Butler Chiropractic HealthCenter

   10932 North East 6th Avenue

   Miami, Florida 33161

   (305) 751-2112  

    www.butler-chiropractic.com 

Newsletter

 

Which is Best for the treatment of Acute Soft-Tissue Injuries, Immobilization or Early Mobilization?

 

 

"In Brief: Experimental and clinical studies demonstrate that early, controlled Mobilization is superior to immobilization for primary treatment of acute Musculoskeletal soft-tissue injuries and postoperative management. Optimal treatment and rehabilitation follow four steps that address response to trauma. First is treating the damaged area with PRICES: protection, rest, ice, compression, elevation, and support. Second, during the first 1 to 3 weeks after the injury, immobilization of the injured tissue areas allows healing without extensive scarring. Third, when soft-tissue regeneration begins, controlled mobilization and stretching of muscle and tendons stimulate healing. Fourth, at 6 to 8 weeks postinjury, the rehabilitative goal is full return to preinjury level of activity."

Acute soft-tissue injuries such as muscle-tendon strains, ligament sprains, and ligament or tendon ruptures occur frequently in sports and exercise. Without correct diagnosis and proper treatment, they may result in long-term breaks in training and competition. Far too often, injuries become chronic and end careers of competitive athletes or force recreational athletes to abandon their favorite activity. For these reasons, and increased focus has been on finding ways to ensure optimal healing. In this regard, the question has centered on immobilization or early mobilization in treatment.

Musculoskeletal soft tissue responds to trauma in three phases: the acute inflammatory phase (0 to 7 days), the proliferative phase (about 7 to 21 days), and the maturation and remodeling phase (21 days and thereafter.

 

Acute inflammatory phase. In this phase, ischemia, metabolic disturbance, and cell membrane damage lead to inflammation, which, in turn, in characterized by infiltration of inflammatory cells, tissue edema, fibrin exudation, capillary wall thickening, capillary occlusions, and plasma leakage. Clinically, inflammation manifests as swelling, erythema, increased temperature, pain, and loss of function. The process is time dependent and mediated by vascular, cellular, and chemical events culminating in tissue repair and sometimes scar (adhesion) formation.

 

Proliferative phase. These changes include fibrin clotting and a proliferation of fibroblast, synovial cells, and capillaries. The inflammatory cells eliminate the damaged tissue fragments by phagocytosis, and fibroblast extensively and markedly elevate production of collagen (initially, the weaker, type 3 collagen, later type 1) and other extracellular matrix components.

 

Maturation and remodeling phase. In this phase, the proteoglycan-water content of the healing tissue decreases and type 1collagen fibers start to assume a normal orientation. Approximately 6 t0 8 weeks postinjury, the new collagen fibers can withstand near-normal stress, although final maturation of tendon and ligament tissue may take as long as 6 to 12 months.

 

 

Injury and Four-Step Treatment

 

 

After an injury, the ideal treatment and rehabilitation program should include four steps.

 

PRICES. Immediately after injury, the damaged area should be treated with PRICES: protection, rest, ice, compression, elevation, and support. The aim is to minimize hemorrhage, swelling, inflammation, cellular metabolism, and pain, and to provide optimal conditions for healing. Since prolonged inflammation may lead to excessive scarring, early, effective treatment seeks to prevent it. N the other hand, one must remember that inflammation is not only the body's response to insult, but also the initial step in healing.

 

Immobilization and protection. The second step is immobilization and protection of the injured tissue area during the first 1 to 3 weeks. In the early phase of healing, immobilization allows undisturbed fibroblast invasion of the injured area that leads to unrestricted cell proliferation and collage fiber production. Premature and intensive mobilization at this time leads to enhanced type 3 collagen production and weaker tissue than that produced during an optimal immobilization period. Protection (such as with a cast or brace) prevents secondary injuries and early distension and lengthening of injured collagenous structures such as a torn anterior cruciate ligament (ACL).

 

Maturation. About 3 weeks after injury, collagen maturation and final scar tissue formation begins. In this phase, injured soft tissue need controlled mobilization. Less injured portions of the tissue or joint, however, can be mobilized earlier, sometimes even during the proliferative phase. Prolonged immobilization, thorough, must be avoided to prevent atrophy of cartilage, bone, muscle, tendons, and ligaments. Controlled muscle stretching and joint movement enhance new collagen fiber orientation parallel to the stress lines of the normal collagen fibers; these activities also serve to prevent tissue atrophy from immobilization. Treatment can be supported with physical therapy to improve local circulation and proprioception, inhibit pain , and strengthen muscle-tendon units.

 

Resumption of activity. Approximately 6 to 8 weeks after the injury, new collage fibers can withstand near-normal stress, and the goal for rehabilitation is rapid and full recovery to activity. If the previous steps were followed, protection is no longer needed, and each component of the damaged soft tissue is ready for a progressive mobilization and rehabilitation program.

 

Summary Controlled experimental and clinical trials have yielded convincing evidence that early, controlled mobilization is superior to immobilization for musculoskeletal soft-tissue injuries. This holds true not only in primary treatment of acute injuries, but also in their postoperative management. The superiority of early controlled mobilization is especially apparent in terms of producing quicker recovery and return to full activity, without jeopardizing the long-term rehabilitative outcome. Therefore, the technique can be recommended as the method of choice for acute soft-tissue injury.

 

The Physician and Sportsmedicine, Vol28 No.3 Mar 2000

Improving Your Golf Game with Orthotics

 

 

Exercise programs have been developed to maximize the effectiveness of the golf swing and to minimize injury risk, and the  golf industry has made various innovations in golf club design to address these factors and improve overall performance.  It has been hypothesized that strengthening the muscles used during golf swing may contribute to increased in power and club-head velocity (CHV).   Another premise is that if pedigenic function can improve, balance may also improve, resulting in improved function of the rest of the closed kinematic chain.   This, an improved golf swing may be an outcome.

To further investigate this latter assumption, 12 experienced golfers participated in a study evaluating the effects of orthotic intervention on CHV before and after nine holes of simulated golf.  Subjects wore custom-made, flexible orthotics daily for six weeks, and CHV measurements were taken using an electronic device that measures club speed as the golfer swings.

 

Custom-fit, flexible orthotics contributed to an approximate increase in CHV of 3-5 miles per hour in experienced golfers.  For reference, a five mph increase in CHV translates to approximately a 15 yard increase in ball air distance.   Additionally , orthotic use appeared to reduce the effects of fatigue associated with nine holes of golf, suggesting the potential for more consistent golf performance.

 

 

 

CONSISTENCY AT IMPACT IS A FUNDAMENTAL KEY



Among the many swing fundamentals, it could be argued that your body position at impact is one of the most important. Just watch a PGA Tour event and you will notice many different styles of taking the club back to the load position. However, if you could freeze frame on the same pros and view their bodies at the impact position, they would look very similar.

Here is a checklist of things to keep in mind with regard to body position at impact:

a) The hips are from 10-45 degrees open and ahead of the
shoulders.

b) The shoulders are square, or parallel to the target line
or 20 degrees open depending on the individual.

c) The right elbow is in front of the right hip.

d) The hands are forward of the ball position.

e) The right knee is pointed inside the line created by the toes.

f) The right heel should be slightly off the ground.

g) 90% of the weight is on the left side.




Golf Tips & Advice To Improve Your Golf Game & Save your Back

 

 

Many avid golfers contort their bodies into oddly twisted postures, generating a great deal of torque. Couple this motion with a bent-over stance, repeat 120 times over three or four hours, add the fatigue that comes with several miles of walking, and you've got a good workout - and a recipe for potential low-back trouble.

As America's love affair with the game continues to grow, the American Chiropractic Association (ACA) has advice on how to take a proactive approach that will prepare your body for many years of pain-free play.

"Most golfers go until they get hurt, then look for help," says Dr. David Stude, member of the ACA Sports Council and founding fellow of the National Golf Fitness Society.  "Back pain is a warning sign that there is an underlying problem responsible for a symptom that will likely get worse.  Doctors of chiropractic look for the cause of the symptom and help reduce the likelihood of future injury."

If you take the chiropractic approach, you're in good company.   According to Dr. Stude, Tiger Woods says that lifting weights and visiting his chiropractor regularly have made him a better golfer.

Dr. Stude and the ACA suggest these simple measures to help you avoid back pain or injury and improve your game:

 

Purchase equipment that fits:  Don't try to adapt your swing to the wrong clubs:  A six-footer playing with irons designed for someone five inches shorter is begging for back trouble.

For the women in golf:  If you have "inherited" your husband's or significant other's golf clubs, they might be difficult for you to use.  Not only are the clubs often too long, but the shaft is often not flexible enough for a woman's grip.  Women typically play better with clubs that are composed of lighter, more flexible material, such as graphite.

For the men in golf:  It is a good idea to spend some extra time performing quality stretches-before and after your game-to increase your trunk flexibility.  While we are traditionally stronger than women, we usually aren't as flexible.  Men need to improve their flexibility to maintain a more even and consistent swing plane and thus improve the likelihood of more consistent performance.

For senior golfers: If you show some signs of arthritis in the hands, consider a larger, more specialized grip for added safety and performance.

For all golfers:  For some, scores may not be as important as enjoying the social benefits of the game.  Having clubs that are comfortable will increase the chances of playing for a long time without significant physical limitations.

Take lessons:  Learning proper swing technique is critical.  At the end of the swing, you want to be standing up straight; the back should not be twisted.

Wear orthotics:  These custom-made shoe inserts support the arch, absorb shock, and increase coordination.  "Studies show custom-made, flexible orthotics can improve the entire body's balance, stability and coordination, which translates into a smoother swing and reduced fatigue," Dr. Stude says.  While the upper part of a shoe may score style points, what the foot rests on affects your game.

Avoid metal spikes:  They tear up greens and can increase stress on the back.  Soft shoes or soft spikes allow for greater motion.

Warm up  before each round: "Stretching before and after 18 holes is the best way to reduce post-game stiffness and soreness,"says Dr. Stude.  Take a brisk walk to get blood flowing to the muscles; then do a set of stretches.  To set up a stretching and/or exercise routine, see a doctor of chiropractic or golf pro who can evaluate your areas of tension and flexibility.

Pull, don't carry, your golf bag: Carrying a heavy bag for 18 holes can cause the spine to shrink, leading to disk problems and nerve irritation. If you prefer to ride in a cart, alternate riding and walking every other hole-bouncing around in a cart can also be hard on the spine.

Keep your entire body involved:  Every third hole, take a few practice swings with the opposite hand to keep your muscles balanced and even out stress on the back.

Drink lots of water:  Dehydration causes early fatigue, leading you to compensate by adjusting your swing, thus increasing the risk of injury.  Don't smoke or drink alcoholic beverages while golfing, as both cause loss of fluid.

Take the "drop":  One bad swing-striking a root or a rock with your club-can damage a wrist.  If unsure whether you can get a clean swing, take the drop.

 

Doctors of chiropractic are trained to treat the entire neuromusculoskeletal system.  The can address other health concerns, such as shoulder, knee, arm and wrist pain that could affect your game.

 

 

ACA, 2000

 


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