Female Athletes and ACL Prevalence

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As a former female division 1 gymnast, I personally experienced and witnessed many types of injuries. I had a few teammates who had recurring injuries that impacted their ability to continue the sport they loved. Seeing the sub-par rehabilitation process in a college setting without physical therapy interventions available, re-injury was extremely common. Many of these recurring injuries involved the knee and internal knee structures such as the ACL, PCL, MCL, and LCL. 

ACL injuries are becoming more and more common in the young athlete, but did you know that female athletes are up to 10 times more likely to experience an ACL injury compared to men? This may be due to the anatomy and biomechanics of the female knee joint. Often due to wider hips and a smaller groove at the bottom of the femur where the ACL inserts, the ACL in the female knee may experience greater stress and further restriction during twisting, jumping, changing direction, and landing movements compared to men. Other contributors to increased risk of injury include weakness of the posterior chain musculature (glutes and hamstrings) and ligament laxity during hormone cycles. Recent studies have found that woman may be more susceptible to ACL injury just prior to ovulation compared to the follicular phase due to increased ligament laxity.

The most common form of treatment following ACL injury is a reconstructive surgery using a graft from either the patient’s own patellar tendon, hamstring, or an ACL from a cadaver. Although an athlete may go through ACL reconstruction, it does not guarantee normal functions of the knee or prevention of subsequent knee injury. In recent studies, it has shown that about half of athletes who underwent ACL reconstruction return to high level sports, and only about 20% of these younger athletes will return to higher level sports in the first year following injury. Given these findings, it is extremely important that ACL rehabilitation encompasses deficits related to surgical interventions as well as initial cause of injury occurring prior to surgery.

Current generalized ACL rehabilitations programs may not have all-inclusive motor training, and neuromuscular re-education needed to safely allow return to sport within one year’s time. It has been statistically proven that proper recruitment and strength of the posterior chain as well as muscles that stabilize the knee will decrease risk of  re-injury in the young athlete with a prior ACL tear. Physical therapists have the training and knowledge to specifically pinpoint weakness and instability within the hip and knee complex, analyze gait and movements patterns, and build sport specific training programs to assist in injury prevention of the young athlete. 

In early rehabilitation, it is crucial to protect the graft site, and begin regenerating the quad musculature. Research shows that following knee injury or surgical interventions there is a reflex response to inhibit muscle activation called Arthrogenic Muscle inhibition (AMI). Physical therapy can assist in targeting the muscles that have been affected during this reflex inhibition process. Some examples include quad setting, resisted terminal knee extension, straight leg raises with a knee extension brace until the patient can complete a straight leg raise without knee flexion. Other exercises to assist overall hip and knee stability include closed chain activity such as partial squats, step ups, single leg balance activities, and bridges. It is critical for the physical therapist to ensure the patient is completing exercises without compensatory strategies and progressing toward proper movement patterns. 

Due to the high prevalence of re-injury, as well as muscular inhibition following knee injury, it is highly recommended that athletes, specifically women receive intensive rehabilitative care following ACL repair. Without specific neuromuscular re-education, proper movement pattern restoration, and addressing pre-injury mechanical deficits, young athletes are at risk for re-injury or significant time lapses as they attempt to return to sport. Physical therapy can provide young athletes with the education and tools they need for success as they return to the sports they love. 

Amanda Lievendag, DPT, CMTPT is a Physical Therapist in the outpatient setting at Frederick Health Physical Therapy & Sports Rehab. Amanda’s professional interests are Sports Orthopedics, Sports Rehab, Trigger Point Dry Needling, and Spine Rehabilitation. She is a high energy physical therapist who has specialized experience with post-op, sports injuries, return-to-sport training, overuse injuries, and general wellness with athletes and patients of all ages.

 

Ask an Expert: Should I Stretch Before a Workout?

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Question: Should I stretch before a workout?  

Yes, but not in the way you probably think! Let’s look at the goals of stretching before a workout- to warm up the muscles and to prevent injury.

To warm up the muscles we need to increase blood flow, which comes from movement. While stretching is technically moving, there are far more effective options, such as walking. A five-minute walk or light cardiovascular exercise (jogging, biking, elliptical) will warm up your muscles much more than stretching will.

Does stretching prevent injury?  

Laursen, et al in 2014 found strength training and proprioception (balance) training both decreased risk of injury but stretching did not have any effect on injury risk. Swing and a miss there. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials – PubMed (nih.gov)

Is there any benefit to stretching? 

Yes, yes there is! We do not need to stretch all our muscles, but if we have limited range of motion, then we should be stretching those involved muscles. A few movements we should be able to do- look up, down, left, right. When we raise our hand, our arm should be in line with our ear. While sitting with our feet in front and legs straight, we should be able to touch our toes.

When we do not have proper mobility, our body will compensate; this can cause overuse or long-term injuries. So, while stretching does not reduce injury risk for your workout, it is still beneficial to our bodies.

Warm-up Routine:  

  • 5-10 minutes of light cardio
  • Targeted stretching for flexibility deficit
  • Exercise!

Alex Strahle, PT, DPT, CSCS is a Physical Therapist in the Employer Based Clinic setting in Indianapolis, IN.  Alex enjoys seeing patients return to an active lifestyle after treatment for their pain and dysfunction. He takes into consideration the psychosocial and physical requirements in treatment and believes in creating a positive and healing environment for his patients.

Tx:Team Welcomes Liz Kotroba, Director of Rehabilitation Services at Frederick Health

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We are pleased to announce Liz Kotroba, PT, DPT, MBA as our new Director of Rehabilitation Services for Tx:Team partnered with Frederick Health.

Liz joins Tx:Team with an extensive background in both rehabilitation and healthcare leadership. She attended The University of Scranton in Scranton, PA, where she earned her Bachelor of Science in Health Sciences, her Master of Physical Therapy, and her Doctor of Physical Therapy. Liz went on to receive her Master of Business Administration from the University of Maryland – University College in Adelphi, MD. She has held leadership positions as Clinic Director, Inpatient Manager, Outpatient Manager, Director of Outpatient Therapy Services, and was promoted to Associate Vice President of Operations and Hospital Administrator with Adventist HealthCare Rehabilitation.

Liz is passionate about rehabilitation services and will continue to advance clinical and operational excellence, innovation, and community engagement throughout the continuum of rehab care at Frederick Health. She has a wealth of knowledge in program assessment, development, and implementation, clinic start-up, mentoring and developing teams, financial management, and regulatory compliance. It was clear throughout the interview process that Liz’s skillset and experience were an ideal fit for this role.

On behalf of Tx:Team, we are delighted to welcome Liz to our team. We look forward to serving our patients and our partners in the Frederick community.

Inclusion, Diversity, and Belonging

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In September 2021, Tx:Team launched a formal Inclusion, Diversity, and Belonging (IDB) Initiative. This initiative came out of a question we asked our leadership team: how do our associates and patients experience Tx:Team?

Our mission is to provide everyone with the opportunity to live the healthiest life possible. Diversity of background, experience, identity, ethnicity, race, sexual identity and orientation, and perspective improves the creativity, innovation, quality, and effectiveness of the therapy we provide.

On October 28th and 29th, 2021, we convened a meeting of Tx:Team’s IDB workgroup comprised of associates from around the country and members of our home office, along with guests from the Indiana University Schools of Physical Therapy and Occupational Therapy. Facilitated by Rob Shook and Bill Kirst, our workshop generated five specific initiatives that Tx:Team has adopted and will execute in 2022 and 2023:

  1. Develop an authentic and clearly articulated statement of Tx:Team’s IDB philosophy.
  2. Establish safe spaces for associates to be themselves, talk openly about key issues, and seek guidance from easily identifiable allies/mentors.
  3. Incorporate IDB into Tx:Team’s internal and external marketing and communication platforms and materials.
  4. Create a one-year fellowship for new Physical and Occupational Therapy, and Speech Language Pathology graduates with a specific focus on engaging therapists from groups that are historically underrepresented in our profession.
  5. Target groups in schools and organizations that are historically underrepresented in our industry and provide education, opportunities for shadowing, and other exposure to possible career paths in the rehab profession.

One of Tx:Team’s core identifying characteristics is authenticity, and we take this very seriously. Our intent was to clearly and publicly state who we are and what we believe, and then put those beliefs into action. To broaden our reach and better reflect the diversity found in our communities, we are creating opportunities for historically underrepresented groups to access the education, experience, and support necessary to join the therapy profession.

Tx:Team is a place for anyone with a passion for healing and a desire to change the world, and we are committed to fostering an environment where each associate can be included, valued, and seen. We want everyone who walks through our doors to feel safe and comfortable just being themselves.

April is Occupational Therapy Month

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Written by Carroll Nelligan, Tx:Team President and Chief Operating Officer

“You know that occupational therapy is more than a profession—it’s a passion, and it’s about people.”  AOTA

It’s April, an entire month dedicated to promote and create more awareness around the great field of Occupational Therapy. I encourage all of our Occupational Therapists to carve out some time to reflect on the great work you do and recharge yourselves with empowerment and inspiration. Here’s what inspires me about our profession:

OT is Creative. I had the pleasure of attending the Quarterly OT meeting with OTRs and COTAs from our Bridge region and our Indiana hospitals. We opened with a sharing activity, “What is a favorite Therapeutic Activity that you use in your practice?”  The inventive and resourceful list included making overnight oatmeal, packing a suitcase, selecting and wrapping a gift and many others. OTs have the training and expertise to select an activity and break it down into all of the required motor, cognitive, visual, and perceptual components to help our patients achieve meaningful occupation based goals. As we were sharing, my first supervisor at Good Samaritan Hospital Georgina Miller’s words echoed in my brain. “If you are doing straight exercise with a patient, you are NOT an occupational therapist.” OTs are creative experts in therapeutic activity!

OT is Evidence Based. Occupational therapy is a science-driven, evidence-based profession that enables people of all ages to participate in daily living or live better with injury, illness, or disability. This is accomplished through designing strategies for everyday living and customizing environments to develop and maximize potential. An independent study published in Medical Care Research found that “occupational therapy is the only spending category that has significantly lowered hospital readmission rates.”  What were the OT interventions that drove this?  Recommendations and training for caregivers, assistive devices, home safety assessments, assessing cognition around medication management, and functional mobility. Tx:Team Occupational Therapists and Certified Occupational Therapy Assistants in the hospital environment are impacting readmission rates each and every day!

OT is Holistic. We do with people not to people. We are about helping people live life to the fullest, regardless of what their life is like or who they are. By taking the full picture into account—a person’s psychological, physical, emotional, and social make-up—occupational therapy assists people in:

  • Achieving their goals
  • Functioning at the highest possible level
  • Concentrating on what matters most to them
  • Maintaining or rebuilding their independence
  • Participating in the everyday activities that they need to do or that simply make life worth living

We are experts in helping people perform the occupations they need and want to do every day.

Forever an OT.  Every weekend I visit my Mom at her senior living campus to spend time with her and help her with household tasks. On my most recent trip, I arrived at her apartment only to I realize I had left an item on my kitchen counter that was meant for her. Honestly, I was a bit frustrated, and I hurriedly exited the building to return (for yet another trip) to CVS.  It was then I saw a car door open in the parking lot and a resident was on the pavement. Her rolling walker (tennis balls in the air!) was turned over and she was struggling to get up. God works in small mysterious ways by sending a frustrated OT out to the parking lot at just at the right time. Occupational therapists (no matter what we are doing) are OTs at heart and are indispensable healthcare professionals within our communities.

Thank you to all of our talented, creative, smart, and dedicated Occupational Therapists and Certified Occupational Therapy Assistants. Take the time this month to celebrate and recognize our fabulous OTRs and COTAs for the passionate professionals that they are.

Pre-Work Screening Program

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There are over 2.9 million non-fatal work injuries per year. Of those injuries, about 30% of them end up being musculoskeletal cases including sprains, strains, and tears that end up costing an average of $30k per case.

Workplace musculoskeletal injuries are often the most expensive of occupational injuries and also account for productivity loss and days away from work.

Wouldn’t it be beneficial if you could identify the risks of work-related musculoskeletal injuries before they happen? That’s where Tx:Team’s pre-work screening program comes in.

Our test replicates the roles and responsibilities that will be required of the employees while they’re on the job. Once we assess the functions of a job, we can plan and implement a strategy to prevent future injuries for current employees while also setting a baseline of what is required when hiring future employees.

Watch this short video to learn more about our success with the pre-work screening program, and fill out the form below if you’re interested in partnering with Tx:Team.

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    What’s Good for the Employee is Good for the Employer

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    As an employer, when you have healthier employees, you achieve more productivity and maintain a healthy bottom line. By delivering early treatment options and preventative care through physical therapy, your employees will be in better health and have an improved quality of life. This saves your employees money and also saves you, the employer, on your health plan expenses.

    At Tx:Team, our FOTO data, Net Promoter Score and patient satisfaction results show that we are consistently delivering superior outcomes and getting employees back to work with higher efficiency and effectiveness. Watch this quick video to learn more about how a Physical-Therapy First model can help address MSK spend.

    Our patients get better faster with almost three fewer visits than our competitors, which saves the employee time but also allows them to be more productive at work. Do you want to learn more about Tx:Team? Contact us today:

      Please provide your email below to continue the conversation with Tx:Team.

      Heart of the Home Safety Tips

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      Occupational therapists help to develop, recover and maintain everyday activities for individuals. The kitchen is often seen as the heart of the home, a space where people spend a lot of time cooking, gathering, and eating, but the kitchen and other areas of your home can pose a lot of challenges for people who are aging. Due to shaky balance, low vision and slower reflexes, many aspects of the kitchen and your home can be dangerous for seniors.

      Household Organization

      • Keep often used items within reach.
      • Move any items you use most out of the highest and lowest cabinets and shelves, and into easily reachable cabinets and drawers.
      • Store heavy items on a counter or at waist level to avoid bending and straining your back.
      • Keep drawers and cabinets closed when not in use.

      Remember the Lights

      • Be sure you have ample lighting near the area you are working in the kitchen or other rooms.

      Home Floors

      • Remove any rugs that slide.
      • If using an anti-fatigue mat in the kitchen, be sure it is secured to the floor to prevent falls.

      Useful Kitchen Tools and Gadgets

      • Use an easy grip opener to help open those tight bottles and jars.
      • Have access to a Reacher grabber to avoid bending over to reach for an item on the floor.
      • Keep a magnifying glass handy to assist in reading labels.
      • Set timers  to avoid overcooking or burning foods.
      • Be sure to have a steady stool in your home for times when you need a rest.
      • Use different cutting boards for different foods. RED for meats  and GREEN for vegetables to avoid foodborne illnesses.
      • Use pots and pans with handles on both sides for easier lifting. Keep the handles turned so they are not sticking out over the edge of the stove or counter to avoid a spill which could lead to a fall.

      Occupational Therapy

      Occupational therapy provides residents with the tools to optimize their home environments relative to individual abilities and promote full participation in daily life activities. As the population of older adults continues to grow, home modifications are a key factor in enabling individuals to age in place.

      What is a Home Safety Assessment?

      A home safety assessment is an in-person review by a licensed Occupational Therapist. The purpose of the assessment is to help the resident identify areas in the home which could lead to a fall or other injury and provide recommendations or modifications to increase usage, safety, security, and independence.

      For more information on safety and independence in your home, talk to your Tx:Team Rehabilitation team!

      Tx:Team Announces Partnership with Beth Cisco

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      Tx:Team is excited to announce our strategic partnership with Cisco Consulting Group, and specifically, Beth Cisco.  Beth will utilize her wealth of experience and expertise in hospital and employer-based healthcare solutions to advise our executive team on business development, brand refinement, and marketing strategies. Welcome, Beth!

      Beth Cisco

      Beth Cisco, Principal of Cisco Consulting Group, has over 24 years of experience in the areas of strategic marketing; account and relationship management; brand development and management; marketing communications; public relations; and business solutions development and execution specific to the employer segment. Much of her background has been focused in the healthcare sector, working with self-funded employers, hospitals and health systems, physician groups, and medical device and product manufacturers. Beth has presented on healthcare marketing topics at the national level, including American College of Healthcare Executives and HealthGrades, and has led award-winning teams recognized by American Advertising Awards, Healthcare Marketing Report and Telly Awards.

      Beth has consulted for a number of prominent healthcare organizations, including Hendricks Regional Health, Hancock Health, and Ascension.  Prior to starting her own company, Beth was Chief Marketing Officer at St. Vincent Health, overseeing all aspects of marketing and communications for the 23 Indiana-based hospital system. Previous roles also include Vice President of Marketing, Development and Guest Relations at St. Vincent Heart Center of Indiana; consultant with Health Evolutions; and partner at St. Claire Cisco Group, a former Indianapolis-based strategic marketing and communications firm. She looks forward to building long-term, valuable relationships and delivering measurable results for Tx:Team’s clients.

      Beth is very involved in the community having served or currently serving on the boards of American Heart Association (Midwest Affiliate); Cancer Support Community; Little Red Door Cancer Agency; Indiana Repertory Theatre; Mentoring Women’s Network; and The New Harmony Project. In her free time, she enjoys spending time with family and friends, traveling, and retreating to the mountains of Colorado.

      Operate Out of Love

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      Carroll Nelligan, President, Chief Operating Officer

       

      My heart is hurting today as I know is the case with all of you.  This is not a political post.  There are plenty of avenues for that.  We have been faced with many months of challenges and we are all fatigued in different ways.

      I am writing about what I know to be true.

      Operate out of love.

      You are healers.  It is your destiny to bring that into the world.   What I kept thinking about over the weekend is that we are all aligned in that.  We are wired to care, to nurture, to help, to love.  We don’t see our patients through a lens of what color their skin is, their political views, or their income.

      When I worked in urban Philadelphia, we treated the worst of the traumatic brain injury cases.  The Philly cop that was shot during a terrible robbery, the Hasidic Jew who was in the school bus bombing, the young boy from the Manayunk projects who had been shot on a corner drug deal, none of it mattered who they were but how we could help them become human beings again.  The love for our patients and the ability to change lives is what drove us.

      In so many ways we have all been pushed to a limit.  We have been stripped down to our basic selves and have nowhere to hide, to safely tuck away, to self-care.  You have an opportunity through your work to bring your best selves into the world each day.  To spread love and compassion and to raise the energy of the world we live in.  We have choices to operate out of fear or operate out of love.

      I am so proud of the way that we have responded during the pandemic.  We are strong, we are resilient.  Those are not just words on a wall.  We have seen this in action. So many stories of those who redefined what it means to be essential.  It brought tears of appreciation to my eyes.   These are very challenging times.  When one wave hits us, another seems to be waiting in the ocean to pummel us again.  We can breathe.  We can survive. And, we can thrive.

      When hearts are hurting like this, focus on the lovely human you are treating in front of you.  Your full and undivided presence and attention to your patients, to your teammates, and to your community is what is needed right now.  We need you on the ground following a moral compass that points in the right direction regardless of what the world is doing wrong.  We need leaders who continue to search for the best answer, not the familiar one.

      We are transforming as a nation, as a world, as a human race.  Thank you for all you do as healers in a world that needs so much healing right now.