Friday, October 30, 2009

Blake Griffin Knee Injury

Clips’ Griffin out 6 weeks with broken kneecap
By GREG BEACHAM, AP Sports Writer
Oct 28, 1:38 am EDT

LOS ANGELES (AP)—Blake Griffin is about to add patience to his repertoire of basketball skills while his broken left kneecap heals.

It’s a vital quality for somebody trying to turn around the Los Angeles Clippers.

The NBA’s No. 1 overall draft pick will be out for up to six weeks with the stress fracture, likely delaying his debut until mid-December—and creating one more reason to believe there’s a curse on this star-crossed franchise.

“It’s disappointing, especially when it happened, but I’m not going to feel sorry for myself,” Griffin said Tuesday at the club’s Playa Vista training complex. “Everybody plays with a certain amount of pain, but it is a fine line, because you do want to take care of your body and make it easier on yourself.”

Griffin watched the Clippers’ 99-92 season-opening loss the Lakers on Tuesday night from behind the bench in a three-piece suit and blue tie, waving to fans shouting encouragement from the stands. The former Oklahoma star won’t be allowed back into practice until his fracture has healed in several weeks.

Griffin wore shorts and no knee protection while watching the Clippers’ morning shootaround. He will undergo bone stimulation and special blood treatments that will limit his activities for at least a month, and he plans to swim for exercise.

Coach Mike Dunleavy believes the process will be frustrating, but hopefully instructive for a power forward whose relentless work ethic sometimes leads him to rush his recovery time and even play through pain unnecessarily.

“He needs to be more honest with his body and with our medical personnel,” Dunleavy said. “There are times when he’s telling us he’s fine, he’s good, and he’s feeling some pain. … He understands better the potential consequences now. Give us the information, and we’ll decipher it and figure out what you should play through, but I think he understands now.”

Griffin was hurt during a preseason game last Friday, wincing in pain as he came down from a dunk late in the third quarter. He claimed as recently as Monday afternoon that he would play through the discomfort, but an MRI revealed the stress fracture Monday.

“He could play on it, but it won’t get better,” Dunleavy said. “Once that became apparent, there was no question: Let’s shut it down. Him playing at a lesser level isn’t going to do us much good.”

While he’s out, the Clippers will move on with a fairly solid roster. Marcus Camby(notes), Chris Kaman(notes), Rasual Butler(notes), Craig Smith(notes) and Al Thornton(notes) all are capable of playing significant frontcourt minutes.

Dunleavy isn’t sure whether the broken kneecap is related to the bruise that Griffin sustained on the same knee in late September. That injury didn’t keep him from playing in the preseason, when he averaged 13.7 points and 8.1 rebounds while appearing fully ready for the NBA challenge.

Griffin’s short tenure with Los Angeles already has been dotted by injuries, starting with a strained right shoulder during summer league play in Las Vegas.

Clippers fans wish they could say they’re shocked by the latest development, but few still doubt the power of the Clipper Curse.

Los Angeles has just two winning seasons in the last 30 years and just one playoff series victory since moving to town in 1984. The Clippers also have a long history of disappointing draft picks, including a pair of No. 1 overall choices that didn’t dazzle.

Danny Manning played just 26 games in his rookie season in 1988-89 after tearing his knee ligament and undergoing surgery, though he eventually became an All-Star before fleeing town on his broken-down joints. Michael Olowokandi(notes), the top pick in 1998, played just 45 games in his rookie season, and he wasn’t much help even when healthy during five underachieving seasons.

Griffin insists his injuries and his franchise’s past have nothing to do with each other.

“It’s not something that requires surgery,” he said. “It’s not something where I’m going to be out for six months, half a year.”

Griffin was the consensus college player of the year with 22.7 points and an NCAA-best 14.4 rebounds per game last season for the Sooners. Shortly after arriving in Los Angeles, he announced he didn’t believe in any Clipper Curse— and he hopes to prove he’s right when he’s finally healthy.

“It’s a setback, but it’s not major,” Griffin said. “It’s something that I can work through, and hopefully use this to work on other things to get better.”

Chiropractor, Fairfax VA

Thursday, October 22, 2009

Study Finds the Availability of Chiropractic Care Improves the Value of Health Benefits Plans

Study Finds the Availability of Chiropractic Care Improves the Value of Health Benefits Plans

Foundation for Chiropractic Progress commissions landmark report delivers incremental impact on population health and total health care spending

Carmichael, CA - October 20, 2009 - A report, prepared by a global leader for trusted human resources and related financial advice, products and services, finds that the addition of chiropractic care for the treatment of low back and neck pain will likely increase value-for-dollar in US employer-sponsored health benefit plans. Authored by Niteesh Choudhry, MD, PhD, and Arnold Milstein, MD, the report can be fully downloaded at:

Full Report Download

Accordingly, this report was commissioned by the Foundation for Chiropractic Progress ( to summarize the existing economic studies of chiropractic care published in peer-reviewed scientific literature, and to use the most robust of these studies to estimate the cost-effectiveness of providing chiropractic insurance coverage in the US.

According to Gerard Clum, DC, spokesperson for the Foundation for Chiropractic Progress and President of Life Chiropractic College West, ?While some studies reflect cost efficiencies and others clinical efficiencies, these findings strongly support both for chiropractic care of neck pain and low back pain.?

Executive Summary:

Low back and neck pain are extremely common conditions that consume large amounts of health care resources. Chiropractic care, including spinal manipulation and mobilization, are used by almost half of US patients with persistent back-pain seeking out this modality of treatment.

The peer-reviewed scientific literature evaluating the effectiveness of US chiropractic treatment for patients with back and neck pain suggests that these treatments are at least as effective as other widely used treatments. However, US cost-effectiveness studies have methodological limitations.

High quality randomized cost-effectiveness studies have to date only been performed in the European Union (EU). To model the EU study findings for US populations, researchers applied US insurer-payable unit price data from a large database of employer-sponsored health plans. The findings rest on the assumption that the relative difference in the cost-effectiveness of low back and neck pain treatment with and without chiropractic services are similar in the US and the EU.

The results of the researchers' analysis are as follows:

-Effectiveness: Chiropractic care is more effective than other modalities for treating low back and neck pain.

Total cost of care per year:

-For low back pain, chiropractic physician care increases total annual per patient spending by $75 compared to medical physician care.

-For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care.

Cost-effectiveness: When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.

These findings, in combination with existing US studies published in peer-reviewed scientific journals, suggest that chiropractic care for the treatment of low back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favorable to most therapies that are routinely covered in US health benefits plans. As a result, the addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health benefit plans will likely increase value-for-dollar by improving clinical outcomes and either reducing total spending (neck pain) or increasing total spending (low back pain) by a smaller percentage than clinical outcomes improve.


About F4CP

A not-for-profit organization, the Foundation for Chiropractic Progress (F4CP) embraces a singular mission to promote positive press for the profession in national, regional and local media. Through effective and ongoing initiatives, the Foundation?s goal is to raise awareness to the many benefits provided by doctors of chiropractic. The F4CP relies upon strategic marketing campaigns that span prominent spokespersons, monthly press releases, public service announcements, and advertisements in high-profile media outlets. To learn more about the Foundation, please visit us on the web at or call 866-901-f4cp.

Monday, October 19, 2009

Female Atletes and ACL Injuries

Female Athletes More Prone To ACL Injuries
By Simeon Margolis, M.D., Ph.D.

One of my granddaughters is a high school long-distance runner and another granddaughter plays just one sport (soccer) almost year round. So I was interested in an article by Michael Sokolove in the May 11 issue of The New York Times Magazine titled, "The Uneven Playing Field."

The greater involvement of American women and young girls in athletics largely stems from an important federal law, Title IX, which was enacted in 1972 to guarantee equal opportunities in sports for both men and women.

The downside of such participation is that now girls, like boys, may suffer ankle, back, and head injuries. Of particular concern to young athletes, however, is a tear or rupture of the anterior cruciate ligament (or ACL), 1 of 4 major ligaments of the knee, and the one most commonly injured.

Football fans hear of ACL injuries to their favorite players, often the result of a direct blow to the knee. But these injuries can occur without any contact or unusual happenstance. For example, the ACL can be damaged when the knee is twisted on landing, or when a foot is firmly planted on the ground but the player's body is forced to rotate.

An ACL tear or rupture is not only quite painful but often ends up needing a surgical repair or reconstruction, followed by a rehabilitation period of 6 to 9 months before a return to competition.

Researchers have determined that girls rupture their ACLs 5 times more often than do boys, even when competing in the same sports — soccer, basketball, and volleyball. This difference may be due to hormonal changes at puberty, when testosterone causes boys to add muscle and grow stronger, though less flexible. By contrast, increased estrogen in girls tends to add more fat than muscle, so that their ligaments, although more flexible, are surrounded by less protective muscle.

Based on what I hear from the parents of our 12-year-old, soccer-playing granddaughter, young girls are apparently getting pressured more and more to play longer and harder, in more and more tournaments. The result is that these youngsters have too many opportunities to get hurt and too little time to recuperate from their injuries.

Just as worrisome, youngsters are urged to concentrate on one sport, so as to increase their chances of standing out. This specialization means that the same groups of muscles and ligaments will be getting the punishment throughout the year. When I was growing up, we played different sports each season, and the muscle stiffness on switching from one sport to another made it apparent that each sport puts the greatest strain on its own particular muscle groups.

What can be done to prevent ACL and other injuries in young girls?

They need:

-to start at a young age with vigorous exercise to gain muscle strength
-to be taught proper stretching and balancing exercises
-to receive less pressure from coaches and parents to spend excessive time and effort on a single sport
-to be given more freedom to try as many sports as they want, so the same group of muscles and ligaments will not be subjected to stress year after year

Wednesday, October 14, 2009

Increasing Severity Of Bicycle Injuries Leads To Concerns About Cycling Infrastructure

Record-high gasoline prices, the slowdown in the economy, and increasing environmental sensitivity are leading more people to bike to work or for play. But an adequate infrastructure may not be in place to protect cyclists from serious injury according to surgeons who presented a new study on the issue during a scientific paper session at the 2009 Clinical Congress of the American College of Surgeons.

The researchers found that the severity of injury and hospital length-of-stay for bicycle injuries at one trauma center has increased significantly over the past 11 years. Despite the wide-spread attention paid to the importance of wearing helmets, helmet use did not change during the time period of the study, and more than 33 percent of 329 bicycle injury victims had a significant head injury. Even more alarming, the number of chest injuries increased by 15 percent and abdominal injuries rose three-fold over the last five years. "We were astounded by that data," said Jeffry Kashuk, MD, FACS, associate professor of surgery at the University of Colorado School of Medicine and senior attending surgeon at the Rocky Mountain Regional Trauma Center at Denver Health Medical Center, Denver. "We're talking about injured spleens and livers, internal bleeding, rib fractures, and hemothorax [blood in the chest]. Those kinds of injuries are reflected by an increase in injury severity score," he added.

The study was conducted in Denver, which has one of the most well-developed bicycle path networks in the country. "Denver is very much a bicycle community. If we are seeing an increase in injuries in a metropolitan area that has fairly mature bike infrastructure from the standpoint of bike pathways, there's reason for concern about what's happening in metropolitan areas that don't have that level of maturity. There seems to be a significant increase nationally in the use of the bicycle for urban transportation. If our data is a microcosm of what is going on nationally, we may be on the cusp of an injury epidemic," Dr. Kashuk said.

Researchers at the University of Colorado hope to obtain funding so they can expand the study nationally and generate data that will support better safety standards and raise community awareness about the lack of cycling infrastructure. "On a local and national level, people need to be aware of the fact that a push for bike transportation for the sake of health, the environment, and lower transportation costs has real potential to raise medical costs because our infrastructure may not be ready for it," Dr. Kashuk said. "Look at all the safety factors that have been incor-porated in automobiles and streets and highways. If even a percentage of that kind of investment went into safety vis-a-vis bike paths and community infrastructure, we would protect people from major injury."

Zachary Hartman, BA; Ernest E. Moore, Jr., MD, FACS; Walter L. Biffl, MD, FACS; Catherine C. Cothren, MD, FACS; Jeffrey L. Johnson, MD, FACS; Carlton C. Barnett, Jr., MD, FACS; and Angela Sauaia, MD, participated in the study.

Source: American College of Surgeons (ACS)

Monday, October 12, 2009

Preventing Sudden Death In Sports By Means Of Genetic Testing: Study Launched

The BBVA Foundation and the Cardiology Service of Madrid's Hospital Clínico San Carlos have launched a new study aimed at detecting DNA alterations linked to sudden cardiac death in sports. Genetic testing is vital if the condition is to be caught in time, since most cases are asymptomatic and hard to diagnose by other means.

The Foundation has donated a latest-generation gene sequencer to the hospital's Cardiovascular Research Unit for use in its research project "Genetic testing in cardiovascular pathologies linked to sudden cardiac death among young athletes". The device is already operating all day round in the Madrid hospital, from Monday to Friday, analyzing 16 samples per hour. It is equipped to detect the Brugada syndrome - the cause of unexpected sudden cardiac death in apparently healthy hearts - in just two hours, compared to the 25 hours needed by preceding technologies.

Although similar gene sequencers exist in Spain, this is the only device devoted exclusively to the study of alterations linked to sudden death in sports.

The donation was made in the frame of the ongoing agreement between the Hospital San Carlos Cardiology Service and the BBVA Foundation spanning basic and clinical research, healthcare and epidemiological analysis.

Seizures and pre-seizures among professional and amateur athletes

Spain, unlike other countries, has no reliable data on the incidence of sudden cardiac death in the general population, although the country has over 6 million registered athletes and over 12 million people engaging in some kind of sport. Estimates suggest that between 30 and 40 sportsmen or women die from this cause each year, though only deaths occurring during official competitions get covered in the media.

"Sudden death is the final consequence, but before that come seizures or pre-seizures, and it is here that we need to detect potential victims and bring them under clinical treatment", explains Antonio López Farré, head of the Cardiovascular Research Unit within the hospital's Cardiology Service.

The research team will keep a record of all cases detected in the course of the study. For the moment, its scope is confined to the Madrid Region, where an agreement has been concluded with ambulance service SAMUR for a special code 33 to be activated in all cases of seizures involving an amateur or professional athlete.

This code indicates that the SAMUR team should transport the patient directly to Hospital Clínico. There, he or she will be treated in the Accident & Emergency Department and offered the choice of taking part in the study. Those who accept will be subjected to genetic tests using the sequencer installed in the Cardiovascular Research Unit in order to detect possible alterations associated with sudden death.

If some such alteration is found, the patient will be placed under the appropriate medical care, and also offered the opportunity to have his or her relatives tested to see if they suffer from the same pathology.

In its first weeks in operation, the sequencer has analyzed the genes of 85 athletes (65 men and 20 women). In each case a series of test were run depending on the possible condition. To date, 4,067 sequencings have been carried out along with 5,523 sequencing reactions.

Silvia Churruca
Fundación BBVA

Basketball Shoes and Injuries

A great article from AAPSM

Basketball Shoes and Injuries

Too many basketball players overlook the importance of buying a durable and high-quality pair of basketball shoes, which is astounding when you consider how much time they spend pounding their feet into the ground. Bad shoes can lead not only to foot and ankle problems, but leg, hip, and even back pain as well. That's because alignment begins with your feet and moves up to influence the rest of your body. In time, the stress to a certain soft tissue or bone structure will create a fatigue injury which then renders the player unable to participate in his or her sport.

The average high school basketball player can greatly decrease his/her incidence of overuse injury by simply replacing his/her basketball shoes frequently, said Michael Lowe, DPM, team podiatrist of the Utah Jazz of the National Basketball Association. Dr. Lowe presented a study which showed that the average high school basketball player will utilize only one pair of new basketball shoes per season. Dr. Lowe recommends that the basketball shoe be changed monthly during the season. This has been found to greatly decrease the rate of injury to professional players, to the point that they will often replace shoe gear every two to three days or games.

The use of proper shoe gear has a strong relationship to the performance and stability of foot function within the shoe. Those shoes which compliment foot requirements for stability, flexibility and shock absorption, can greatly aid in the dissemination of stress to foot and leg structure. The amount of stress applied to the shoe gear before replacement with a new shoe also has a profound influence upon protecting the athlete. Most runners are encouraged to replace shoe gear every 350 -500 miles depending upon the size of the runner and his or her running environment. The same should be true of the basketball player. The average runner will spend about 66 hours in running to accumulate 500 miles on a pair of shoes ( 8 minute per mile pace times 500 miles). The average high school or collegiate athlete will work out easily 72 hours per month. Basketball shoes are now made of the same types of materials, i.e. eva or polyurethane midsole and a harder outer sole material. These materials all have a fatigue factor which greatly influences function of foot and stress delivered to bone and soft tissue structures. Players in the NBA will rarely use a basketball shoe for longer than 7-10 days before replacing it with a new pair of shoes.

A positive secondary by-product of frequent shoe change is that of a protective influence of shoe gear to foot and ankle stability to external forces. As the shoe is worn over hours of use the leather uppers slowly begin to stretch to the rotational forces applied. Also the midsole material slowly deforms or compresses to repetitive ballistic starting and stopping of play. As these external changes to the shoe continue the rotational movement of the foot within the shoe slowly increases in range of motion. Therefore it can be seen that with newer shoe usage, there will be fewer inversion injuries as compared to injuries due to the lack of support from worn and stretched shoe gear materials which lack the integrity to decelerate foot rotational movement beyond normal positioning.

The use of a high top basketball shoe is still one of the best means for protecting the ankle from inversion sprains. NBA players choose a wide variety of shoe gear styles to play in; 68% of the players utilize a high top shoe, 15% utilize a 3/4 top shoe, and only 10% will use a low top basketball shoe for regular play. Your choice will be tempered by what is available and what properly fits.

Friday, October 9, 2009

Exercise can decrease the incidence of colds

As the weather turns colder, the noses turn runnier - but incidence of colds can be greatly reduced by making exercise a part of daily life, according to an expert from the American College of Sports Medicine.

David C. Nieman, DrPH, FACSM, says that multiple studies have shown a 25- to 50-percent decrease in sick time for active people completing at least 45 minutes of moderate-intensity exercise (such as walking) most days of the week.

"This reduction in illness far exceeds anything a drug or pill can offer," Nieman said. "All is takes is a pair of walking shoes to help prevent becoming one of the thousands predicted to suffer from the common cold this winter."

However, if you're already sick and aren't sure whether to hit the gym or the couch, Nieman offers these tips:

- DO exercise if your cold is confined to your head, such as illnesses with runny noses and sore throats.

- DON'T overdo it. If you have a cold, keep exercise to a moderate-intensity level (i.e., walking). Studies have not shown any negative effects of moderate exercise for those suffering from common colds.

- DO stay in bed if your illness is "systemic" - that is, beyond just the sniffles of a regular cold. Respiratory infections, fever, swollen glands and extreme aches and pains are all good reasons to rest up instead of work out.

- DON'T jump back in too soon. If you're recovering from a more serious bout of cold or flu, gradually ease back into training after at least two weeks of rest.

Nieman also advises exercising prior to receiving a flu shot. Moderate-intensity exercise just before getting the shot has been shown to improve the body's response to the vaccine, boosting immunity.

Nieman's advice aligns with the Exercise is Medicine ™ program, a component of which centers on including physical activity as a standard part of health care, like any other vital sign.

American College of Sports Medicine

L-Arginine Exerts Anti-Inflammatory Effects


Reference:"Oral l-arginine supplementation improves endothelial function and ameliorates insulin sensitivity and inflammation in cardiopathic nondiabetic patients after an aortocoronary bypass," Lucotti P, Monti L, et al, Metabolism, 2009 July 8; [Epub ahead of print]. (Address: Internal Medicine Department, Cardio-Diabetes Trials Unit, Scientific Institute San Raffaele, 20132 Milan, Italy. E-mail: ).

Summary:In a randomized, double-blind, placebo-controlled study involving 64 patients with cardiovascular disease who previously underwent autocoronary bypass, supplementation with l-arginine (6.4 g/d) for a period of 6 months (in 32 of the 64 patients found to have a non-diabetic response to an oral glucose load), was found to decrease asymmetric dimethylarginine levels, decrease indices of endothelial dysfunction, and increase cyclic guanosine monophosphate, l-arginine to asymmetric dimethylarginine ratio, and reactive hyperemia. In addition, increases in adiponectin and the insulin sensitive index and decreases in interleukin-6 and monocyte chemoattractant protein-1 were also associated with l-arginine treatment. The authors conclude, "…insulin resistance, endothelial dysfunction, and inflammation are important cardiovascular risk factors in coronary artery disease patients; and l-arginine seems to have anti-inflammatory and metabolic advantages in these patients."

Friday, October 2, 2009

Gilbert Arenas Finger Injury

RICHMOND, Va. (AP)—The Washington Wizards say Gilbert Arenas(notes) has missed scrimmages at training camp because of a finger injury—not because of any problems with his surgically repaired left knee.

Arenas sat out a scrimmage for the second consecutive day Thursday, although he did participate in drills.

He dislocated the middle finger on his left hand in a pickup game before training camp began, then aggravated it this week.

Arenas had three operations on his left knee in 1 1/2 years, and he missed all but two games last season. But Wizards coach Flip Saunders said the knee is not limiting Arenas at the moment, the finger is.

See the short article on Yahoo!

Tai Chi Can Help People With Diabetes Lower Glucose Levels

A regular tai chi exercise program can help people better control their diabetes and lower glucose levels, according to a University of Florida study.

In a study of adults diagnosed with type 2 diabetes, those who participated in a supervised tai chi exercise program two days a week with three days of home practice for six months significantly lowered their fasting blood glucose levels, improved their management of the disease, and enhanced their overall quality of life, including mental health, vitality and energy.

"Tai chi really has similar effects as other aerobic exercises on diabetic control. The difference is tai chi is a low-impact exercise, which means that it's less stressful on the bones, joints and muscles than more strenuous exercise," said Beverly Roberts, Ph.D., R.N., the Annabel Davis Jenks endowed professor at the UF College of Nursing.

Roberts, with Rhayun Song, Ph.D., R.N., of Chungham National University, studied tai chi's effect on older Korean residents. The research was featured in the June issue of The Journal of Alternative and Complementary Medicine.

About 23.6 million children and adults in the United States, or 7.8 percent of the population, have diabetes. It occurs when the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.

Risk factors include obesity, sedentary lifestyle, unhealthy eating habits, high blood pressure and cholesterol, a history of gestational diabetes and increased age, many of which can be reduced through exercise.

"People assume that for exercise to be beneficial you have to be huffing and puffing, sweating and red-faced afterward," Roberts said. "This may turn people off, particularly older adults. However, we have found that activities like tai chi can be just as beneficial in improving health."

Tai chi is an ancient Chinese martial art that combines deep breathing and relaxation with slow, gentle circular movements. This low impact exercise uses shifts in body position and stepping in coordination with arm movements.

Sixty-two participants, mostly Korean women, took part in the study. Half the group participated in at least 80 percent of two supervised sessions one hour per week, with three days of home practice for six months, and the other half served as a control group. Those who completed the sessions had significantly improved glucose control and reported higher levels of vitality and energy.

"Those who participated in the tai chi sessions actually had lower blood glucose at three and six months," Roberts said. "Those individuals also had lower hemoglobin A1c, which means they had better diabetic control."

In addition to improved blood glucose levels, participants also reported significantly improved mental health. This was very encouraging especially since people with less depression are typically more active and independent, Roberts said.

Tai chi has also been used for people with arthritis and disabilities to increase balance, muscle strength and mobility and to reduce the risk of falls. It is worth investigating its effects in other conditions, especially in older people, Roberts said.

"Tai chi provides a great alternative for people who may want the benefits of exercise on diabetic control but may be physically unable to complete strenuous activities due to age, condition or injury," Roberts said. "Future studies could examine if tai chi could similarly benefit conditions such as osteoporosis or heart disease."

Since tai chi is an exercise that involves so many parts of the body and also helps to relax the mind, it is more likely participants will adhere to the exercise, said Paul Lam, M.B.B.S., a lecturer with the University of South Wales School of Public Health and Community Medicine and a practicing family physician in Sydney, Australia.

"This study shows that tai chi can have a significant effect on the management and treatment of diabetes - a significant and growing health challenge for all Western countries," Lam said.

University of Florida Health Science Center

LaDainian Tomlinson on Injury Prevention

To Your Health
Playing to Win: Injury Prevention Is the Key
By Alex Guerrero

With nearly 12,000 rushing yards, San Diego Chargers running back LaDainian Tomlinson is on track to become the National Football League's most prolific runner. He's starting his ninth year in the league and is less than 7,000 rushing yards (four to five seasons) short of the all-time career mark, held by former Dallas Cowboys running back Emmitt Smith. A former MVP of the NFL, LaDainian owns or shares 28 Chargers team records and holds the NFL record for most total touchdowns scored in a single season. And none of it happened by accident.

While LaDainian has suffered his share of injuries over the years (including last year), he's stayed remarkably healthy in a sport (and at a position) that features constant physical contact. After all, he's already played for eight years when the average NFL player's career is only 3.5 years. So, how's he done it? The same way you can do it. It's all about injury prevention. Whether you're an All-Pro running back like L.T. or a weekend warrior, the goal is the same: You undoubtedly want to lower your chances of incurring an injury while participating in your favorite sport. Fortunately, there are some general rules for injury prevention that apply to all sports, which is important because sports scientists suggest injury rates could be reduced by 25 percent if athletes took appropriate preventative action. Here are a few tips on how to stay healthy and reduce your risk of suffering an injury.

The #1 Rule: Don't Overdo It

The amount of training you do plays a key role in determining your real injury risk. Studies have shown that your best direct injury predictor may be the amount of training you completed last month. Fatigued muscles do a poor job of protecting their associated connective tissues, increasing the risk of damage to bone, cartilage, tendons and ligaments. If you are a runner, the link between training quantity and injury means total mileage is an excellent indicator of your injury risk. The more miles you accrue per week, the higher the chances of injury. One recent investigation found a marked upswing in injury risk above 40 miles of running per week. Of course, this can be minimized and often avoided by regular chiropractic and massage therapy treatments, along with getting adequate rest between training sessions. The point isn't to avoid exercise, but rather to appreciate that overdoing it can lead to injury, and that when your muscles are fatigued, they need rest. It's about knowing what your body can handle at any particular point in time.

Says LaDainian: "I know my body real well and I know exactly what I need to do and when to get in shape. I start a couple of weeks after the last game. You get broken down, and you get weak [during the season], so I start with the basics: core, hips, shoulders, and then I move into the more functional stuff, building strength through movement." L.T. and other professional athletes also use an anti-inflammatory cream before and after physical activity to minimize pain and overuse injuries.

If You Can Predict an Injury, You May Avoid an Injury

If you have been injured before, you are much more likely to get hurt again than an athlete who has been injury free. Regular exercises have a way of uncovering the weak areas of the body. If you have knees that are put under heavy stress because of your unique biomechanics during exercise, your knees are likely to hurt when you engage in your sport for a prolonged time. After recovery, if you re-establish your desired training load without modification to your biomechanics, your knees are likely to be injured again. In layperson's terms, that means figuring out why you got injured in the first place and how to avoid it from happening again.

The second predictor of injury is probably the number of consecutive days of training you carry out each week. Scientific studies strongly suggest that reducing the number of consecutive days of training can lower the risk of injury. Recovery time reduces injury rates by giving muscles and connective tissues an opportunity to restore and repair themselves between workouts.

Specific Factors Influencing Injury Risk: Which Apply to You?

Psychological Factors

Some studies have shown that athletes who are aggressive, tense and compulsive have a higher risk of injury than their more relaxed peers. Tension may make muscles and tendons tighter, increasing the risk that they will be harmed during workouts. Try some breathing exercises or visualization before starting your workout to ensure you are as relaxed as possible.

Weak Muscles

Many injuries are caused by weak muscles that are simply not ready to handle the specific demands of your sport. This is why people who start a running program for the first time often do well for a few weeks, but then suddenly develop foot or ankle problems, hamstring soreness or perhaps lower back pain as they add the mileage on. Their bodies simply are not strong enough to cope with the demands of the increased training load. For this reason, it is always wise to couple resistance training with regular training. Your body needs to be stronger before it can handle the "new" demands being put on it.

Muscle Imbalances

Screening for muscle imbalances is the current cutting edge of injury prevention. The rationale behind this is that there are detectable and correctable abnormalities of muscle strength and length that are fundamental to the development of almost all musculoskeletal pain and dysfunction. Detection of these abnormalities and correction before injury has occurred should be part of any injury prevention strategy. Assessment of muscle strength and imbalances, as well as regular chiropractic and massage therapy, can be beneficial in this strategy.

Muscle Stiffness

Technically speaking, muscle stiffness refers to the ratio between the change in muscle resistance and the change in muscle length. Muscle stiffness is directly related to muscle injury risk, so it is important to reduce muscle stiffness during your warm-up. Research indicates that only dynamic stretches (slow, controlled movements through the full range of motion) decrease muscle stiffness. Static exercises (holding a stretch in one position for a period of time) do not decrease muscle stiffness. This suggests that dynamic stretches are the most appropriate exercises for warming up; static stretches are perhaps more appropriate for the cool-down period, as they help to relax the muscles and increase their range of movement.

Trigger Points

When pain syndromes develop, certain locations on the body called trigger points develop. A "trigger point" (TP) is a thick knot in a muscle that is palpable and tender (even painful to the touch). A diagnostic sign of a trigger point is a so-called jump sign. This sign is produced by accurately palpating the TP to produce pain in the area of referral as well as muscle contraction (or a jump) of the involved extremity.

Treatment of a TP (separating the fibers of the muscle knot) can be achieved by applying direct pressure to the point for 10 to 20 seconds, gradually releasing the pressure and repeating the process four or five times. The amount of pressure, which will depend on the sensitivity of the TP, can be applied by using one or both thumbs. A number of treatments may be required but as the sensitivity of the TP reduces it will become harder to find.

Trigger points are an early warning to a potential serious injury, getting checked for TPs is very beneficial. A regular massage is well worth it as the therapist, when conducting a massage, can check for TPs and treat them. I also always use an anti-inflammatory cream when treating TPs to help reduce pain and inflammation, which helps the healing process.

The Value of Sport-Specific Training

Resistance training can fortify muscles and make them less susceptible to injury, especially if the strength-building exercises involve movements that are similar to those used in the performance of the sport. As L.T. says, "Football is a movement game. You don't lie down, like you're on a bench press, and tackle somebody; skill players want to be quick, so you don't need to do a lot of heavy lifting, not all the time."

For example, if you are a thrower, then lots of time should be spent developing muscles at the front of the shoulder that increases the force with which you can throw, but you must also work systematically on the muscles at the back of the shoulder which control and stabilize the shoulder joint.

By following these simple recommendations, you can live an active life and enjoy the sports and other activities that make you feel great. That's what keeps LaDainian Tomlinson going strong, and that's what can keep you doing the same thing when you're working out, playing your favorite sport or just playing with the kids. To learn more about ways to stay in shape and avoid injury, talk to your doctor.

Injury Prevention Tips

-Avoid training when you are tired; you should be strong and ready to exercise.
-Increase your consumption of carbohydrates during periods of heavy training.
-Match increases in training with increases in resting. (Rest is how the body regenerates.)
-Precede any increase in training load with an increase in strengthening.
-Treat even seemingly minor injuries very carefully to prevent them from becoming a big problem.
-If you experience pain when training, stop your training session immediately.
-Never train hard if you are stiff from the previous effort.
-Pay attention to hydration and nutrition (water before exercise, electrolyte drink during exercise and water after exercise).
-Use appropriate training surfaces.
-Check that training and competition areas are clear of hazards.
-Check that equipment is appropriate and safe to use.
-Introduce new activities gradually and make sure you are clear on how to perform them safely.
-Allow lots of time for warming up before your workout/activity and cooling off after your workout/activity.
-Review training and competition courses beforehand.
-Train on different surfaces, using the right footwear.
-Shower and change immediately after the cool-down (after exercise).
-Stay away from infectious areas when training or competing very hard.
-Be extremely fussy about hygiene, particularly in hot weather.
-Monitor daily for signs of fatigue; if in doubt, ease off your workouts for a day or two.
-Get regular massages to keep muscles loose and blood circulating properly.


Alex Guerrero is a sports therapist who works with many professional and world-class athletes. He specializes in sports injury, rehabilitation, performance enhancement and nutrition.