Author Archives: Sports PT Blog Team

by: Lynn Steenberg, CEO

In January 2005, Sports PT was part of a unique arrangement with HealthSouth Corporation, an international healthcare organization. Due to a New York State law banning corporations from practicing medicine, Sports PT and HealthSouth were partners in the healthcare arena. Our full name was “Sports Physical Therapy of New York, PC, Managed by HealthSouth.” Through a management agreement, HealthSouth provided all the non-clinical support services for us (front-desk support, billing/collection, electronic medical records [EMR], human resources, real estate, etc.).

At that time, HealthSouth was in the midst of reorganization resulting from an accounting fraud scandal. This became our opportunity. In February, HealthSouth and I agreed to begin working to end our management agreement. Over the next four months, the Sports PT leadership team determined which of the 40 facilities would remain part of the organization. We worked diligently to re-create all the non-clinical services. This included purchasing all the equipment, assuming all leases, hiring all non-clinical personnel, implementing new EMR and billing/collection systems and new employee benefits programs, and much more.

On July 1, the management agreement with HealthSouth was terminated and the new Sports PT was born. We were comprised of 285 team members in 27 locations, from Buffalo to the tip of Long Island. The next six months were a whirlwind of activity. The leadership team wrote the Sports PT mission statement and established the values that still guide us today. By year’s end, Sports PT was caring for nearly 1000 patients per day!

How much did luck play a role in where we are today? Throughout my career, I have firmly believed that every challenge presents opportunity. I feel incredibly grateful for the support of the exceptional team of individuals (14 of whom are still here today) who helped make it all possible. In the book Great by Choice, author Jim Collins suggests that luck is really what we do with it. That is, luck is the sum of opportunity and preparedness. How true!

By: Rebecca Korosi, ATC, PT, DPT

Literally! Much more often than not, when an individual sustains a concussion, a complaint of neck pain will accompany it. This is due to the head being directly connected to the neck. When a force or blow to the head occurs, the energy dissipates down into our necks. The force on our head can also cause our neck to move in an awkward position, thus stressing the neck’s ligaments, joints, soft tissue, and muscle. This is commonly referred to as a “whiplash” injury. Our muscles will oftentimes go into “defensive mode” after such an injury. This will feel as if the muscles around the neck are tight, especially the upper trapezius muscle, which sits right at the tops of the shoulders and attaches near the base of the skull. Another common complaint of concussion sufferers may be “knots” or trigger points in the muscles of the neck. This stems from the continuation of the body’s defensive mode, which causes these muscles to contract for protection. This then leads to over-activation of the muscles. In addition to neck pain, the stress to these tissues may cause a loss in range of motion of the neck, stiffness in the neck, pain that radiates down into the arms, headache, dizziness, poor memory, irritability, sleep disturbance, fatigue, and vertigo (the feeling of spinning).

It can be difficult to determine whether the neck has suffered a “whiplash” injury due to its ability to present itself very much like a concussion. Therefore, it is important to undergo a comprehensive exam by a healthcare professional who is efficient in the care of concussions to determine if the neck itself has also been injured after a concussion.

To read more on new research involving concussion, neck injury, and concussion with neck injury, click here: http://www.buffalo.edu/news/releases/2014/07/040.html.

References: Leddy, J. J., et al. (2014). “Brain or Strain? Symptoms Alone Do Not Distinguish Physiologic Concussion from Cervical/Vestibular Injury.” Clinical Journal of Sports Medicine 0 (0): 1–6. cjsportmed.com.

By: Sports PT Clinical Team

1.) Every 2 hours, stop to stand and stretch. WHY? Remaining in a seated position for extended periods of time can restrict blood flow to your lower extremities, causing flexion, which is a compressive force in the spine. Stopping to stand and stretch is critical for your spine, as it releases the compression, allows for blood to flow to the nerves, and helps maintain flexibility during these long rides.

2.) Stay hydrated. WHY? Muscles and joints are healthier and function better when your body is hydrated. Think of it as oil for your joints. When you are hydrated, there is less chance for stiffness and cramping.

3.) Watch posture. WHY? Oftentimes, we are playing on our phones or tablets when on long car rides. Be sure the screen is at eye level rather than in your lap, causing you to look down. Poor posture can create pain in both the neck and the low back, not to mention increasing risk for headaches.

These three tips can help you enjoy the car ride experience and the fun destination! SAFE TRAVELS!

By: Teresa Hall, PT, DPT, OCS

Do you know what the number-ONE predictor of a longer recovery from a concussion is? Surprisingly, it’s not vomiting, headache, or even loss of consciousness. Most people don’t realize that dizziness immediately after a head injury indicates a longer recovery process.

The reason that dizziness is so common and difficult to recover from is that it often involves the vestibular system, meaning that the dizziness is caused by something more than just having spun in too many circles. The vestibular system comprises the organs and nerves in your inner ears that help to control your equilibrium. It’s obviously important that this system be working correctly because we rely on our equilibrium to maintain balance and spatial orientation.

Sometimes a victim of a concussion will hit his or her head so hard that the microscopic crystals in the inner ear will get knocked loose. Once the crystals are loose, they can get stuck in the wrong part of the inner ear and cause positional vertigo. This condition causes severe, room-spinning vertigo, nausea, and loss of balance – it affects our equilibrium.

Another common occurrence after a concussion is that the nerve pathways from the vestibular system to the brain suffer trauma. Then the communication system is impaired, and this causes a mismatch of information between the ears, the eyes, and the brain’s response for balance. Often, people with this injury will avoid moving their heads and avoid situations where their balance may be challenged.

Most vestibular symptoms following a concussion can be cured and improved by a course of physical therapy, more specifically from a therapist who specializes in vestibular rehab. They are well trained in these conditions, and proper rehabilitation will make a huge difference in the time and quality of recovery from a concussion.

For more information on vestibular care after a concussion, contact our vestibular PTs at .

By: Sports PT Blog Team

Growing older comes with many joys, but it also brings many challenges. Some may feel that aging is synonymous with declining physical abilities, but this is simply not true. Another myth of aging is that falls are normal and just a part of growing older – this is a completely false misconception.

Each year, a third of adults over the age of 65 will suffer from a fall; many of which cause serious health complications such as fractures or trauma. For this population of adults, falls are the number-one reason for loss of independence. And some of these falls may even result in injuries that turn fatal.

Did you know?

40% of all concussions are a result of falls

More than half (55%) of traumatic brain injuries among children 0 to 14 years old were caused by falls

81% of traumatic brain injuries in adults aged 65 and older are caused by falls

Getting screened for your individual falls risk assessment can prevent or drastically reduce the chances of falling. Since falling is often associated with serious head injury, it is worth the 20 minutes to see what risk factors you have in your life. They can be intrinsic or extrinsic risks. Examples of intrinsic risks could be things related to your own strength, balance, fear of falling, or perhaps dizziness. Extrinsic risks could be identified as rug positioning in your home, slippery surfaces, uneven ground, or how your medications interact with each other.

Physical therapists are experts in assessing concussion symptoms as well as performing falls risk assessments. Please contact us at for more information or to schedule a concussion evaluation or falls risk screening.

Reference:
CDC website

By Drew Jenk, PT, DPT

People who have been diagnosed with a concussion require both physical and cognitive rest. Not following medical provider orders for rest can significantly prolong recovery from a concussion. A medical provider’s orders to avoid cognitive and physical activity after a concussion should be strictly followed at home, school, and work. Return to those activities should be slow and gradual.

Additionally, children are at increased risk for delayed recovery as well as severe, permanent disability (e.g., early dementia, also known as chronic traumatic encephalopathy), or even death if they sustain another concussion before fully recovering from the first concussion.

Therefore, it is imperative that an individual is fully recovered before resuming activities that may result in another concussion. Best practice warrants that, whenever there is a question of safety, a medical professional err on the side of caution and hold an athlete out for a game, the remainder of the season, or even a full year.

What Is Cognitive Rest?

Cognitive rest requires that the student avoid participation in or exposure to activities that require concentration or mental stimulation including, but not limited to:

Playing computer and video games
Watching television
Texting
Reading or writing
Studying or doing homework
Taking a test or completing significant projects
Listening to loud music
Exposure to bright lights

What Is Physical Rest?

Physical rest includes getting adequate sleep, taking frequent rest periods or naps, and avoiding physical activity that requires exertion. Some activities that should be avoided include, but are not limited to:

Those that result in contact and collision and are high risk for re-injury
High-speed and/or high-intensity exercise and/or sports

Any activity that results in an increased heart rate or increased head pressure (e.g., straining or strength training)

Adapted from: http://www.nysphsaa.org/portals/0/pdf/safety/NYSED%20Guidelines%20for%20Concussion%20Management.pdf

Vestibular Rehabilitation: An effective treatment for dizziness, vertigo, and balance problems stemming from inner ear dysfunction.

Do you suffer from dizziness, lightheadedness, or unsteadiness? If so, you are not alone. It has been estimated that 65% of individuals over the age of 60 experience dizziness or loss of balance on a regular basis, and vestibular problems account for a third of all patients presenting to healthcare professionals with symptoms of vertigo and dizziness.^{1, 2} In fact, recent research out of Johns Hopkins University suggests that as many as 35% of adults over the age of 40 in the United States (i.e., 69 million Americans) have experienced some form of vestibular dysfunction as measured by a postural balance test.³

What Is the Vestibular System? 

The vestibular system lies deep within the ear and includes the utricle, saccule, and three semicircular canals. The utricle and saccule detect vertical and linear head movement, and the semicircular canals detect rotational head movement. Both left and right vestibular systems constantly send information to the brain about your head position. The brain integrates this information with the input it receives from your eyes, muscles, and joints to assist in coordinating head, eye, and body movements to maintain equilibrium. When the vestibular system is not working properly due to illness or injury, the input to the brain is altered and symptoms may develop including dizziness, vertigo, imbalance, nausea, and disequilibrium.

What Are Common Vestibular Pathologies?

Common disorders of the inner ear include benign paroxysmal positional vertigo (BPPV), vestibular neuritis and labyrinthitis, acoustic neuroma, bilateral loss of inner ear function due to ototoxicity or autoimmune disease, and Meniere’s disease. Other conditions that may cause dizziness and/or imbalance that would benefit from vestibular rehabilitation include cervicogenic dizziness and brain damage from head trauma, tumors, or stroke.

What Is Vestibular Rehabilitation?

Vestibular rehabilitation is a specialized type of physical therapy in which specific exercises are used to promote brain/central nervous system compensation for inner ear deficits. Your physical therapist will perform a thorough assessment and develop an individualized treatment program aimed at decreasing your symptoms and improving your function. A treatment program may include:

• Balance/coordination activities to retrain body awareness
• Gaze stability exercises to decrease dizziness
• Flexibility and/or strengthening exercises
• Particle repositioning maneuvers to treat BPPV

Does Vestibular Rehabilitation Work?

High-quality evidence suggests that vestibular rehabilitation therapy is very effective in reducing symptoms of many types of vestibular disorders.⁴ Additionally, multiple randomized controlled trials provide strong evidence that the Canalith Repositioning maneuver / Epley maneuver is very successful in treating BPPV in as little as one to two sessions.^{5, 6, 7}

Next Step: 

Many other serious health conditions can cause dizziness, including cardiovascular, neurological, and metabolic problems. If you experience dizziness, discuss your symptoms with your healthcare provider to determine if you are a good candidate for vestibular rehabilitation.

Additional Reading: 

To learn more about vestibular rehabilitation, look here. For more information about BPPV, look here.

References:

¹Hobeika CP. Equilibrium and balance in the elderly. Ear Nose Throat J. August 1999; 78(8): 558–62, 565–6.

²Neuhauser HK, Radtke A, von Brevern M et al. Burden of dizziness and vertigo in the community. Arch Intern Med. 2008; 168(19):2118–2124.

³Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009; 169(10): 938 944.

⁴Hillier SL, Hollohan V. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews 2007. Issue 4. CD005397.Pub. 2; 2007.

⁵Helminski J, Janssen I, Hain T, Zee DS. Effectiveness of Particle Repositioning Maneuvers in the Treatment of Benign Paroxysmal Positional Vertigo: A Systematic Review. PHYS THER. 2010; 90:663–678.

⁶Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, Hain TC, Herdman S, Morrow MJ, Gronseth GS. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurol. 2008; 70:2067–2074.

⁷Hilton M, Pinder D. The Epley (canalith repositioning) maneuver for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews 2004. Issue 2.

By: Sports PT Clinical Team

When we see an elite athlete like Rory McIlroy rupture the ligament in his ankle (the ATFL, or anterior talofibular ligament), we reflect on principles of training and prevention. And we ask ourselves, “Could his injury have been prevented?”

It’s unclear if certain injuries could have been prevented. We need to recognize that some injuries are simply accidents: the wrong place, the wrong conditions, the wrong time with the wrong force. Not all injuries can be prevented. However, many can be reduced.

To help reduce ankle injuries in general, three key principles are to be considered:

1.) It’s not all about the ankle. The hip and the entire lower leg play a role in the stability and flexibility of the ankle. In fact, many will argue that the hip is a main contributing factor to the mechanics and strength of the ankle. Strengthening the hip, especially the gluteus medius, will help to improve overall ankle and lower extremity stability.

2.) Flexibility. Keeping muscles and joints flexible in the leg will help create stronger mechanics in the ankle to mobilize itself in certain positions.

3.) Balance. Balance can be trained and can improve, but it has to be challenged. This means training on uneven surfaces, eyes open, eyes closed, and holding steady for longer periods of time. Most ankle injuries occur on uneven surfaces, so we must train balance and proprioception. Proprioception is recognizing where your body is in space and making adjustments. This is something that is a trainable skill and often helps to reduce injury.

TRUE OR FALSE?? Once the pain of an ankle sprain is gone, the ankle is stable again.

FALSE!! A sprained ligament takes six to eight weeks to heal. Following through with the above strengthening, flexibility, and balance/proprioceptive program will help to reduce the recurrence of injury or the likelihood of rupturing of the ligament.

Contact us at for more information on reducing ankle injuries.

Aimee Alexander, PT, DPT, OCS, CPC

There are an estimated 1.8–3.6 million head injuries in adolescents each year. According to the Centers for Disease Control and Prevention (CDC), concussions are thought to account for approximately 6–9% of the injuries in organized sports. Because of the vast amount of emerging research on concussions and the number of head injuries in the media these days, it is more important than ever to educate athletes, parents, coaches, and the general population on the signs and symptoms of a concussion.

What Is a Concussion?

A concussion occurs when there is a rapid deceleration of the brain, due to either a direct or an indirect blow to the head, causing the soft tissue of the brain to collide with the hard skull. (For a visualization of this, see https://www.youtube.com/watch?v=fY7J7bccNoU.)

Concussion Signs and Symptoms.

 There are several signs and symptoms to be aware of if you think someone you know has suffered a concussion. To be diagnosed with a concussion, only one persisting symptom needs to be present after a blow to the head.

• Amnesia (of any kind)
• Confusion or appearing dazed
• Loss of consciousness (*not necessary to be diagnosed with a concussion)
• Irritability, sadness, or other changes in personality
• Feeling sluggish, “foggy,” or lightheaded
• Slowed reaction time
• Headache or a feeling of pressure on the head
• Difficulty concentrating
• Sensitivity to light and/or sound
• Double or blurry vision
• Dizziness
• Nausea, vomiting, or loss of appetite
• Sleep disturbances (sleeping more or less than usual)

This video answers many frequently asked questions regarding the facts and myths of concussions: https://www.youtube.com/watch?v=pGFq0jDr3Tw.

Dr. Drew Jenk, PT, DPT

Anyone who is observed to, or is suspected of, suffering a significant blow to the head, has fallen from any height, or collides hard with another person or object may have sustained a concussion. Symptoms of a concussion may appear immediately, become evident in a few hours, or evolve and worsen over a few days. Concussions can occur anywhere. Anyone suspected of having a concussion based on either the disclosure of a head injury, observed or reported symptoms, or sustaining a significant blow to the head or body must be removed from athletic activity and/or physical activities (e.g., PE class, recess) and observed until an evaluation can be completed by a medical provider. Symptoms of a concussion include but are not necessarily limited to:

Amnesia (e.g., decreased or absent memory of events prior to or immediately after the injury, or difficulty retaining new information)

Confusion or dazed appearance

Headache or head pressure

Loss of consciousness

Balance difficulty or dizziness, or clumsy movements

Double or blurry vision

Sensitivity to light and/or sound

Nausea, vomiting, and/or loss of appetite

Irritability, sadness, or other changes in personality

Feeling sluggish, foggy, groggy, or lightheaded

Concentration or focusing problems

Slowed reaction times, drowsiness

Fatigue and/or sleep issues (e.g., sleeping more or less than usual)

If an individual develops any of the following signs, or if the symptoms listed above worsen, he or she must be seen and evaluated immediately at the nearest hospital emergency room:

Headaches that worsen

Seizures

Drowsy appearance and/or cannot be woken

Repeated vomiting

Slurred speech

Unable to recognize people or places

Weakness or numbing in arms or legs, facial drooping

Unsteady gait

Dilated or pinpoint pupils, or change in pupil size of only one eye

Significant irritability

Any loss of consciousness

Suspicion of skull fracture (e.g., blood draining from ear or clear fluid draining from nose)

Adapted from http://www.nysphsaa.org/portals/0/pdf/safety/NYSED%20Guidelines%20for%20Concussion%20Management.pdf.