Written by: Charlene Challenger Smith, PT, SCS, ATC Proaxis Therapy

As the spring season approaches, endurance athletes are spending increased time building up their base mileage in preparation for the upcoming racing season.  Whether you prefer to participate in multi-sport events like triathlon or single sport endurance events such as marathons and cycling races, proper conditioning is a critical component to your training plan.

In addition to specific sport training such as running, cycling or swimming, strength training plays a critical role in conditioning.  Benefits of strength and conditioning programs include both injury prevention and overall performance enhancement.  Endurance athletes who spend time each week conditioning with activities that include functional or corrective exercises, plyometric movements and dynamic activities demonstrate improved endurance capacity,

Contrary to popular belief, higher repetitions with lighter weights does not result in optimal performance for endurance athletes.  Research indicates that endurance athletes who perform heavier training with plyometric strength programs over the course of 6 weeks can improve their running economy 2-8%.  Running economy is defined as how efficiently oxygen is used during running.  Therefore, regular performance of plyometric activities or explosive movements with higher resistance can optimize endurance performance.

In addition to plyometric training, performing corrective and postural exercises along with hip and core work can result in improved ability to sustain form and posture throughout an endurance event.  As the race season approaches consider the addition of plyometric exercises such as squat jumps, scissor lunges, and box jumps to enhance your training. Additionally, perform strength exercises that emphasize stability by standing on 1 foot or performing planks and push-ups.  These exercises will to help maintain form during prolonged endurance events. 

As you prepare for your season, keep in mind building your base mileage along with incorporating strength and conditioning exercises will result in a healthy and successful season.

Written by: Adam Riffle, ATC Steadman Hawkins Sports Medicine

Etiology of injury

Tennis Elbow also known as Lateral Epicondylitis is inflammation of the lateral epicondyle. The inflammation occurs due to micro trauma to the attachment site of the wrist extensor group. Although any or all of the wrist extensor’s functions may be inhibited the extensor carpi radialis brevis is the muscle most commonly affected.

Repeated, forceful eccentric (muscle lengthening) contractions of the wrist extensor muscles result in the accumulation of degenerative forces at their attachment site. The relatively small area of attachment for these muscles causes a great force load to be applied to the bone as these muscles contract.

The micro trauma or overuse can be caused by activities that involve repetitive wrist extension, supination or repetitive heavy lifting. Tennis elbow is prevalent in racquet sports but also can occur in baseball, swimming, and golf, javelin throwing, and fencing athletes.

The most common chief complaints are pain over the lateral epicondyle, decreased grip strength, and pain with gripping.

Treatment Approaches for Tennis Elbow

There are two different rehabilitation approaches in the treatment of tennis elbow.

Conservative treatment usually is extremely effective, however may take several months to resolve. Also, if both of the following approaches are unsuccessful then arthroscopic release is usually recommended with good results.

Conservative Approach

Athletes Responsibility

1. Several weeks of rest or restricted activity in which painful movements are avoided.

2. The use of therapeutic modalities i.e. cryotherpy (ice) and electrical stimulating currents.

3. Oral medication such as Non Steroidal Anti-Inflammatory i.e. (Advil ®)

Physician and Athletic Trainer Responsibility

1.  Ultrasound using Phonophoresis with hydrocortisone

2.  Electrical Stimulating Current Iontophoresis with Dexamethasone

3. If pain persists some physicians might recommend a steroid injection

4. Counter force bracing

Aggressive Approach

1. Physician or athletic trainer comes to the conclusion that the athlete has chronic inflammation of the extensor tendons.

2. The inflammatory process is jump started by cross friction massage.

                    a. Before massage stretch extensor tendons and apply ice for 5 minutes to numb the area.

                     b. Transverse friction massage involves firm pressure massage over the point of maximum tenderness.

                     c. Duration: 5-7 minutes

                     d. Frequency: Every other day for a 7-10 day period

                     e. Must be emphasized that during this treatment approach all methods from the conservative approach are stopped.

Regardless of the techniques chosen strengthening techniques can begin once athlete is asymptomatic. If rest and anti-inflammatory approach is used, a period of restricted activity with little or no exercise might be necessary to reduce inflammation and pain. If the more aggressive approach is chosen, stretching exercises can be started within pain free limits.

Tips on prevention of Tennis Elbow

1. Learn the proper backhand technique.

2. Stretch wrist extensors before activity and ice after activity for 20 minutes.

3. Choose a racquet with the proper grip size.

4. Be sure your racquet is not strung with too much tension (55 to 60 lbs is recommended).

5. Eccentric strengthening for the muscles of the Forearm.

Return to play criteria

The biggest mistake made by individuals who have tennis elbow is returning to play too quickly. The athlete needs to have full pain free ROM. The involved muscles must regain appropriate strength, flexibility, and endurance with reduced inflammation and pain. Functional activity needs to progress slowly to prepare the athlete for the return without restrictions.

Written By: Joni Canter, ATC Steadman Hawkins Sports Medicine

Achilles Tendonitis is an overuse syndrome associated with the calf muscles and the heel.

The Achilles Tendon is made up of the lower end of the two muscles in the calf on the back of the lower leg. These muscles assist in knee movement and because they attach to the heel; they also move the foot.

Achilles Tendonitis is typically associated with foot movement. Pain with walking can be described as burning and radiating through the entire tendon. There may be some tightness in the tendon and calf muscles and the area will be tender to the touch. Inflammation, warmth around the area, and swelling, are all common signs for Achilles Tendonitis.

The main cause of Achilles Tendonitis is repeated over-stretching movements in the calf muscle which lead to micro tears, that overtime can lead to chronic inflammation and eventually degeneration of the tissue.

Other causes include: tight hamstring muscles, tight calf muscles, a high foot arch, poor foot biomechanics, poor training mechanics, running on uneven surfaces, and improperly fitted footwear that do not adequately stabilize the heel.

Management of Achilles Tendonitis is very conservative:
• RICE (Rest, Ice, Compression, Elevation)
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen
• Analgesics such as acetaminophen (Tylenol)
• ROM (Range of Motion) exercises for 1-3 weeks
• PRE (Progressive Resistive Exercises) for 1-3 weeks
• Heel Lift/Gel Insert

Prevention of Achilles Tendonitis can be as simple as using:
• an orthotic device to correct foot alignment
• a 10 – 15 mm heel lift to decrease the tendon stretch
• a flexible shoe and an Achilles pad to prevent irritation from friction

Tips from the ATC:

I have found that athletes do not typically like to hold an ice pack to their leg, so I have had better luck with immersion. Filling a Rubbermaid tub or garbage can with ice and water allows the entire area to be completed surrounded, thereby reducing pain and swelling. Ice by immersion for 10-15 minutes tends to be terribly cold at first, but after a few minutes the analgesic effects hit. My athletes prefer it to ice packs.

Written by Dawn Heeke, RD Steadman Hawkins Nutrition Science Center

School, work, long practices, and games limit your time to eat home cooked meals.  You are trying to pack more coolers, but there are many times you find yourself eating fast food.  If this sounds all too familiar learn how to make the best choices when eating “on the run”. 

Keep in mind that as an athlete you need plenty of nutritious calories, lots of healthy carbohydrate containing foods, lean proteins, and low-fat dairy foods to keep your body fueled and your muscles strong.  The main thing you are trying to avoid at fast food restaurants are the unhealthy fats that will clog your arteries and slow down your performance (French fries, burgers).  Also try to avoid the food choices that offer little nutrients (soda and pastries). 

To make smarter choices remember these golden rules: 

Rule #1:  Avoid all foods submerged in hot oil.  If the food item goes in “the fryer” it is
               not the best choice. Examples are French fries, tater tots, chicken nuggets

Rule #2:  Go Grilled and remove any skin that might be left on.  When it comes to protein
                choices… the fewer legs the better to keep it lean.  Example would be a char-
                grilled chicken sandwich vs. a greasy burger.

Rule #3:  Avoid foods mixed or topped with mayonnaise (“special” sauces made with  
               mayo).  Also use very little dipping sauces, sour cream, cheese, butter, creamy
               full fat salad dressings.

Rule #4:  Choose water, low-fat milk, or 100% fruit juices as your beverage of choice.
               Sodas and sweet tea are examples of sources of unhealthy carbs that do not offer
               any other nutrients.

Rule #5:  Always scan the menu for ways you can include healthy carbohydrate sources
               such as fruit cups, low-fat yogurts and milk, rice, beans, salads, baked potatoes,
               and breads.  Tip:  Salads alone may not give you enough carbs and calories, but
               are fantastic additions to your meal when a low-fat salad dressing is used.

Chipotle’s 
Order:
          Chicken or steak (it’s lean) burrito topped with healthy carbs such as black or pinto beans, fajita vegetables, tomatoes, rice, and any salsa.  Can add some guacamole (healthy fat) if eating after game or practice. Avoid eating lots of chips, cheese, or sour cream because they contain large amounts of fat and some not so healthy.

Chick-fil-A
Order:
- Chargrilled chicken sandwich (1-2 honey mustard ok)
- Breakfast Chick-n-minis (limit to 3 due to fat content)

Eat these with two or three suggested sides below to fuel or refuel with enough calories and carbs  yet not a lot of unhealthy fat.

Suggested sides:
- yogurt parfait with granola
- fruit cups
- multigrain steel cut oatmeal
- salads with low-fat dressing
- ice dream cups or cones (skip the fudge brownie)
- chicken soup
- low-fat white or chocolate milk

Wendy’s
Order:
- Ultimate chicken grill sandwich

Eat with two or three sides below to eat enough calories and carbs with little fat

Suggested sides:
-baked potato topped with broccoli (limit butter &
   cheese) –
-chili
-side salad with low-fat salad dressing + apple slices

Arby’s
Order:
-Roast Turkey MarketFresh sandwich (hold cheese & mayo)
-French Dip Sub (hold cheese & mayo)

Eat with two or three sides below to eat enough necessary calories and carbs without a lot of fat

Suggested sides:
- low-fat chocolate and white milk
- sliced apples and strawberry yogurt dip
- side salad (hold the cheese before a game) and light Italian salad dressing

Subway 
Order:
- Any 12 inch sub off the 6 grams of fat or less menu such as ham, oven roasted chicken,
  roast beef, or turkey breast (hold the cheese, mayo, & oil unless after a game or
  practice)

Eat with two or three sides below to eat enough necessary calories and carbs without a lot of fat

Suggested sides:
- low-fat chocolate or white milk
- 100 % fruit juice
- Light & Fit yogurt
- apple slices
- baked chips

Strengthening best defense against ankle sprains

More than 23,000 ankle sprains occur every day, according to a 2008 article in the Journal of Athletic Training.

While initial ankle sprains are painful and debilitating, the bigger problem is that each ankle sprain pushes a person toward another occurrence. And another. The same Journal study found 70 percent of patients have repetitive ankle sprains and chronic symptoms.

Read the full article  to learn about grades of sprains and when to seek medical treatment.

Baptist Easley Hospital broke ground today on the Medical Center of Powdersville a 32,000-square-foot, $8 million medical complex. Steadman Hawkins Clinic of the Carolinas, Proaxis Therapy and specialty surgeons from GHS will all have space at the facility.  It will be anchored by MD360, an urgent-care center operated by Greenville Hospital System University Medical Center. This will be the fourth MD360 for GHS, joining locations in Greenville, Greer and Simpsonville. The projected timeline for completion is January 2013.

 Read more….

http://www.gsabusiness.com/news/42452-baptist-easley-constructing-medical-complex?rss=0

Written by: Ellen Shanley PhD, PT, OCS, CSCS Proaxis Therapy

Baseball and softball have been shown to be relatively safe sports.  However injuries occur that require treatment often to the shoulder or elbow of players. Once a player has an injury they are at a higher risk for an ensuing injury.  We know that most injuries happen very early or late in the season.

The spring scholastic season is long and is often followed by a longer summer season.  There are many practices and games requiring lots of throwing.  To give an athlete the best chance for a successful and healthy season preparation and monitoring are the keys. 

To prevent arm injuries, we recommend that athletes prepare for the season by conditioning their arms prior to tryouts and competition.  The athlete should focus on building and maintaining flexibility, strength, and endurance.  In addition to specific band and stretching exercises we believe that athletes should follow a stepwise progression to increasing their tolerance to throwing.  Athletes should begin by throwing 2 sets of 25 throws for 45 feet (2 to 3 separate sessions) prior to extending the distance thrown to 60 feet.  This process is repeated through 90 and 120 feet at a minimum prior to beginning competition.  The distance and effort of throwing should not advance until the athlete can complete the step without pain or residual soreness.  If the player is sore after throwing they should wait 24-48 hours for the soreness to resolve. 

Other suggestions include incorporating rest days by limiting the number of teams a player competes on during one season and adding days off from pitching.  Adherence to Little League andUSAbaseball recommendations for pitch count limits is strongly encouraged.  Athletes should avoid pitching and catching on the same day and should monitor their fatigue, soreness, and pain.  

For more information please visit The Hawkins Throwing Academy , email baseball@hawkinsfoundation.com or call (864) 454-SHCC (7422).

Best of luck to all for a happy and healthy Spring.

Written by: Jonathan Williams, ATC Steadman Hawkins Sports Medicine

Shoulder injuries in overhead athletes are extremely common.  Injuries to the growth plate (little league shoulder), and rotator cuff tendonitis are two conditions that occur in overhead athletes.  Left untreated it could eventually lead to a rotator cuff tear. 

What is the rotator cuff? 

The rotator cuff is a group of muscles that provide stability for the shoulder joint.  The group originates on the scapula from which they attach to the head of the humerus. This structure allows the shoulder more mobility than other joints, but requires hard work to keep the shoulder together. 

What causes rotator cuff tendonitis?

In general, tendonitis is caused by repetitive movements that over time cause the tissues to become inflamed.  Over time the inflammation will cause pain and may eventually lead to a tear.  

Rotator cuff tendonitis is most common in sports that require a lot of overhead arm motions.  Baseball, tennis, and swimming are great examples of these types of sports.  

How do I know if I may have rotator cuff tendonitis? 

The first symptom most individuals will experience will be pain associated with shoulder movement.  Many will also notice a feeling of weakness any time the arm is in an elevated position.  

How to treat rotator cuff tendonitis:

ü  Manage the inflammation with ice and anti-inflammatory medications (such as naproxen or ibuprofen), and rest.  This will reduce the inflammation within the tendons which speeds recovery.

ü  As the pain begins to decrease, begin to move and lightly stretch the shoulder. 

How to prevent rotator cuff tendonitis: 

ü  Condition your shoulder for your chosen sport by strengthening the rotator cuff. 

ü  Increase the flexibility of your shoulders with a stretching program that emphasizes the rotator cuff.

ü  Complete a proper warm-up prior to activity.   

Tips from the ATC… 

I encourage my athletes who are at risk for shoulder problems to emphasize prevention in their daily life.  I routinely have them start a strength and flexibility program early in the preseason and encourage ice daily after activity to prevent the problem from occurring at all. 

Written by: Amanda Fly, ATC Steadman Hawkins Sports Medicine

Medial Epicondylitis, also known as Golfer’s elbow, is a common cause of pain along the inside (medial) of the elbow. This condition is similar to what is known as Tennis Elbow (Lateral Epicondylitis), which is the common cause of pain on the lateral (outside) of the elbow.

 What is Medial Epicondylitis? 

An injury caused by overuse of primarily the flexor-pronator muscles (pronator teres, flexor carpi radialis, and palmaris longus) at their origin on the anterior medial epicondyle. These muscles run along the forearm and attach on the inside of the elbow at the end of the humerus (upperarm bone). These muscles’ primary function is to flex the wrist. The flexor pronator muscle group also serves as a secondary stabilizer of the medial elbow, assisting the ulnar collateral ligament (UCL).  When the muscles are overused it causes inflammation/swelling and pain around the attachment at the epicondyle. 

What Causes Medial Epicondylitis? 

Medial epicondylitis is caused by overuse of the muscles of the forearm and repeatedly flexing the wrist. This is most common in throwing sports and golf. It has also been seen in bowlers, archers, and weightlifters. All of these activities involve excessive wrist flexion and overuse of the forearm muscles. 

How to Treat Medial Epicondylitis: 

-          Try to limit activities involving wrist flexion as much as possible.

-          General forearm stretching

-          Ice and ultrasound treatments will help reduce the inflammation

-          Compression wraps or sleeves may help with reducing inflammation

-          NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like Ibuprofen should help ease the pain and reduce the inflammation.

-          Local steroid or lidocaine injection by a physician is a way to localize medication that can help reduce inflammation.

-          Most importantly is RICE (rest, ice, compression, elevation) 

How to Prevent Medial Epicondylitis: 

• After a short warm-up period, make sure you stretch forearm and shoulder muscles before activity involving upper body movements.
• Keep your arm muscles strong so they can absorb the energy of sudden physical stress.
• Learn the proper technique for activities that require forearm motion.
• If you play golf, ask a golf specialist to check your:
• If you play baseball, make sure you have proper throwing technique
• Ice the medial(inside) of elbow for 15-20 minutes after activity

• Swing technique
• Grip
• Model of golf clubs

GHS looks back with pride

Courtesy of Greenville Online
By Liv Osby | Staff writer

Greenville Hospital System celebrated its 100th anniversary Tuesday with an exhibit of historic medical artifacts, the unveiling of a memorial marker at its original location and recognition by local dignitaries.

“Today is an important and historic day as we commemorate 100 years of service to this great community,” Jerry Dempsey, chairman of GHS’s board of trustees, told a crowd gathered in Greenville Memorial Hospital’s lobby.

“GHS is the state’s largest not-for-profit health care organization and provides nearly $300 million annually in charity care,” he said. “It is a privilege to take care of this community and provide necessary medical care for our patients.”

Greenville’s first hospital opened in a building called the Corbett Home on Memminger Street on Jan. 10, 1912, after years of planning and fundraising by members of the community.

The 84-bed City Hospital was sold to Greenville in 1917 and expanded to 125 beds in 1921. Today, it’s a 1,268-bed hospital system with satellite facilities in Greer, North Greenville, Simpsonville and the Eastside.

“How far we’ve come in 100 years,” said GHS CEO Michael Riordan, ticking off a century of milestones from GHS’s founding to the expansion of its satellite hospitals to the opening of the University of South Carolina School of Medicine in Greenville planned for later this year.

“What was once a single, free-standing hospital has evolved into an integrated delivery system,” he said, “and now an academic medical center.”

The day’s events began with a tribute to former hospital trustee C. Dan Joyner, who died Sunday.

“I know he’d be proud of where Greenville Hospital System is today and where we’re going in the future,” said Riordan, noting Joyner was chairman of the board when he was recruited to GHS. “I also know he would have loved to have been here with us today.”

Former GHS CEO Frank Pinckney paid honor to those who contributed to the hospital’s evolution over the past century.

“You have made it a cornerstone for the future of health care for the Upstate,” he said.

And Greenville Mayor Knox White proclaimed Jan. 10 Greenville Hospital System University Medical Center Day.

“I recognize that just as in 1912, the city came of age with the founding of the hospital,” he said, “in 2012, with the coming of the medical university here in Greenville, truly we have come of age.”

Calling GHS the state’s largest nonprofit health-care system, Dempsey read a proclamation from Gov. Nikki Haley who declared the day as GHS-UMC 100th Anniversary Day in recognition of its impact on the quality of life of South Carolina’s citizens.

Greenville County Council Chairman Butch Kirven said GHS is one reason the county can attract high-quality businesses and individuals, while state Sen. Mike Fair called the hospital system “one of the Southeast’s leading health-care providers.”

Saying GHS will still be standing in another 100 years, U.S. Rep. Trey Gowdy told the crowd he was born at GHS in 1964. And U.S. Sen. Jim DeMint said he and his wife and first two children were born at Greenville General Hospital while his second two were born at Greenville Memorial.

“All of us have benefitted from (GHS),” he said. “The best is ahead of us.”

Also in attendance were former Gov. Dick Riley and former Lt. Gov Nick Theodore, while U.S. Sen. Lindsey Graham sent a video message congratulating GHS on its 100th birthday.

Throughout the year, GHS will hold events to mark the centennial, including historic exhibits at the Upcountry History Museum and local libraries, a book about the hospital’s first century, and a time capsule to be buried in December.

Held in Greenville Memorial’s lobby, the event was watched by patients and staffers from all six floors, and viewed by about 1,800 hospital employees via streaming video on the Internet, officials said.

And as the celebration continued, the business of the hospital did, too. A doctor dressed in scrubs brought news to a patient’s loved ones, visitors arrived with balloons and flowers, and family members kept vigil in waiting rooms.

“GHS is committed to advancing health care for generations,” Dempsey said, “and plans to do so for another 100 years and beyond.”

Photos from the day can be viewed HERE