Fitness Matters

Community Newsletter from New Heights Physical Therapy Plus, Inc.

January / February 2011

In this issue:

The Sixth Sense that Prevents Injuries and Improves Athletic Performance- Proprioception is an acutal internal sensory system. Learn how and why to enhance proprioception.
The Fastest Way to Recover from Whiplash- Physical therapy for whiplash should begin within 96 hours of the injury, but later starts can also be helpful.

The Sixth Sense

that Prevents Injury and Improves Athletic Performance

Balance Based Exercises are one way to improve proprioception.We are all well aware of our five senses: sight, touch, taste, smell, hearing. Our bodies have a sixth sense that many people take for granted: proprioception. For many athletes who have experienced sprains and tears, proprioception is damaged, and they don’t even know it. Proprioception is an internal sensory system that informs your brain about the exact position of your various body parts. To demonstrate this sixth sense to yourself, simply hold your arm straight out. Close your eyes. Then move your arm up and down, back and forth, even rotate it. For the majority of you who have a basically functional proprioceptive system, even with your eyes closed, you will instantly sense where your arm is in relation to the rest of your body. You will also be able to sense if your arm is rotated, if your wrist is flexed, and if one or more of your fingers are curled. This is all due to a sensory system in your body generally referred to as proprioception.

For your body to be safe from injury and to have peak athletic performance, proprioception needs to work extremely quickly and be extremely accurate. Imagine that you are kicking a ball with all your might. You must instantaneously coordinate movement in your hip, your thighs, your ankles. You are probably swinging your arm as a counter-balance. All these movements must be perfectly coordinated, and the correct amount of exertion must be applied based on the exact position of each joint through each moment of the kick. At precisely the right time, your quadriceps must relax and your hamstring must contract to decelerate the kick and not over extend and injure the knee. The ability to coordinate all these movements well relies on good proprioception. Consider also how quickly your body reacts when you experience uneven terrain such as stepping off a curb unexpectedly. You didn’t see the curb, but your body was able to react and maintain your balance without injury due to proprioception.

Even good athletes often have less than optimal proprioception. In the newsletter New Heights sends to physicians, we recently reported on a large study using soccer players. The researchers recruited 600 amateur and semi-professional soccer players (40 Italian teams) for a study on proprioception. They introduced proprioceptive rehabilitation exercises into the regular work out of half of the players. This included work with various balance boards, up-step routines, and other procedures. After three seasons, the 20 teams without the change in workout experienced 70 ACL (anterior cruciate ligament in the knee) injuries. The 20 teams with the enhanced training only experienced 10 ACL injuries! Even these athletes had much room for improvement in their proprioceptive ability.

Injury can damage proprioception. Just like your tongue has taste buds and your eyes have rods and cones, your ligaments have mechanoreceptors. These are tiny gadgets in your soft tissues that send feedback to the central nervous system about position. When you have an ankle sprain or similar injury, these mechanoreceptors become damaged and proprioception gets damaged. Damaged proprioception makes future injury even more likely. Fortunately, proprioception can be rehabilitated and enhanced. CoachHR.org provides some general advice on proprioceptive exercises. However, if you have suffered an injury such as an ankle sprain or pulled hamstring, you should consider having an evaluation at New Heights. We can evaluate and discover specific deficits and teach you exercises specific to your situation. Furthermore, if you are an athlete, coach, or trainer looking to enhance your specific workout routine, we can offer custom consultation on those issues as well.

Whiplash

When to Begin Therapy Treatment

Current science demonstrates unequivocally that whiplash should receive physical therapy treatment within 96 hours of the injury. More than 50% of patients injured in motor vehicle accidents receive a whiplash diagnosis. Patients with acute neck pain develop chronic neck pain in 15% to 40% of cases. Until recently, standard medical treatment for the early phases of whiplash injury consisted of pain control, rest, and a soft-cervical collar. However, for the past five years of so, the science has suggested a more active approach to the acute phase of whiplash injury.

A researcher named Rosenfeld published a series of studies on the subject in Spine, a well respected research journal. In one of those studies, Rosenfeld randomized 100 people with whiplash to three treatment groups. Group 1 received standard care: advice from a doctor, restricted activity, and advice on independent stretching to begin several weeks after the injury. Group 2 received physical therapy care within 96 hours of the whiplash. Group 3 received standard care plus physical therapy care within 14 days of the injury. Even three years after the whiplash, only the group receiving active care within 96 hours of the injury had a neck range of motion that was close to normal. Group 2 was also the fastest to return to work – lessening the economic hardship on those patients. It’s important to introduce the right kind of motion into injured tissues early in the healing so that new tissues created by the healing process will lie down in correct patterns.

Some people think, “Physical therapy right after an injury – no way!” They are afraid that the therapist will cause them pain and discomfort. In fact, whiplash management early in the healing process typically involves slow, gentle, passive movements. Furthermore, pain inhibits some healing processes. That’s why injury treatment at New Heights Physical Therapy Plus focuses on procedures that are not painful.

When you are injured, especially in an automobile accident, see one of our therapists as soon as possible for advice and evaluation.

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3. Rosenfeld M, Gunnarsson R, Borenstein P. Early intervention in whiplash-associated disorders. Spine, 2000, 25 (14): 1782-87.

4. Rosenfeld M, Seferiadis A, Carlsson UJ, et al. Active intervention in patients with whiplash associated disorders improves long term prognosis. A randomised controlled clinical trial. Spine 2003, 28, 2491-2498.

5. Rosenfeld M, Seferiadis, Gunnarsson. Active invlovlement and intervention in patients exposed to whiplash trauma in automobile pressures reduces costs. A randomised controlled clinical trial and health economic evaluation. Spine 2006, 31, 1799-1804.

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7. De las Penas C, Fernadez-Carnero J, Palomeque del Cerro L, et al Manipulative treatment vs. conventional physiotherapy treatment in whiplash injury: A randomized controlled trial. Jouranl of Whiplash & Related Disorders, 2004, 3 (2): 73-90.

8. Vassiliou T, Kaluza G, Pulzke C, et al. Physical Therapy and active exercises – An adequate treatment for prevention of late whiplash syndrome? Randomized controlled trial in 200 patients. Pain, 124 (1): 69-76.

9. Wang W, Olson S, Campbell A, et al. Effectiveness of physical therapy for patients with neck pain: an individualized approach using a clinical decision-making algorithm. American Journal of Physical Medicine & Rehabilitation, March 2003, 82(3): 203-218.

10. Bunketorp L, Lindh M, Carlsson J, et al. The effective ness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders – a randomized controlled trial. Clinical Rehabilitation, 2006, 20 (3): 201-217.