months postsurgery only if they were pain-free, had equal quadriceps/hamstring strength, and if they had graduated from the rehabilitation program.

“Given the results of our study, we feel that surgeons should counsel their younger, female patients accordingly and consider modifying their surgical techniques to utilize larger-size grafts and/or rehabilitation strategies to lessen the chance of a re-tear,” Nguyen states in the release.

Source(s): American Orthopaedic Society of Sports Medicine, PRWeb


  Why Knee Injuries Often Don't Heal

If you fall on the ski slopes or slip on a patch of ice, you’ll probably be better off if you break your leg than if you rip the cartilage in your knee. Unlike bones, your cartilage is never going regrow or heal, according to a new study based in part on fallout from past nuclear explosions.

“The surgeons who do joint replacements should not be afraid,” says study co-author and rheumatologist Michael Kjær of the University of Copenhagen. “They are going to be in business for some time.”

As plenty of athletes and weekend warriors can attest, damaged knee cartilage is reluctant to mend. But because measuring cartilage turnover is difficult, researchers have never been sure whether adults replace any of the material.

To find out, Kjær and colleagues used a technique that determines the age of molecules based on levels of the carbon-14 isotope, a hefty version of carbon. The amount of carbon-14 in the atmosphere surged in the 1950s because of above ground nuclear weapons testing, but it declined rapidly after a 1963 treaty banned these explosions. Measuring the abundance of the isotope can reveal how old a molecule is. If the molecule is continually being replaced, it should appear young—the quantity of carbon-14 should be close to current levels in the atmosphere. But if the molecule remains stable for a long time and isn’t swapped out, its carbon-14 content should match the atmospheric levels from when it was made.

Kjær’s team measured carbon-14 levels in knee cartilage from one donated body and from 22 patients born before the year 2000 who had undergone knee replacement surgery. Some of these people were getting new knees because they suffered from osteoarthritis. Others had healthy joints but needed replacements because of bone tumors. The researchers analyzed cartilage from the middle of the knee joint, which endures the most strain, and from the edge of the joint, which carries a lighter load.

Carbon-14 levels in the subjects’ knee collagen—the protein that provides cartilage’s tensile strength—corresponded to atmospheric levels from when they were 8 to 13 years old, suggesting that they didn't produce new collagen after becoming adults as reported in Science Translational Medicine. One of the patients, for example, was born in 1935 and had little carbon-14. Collagen from patients born in the 1950s, by contrast, showed the largest amounts of the isotope, reflecting the rapid rise in atmospheric carbon-14 after nuclear tests began.

In some previous studies, scientists saw an increase in collagen synthesis in patients with osteoarthritis, which could represent the joint’s attempt to repair itself. But Kjær’s team didn’t detect this effect. An explanation for this difference, the scientists suggest, is that previous studies used indirect measures of collagen turnover in the joints. Even in the areas of the joint that are under the most stress, adults didn’t make new collagen, the team found.

Although researchers have tried several approaches to induce regrowth of knee cartilage, such as inserting stem cells or slivers of healthy cartilage into the joint, they haven’t worked. Developing methods to prevent cartilage from deteriorating might be more successful, Kjær says.

The study highlights the importance of protecting our cartilage, agrees cartilage biologist Richard Loeser of the University of North Carolina School of Medicine in Chapel Hill.

“You need to take care of your joints while you are young,” he says. “Once you have damage to the cartilage, it’s not going to repair itself.”

One of the best ways to prevent cartilage damage or excessive wear and tear is to establish a comprehensive rehabilitation program that includes coordination, endurance, strength and balance.

Consult your physical therapist or health care provider for direction on how to ensure the proper balance of these qualities for good cartilage health.

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