May 2018 newsletter

M AY

FOCUS ON SPECIAL INTEREST GROUPS: THE INTERCOLLEGIATE AND PROFESSIONAL SPORTS SIG The Sports Physical Therapy Section is proud to offer its members the opportunity to focus on issues of specific areas of practice in the form of our Special Interest Groups (SIGs). We will be highlighting each of our SIGs in a new newsletter spotlight!

This issue’s spotlight is on the Intercollegiate and Professional Sports SIG. The Intercollegiate and Professional Sports Special Interest Group (SIG) is a place where students and young professionals can connect with professionals who have established themselves in the intercollegiate and professional sports world.

The SIG’s mission is to 1. Identify sports physical therapists employed by or consulting with professional sports organizations and/or intercollegiate athletics programs.

2. Provide a forum for professional development through collegial interaction and networking.

3. Implement educational programming which focuses on issues specific to the professional sports / intercollegiate athletics setting(s).

4. Disseminate information regarding the benefits of

utilizing sports physical therapy services in the professional sports and intercollegiate athletics setting(s).

Jill Thein-Nissenbaum, PT, DSC, SCS, ATC is an associate professor at the University of Wisconsin-Madison and chairs the Intercollegiate and Professional Sports SIG. Dr. TheinNissenbaum emphasizes the SIG’s importance with those who are interested in working in a collegiate or professional sports setting, as it can often be difficult for physical therapists to break into the field.

Recognizing the SIG’s demographics, which have

become increasingly younger and has seen an increase in female members, Dr. TheinNissenbaum and various SIG members are working collaboratively on two projects to better serve the SIG’s members.

The first project involves creating a database of SIG members which would make it easier to connect with each other. This is also an initiative that is being considered for expansion into the general SPTS membership database. The primary goal of this database would be to create mentorship opportunities so that students and younger professionals can build their network and gain experience in the field.

The second project is establishing a stronger social media pres-

ence. The hope is that the SIG will be able to share content with the PT community, as well as grow its membership.

Finally, the SIG’s long-term goal is to help create continuing education courses, such webinars or on-line courses, that will fulfill requirements for both the American Physical Therapy Association (APTA) and the National Athletic Trainers’ Association (NATA) through the cooperation of the existing SPTS education committee.

Many of the SIG’s members are dual credentialed with PT and ATC licenses. Creating these courses would save members both time and money when searching to fulfill their continuing education requirements.

Currently, the Team Concept Conference and SPTS EMR courses provided by CogentSteps provide NATA BOC certifications.

APTA courses no longer provide certification for BOC hours. In addition, the Section is applying for the Evidence Base Practice approval through NATA, further supporting dual-credentialed members.

Dr. Thein-Nissenbaum, along with Vice Chair Lisa Pataky encourage student involvement along with seasoned professionals, as it is a great way for students to learn and make connections within the SIG. They welcome feedback and are eager to serve the SIG’s and SPTS members.

2018 ELECTIONS: OFFICIAL RESULTS Congratulations to those selected by the SPTS membership to serve our organization!

Vice-President

Nominating Committee

Blaise Williams, PT, PhD Senior researcher for Sports Performance Insights, Nike Sport Research Lab, Beaverton, Oregon Second Term, 2018-2021

Tim Sell, PT, PhD Associate Professor, Duke University First Term, 2018-2021

The Vice-President, Secretary and Nominating Committee terms begin July 1, 2018. The President term begins July 1, 2019.

President

Secretary

Thank you to all who volunteered to run for a position on the SPTS board. We cannot exist without the help of our member volunteers.

The next election will be held in spring of 2019 for two board positions: Treasurer and Representative-At-Large.

Walt Jenkins, PT, DHS, ATC, L-ATC Professor, Physical Therapy Nazareth College Rochester, NY Second Term, 2019-2022 Mitchell Rauh, PT, PhD, MPH, FACSM Professor & Director, Doctor of Physical Therapy Program San Diego State University Second Term, 2018-2021

NOMINATIONS NOW BEING ACCEPTED FOR 2019 AWARDS CEREMONY AT CSM An important reminder: Award Nominations are accepted all year for the next year's awards ceremony!

Don't wait until the last minute to nominate an SPTS member you feel deserves recognition.

You may nominate any time until October 31, 2018.

Find information about each award, descriptions and how to submit at this link: https://spts.org/about-spts/awards/award-descriptions

MEMBER SPOTLIGHT: RICH WESTRICK, PT, DPT, DSc, SCS, OCS If you follow the SPTS on Social Media, you’ve likely seen Rich’s face show up on your feed, particularly during last year’s Team Concept Conference when he visited and promoted every single one of the sponsors and exhibitors in the Exhibit Hall.

However, it’s not just Rich’s smiling face that has won him attention in the sports physical therapy world. He is a respected and prominent voice working to improve awareness of role of Physical Therapy for military, law enforcement and rescue personnel. In 2015, he founded the SPTS Tactical Athlete Special Interest Group, and currently serves as its Chair.

By Sylvia Czuppon

him and encouraged him to become a physical therapist.

Following this dream, he commissioned as an Army Officer and became a member of ArmyBaylor’s inaugural DPT class, graduating in 2006. During his

DPT internship year at Evans Army Community Hospital at Fort Carson, Colorado, he knew he had made the right decision to become a PT being further inspired by his Clinical Instructor Mark Blackley, a dual-credentialed PT/ATC, who Rich says he can “only hope to be half as good a PT as Mark one day.”

After graduation, Rich was assigned overseas to rehab soldiers in Korea for one year before returning to the US to work with the 10th Special Forces Group in Ft. Carson, Colorado. In his 3.5 years there, Rich teamed with others to develop a sports medicine model of health care for these military personnel. Among these team members, Rich identified Danny McMillian, who was involved in the Army RangerAthlete Warrior Program. Afterwards, Rich entered the West Point’s sports physical therapy residency program. At West Point, Rich credits the entire Athletic Training staff along with Perry Gerber and Mike Johnson, two important mentors that Rich says “taught me everything about sports medicine.” He graduated with his DSc in 2011.

Rich initially joined the Army as a medic in 1994. During his first assignment in Heidelberg, Germany, he found himself enjoying his interactions with Army physical therapists, especially after being treated by an Army PT following a neck injury. When his initial tour was completed, he re-enlisted as an Army PT Tech (formerly known as “N9”) where he was assigned to work at Walter Reed Army Medical Center in Washington, D.C. He had the fortune of working with Deydre Teyhen, Jane Freund, Rich Westrick, with SPTS Secretary Mitch Rauh, presents at and Shane Koppenhaver who all inspired CSM 2018.

In his last active duty assignment, Rich worked for the US Army Research Institute of Environmental

Medicine (USand sleep. ThankARIEM) where he fully, Rich is not served as the alone in his misDeputy Chief of sion – he notes that the Military Perthere are multiple formance Division, injury prevention investigating methprograms springing ods to mitigate the up across the US, threat of muscusuch as the proloskeletal injury in grams developed the Army. Rich ofby physical theraficially retired from pists Casey the Army on Jan Stoneberger with 1st, 2018 after the Denver Fire nearly 23 years of Department and service. He is curJulie Collier with With fellow SPTS Tactical SIG co-presenters at CSM 2018. rently Associate the Fairfax County Professor of PhysiFire Department.

However many of these individucal Therapy at the MGH Institute Rich’s hope is to continue conals do not view themselves as of Health Professions DPT Pronecting more PTs interested in athletes and as a result may not gram in Boston, Massachusetts. working with these populations appropriately prepare for both He continues to engage in rethrough the Tactical Athlete SIG. the physical and mental desearch as an ORISE Research Felmands required while operating Rich’s advice to new PT gradulow with the USARIEM Army in uncontrolled environments, ates and young SPTS members is Research Lab. potentially setting them up for that if you identify a patient popinjury. This is where physical Rich is passionate about his work ulation you really want to work therapists can play an important with “tactical athlete” populawith – reach out to the section! role. Rich says that it’s in all of tions. “I am deeply committed to He notes that many experienced our best interest if “tactical athseeing that tactical athletes get clinicians are willing to serve as letes take great care of themthe attention and care they dementors, but you have to be willselves,” which includes physical serve. Given all they do for us as ing to ask, even if you don’t have activity but also a healthy diet a society, I think we owe it to a particular person in mind. Adthem to help them ditionally, take adavoid injury if posvantage of sible and to faciliopportunities like tate their return to SPTS Teammates work as quickly events at CSM or but safely as is feaTeam Concept Consible when they ference. For those are injured." Tactithat are specifically cal athletes include interested in worklaw enforcement, ing with tactical military, and resathletes, Rich cue personnel, all would love to talk of whom have to you! unique physical If you’re interested training strategies in developing prothat optimize occugrams for a target pational physical Hamming it up while visiting exhibitors at 2017 Team Concept tactical athlete performance.

Conference

“I am deeply committed to seeing that tactical athletes get the attention and care they deserve.” group, someone in the SIG can likely help you.

day on Thursday will feature the tactical athlete!

Follow Rich on Twitter @rbwestrick and the Tactical SIG at @SPTSTactical. To find out more about the Tactical Athlete SIG, visit spts.org!

This year’s specialty topic is Sports Physical Therapy for Tactical and Combat Athletes: Here it’s not a game! Current sessions include Military, Law Enforcement, and Firefighters: Here it’s not a game!; Tactical Athlete Injuries and Recovery: Are they “athletes”? ; How to De-

Watch for more information about Team Concept Conference 2018 – the special symposium

velop Opportunities: Can you work with Tactical Athletes? ; and Martial Arts, MMA, and Combat Sports Athletes. Speakers will include physical therapists from the military, fire departments and police departments, as well as those specializing in the care of tactical and combat athletes.

TACTICAL ATHLETE SIG: SERVING THOSE WHO SERVE What are the goals of the SIG? The goal of the Tactical Athlete Special Interest Group is to support and expand the knowledge and understanding of Sports Physical Therapy members working with “tactical athlete” communities. The SIG will serve to facilitate collaboration and communication between researchers, clinicians, and tactical athletes regarding various aspects of training, injury prevention, performance, and physical therapy unique to this population.

What hot topics do you feel will be most pertinent to target with SIG activities and sponsored educational sessions in the near future?

Stay tuned! We will survey our SIG members to get a better idea of the most pertinent “hot topics” in the coming months. We will be seeking input from members as

we define the important role of physical therapists for tactical athletes. Musculoskeletal injuries continue to create the largest burden in this community and understanding return-to-duty considerations will of utmost importance.

Who is the targeted population for membership into the SIG? Sports Physical Therapy members with a particular interest in law enforcement, fire & rescue, special operations and military “tactical athletes” are the target population for this Special Interest Group.

Do you have to have a military background to be a part of the SIG? Absolutely not! We actually anticipate the number of members working with law enforcement and firefighters to outnumber those who work with the mili-

tary. I am a former active-duty Army officer and Sports Physical Therapist and have been afforded the opportunity to support military Tactical Athletes around the world over the past 20 years.

During this time I’ve recognized the unique considerations relative to this population, but I also recognize the potential to collaborate and learn from those with work with various types of tactical athletes.

To join the Tactical Athlete Special Interest Group, simply login to the SPTS website with your member credentials and click “Join A SIG” in the top bar of the site. Go to the dropbox in the lower left corner and choose the Tactical Athlete SIG. You’re in!

Find us on Facebook!

Twitter: @SPTSTactical

CHANGES TO EMR REQUIREMENTS FOR SPORTS CERTIFIED SPECIALIZATION The Sports Specialty Council recognizes the need of sports physical therapists to demonstrate continuous competency in all content areas identified in the Sports Description of Specialty Practice (DSP). One of the hallmark areas identified in the DSP that delineates a sports physical therapist is Acute Management of Injury and Illness. Thus, all physical therapists who wish to become Board-certified Sports Clinical Specialists must possess certification through continuing education credits in Acute Management of Injury and Illness for conditions encountered in sports medicine.

The ABPTS Sports Specialty Council has announced that it will no longer use the “EMR” nomenclature, but rather replace it with “Acute Management of Injury & Illness” certification.

According to Patrick Pabian, Sports Specialty Council member, “The previous “EMR” course requirement is now being replaced with a CEU course

requirement, due to challenges in the sports physical therapy community throughout the country accessing the EMR courses nationwide, as well as changes in many providers. We anticipate the change will increase access to courses, improve relevance of course information to sports physical therapy, and keep costs down to the sports physical therapy community. The SPTS courses managed through CogentSteps clearly match and exceed the minimum, as do a few others.”

Requirements of this certification: In order to be eligible to sit for initial certification • Applicants must complete a face to face or mixed delivery continuing education course (content outline specified below) • Course must be no less than 14 total hours in duration - Course must include at least 7 hours of face to face

instruction with inclusion of hands-on activities - Course must include both didactic and clinical instruction - Course must include didactic and clinical testing For recertification and during each MOSC period (3 year cycle) • Each certified specialist must have completed a continuing education course (content outline below) • Course must be no less than 7 hours in duration • Course can be any educational format: face to face, online, or mixed delivery The above continuing education courses may be offered by any entity that is serving as a continuing education provider and awarding continuing education contact hours and/or units within the physical therapy jurisdiction.

University, college or other coursework by a certified educational agency also qualifies

as long as the content areas outlined below are satisfied.

Content areas that must be included in the course: • Emergency management systems • Legal issues • Disease transmission • Primary and secondary assessment • Airway emergencies and oxygen • Epipen administration • Chain of survival and cardiac emergencies - Cardiopulmonary resuscitation - Automated external defibrillation • Injury incidence, etiology and management - Bleeding and wound management

- Head injuries • Concussion management - Spine injuries • Equipment removal • Spine boarding - Facial injuries • Nasal and ocular - Chest, thorax and abdominal injuries - Injuries to the extremities • Fracture and dislocation management Pre-approved courses include the currently offered courses through the Sports Section presented by CogentSteps.

The ABPTS now has the most recent information available on its website, outlining the certification requirement for reference as well as the updated resources.

Links for information on the ABPTS site: ABPTS Sports Specialty Council: New guidelines for acute management of injury & illness requirement: http://www.abpts.org/uploadedFiles/ABPTSorg/Specialist_Certification/Sports/Requirements%2 0for%20EMR%20Certification%2 0Course.pdf Acute Management of Injury & Illness Requirement resources: http://www.abpts.org/Certification/Sports/EMRRequirement/ ABPTS Sports Specialty Council main page http://www.abpts.org/Certification/Sports/ For any further questions, members may refer to the ABPTS site or contact a member of the Sports Specialty Council.

DEADLINE APPROACHING FOR KEVIN WILK TRAVELING FELLOWSHIP FALL 2018 CLASS: DATES ANNOUNCED There’s no question that residencies and fellowships help develop sports physical therapists’ abilities for advanced competencies in the field. These programs allow professionals to develop their skills under the mentorship of a recognized clinical expert.

Residencies and fellowships require the dedication of many hours of time toward the program...something that can be difficult to arrange in the post-graduate world.

The SPTS is pleased to announce the creation of the SPTS Kevin Wilk Traveling Fellowship. Fellows will spend a single week traveling to three educational sites, spending one to two days each with noted leaders in our

field. At each site, fellows will be involved in various activities: • Observation of the host therapist in the clinic • Surgery observation • Didactic component • Social activities to expand the fellows’ professional network The SPTS Traveling Fellowship is funded by SPTS and corporate sponsor DJO Global, which will allow two SPTS member classes to participate each year.

If you have any questions regarding the fellowship or the application process, please contact Rob Manske at robert.manske@wichita.edu.

Applications for the fall 2018 class are now being accepted.

Fall 2018 Sites, October 21-30 Cleveland, Ohio Gary Calabrese, host Cleveland Clinic Birmingham, Alabama Kevin Wilk, host Champion Physical Therapy New York, New York Tim Tyler, host Pro Sports PT Applications for the fall 2018 Kevin Wilk Traveling Fellowship are now being accepted until June 30.

For more information and application forms, follow this link: https://spts.org/education/sptstraveling-fellowship

COMMON RUNNING INJURIES: SELF HELP FOR THE RUNNER This article is from Dr. Kari Brown-Budde’s Refined Run blog. It is intended to be used as a tool by runners to self-examine and self-treat, and how to know when to go to see their physical therapist for issues. It also is a comprehensive tool for the sports physical therapist to offer to their patients who are runners.

Unfortunately, most runners know a thing or two about injuries. With up to 80% of all runners getting injured yearly, my goal is to help prevent those injuries and keep you enjoying all of your runs! Below are a few of the most common injuries a runner may encounter – and ways to prevent them. Remember, these are general suggestions for self treatment, what works for your friend may not work for you.

Even people with the same injury will have different causes for that injury.

KNEE PAIN There are different types of knee pain common in runners. Depending on the area where your knee hurts and your specific symptoms, treatment may differ.

Pain the front of your knee / Runner’s Knee Pain in the front of your knee or under your kneecap is called Anterior Knee Pain by medical professionals. It may also be referred to as Patello-Femoral Pain Syndrome (PFPS), Chondromalacia or commonly known as Runner’s Knee.

By Kari Brown-Budde, PT, DPT, SCS, Refined Run This pain around the knee cap can have multiple causes: poor movements at the hip, knee, ankle and foot can cause increased stress and abnormal wear and strain on the front of the knee. These movements may develop from weakness, tightness, limited joint mobility or lack of proper muscle timing.

Hip Flexor Stretch

Self Treatment Suggestions The first line of treatment you can try is RICE (rest, ice, compression, and elevation).

Strengthening the muscles around your hips and increasing your flexibility in the hips and around the knees can decrease the pressure affecting your knee cap and ultimately, your pain.

Hip Flexor Stretch: Kneeling on one leg, tuck your butt under you so your low back is flat, then slightly push your pelvis forward until you feel a pull in the front of the hip of the leg that is kneeling.

Quadriceps Stretch Quadriceps Stretch: Standing on one leg, tuck the butt under (as described above) pull the opposite heel toward your butt, and pull the thigh behind you until you feel a stretch in the front of your thigh.

Clamshells Clamshells: Lying on your side, bend your knees and hips slightly. While keeping your heels together, slowly lift your top

knee as far as you can lift it without rolling at the low back, then slowly lower.

Pain the outside of your knee / IT Band Syndrome Pain on the outside of your knee or outside lower thigh is called Ilio-tibial(I-T) Band Syndrome. It may also be referred to as Iliotibial Band Friction Syndrome (ITBFS). IT Band syndrome is the most common cause of pain on the outside of your knee.

This pain on the outside of your knee can have multiple causes.

Poor movements at the hip, knee, ankle and foot can cause increased stress and abnormal wear and strain on the outside of the knee. These movements may develop from weakness, tightness, limited joint mobility or lack of proper muscle timing. Weakness and poor muscle firing patterns at the hip may allow your thigh to rotate inwards toward the opposite leg or poor pelvic control can place increased pressure on the IT Band and surrounding soft tissue. Training factors related to this injury include excessive running in the same direction on a track, greater-than-normal weekly mileage and downhill running.

Self Treatment Suggestions The first line of treatment you can try is RICE (rest, ice, compression, and elevation).

Strengthening the muscles around your hips and your core is recommended, and increasing your flexibility in the hips and using a foam roller can help relieve tightness and release soft tissue restrictions.

Clamshells ITB, Hip, Quadriceps Foam Roller: Lie on your side on top of a foam roller. Gently use your arms to roll the outside of your

Treatment should also focus on hamstring, pelvic and core strengthening. Flexibility training such as stretching should be continued, but should always be pain free.

Clamshells

Bridges IT Band Rolling thigh up and down over the roller. Roll from your hip to the outside of your knee. For the quadriceps rolling: roll over the front of your thigh in the same manner as for the IT Band.

Bridges: Lying flat on your back with your knees bent and feet on the ground, squeeze your glutes and then lift your hips off of the ground, then slowly lower.

HAMSTRING PAIN / STRAIN Hamstring strains can result in pain behind your knee, pain in the back of your thigh, or even pain in the butt. Runners are more susceptible to hamstring strains due to the stress and stretch placed upon the hamstring muscles at times.

Hamstring strains can occur from: poor movements at the hip, pelvis, and trunk; weak hamstring and butt muscles; lack of flexibility; and strength imbalance between the hamstrings and quadriceps.

Self Treatment Suggestions During the initial stages of injury icing and pain free range of motion is recommended. Painful stretching should be avoided.

The first line of treatment you can try is RICE (rest, ice, compression, and elevation).

Hip Flexor Stretch Hip Flexor Stretches (see above) PIRIFORMIS SYNDROME / A Pain in the Butt The piriformis is a muscle located in the mid buttock region.

The sciatic nerve can pass above, below, or even through the piriformis. If the piriformis is tight, or in spasm, or has fibrotic tissue from a previous injury, this can place pressure and irritation on the sciatic nerve resulting in pain

that can radiate down the back of the hip to the foot/ankle.

Treatment focuses on decreasing pain, decreasing muscle spasm, and decreasing sciatic nerve irritation.

Self Treatment Suggestions The first line of treatment you can try is RICE (or really just RI – Rest and Ice. Not sure how elevation would work here!) Strengthening the muscles around your hips and your core is recommended, and increasing your flexibility in the hips and using a foam roller can help relieve tightness and release soft tissue restrictions. Focus on good postural position: avoid crossing legs when in seated position; avoid sitting on wallets in back pockets.

Glute, Piriformis Rolling SACRO-ILIAC (SI) JOINT DYSFUNCTION / Another Pain in the Butt The SI Joint is formed by the Sacrum and Ilium (Pelvis). SI joint pain is more common in females and is often caused by a torsion stress or repetitive strain to the SI Joint. Torsion stress can be related to a backward rotation of the Ilium on the Sacrum that can occur with activities such as heavy lifting, stepping off a curb and landing quickly with the leg extended, running or muscle im-

balances. Torsion stress can also be related to a forward rotation of the Ilium on the Sacrum, from muscle imbalances. SI joint pain can be a result of too much or too little mobility at the joint.

Self Treatment Suggestions The first line of treatment you can try is RICE (or really just RI again – Rest and Ice. Not sure how elevation would work here!)

Strengthening the muscles around your hips and your core is recommended, and increasing your flexibility in the hips and using a foam roller can help relieve tightness and release soft tissue restrictions. Similar to piriformis syndrome, focus on good postural position: avoid crossing legs when in seated position; avoid sitting on wallets in back pockets.

PLANTAR FASCIITIS Pain in the bottom of your foot or in your arch is possibly Plantar Fasciitis. This thick band of tissue on the bottom of the foot connects the heel bone to the toes, helping create the arch of the foot. Poor movements at the knee, ankle and foot can cause increased stress and abnormal wear and strain on the plantar fascia. Poor flexibility and foot structure along with too much or too little motion at the arch may cause abnormal motion at the shin and place increased pressure on the plantar fascia and soft tissue.

Self Treatment Suggestions Strengthening the muscles in your foot and increasing your flexibility in the foot, calf and knees can decrease the stress affecting your foot and ultimately, your pain.

SHIN SPLINTS / MEDIAL TIBIAL STRESS SYNDROME (MTSS) / POSTERIOR TIBIALIS TENDON DYSFUNCTION (PTTD) Shin splints are relatively common in runners and athletes that are involved in hopping sports. It is caused by too much stress on the tibia (main shin bone) causing an imbalance between bone break down and formation. In normal, healthy bone, stress to the bone from exercise promotes bone strength. The muscles that attach to the tibia can cause the overload of stress on the bone.

Pain is primarily localized to the middle or lower third of the inner shin. Shin splints can arise from too flexible or weak of a foot, too stiff or tight of an arch or calf muscles or poor training.

Treatment focuses on decreasing pain through rest as well as specific ankle/foot strengthening exercises to improve leg mechanics / running form. Manual interventions help reduce the pain and return the athlete to running.

Self Treatment Suggestions Calf stretching: Lean forward (or push against a wall) with your legs staggered. The rear leg is the one you are stretching. With the back knee straight, you will feel a stretch higher in the calf / behind the knee (Gastrocnemius). With the rear leg bent, you will feel the stretch lower in the calf (Soleus).

Soleus Stretch (next page) Single Leg Heel Raises (next page): Standing on one leg and holding your balance with a hand, slowly raise as far as you can on one toe and then slowly lower back down.

slowly lower down on the painful side so it stretches below the step height.

WHEN TO SEE YOUR RUNNING SPECIALIST If your pain has persisted for more than one week after attempting the exercises above, there are other treatment options.

Soleus Stretch

Single-leg Heel Raise

ACHILLES TENDONOPATHY / TENDONITIS Pain in your calf or in the back of the heel may be due to overuse of the achilles tendon. Training factors including running technique, footwear and running surface can all play a role in achilles tendonitis. Other factors such as muscle weakness, decreased flexibility, and arch type can lead to achilles tendon pain. Increased tightness of the calf and weakness of the ankle can cause altered mechanics of the foot, such as excessive flattening or pronation, which requires the calf to perform more work while running. Many of these factors com-

bine to cause over-activation of the calf muscles while running, therefore causing pain.

Self Treatment Suggestions Strengthening the muscles around your hips, knees and calves and increasing flexibility of the ankle and calf can decrease the stress to your achilles. Pain should never last longer than a day after running.

See Single Leg Heel Raise, left.

To modify the single leg heel raise for Achilles Tendonopathy, raise up on both legs, and slowly lower on the painful side. To make this more difficult: raise up on both legs on a stair step and

Modifying how you run can improve muscle control, movement patterns and decrease the stress on the tender area. In addition to changing your running technique, hands-on care including manual intervention and an individualized treatment program can ultimately get you back to running pain free. Contact your physical therapist to see how we can prevent the pain from getting worse and get you back to running!

Kari Brown-Budde, PT, DPT, SCS of Refined Run is a longtime SPTS member and is the Chair of the Running Special Interest Group. She may be contacted at kari.brown.budde@gmail.com Kari is our model in this article as well!

LOVE RUNNING? THIS SIG IS FOR YOU! The Running Special Interest Group (Running SIG) exists to further the knowledge of Sports Physical Therapy Section members who have a particular interest in running-related issues. The Running SIG will act as a facilitator for its members by bringing together individuals with a common interest in running issues at regular business meetings and continuing education programming. The Running SIG will also serve as a facilitator for research on various aspects of running performance, injury prevention and the physical therapy management of running-related injuries.

The Running SIG, like all other SPTS SIGs, is open to all members. To join, simply login to the SPTS website with your member credentials and click “Join A SIG” in the top bar of the site. Go to the dropbox in the lower left corner and choose the Running SIG. You’re in!

DEHYDRATION: THE SIMPLE MISTAKE HURTING YOUR TRAINING A two-part series on the importance of the body's fluid balance.

Part I Thirst is our bodies’ signal that we need more fluid. But sometimes there is a “lag” in this signal – dehydration may happen before we become thirsty. Or we miss these thirst cues because we aren’t aware of them.

By Carol Ferkovic Mack CLE Sports PT and Performance Not a great thought process…

I made this mistake due to years of conditioning myself to “not need water breaks” when I played college soccer because I thought it made me look tough.

After college, during my early years as a runner, I thought I was young and resilient enough (in actuality…stupid) to not need as much water as everyone else. I didn’t feel thirsty – why would I need to drink?

One year, our cold Cleveland spring quickly turned into summer. A rapid change from a 40 degree month of April into an 80 degree first week of May left me wondering why my CrossFit workouts suddenly were harder than normal and why the Cleveland Half Marathon was one of my worst races in memory. I PRed a 10 mile race a few weeks earlier (in the cold) and was expecting to do that same with my 13.1.

If I ran through the water stations, maybe I could pass a few extra people who were stopping?!

I chalked my disappointing race up to a crazy work schedule, bridesmaid duties at a cousin’s

wedding, and not tapering my weight training properly. But my poor performances continued for another month and I started getting headaches, craving salty foods, and being horribly tired (and cranky). Then, I noticed my stomach was bloated all the timeso much so that I gained 10 pounds without any change in my diet. At that point, I knew something was wrong.

After researching probiotics, adrenal fatigue, and a million other things that were more complicated than drinking more water, I finally wised up and decided to calculate my hydration needs per day.

I was drinking only half as much as I should have been. I was clearly dehydrated and this had compounded for over 2 months.

As soon as I drank what my body needed, I felt better. I told people I felt like I was a video game character that just got a “power up.”

I’m not the only one with poor ability to notice my dehydration.

In 2016, this study from the International Journal of Sports Nutrition and Exercise Metabolism found that 32% college athletes started training in a dehydrated state and almost 44% finished in one.

It’s also common for people to rely on processed and nutrientpoor drinks. We get mixed messages from the beverage industry about what is healthy and what isn’t. Does anyone remember

Coke’s marketing campaign from a few years ago that said “all beverages are hydrating?” Talk about misleading…

We need water for every bodily function, which is why dehydration is so dangerous.

These drinks can mute our thirst indicators. Some contain caffeine, which can further dehydrate us, and the extra sugar or other chemicals can interfere with other body functions.

I mentioned before that sometimes there is a ‘lag” between losing fluid and being thirsty. As a result, we may notice something is off with how we are thinking, focusing, or performing before we realize we are dehydrated.

So why is water important?

Water makes up over half of who we are – 55-60% to be exact.

Our thirst signals may not kick in until we’ve lost 1-2% of our body fluid.

Why do we need it?

Other signs of dehydration include:

• Water helps regulate our body temperature. When we get too hot, we sweat. The evaporation cools us down.

• Water also carries nutrients to cells and takes waste products away; allows most chemical reactions in the body to happen (water is a “catalyst” for them); and lubricates joints; acts as a shock absorber for the eyes and spinal cord.

• headache • fatigue • low blood pressure • dizziness, fainting • nausea • rapid heart rate

Loss of body fluid gets dangerous quickly: • 0.5% loss = increased strain on the heart.

• 4% loss = decreased muscle strength, heat cramps • 6% = physical exhaustion, heat stroke, coma • 10% or more = death How much water do we need?

Everyone’s hydration needs are different. Most adults need 3L (12 cups) of fluid each day, but this goes up or down with certain factors: • Types of food eaten on a given day: Raw fruits and vegetables= high water content High-fat foods (nuts, seeds, oil, butter) = low water content • Body size: bigger people need more fluid

• Climate and temperature.

Warmer weather? May need an extra 500 ml (2 cups) Drier air? May need up to 6L (24 cups) per day • Alcohol consumption • Excessive caffeine consumption.

One cup of coffee is probably ok per the National Athletic Trainers Association.

• Stomach or digestive issues; diarrhea, vomiting, sickness Estimating your own individual needs: 1. Divide your body weight in pounds by 2.2 to determine how many kilograms you weigh.

2. Take your weight in kilograms and multiply by 30-40 to determine how many milliliters of water needed per day.

3. Convert millimeters to cups, ounces, or whatever is easiest for you – and drink up!

A 110 lb person would need between 6-8.4 cups per day (1.52L) A 220lb person would need 12.517 cups (3-4L) For exercise: we generally sweat out .5-2.0 L per hour of activity.

Make sure to replace that as well.

Hydration done right: • For light to moderate exercise…

Drink .5-1 liters (2-4 cups) of water during activity and another 2-4 cups after workouts.

Make sure to drink 1-2 cups of water at each meal.

Doing this alone would account for 3-6 cups of water per day!

• For elite athletes – calculate hydration needs based on body weight as above. Also consider sports drinks or recovery drinks to replenish carbohydrates, electrolytes, and protein. Stay tuned for Part 2.

• Drink 1 cup of water for each cup of caffeinated or alcoholic beverages you consume.

• Increase your water intake for longer workouts, warmer weather, or drier weather.

• Carry a water bottle with you and fill it up twice a day. (This, along with a drink journal are my “go-to” strategies.)

• Keep a “drink journal” to track cups of water, alcohol, sugarsweetened beverages, etc. for 2 weeks. You can track it in the “notes” section on your phone, a calendar, note pad, or whatever is easier. After 2 weeks, review it and see what changes need to be made – increasing water intake? Scaling back on sugary drinks or alcohol? Set a goal to change one thing over the next two weeks BOTTOM LINE: Drink regularly, especially if you are an athlete. YOU NEED MORE FLUID THAN YOU THINK YOU DO. Trust me on this. Stay tuned for Part 2 where we look at electrolytes, proteins, and carbohydrate based sports drinks and who can benefit from them.

REFERENCES: 1. Berardi, John et al. The Essentials of Sport and Exercise Nutrition. Precision Nutrition, Inc, 2017.

2. Magee PJ, Gallagher AM, McCormack JM. High Prevalence of Dehydration and Inadequate Nutritional Knowledge Among University and Club Level Athletes. Int J Sport Nutr Exerc Metab. 2017 Apr;27(2):158168. doi: 10.1123/ijsnem.2016-0053.

Epub 2016 Oct 6.

3. McDermott BP1, Anderson SA2, Armstrong LE3, Casa DJ3, Cheuvront SN4, Cooper L5, Kenney WL6, O’Connor FG7, Roberts WO8.

National Athletic Trainers’ Association Position Statement: Fluid Replacement for the Physically Active.

J Athl Train. 2017 Sep;52(9):877-895. doi: 10.4085/1062-6050-52.9.02. (http://natajournals.org/doi/pdf/10 .4085/1062-605052.9.02?code=nata-site)

FEMALE ATHLETE SIG Have an interest in female athlete topics? Join the Female Athlete SIG! Membership is open to all SPTS members. To join, to the SPTS website with your member credentials and click “Join A SIG” in the top bar of the site. Go to the dropbox in the lower left corner and choose the Tactical Athlete SIG. You’re in!

Carol Ferkovic Mack of CLE Sports PT and Performance has been an SPTS member since her student days and is serving her second term as chair of the Female Athlete Special Interest Group. You can contact Carol at carol.ferkovic.mack@gmail.co m

DON’T FORGET TO SAVE THE DATE AND REGISTER!

REGISTER NOW! APTA LINK: http://www.apta.org/next/

NEXT 2018: BE SURE TO CHECK OUT SPTS MEMBERS PROVIDING PROGRAMMING

REGISTER NOW! APTA LINK: http://www.apta.org/next/ Programming featuring SPTS members: What Would You Do? Knee and Rotator Cuff Speaker(s): Gary Calabrese, PT, DPT Walter Jenkins, PT, DHS, ATC Terry Malone, PT, EdD, ATC, FAPTA Rob Manske, PT, DPT Jimmy McKay, PT, DPT All speakers at this session are SPTS members...don’t miss it!

Linking CoHSTAR Research Activities to Priorities of the Physical Therapy Profession

Medical Screening for the Practicing Physical Therapist: Acute Care and Outpatient What Would You Do? Tactical Athletes/Management of LBP Following C-Section Transforming Health Care Delivery: Case Presentations A Systematic Approach to Achieving Personal and Professional Mastery Musculoskeletal Pain: Relevance of Myofascial & Acupuncture Meridians eSportsMed: Developing a Sports Medicine Program for Collegiate Gamers

A Head Case: Injury to Integration Innovative Approach to Health and Wellness for Students With Disabilities Overcoming Obstacles: Nothing Is Impossible Bridging Injury and Performance Training in the Military Tactical Athlete, Part 1 Bridging Injury and Performance Training in the Military Tactical Athlete, Part 2 Advocacy and Leadership in Physical Therapy: Successful Methods for All Levels

COURSES June Full EMR Course from 8am to 5pm on Friday, June 1 through Sunday, June 3, 2018 at Mayo Clinic Sports Medicine Dan Abraham Healthy Living Center 565 1st St SW Rochester, MN 55902 EMR Recertification from 8am until 5pm on Saturday, June 2, 2018 at Mayo Clinic Sports Medicine Dan Abraham Healthy Living Center 565 1st St SW Rochester, MN 55902 Full EMR Course from 8am to 5pm on Friday, June 1 through Sunday, June 3, 2018 at Cleveland Clinic Independence Family Health Center 5001 Rockside Road Independence, Ohio 44131 EMR Recertification Course from 8am to 5pm on Saturday, June 2, 2018 at Cleveland Clinic Independence Family Health Center 5001 Rockside Road Independence, Ohio 44131 Registration June 1-3, 2018 Emergency Medical Responder Course: Sidelines Care Instructor: Matthew Owens, PT, DPT, SCS, ATC, CSCS Location: Children’s Office Park, 1680 Tullie Circle, Classroom 3, Atlanta, Georgia Target Audience: Physical Therapists seeking a Specialist Certification in Sports (SCS) or requiring certification for on-field coverage of sporting events Sponsor: Children's Healthcare of Atlanta Contact: michelle.moore@choa.org or online brochure at www.choa.org/therapisteducation When the Foot Hits The Ground Everything Changes June 2-3 | San Diego, CA Registration: https://www.whenthefeethittheground.com/course-registration Certified Running Gait Analyst Level 1 June 9th and 10th, 2018 Philadelphia, PA

Course Description If you've been looking for a systematic evidence based approach for working with runners, you've found it! Learn the essential skills and knowledge to simplify running and provide running specific interventions to get excellent results. This is a hybrid course with an online pre-requisite and two day live lab based portion that is all about giving you everything you need to analyze and improve running gait.

You will learn: - Why Runners Get Injured - The 5 Categories of Running Gait Impairments - Corrective exercise programs including gait retraining for each of the 5 Categories (~20 page handouts for each category included!)

- The ACE Running Movement screen designed specifically for runners - Corrective exercise programs for each of the ACE Running Movement Screen Sub Categories - Running Gait Analysis procedures in 2D and 3D (Lab based, you will actually use 2D and 3D during the course!)

- And much more!

Spots are limited to allow for high class participation, so register early. Sports Section Members get a $100 discount by entering code SPTSRunners (applied at checkout) Email Admin@LearnWithACE.com for questions and/or to learn about training your whole team by hosting a course at your facility. You can also take the online portion as a separate course if you cannot attend a live course yet!

Register: https://learnwithace.com/downloads/certified-running-gait-analyst-level1/

July

Certified Running Gait Analyst Level 1 July 28th and 29th, 2018 Chicago, IL Spots are limited to allow for high class participation, so register early. Sports Section Members get a $100 discount by entering code SPTSRunners (applied at checkout) Email Admin@LearnWithACE.com for questions and/or to learn about training your whole team by hosting a course at your facility. You can also take the online portion as a separate course if you cannot attend a live course yet!

Register: https://learnwithace.com/downloads/certified-running-gait-analyst-level1-jul-28-29/ August

Open EMR Recertification from 8am until 5pm on Saturday, August 18, 2018 at BodyCentral Physical Therapy 1991 E Ajo Way, Suite 149 Tucson, AZ 85712 Open Full EMR Course from 8am to 5pm on Friday, August 24 through Sunday, August 26, 2018 at BodyCentral Physical Therapy 1991 E Ajo Way, Suite 149 Tucson, AZ 85712 September

Certified Running Gait Analyst Level 1 Sep 22nd-23rd, 2018 Minneapolis, MN This is a semi-private course with only 5 spots available, so register early. Sports Section Members get a $100 discount by entering code SPTSRunners (applied at checkout) Email Admin@LearnWithACE.com for questions and/or to learn about training your whole team by hosting a course at your facility. You can also take the online portion as a separate course if you cannot attend a live course yet!

Register: https://learnwithace.com/down-

loads/certified-running-gait-analyst-level1-sep-22-23/

November

October

October 11-13, 2018 Providence, RI www.apta.org/NSC

SAVE THE DATE! Team Concept Conference 2018 November 29-December 1 Westgate Las Vegas Resort and Casino EMR Courses identified in this color are Sponsored by SPTS and presented by CogentSteps. These courses offer discounts to SPTS members.

Information about EMR courses may be found here: https://spts.org/education/study-courses/emr-courses--mg/upcoming-emr-courses

October 27-28 Kahn Auditorium University of Michigan Biomedical Science Research Building 109 Zina Pitcher Place Ann Arbor, MI 48109 Hotel availability at special rates Running is a demanding physical activity performed by millions of persons worldwide. Given the repetitive high-impact nature of running, many individuals who engage in this form of exercise experience pain or become injured. For the professional or avid runner, this pain and injury can cause frustration and loss of running time. For the sports medicine clinician, managing the injured runner can be challenging as the cause(s) of running injuries are often multifactorial.

The Science of Running Medicine brings together three of the leading clinical researchers involving running mechanics and injury. With a combined 75+ years of clinical practice and 350+ publications, the faculty is committed to providing health care professionals and the running community with evidenced-based strategies to advance running injury management.

Information and Registration: http://scienceofrunning.net/?page_id=57

Sheraton Baltimore North Hotel 903 Dulaney Valley Road Towson, MD 21204 Sat Jun 02 2018 8:30 AM - 5:00 PM Sun Jun 03 2018 8:00 AM - 1:00 PM Hilton Garden Inn - Chicago O'Hare Airport 2930 South River Road Des Plaines, IL 60018 Sat Jun 09 2018 8:30 AM - 5:00 PM Sun Jun 10 2018 8:00 AM - 1:00 PM Institute for Physical Therapy Education at Widener University 1606 Walnut St Chester, PA 19013 Fri Jun 15 2018 8:30 AM - 5:00 PM Sat Jun 16 2018 8:00 AM - 1:00 PM A. T. Still University-Physical Therapy Dept.

5850 E Still Circle Mesa, AZ 85206 Sat Jul 14 2018 8:30 AM - 5:00 PM Sun Jul 15 2018 8:00 AM - 1:00 PM Drake University-Occupational Therapy 3003 Forest Ave Des Moines, IA 50311 Sat Jul 28 2018 8:30 AM - 5:00 PM Sun Jul 29 2018 8:00 AM - 1:00 PM Omni William Penn Hotel 530 William Penn Place Pittsburgh, PA 15219 Sat Aug 18 2018 8:30 AM - 5:00 PM Sun Aug 19 2018 8:00 AM - 1:00 PM Register for all courses at this link: http://www.grastontechnique.com/Clinicians/M1_Trainings