Uncategorized – Page 9 – Dr. Abbate Physical Therapy

December 19, 2023December 20, 2023

Helping circus artists recover from low back pain: a movement system impairment style

If you are a circus artists (aerial, acrobat, contortionist or other performing artist) experiencing low back pain, this article is for you.

We will discuss why low back pain is so widespread in the circus artist community, how a physical therapists like me can help to identify a possible cause of your back pain, and what you can do to relieve yourself of low back pain.

Recreational circus has been a growing community in the past decade, with practitioners using performing arts as a form of exercise. And this is absolutely amazing! We need more folks participating in regular physical activity for physical and mental health- the circus arts are a perfect way to do it.

Low back pain is common in circus artists. Seeing that more people are participating in circus, this article may help prevent low back pain from occurring. One possible cause of low back pain in circus artists is the extremes of flexibility that you are required to have for “aesthetic” purposes. Great flexibility with strength can help you look in control of every inch of movement- appearing graceful. But repeatedly moving into these extremes of position may increase the risk of developing low back pain.

A 5 minute performance may require repeated spinal movements towards the end range of flexibility, oftentimes holding this position for several seconds. Over many years of practicing circus, you may find yourself favoring one side more than the other in certain positions or sequence of movements. The Movement System Impairment assessment we will now discuss is used to identify these imbalances in circus artists and direct treatment to correct them. This may help guide you in the right direction for assessing positions frequently performed in circus arts, with a trained eye.

Movement or positional imbalances often result in compensatory patterns or static position. These imbalances may help direct treatment towards the root cause: altered muscle function, areas of poor flexibility, pain or maybe even fear of the position itself.

The Movement System Impairment (MSI) assessment looks at a circus artists ability to maintain a specific body position with 8 different movements. Movement outside of, or inability to get into these positions will be a clinical observation that can then begin to establish a movement impairment diagnosis. The movements are chosen because they offer an opportunity to find a common movement-specific impairment, and begin there as a starting point for intervention. For example, if you have low back pain when inverting when hanging, and you also have low back pain when performing a leg lift with the MSI assessment, that would be the starting point for pain-provoking positions.

The MSI diagnosis contains 5 categories. The artist is categorized based on the direction preference of the limbs or spine in any of the 8 movements. Whens the movement assessment is over, the physical therapists will make a MSI-specific diagnosis, and a treatment plan will be developed with the artist.

Like every other single athlete out there, circus artists do not like to take time off. Every athlete knows that the more time spent on their craft gets them one step closer to their goal. It doesn’t matter if they’re fitness goals, technique acquisition, training for a performance, or just for peace of mind, athletes want and deserve to have a body that moves well.

If you are a circus artist experiencing low back pain and feel like you do not have a reliable source of direction, give our office a call and we will do whatever it takes to get you the help you need no matter where you are.

I also help circus artists improve their strength and flexibility with my circus strength training program. These programs are custom made, based on your specific goals and time. We first take a thorough history and examination, discussing previous injuries, how they’re being managed, and then coming up with a plan to get you swinging in the right direction.

Give our office a call and we can schedule a phone call to see if we’re a right fit for each other.

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December 19, 2023January 7, 2024

Should I stop exercising if I’m injured?

Should I stop exercising if I'm injured?

Should you stop training if you’re injured?

No.

In this article we will discuss how strength training can improve pain and function when you are managing your injury.

The absolute WORST advice I hear from my patients on behalf of their medical doctors is to take time off and rest. Why is this the worst advice? Because it completely misses out on the benefits of regular, consistent exercise.

Even in elite athletes, deconditioning occurs quickly and can make the rehab process even longer. I’m not suggesting your continue to use the injured body part without consideration of movements or activities that make the condition worse. What I almost always encourage my patients to do is to continue with strength training and drilling techniques with modifications.

These modifications include avoiding painful movements/positions, limiting the full range of the joint to avoid pain and carefully choosing partners that can work around the injury.

So how does exercise improve pain?

Regular exercise has profound impacts on physical and mental health. This includes cardiovascular health, stress, mood and sleep. I know for a fact that athletes ordered to “rest” to “recover” from an injury for almost any length of time, become frustrated and let down because they can’t participate in the sport they love. Sports physical therapists like myself can create mutual goals and boundaries for athletes to continue to train despite an injury offers that athlete hope and something to work towards- return to sport.

There are several benefits to continue training even when experiencing pain. These include pain threshold, pain tolerance, perception of pain and function.

The first is improved pain threshold. The pain threshold is the minimum level of stimulus intensity that is perceived as pain. For example, if someone were to squeeze your fingers, at what point would that become painful? Exercise raises this threshold of when the pain begins.

The second is improved pain tolerance. Pain tolerance is the maximal intensity of pain someone is willing to tolerate. For example, how long can that person maximally squeeze your fingers before you tell them to stop?

Exercise can improve pain threshold and pain tolerance.

Exercise can also improve pain perception at the neurological level.

A third benefit is temporal summation, or the increase in pain after repetitive stimulation at the same intensity, can be reduced. For example, if every time you raised your hand overhead, how many times could you do it before it becomes unbearable? Exercise-induced pain relief can increase the number of “reps”, so to speak, that can be performed before reaching the pain tolerance.

A fourth benefit of exercise to manage pain is conditioned pain modulation. This is a measurement of strength of pain inhibition. Pain modulation allows for progressively painful stimuli to be perceived as non-threatening.

A fifth benefit is improving how the brain processes pain. When exposed to pain, the brain responds by adjusting its attention through various chemicals and neurological signals. Exercise can make this response more profound by minimizing the “excitement” around the pain experience.

To summarize: improved pain threshold, improved pain tolerance, movement becomes more manageable, better pain-response conditioning and improved pain processing.

So now you might be asking:

What kind of exercises can help reduce my pain?

Any and all of it really. Studies over the past 2 decades show consistent improvements in the pain experience regardless of the type of exercise and the duration. However, there is a intensity-dose curve. The more intense and painful (not injury/pathological pain) the exercise is, the better the pain management.

The neat thing about the “openness” of choosing your preferred mode of exercise, is that even the non-exercised body part can experience reductions in pain. For example, if you have shoulder pain and you want to avoid a repeat injury from doing an upper body workout, simply get on a bike or treadmill and work the lower body. How cool is that?

Studies demonstrate a 15-20% reduction in pain of the injured body part even when exercising non-injured limbs!

Choose your exercise medicine! You can bike, swim, or run. You can do traditional strength training, isometric training or plyometric training. You can workout by yourself, or you can join a group fitness class.

It doesn’t really matter when it comes to exercise selection and pain relief.

What does matter is the exercise intensity and duration.

To summarize: Studies exposing people to higher intensity and longer duration exercises seem to have much better tolerance and thresholds.

What kind of exercises can help reduce my pain?

For one, treatment expectations can have a profound impact. Individuals who have a positive outlook and favorable view of exercise tend to experience greater benefits.

If the person perceives exercise as non-threatening, they tend to do better. People that perceive exercise to potentially make their condition worse, tend to do worse.

Very often doctors and friends will discuss the condition and make it sound scary or threatening. This happens very often with knee arthritis and x-rays. The x-ray will show “bone on bone” and the doctor will explain that this is the cause of pain. They may also throw in that continuing to exercise, or run or bike or whatever will make the condition worse.

Categorically not true! And that is such a beautiful thing! Research has consistently demonstrated that there is absolutely no correlation between pain levels and diagnostic imaging. People can have x-rays showing the worst kinds of findings have no pain at all and continue to go about their lives playing sports and going out to socialize.

Hearing from a medical authority, someone you trust, that your “bone on bone” knee will be made worse with exercise can create a downward spiral of fear of activity, leading to a reduction in exercise, resulting in serious deconditioning, possibly causing even more pain in the long run.

We need to break people out of this cycle. More encouragement from health care providers on importance of regular physical activity, and better information on how resilient our human body is should be the cornerstone of the health model. Sadly, it’s not.

Secondly, physical fit people experience more robust pain relief from exercise. This includes better pain thresholds and better pain tolerance. Regular exposure to physical activity shows consistent results. In fact, regular exercise 2-3 days per week reduces the risk of low back pain by 33%. This is true even of people who have a high risk of developing chronic pain.

To summarize: personal beliefs regarding pain due to exercise can emphasize the direction of helpfulness (belief that pain during exercise will make the condition worse, may have less pain relief from exercise than someone who believes pain during exercise will improve pain).

So how exactly does exercise improve the pain experience?

There are several mechanisms believed to facilitate an improved pain experience. One system is the opioid and cannabinoid systems. Indeed, many pharmaceutical medications are designed to influence these two systems.

It has been shown that contracting muscles activate the opioid and cannabinoid pathways in the brain and spinal cord. These systems have receptors throughout the body that produce analgesia (pain relief) when stimulate (as in the case of exercise).

Exercise releases stress hormones in the body. These stress hormones (like growth hormone) may play a role in mediating pain. At the current writing of this article, more studies are needed to clearly define exactly how stress hormones may contribute to pain management.

Changes in pain perception, specifically the discomfort caused during exercise, may occur. Cognitive and psychosocial factors may help facilitate better self-efficacy, coping strategies, fear of pain and stress.

To summarize: receptors throughout the body, hormones and psychological disposition can influence the magnitude of exercise-induced pain relief.

So what is the takeaway of this article?

Exercising non-painful body parts and using low-intensity exercise may be useful as a first step for using exercise as pain relief
Individual beliefs, expectations and preference in regards to exercise can influence pain relief
Beliefs and expectations that exercise can have negative impact on health and function can be changed through education

tinue to exercise at an intensity, type and duration that is beneficial to you and your specific injury. Getting advice from a health care provider that is well-versed in exercise selection, prescription and support can have a profound impact on your health and well-being.

If you are in Miami, Florida and are experiencing shoulder pain, back pain or hip pain, and are unsure of how to begin the process of recovering from an injury, give our office a call. We have a tested and proven method that works with Olympic athletes to weekend warriors.

Here are a few things we discuss and help you manage with injuries:

Aggravating movements or positions
Relieving movements or positions
Create a clear plan to get back to the things you love

You will not find another physical therapist in all of Miami that has helped out high caliber athletes like me. I guarantee that.

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December 19, 2023December 20, 2023

Why do I hurt?

One question I find myself answering from every patient is: Why do I have pain? We all want to know the cause and the cure. So we seek professional help from doctors, family and friends. We are offered medicine, ointments and advice. Do this, don’t do that. Some of it helps, much of it won’t.

We can patch up wounds, mend broken bones and repair tendons. But sometimes, long after the injury resolved, we are left with pain. Sometimes the pain is made worse with activity, or maybe its only there in the morning. Most often rest and “feel good” stuff like heat and ice is good enough to take care of daily mishaps. Still others may have such dysfunction that they seek surgery.

In the United States alone there are 800,000+ knee replacements a year, and that number is growing every year! Advanced knee arthritis is a primary cause. A study from Harvard determined that arthritis is a largely preventable disease. People born before WWII were half as likely to have developed arthritis in their lifetime. Something changed, and we’re still combing through the details of why that’s happening.

So why do we still have pain after surgery or after an injury has healed? What exactly is pain?

Pain is an experience. Think of the smell, taste, texture of your favorite meal. I bet you can even imagine eating that meal in your favorite chair surrounded by your best friends. That’s kind of how pain is. It’s not only a physical sensation of discomfort. It is also a memory. If you were to revisit the place where you had a serious injury, you may be able to recall who else was in the room, what you were wearing, and how you took care of the injury at that moment.

Pain is all of those things. It can be caused by a physical sensation like heat or cold. It can also be triggered by a memory. Recollection obviously does not recreate the physical trauma, but you may still experience pain.

Scientists have been measuring certain components of nociception for decades. Nociception is sending a pain signal to the brain. These signals travel along nerves. Some nerves can sense pressure, others can sense heat or cold. Nociception acts as an alarm bell, drawing attention to the body part.

Sometimes the alarm system becomes dysfunctional. If you were to step on a thumbtack, you would immediately retract the foot. This is a reflex. It is an automatic process. First, the pin pierced the skin, and a signal was sent to the spinal cord and brain. The body automatically responded by removing the foot from the pin, and a signal also went to the brain to say “PAIN”. This is a normally functioning response.

However, in a dysfunctional system, that signal from the pin piercing the skin would be sent without the pin ever physically piercing the skin. Kind of “All bark, no bite”. That signal is relentless, screaming “Pay attention, pay attention!” But there’s no pin in the foot. There is no structural damage going on.

Research has uncovered part of why this happens. Some causes may be attributed to physical nerve damage, altered chemical metabolism, changes in nerve signaling, our perceptions and even cultural perspectives.

Whatever the “cause” is, treatment interventions have been extensively studied for generations. Our understanding has come a long way, and much work needs to be done. Dysfunctional “signals” can be more of just a small bother. Very often chronic pain conditions can significantly affect our quality of life.

Pain can shrink our worlds, pulling us away from friends and family because we developed a long held belief that movement causes pain, and you don’t want to experience pain. So over the months and years, people categorically eliminate social functions or hobbies, or even careers to avoid pain.

As a physical therapist in Miami, Florida I have been helping athletes of all types learn about their injuries, guiding them through throughout the entire process. From the clinic straight to competition, I have assisted thousands of professional athletes- dancers, fighters, weightlifters and even Olympians! I help them better understand why they’re in pain, then develop a plan to get back to training and competing. Whatever their goals are, we get them done.

So if you are an active person looking to stay fit for life and there’s a pain that you just can’t get rid of, give me a call and let me help you solve it.

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December 19, 2023March 15, 2024

Why the advice you hear about injuries is trash.

Why the advice you hear about injuries is trash

I’ve heard some awful stories from my patients when they ask friends, family and even medical doctors for advice about their injuries. Sometimes the advice is harmless, but might delay recovery, like resting and icing. Other advice is career ending.

I remember a 19 year old gymnastic coming back from his first medical appointment when I was working at Royal Caribbean studios a few years ago. He looked absolutely distraught. This young man flew over from England on the first big contract of his career. During the second week of rehearsals he did a back handspring and injured his shoulder. It was the first time in some 10 years as a gymnast he had shoulder pain. At his medical appointment, without ever even observing how he moved, asking how much pain he was in or how his performance was affected, the doctor advised: “I think it’s time you consider a different profession.”

Wow. Imagine being 19 at the start of your career and a medical “authority” completely crushes your dreams.

Needless to say, we had him doing his entire routine within 4 weeks. He went on to complete the contract and emailed me a few months later saying his shoulder never felt stronger.

I can’t imagine how many times a day this happens in a doctors office, and how many people would listen to that advice?!

It doesn’t need to be this way. It’s my personal life mission to change the perspective of as many people as possible on the benefits and advantages of choosing movement over medicine for pain management. Don’t get me wrong, medicine can be helpful. But its role in recovery is very specific. If you’re dosing yourself with medication before, during and after every training session, you’re doing it wrong. Besides the harmful side effects of treatment like liver damage, gut damage, heart attacks, strokes and sometimes cancer, it does nothing to improve the strength and resiliency of the injured tissue. It does not provide the proper environment to load tendons, muscles, ligaments and bones. It does not help with addressing the fear of the movement that may have caused the injury. It does not address biomechanical inefficiencies that reduce power and increase the risk of certain injuries.

It’s ok to take medicine or injections to address specific components at specific times during the recovery process. But if you’re placing bets on injury prevention and performance enhancement, medicine just isn’t it.

Let me introduce you to properly prescribed exercises. If you’re an injured athlete, chances are there are some activities that you can still perform with ease and without pain. Then there will probably be a set of things that you cannot do as a result of pain, fear or poor movement. The underlying cause of these issues needs to be first assessed, then addressed.

A professional who has an eye for movement and a system in place to return to sport can create a specific plan for you to get you from where you’re at now, to where you want to be.

Stop looking up random exercises on YouTube and social media. Stop asking friends and family for advice, unless they are health care professionals in the sports space.

If you are an athlete in Miami Florida and you are frustrated with how long you’ve been dealing with pain or managing your injury, you need to call me right now and get it sorted out. There is no other physical therapist in Miami Florida that has my credentials, my certifications, or my level of commitment. There are few, if any, therapists that have helped Olympic and Internationally competitive athletes.

I’ve worked with thousands of professional performers at Royal Caribbean and Celebrity cruises, the LARGEST employer of performing artists in the entire world. I have helped career fighters- people that literally get punched in the face and have ligaments torn right off their joints, get back on the mat. I helped athletes break their PR after thinking their days of lifting were over.

I’m not writing this because I’m bragging. I’m writing this because I have committed to serving nothing but the best with the people that choose me. You don’t get a cookie-cutter list of basic exercises and some general advice on getting better.

You will get custom made programs with your goals as the driver of treatment. You’ll have access to me for the entire time treatment is rendered, and then even after that if you want to work with me as a strength & conditioning coach. Already have a coach? Phenomenal, I will work with them to develop a comprehensive plan of care to make sure you never have to see me again for the same injury.

What you need to help address this injury won’t be found in books, videos or unsolicited advice. It’s going to be right here with me guiding you every step of the way.

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December 19, 2023January 7, 2024

How long should I wait to train after a concussion?

Why am I nauseous after being punched/kicked in the head?

Anatomy: The brain is a gelatinous globe encompassed within a rigid box (the skull). The trillions of nerve cells that comprise the brain are responsible for all the five senses, as well as working memory, your emotions and decision making. Each part of the brain is responsible for specific functions, all of them are required to be able to live a full and healthy life. Important feedback and feedforward mechanisms allow the brain to interpret and adapt to changes in the environment and body, then react appropriately (slipping a punch).

Injury: There has been an explosion of research regarding the assessment, treatment and effects of cerebral injuries (concussion). Concussions occur due to a blow to the head and can be linear (forward/backward) or rotational (spinning). Linear acceleration causes gliding contusions (bruises) of the cerebral cortex (responsible for higher level processing), ischemic (lack of blood flow) lesions of the cerebellum (balance) and axonal (tissues carrying the signal of nerves) damage in the brainstem. Rotational acceleration may stretch and tear the veins, resulting in axonal damage and hematoma (bleeding)

Acute brain injuries

Subdural hematoma: a collection of blood between the brain and skull, causing compression, edema and herniation of the brain. Sometimes fatal, can be diagnosed by CT scan
Intracerebral hemorrhage: torn blood vessels with accumulating fluid in the deeper regions of the brain such as the corpus collosum (communication between the two hemispheres) and cerebellar peduncles (communication of the cerebellum with the brain). Can be diagnosed by CT scan.
Second impact syndrome (SIS): receiving a second blow to the head after an initial contact that caused significant swelling. In SIS the brain does not have time to recover between blows, resulting in loss of the brain to regulate itself and an increase in swelling in the cranium.
Diffuse axonal injury: severing of axons, a structure that provides the “avenue” for communication within nerve cells. Can be diagnosed by CT scan
Concussion: trauma of the brain as a result of impact resulting in a host of pathological changes including headaches, dizziness, nausea, vomiting. Concussions do not necessarily have to be accompanied by being KO’d or result in “blacking out”.

Factors influencing the severity of the injury include undisclosed/ignored injuries from past competitions; second impact syndrome (two successive blows to the head that can result in life threatening swelling); poor medical history intake (diabetes, blood and heart disorders); cerebral abnormalities (aneurysm, arteriovenous malformation, angiomas, arachnoid cysts, contusions, subdural hematoma); weight loss/dehydration (severe dehydration can result in death); age (older fighters bodies have a more difficult time recovering from injury or illness); medication (blood thinners can increase the risk of hemorrhaging); alcohol/PEDS (stimulants can be cytotoxic); inadequate rest (potential for overtraining, not allowing the body appropriate time to heal). Not fully disclosing prior concussions to your medical provider can result in serious consequences, especially if there was not adequate enough time to recover. Second impact syndrome occurs when the brain has not recovered from swelling due to head trauma, and a second blow is sustained. Even if the second strike is minor, this can result in death. Some cerebral abnormalities can be screened by an MRI and properly treated or advice will be given to the fighter for how to adjust their career accordingly. Medications such as aspirin can limit the clotting of blood, leading to hemorrhaging if a brain bleed occurs.

Prevention: It is important to note that wearing head gear, mouthpieces and padding on the hands or the legs DO NOT prevent or limit your risk from suffering serious head trauma. At best, soft padding does prevent other fight-stoppage injuries from occurring such as cuts of the face and eyes; mouthpieces may also prevent expensive dental damage from occurring. Studies demonstrate that a force of only 8g’s can cause a concussion. To put that into perspective, consider this: have you ever propped your head on your hand with the elbow on a desk, fell asleep and your head hit the desk? Thats about 8g’s. Yes, that is enough to cause a concussion.

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December 19, 2023December 20, 2023

MMA, BJJ injuries

Mixed martial arts and their component practices, primarily striking and grappling (including boxing, Muay Thai, wrestling, Brazilian Jiu Jitsu, Judo). Athletes are driven by the necessity to participate in tactical and technical training to develop a strong base and improve their skills. Multiple “training camps”, sometimes run by different coaches, can result in a poorly designed program when there is little communication amongst the athletes’ camp. Additionally, the competitor must juggle hours of sport specific drills (BJJ, Muaythai, wrestling) and a strength and conditioning program while allowing for adequate rest in between sessions. This potentially exposes the athlete to acute injuries as well as the potential for overtraining.

Injuries can occur during competition and training. Mixed martial arts competition injuries are sustained at an average of 26 injuries per 100 fight-participations (a fight-participation is a competitive event). About half are facial injuries, then injuries of the hand (13%), nose (10%) and eye (8%). The most frequent type of injury is skin lacerations (45%), followed by fractures (range of 7-43%) and concussions (3-20%). Injury rates are largely dependent on the specific type of training program. Grappling sports such as Brazilian Jiu-Jitsu (BJJ), wrestling and Judo, have higher rates of joint injuries. These are predominantly of the elbow and knee for BJJ (64%); shoulder, elbow and knee for Judoka’s; shoulder (24%) and knee (17%) with wrestlers. Those with striking backgrounds including boxing, Muaythai and Tae-Kwon-Do (TKD), tend to have greater rates of injuries to the face and head including concussion, facial lacerations and fractures. If we were to take a closer look at striking sports it is apparent that boxers will often have more frequent injuries of the upper extremities whereas Muaythai or TKD are relatively more likely to have them of the lower extremities. Nearly 61% of karate and 42% of Muaythai injuries were of the head/neck region.

On the flip side, training accounts for the largest portion of athletes injuries. As mentioned before, the total volume and intensity spent during training exposes the athlete to a higher risk for injury. A combination of factors including poorly fitting or lack of equipment, fatigue, unnecessary aggressiveness when sparring and inadequate nutrition or fluid intake, all increase the athletes risk. Studies have demonstrated that anywhere from 80-90% of injuries are sustained during training and nearly 32% of these injuries will be recurring. You are four times more likely to be injured during training than you are while competing. If you have a fight coming up, how important would a well-designed program be to reduce your risk of injury? What are you risking when you’re name is pulled from a fight card due to an injury? A report by Michael Hutchinson on bloodyelbow.com titled “A look at the injury rates of major MMA fight camps (2009-2016)” demonstrates that some camps can lose up to 18% of their fighters to injury. This is not to say that no one went on after treatment to compete, but that they had to take off a considerable amount of time from training and earning a living due to something that may have been avoided. The numbers do not point fingers, faulting the coaches or management. It could be that certain types of fighters (coming from a specific background like wrestling or judo) gravitate to a particular school for whatever reason, and those fighters tend to be more injury prone for certain injuries. For example, someone with a strong wrestling background may have great take downs, but have a poor guard, increasing their risk of injury for muscle strains of the hips or legs to block an opponent from passing. Or a traditional stand-up boxer might have no idea how to sprawl or block certain shots, leading to knee or ankle injuries.

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December 19, 2023December 20, 2023

Eye injuries in combat sports

Why do I see floaters?

When should I see a doctor for an eye injury?

Anatomy: The eye is a an oblong sphere containing muscles to direct the gaze, nerves to send signals based upon colors and shapes of objects, blood vessels to provide nutrients and a pupil and iris to allow light to enter. Being able to visualize your opponent, read their movements and even gauge how fatigued they are is important for gaining an advantage.

Fights should be immediately stopped if the competitor is unable to see from the eye. This includes swelling around the socket, blood from a laceration entering the eye or a corneal abrasion causing significantly blurred vision. Oftentimes blunt trauma to the eye may have you seeing “floaters”; less severe abrasions resolve within 3 days. However, if you see “floaters” and lose peripheral vision in the eye after being struck, you should seek medical attention immediately as you may have a severe corneal abrasion.

Injury: It is especially important for combat sport athletes to ensure proper care of their eyes. It is recommended that they undergo yearly dilatation to detect subtle changes that may result in permanent, lifelong complications if not addressed in a timely manner. Blows to the head can cause early onset glaucoma (due to increased pressure on the optic nerve); cataracts (clouding of vision over the lens blocking light entry); corneal abrasion (contact with foreign object, possible infection); and retinal detachment, holes or tears (loss of peripheral vision, onset of floaters).

Prevention & Treatment: Since there are no exercises to strengthen the soft tissue of the eye, proper use of equipment is a must. Hall of Famer Pat Miletich recommends using MMA gloves for grappling but full boxing gloves during striking practice. This will reduce the possibility of unintentional eye-poking when training which may cause a corneal abrasion.

Treatment of retinal tears or holes with laser surgery may require more than a month away from engaging in activity with aggressive head contact (pretty much all MMA practices). Cataract surgery sometimes takes more than 4 months to recover. Retinal detachments have a 90% successful correction rate if treated within the first week of injury.

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December 19, 2023December 20, 2023

Facial injuries in combat sports

How long should I wait for my facial cut to heal before training again?

Anatomy: Your face houses two eyes, a nose and a mouth. You need to present these things to the world and thus you should take care of it. The skin of the face is relatively thin and is not very resistant to abrasions. Take a punch, elbow or shin to the face and the skin is caught between two bones- your own and those of your opponent.

The soft, gelatinous eyes are protected on all but one side by hard bones. Your eyelid covers the iris and pupil from certain potentially harmful contact, but is very limited in its capacity to due so. The nose is about 1/3 bone and 2/3 soft cartilage and contains very sensitive blood vessels. The nose can be “toughened” in seasoned fighters but is much more prone to bleeding in novice or amateurs combatants. The ears, like the nose, are cartilaginous and excessive rubbing or pressure can lead to cauliflower ear. While not threatening to health in particular, some may consider it not very aesthetically appealing.

Injuries: Special consideration need to be taken when there is arterial bleeding (very difficult to stop, typically spurting blood) or exposure of an underlying nerve. Facial skin that has not been damage before is typically 20% as strong pre-injury at two weeks, 50% by 5 weeks and is about 80% as strong 10 weeks out. Controlling blood loss is imperative for both the fighter and the opponent. Gushing blood from a wound can cause vision impairment. In a fight, the cutman should have the appropriate equipment to control bleeding and swelling, especially around the eye.

Stoppage of a fight may be due to a deep laceration around the orbit or the vermillion border of the lips (see photo). Exposure of underlying nerve can result in permanent damage if not treated immediately and safely. Additionally, post-fight care should include cleaning of debris and foreign particles from the wound to prevent infection. Infection control includes use of sterile bandages, changing of bandages when necessary, maintaining a clean wound and limit training that might reopen laceration.

Prevention: the use of headgear, gloves, elbow and leg padding will dramatically reduce the risk for skin lacerations during training. Having a skilled sparring partner is beneficial as well (novice athletes have less control over their movement and might “over-strike”). Applying small amounts of vaseline during practice can reduce the friction caused by glove contact.

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December 19, 2023December 20, 2023

Knee injuries in combat sports

Why does my knee hurt when I shoot?

Anatomy: The knee is a relatively unstable joint because of the lack of bony congruency, or the amount of bony contact between the two joints. Ligaments, capsules & muscles work in concert to prevent excessive movement. There are four bones that make up the knee: the patella (knee cap), femur, tibia and fibula. The large femur forms two oval shaped balls which rests on the flat surface of the tibia. The knee cap provides a site of attachment for the large quadriceps muscle group, situated within a “groove” on the front part of the femur. The fibula (bone on the side of the leg) also provides an anchor site for a handful of muscles. The meniscus, ligaments and joint capsule all provide stability to the knee. Depending on the angle of the knee, different parts of the ligaments are tight and limit movement in specific directions (imagine clasping your hands together to prevent your opponent from ripping an arm bar). If the structure (meniscus, ligament) is under a load it cannot handle, the tissue will tear. Take a look at the infograph. It demonstrates the angle of knee flexion at which various parts of the leg muscles are either active or the ligaments are checking movement. When the knee is in the early phase of a squat, the femur will slide forward, the ACL and hamstrings will check the movement. Squat a little further (about 90 degrees, or thigh parallel to the ground) and the PCL and quadriceps muscle group will check movement. Squatting lower than thigh parallel to the ground will activate the glutes while the knee comes under the greatest amount of compressive force. Symptoms of pain or instability in various degrees of knee flexion can help determine which structures are implicated in an injury.

Ligaments and menisci have a limited capacity to heal. The portion of a ligament that is torn will remain that way unless unless you undergo surgery. Without surgery, the remaining part of the ligament does have some capacity to adapt and retain strength. Specific exercises can improve muscle strength to make up for a lack of ligamentous stability.

Injury: Oftentimes there is more than one part of the knee that is damaged. The “Terrible Triad” includes an anterior cruciate ligament (ACL), medial collateral ligament (MCL) and medial meniscus tear. This can significantly complicate surgery, rehabilitation and return to sport as less than 50% of all athletes undergoing knee surgery will not return to sport (for various reasons). Less than half of the athletes that do return to sport, do so at their pre-injury level of skill. That means that more than 50% of those returning to sport post-op will have a clinically weaker knee.

Connor McGregor is a phenomenal example because his knee injury (the dreaded “Terrible Triad”), subsequent surgery and rehabilitation was a resounding success. Athletes with an unstable knee due to a ligamentous tear will require surgery because they are much more likely to develop a meniscus tear within the following year.

Prevention Tips: Because of the inherently unstable nature of the knee, a well designed strength and conditioning program is essential if you want to avoid surgery, the harmful side effects of medicine and time off from competition or training. The section on medical exercise therapy (MET) and sport specific strength & conditioning provide a sound approach to implementing an effective and efficient injury prevention program. There should be a healthy mix of calisthenics-based mobility exercises, plyometrics and heavy resistance for improving local muscle strength.

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

December 19, 2023December 20, 2023

Ankle sprains affect how you cut and pivot

In previous articles here, we discussed how ankle sprains can affect balance, walking, running and a functional tasks seen in strength training, drop jumps. Other articles I wrote about ankle sprain epidemiology including reinjury rates and associated complications.

Now let’s turn to how ankle sprains affect cutting in field sports. If you are an experiencing pain, instability and dysfunction after an ankle sprain, this article should help you better understand how to treat ankle sprain and how ankle sprains affect cutting mechanics.

Cutting and pivoting in sports intends to rapidly change the direction of the athlete in an attempt to outmaneuver their opponent. Planting the foot on the ground and changing direction requires a high degree of muscular force, balance and “field awareness”. Not only is the athlete focusing on what their body is doing, they must also be mindful of their environment- opponents, team mates, boundaries and the “goal”.

In this article the researchers want to identify if there are changes in foot and ankle function when athletes experience functional ankle instability when they are cutting or pivoting on the field of play. Functional ankle instability is characterized by “giving way” of the ankle joint when participating in sport.

Previous research, and articles that I wrote, demonstrate a significant difference in muscle function, joint position and compensatory movement patterns due to ankle instability. Given the position and high demands of cutting type motions, it would greatly benefit physical therapists helping athletes with ankle sprains to better understand what happens when an athlete is cutting, and they experience ankle instability.

In this current article, the researchers observed fifteen male basketball players with cutting movements with a history of functional ankle instability due to an ankle sprain. The researchers measured ground reaction forces (amount of force placed through the foot when planted) when performing a v-cut and a shuffling movement. The athletes experiencing ankle instability were compared to a similar group of athletes that did not have ankle instability.

The results demonstrate that unstable ankles had significantly higher initial contact forces and a shorter time to maximal force compared to stable ankles in the V-cut movement. Measurements from the lateral shuffle showed no significant differences between the two groups, meaning they performed the shuffle similarly.

What does this mean for athletes experiencing ankle sprains?

For athletes that regularly engage in cutting-type activities on the field of play, there is a significant difference in how well the foot and ankle perform. Field sports including soccer, football, basketball and volleyball all require near-continuous cutting or shuffling to play offensively and defensively.

The increase in force applied through the foot is compounded by body weight and it is directed towards a part of the joint that may not be adequately adapted to that stress. Over time, this repetitive excessive force can cause early arthritic changes as well as increase the risk of injury.

Can my cutting mechanics improve with training?

Absolutely! Specifically designed programs can “rewire” the brain and body to perform more efficiently. Progressively challenging exercises in a controlled environment can significantly improve confidence and facilitate quality movement for a safe return to sport.

Injury prevention programs have successfully reduced lower limb injury by up to 80%. Given that 74% of athletes experience a repeat ankle injury of the same ankle, an 80% reduction could make or break an athletes career.

A well-structured and progressive balance and strength training program can help bring you one step closer to the field.

If you are an athlete experiencing dysfunction due to an ankle sprain, we can help you recover and return to sport without medication and without surgery.

Give our office a call so we can help you get back to being an athlete!