Trail Blazer to Trailblazer

Ray Mack is inducted into the St. Francis High School Hall of Fame by Dr. Deborah Kerr, Superintendent of Schools, on December 9, 2022

Many physical therapists have an injury story that contributes to a career path.

But most don’t include a connection to a legendary Wisconsin team whose mad dash to a national championship helped make March Madness what it is today.

Ray Mack of Advanced Physical Therapy & Sports Medicine vividly recalled a high school football injury from six decades ago that led him from athlete to athletic trainer.

“As defensive end, it was my job to get crushed first on a student body left,” Mack said. “Hurt my back and that was it. To continue participating in sports, I decided to become a student athletic trainer.”

And the rest, they say, is history. A history that includes the improbable journey with the Marquette Warriors basketball team from 1973 through 1977.

Understand that at the time of Mack’s injury, circa 1970, athletic training was in its infancy: it was the coaches who primarily handled injuries to their athletes. Outside of football hotbeds like Texas, the presence of athletic trainers was few and far between.

The year after Mack’s injury, he became the student trainer at St. Francis High School and would continue for the remainder of his high school career.

“I wanted to continue participating in sports and I had the aptitude for the health and medical stuff,” said Mack.

As a result of his performance, the St. Francis football coach obtained a scholarship for Mack to Marquette University as a student athletic trainer, which also allowed him to attend physical therapy school there. He covered multiple sports at the university including soccer, wrestling and cross country/track. Ray was also one of the first student athletic trainers for the new Marquette University's Title IX women’s sports program.

It was Division 1 college basketball, however, that powered the engine that was Marquette sports.

“I was blessed to be part of the national championship at Marquette in 1977 under legends Al McGuire, Hank Raymonds, Rick Majerus, and Bob Weingart,” said Mack. “All Hall of Fame members.”

While many know the names of the coaching legends, Mack highlighted Weingart’s impressive resume, which included 38 years as Marquette’s head athletic trainer as well as trainer for the USA track team in the 1972 Olympics.

“He was the man at Marquette,” said Mack. “Working with Bob was both an honor and an opportunity.”

It was during Mack’s senior year stint as the Warriors student athletic trainer when he was told he couldn’t continue with the basketball program during his second semester, as he was being sent to New York for his physical therapy residence—exactly when Marquette would make their run to college basketball’s ultimate prize.

Though Mack didn’t exactly appreciate the timing of the move, he later came to appreciate the wisdom of the choice his advisors made, sending him to areas that took him well beyond his identified niche in sports medicine.

“As a function of that experience, I became through my VA tenure an amputee specialist and a medical surgical clinic specialist,” said Mack. “It broadened my horizons dramatically.”

After 45+ years as a physical therapist, Mack continues to treat patients, specializing in the non-operative treatment of orthopedic-related injuries of the spine/pelvis and extremities. His personal interests are as vast as his medical pursuits and include photography, website development, history, learning theory and aquatics.

Oh, throw in mustaches and Hawaiian shirts too.

Mack described his work as an athletic trainer and physical therapist not as an occupation but a vocation, something he was meant to do in life. And while there is plenty to look back upon, there’s much more ahead.

“I'll do this for as long as I feel like I can contribute and make a difference.”

Baseline Concussion Testing

Ben Benesh, PT, SCS

What is a concussion?  The Center for Disease Control and Prevention (CDC) definition:

“A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

According to a Pediatrics study from 2016, it was estimated that between 1.6 and 3.8 million sports concussions occur annually in the United States. Concussions can happen in sport during a violent head to head collision in football or taking a charge and hitting the back of your head in basketball. They can be sustained during a whiplash-type injury in a flyer during a competitive cheer stunt or when a young athlete takes a volleyball spike to the head or face. Besides the obvious appropriate post-concussion management for these athletes, a proper baseline concussion test is key in the successful return to school and sport.

High school-age athletes are baseline concussion tested as a Freshman and again as a Junior. They are usually tested in school by their athletic training team. The group that needs the most attention are the elementary and middle school-aged children, that do not have access to athletic training staff, and do not have school-based concussion baseline testing. These kids are still playing sports, including collision type sports that put them at risk for a concussion. Over the last 7 years of treating patients following a concussion, I have seen plenty of soccer and football athletes, but have also treated basketball players, volleyball players, wrestlers, competitive cheer athletes, and even swimmers! In order to treat these patients as effectively as possible following a concussion, baseline testing is crucial.

In healthy athletes, baseline concussion testing includes concussion education, past head injury medical history, baseline ImPACT neurocognitive computer testing, baseline vestibular/oculomotor screening and assessment, and baseline balance assessment. These objective measurements will be saved and used following a concussion to determine if your athlete is back to “normal” following injury and can safely return to their sport they love to do.

In this crazy time dealing with the COVID-19 pandemic, sporting events are delayed or canceled and then rescheduled without notice. The training schedule may not be as consistent or as intense as previous years as kids are quarantined or had exposure to COVID-19 or coaches are unable to secure facilities to practice. Parents are often not even able to watch their children play sports because of spectator restrictions in gyms. All of these reasons make this year unique. But the truth is, concussions still happen during a pandemic and we need to be best prepared to give our young athletes the best care possible if they sustain a concussion.

Please contact us for more information or to schedule your Baseline Concussion Test at our Appleton North or Community First Champion Center or online (ages 12+) clinics!

References

https://www.cdc.gov/headsup/basics/return_to_sports.html

McCrory et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. BJSM April, 2017

Elbin et al. Removal From Play After Concussion and Recovery Time. Pediatrics August, 2016

Speed and Agility Training

David Reybrock, MPT

Speed and agility are primarily associated with athletes training for sport; but it also occurs in our everyday activities. We are all athletes in one form or another. Whether you are in a sport, involved in recreation, participate in regular exercise, walk a dog, or play with your children; speed and agility training can help enhance your movement skill acquisition and functional mobility.

As movement specialists, Physical Therapists can use speed and agility training to provide stability by varying speeds of motion and body position.  Everyone can benefit from improved balance, quicker feet, and faster reaction time.  Speed and agility in youth can be used for injury prevention, promote exercise participation, and improve physical fitness.  Speed and agility in elderly can be used to improve coordination, prevent falls, and maintain independent living.  Adding speed and agility to an exercise routine or treatment program can help you move more efficiently and effectively.  

What is Speed, what is Agility?

Speed is defined as the ability to move the body in one direction as fast as possible. Training for speed requires strength in the arms and legs to propel your body forward. The muscles in the back of the thigh and leg create triple extension- forceful extension of the hip, knee, and ankle joints. The gluteus maximus muscle of the hip; hamstring muscles of the knee; and gastroc-soleus muscles of the ankle are the muscles used to run faster.

Agility on the other hand, is the ability to accelerate, decelerate, stabilize, and quickly change directions with proper posture. Agility training focuses on performing a variety of movements in a quick manner. It is not simply going as fast as you can, but rather adjusting movements while going as fast and as steady as possible. Training for agility requires good balance and a strong core to support the body as it moves through all three planes of motion.

The combination of speed and agility training should be used to develop movement skills that include acceleration, deceleration, dynamic balance, and change of direction. In developing these skills, appropriate stability, mobility, and sequencing of movement patterns is important for training athletes and treating patients in physical therapy.

Here are some examples of speed and agility drills that can be used to train athletes and treat patients to be able to speed up, slow down, and change direction more efficiently:

Sprints or walking. Run or walk as fast as possible from a standing still position. The distance will vary based on ability and sport specificity. Add change of speed, stop and pivot turns, head movement, inclines or declines to incorporate agility.

High knees wall drill. With arms extended forward and hands on a wall for stability, alternate knees to hip level up and down as fast as possible. For agility, remove hands from the wall and perform with opposite arm swing and change of speed.

Static balance. Sit on a stability ball, stand with a wide or narrow BOS, or single limb stand.

Dynamic balance. Seated balance with arm and leg movement. Tandem forward walking, side-stepping, and carrying objects while walking.

Cone drill example:

Pro-Agility: 20-yard line sprint, 5-10-5
Purpose: Improve the ability to change direction by enhancing footwork and reaction time.
Procedure: Place each cone 5 yards apart. Start in a two-point stance at the starting line, the center cone. Sprint to the end line and touch with your hand. Turn back and sprint to the far cone (10 yards) and touch the line. Turn back and sprint 5 yards through the start line to the finish.

Image- https://mishockpt.com/speed-and-agility-training/

Agility Ladder drill example:

2 feet out, 1 foot in.

Image- https://i.pinimg.com/564x/97/db/15/97db15d22b150e4585a1caa89056b39a.jpg

Plyometrics: Jump, leap, and hop.

References:

Clark, M.A., Sutton, B.G., Lucett, S.C. (2014). NASM Essentials of Personal Fitness Training, 4th Edition, Revised. Burlington, MA: Jones and Bartlett Learning.

Does Selecting the Right Running Shoe Help Prevent Injury?

Josh Zilm PT, DPT

Does Selecting the Right Running Shoe Help Prevent Injury?

It’s spring and time to strap on those shoes and get outside.

There has been an entire industry built around providing runners with the best possible shoe.  When answering the question, “Does selecting the right running shoe help prevent injury?” one often has to tread lightly as there are many opinions.  As physical therapists, we like to turn to the scientific literature to answer a question.  Can a running shoe offer a return on energy? Is it better to run barefoot?  Are minimalist shoes better? What about orthotics?  Those are topics for another time.  This post will focus only on the running shoe’s ability to reduce injury and not attempt to answer any of those other questions that can often muddy the waters. 

The industry

The running shoe industry dates back to the mid to late 1800s, but most credit the start of the modern-day training shoe to the founder of a little company called Nike when he started selling shoes out of the back of a van in the 1960s.  Since that time running and shoes have grown into a multi-billion dollar industry.  Did you know that the first New York City Marathon was held in 1970 and had 127 competitors?  That is quite a contrast from 52,812 finishers in 2018.  As the sport has grown so has the market for better shoes with an attempt to meet the needs and demands of the runner.  Research, technology, science, expert opinion, and business has delivered a vast shoe market that boast a variety spanning barefoot the ultimate support and cushion.  So with all the shoes available today, is there a shoe for your foot type that can reduce injury associated with rigors of the sport?

The Amazing Foot

The foot is designed to help our bodies absorb energy as we impact the ground in an action called pronation.  The foot and ankle accomplish these amazing feet through a team effort.  We have muscles from our trunk to our feet that actually fine-tune how the body absorbs shock and then in a split second prepares to propel us forward with each step.  Running injuries are most often associated with the loading phase of running and more specifically the rate at which we load.  Don’t be afraid I won’t get too technical, but it is important to understand that the primary focus on injury reduction regarding the shoe is slowing the rate of loading, that is how fast our bodies have to accept the load with each strike of the foot on the ground. 

Foot Type

The hard part about designing the perfect shoe is that there are 7.66 billion people on the planet with a lot of different foot types (I know they are not all runners).  Thankfully, the orthopedic and running world has been able to classify foot type to offer some order to our attempts to best categorize the variety of feet that walk or run into the clinic.  Foot type does offer some predictive value to the injuries that we typically experience.  Nature(genetics) and nurture(lifestyle) lend way to a spectrum of people have rigid high arched feet, flat feet flexible feet, and everything in between.  The shoe industry has tried to match foot type with the appropriate shoe.  For example, the rigid high arch foot type should consider a softer shoe, while the flat flexible foot could use a more supportive shoe. 

The Shoe Spectrum

The soft shoe would be categorized as a “cushioned” shoe while the more supportive shoe is given the name “motion control”.   It would be intuitive to think that a person with a poor ability to control the position of the foot would benefit from added support and the person with a rigid high arch foot may need a little more cushion because they hit the ground harder.  (funny that studies show that joint reaction forces are actually higher in a cushioned shoe versus minimal support.  The working theory is that runners hit the ground harder with a cushioned heel simply because it’s cushioned.)  This could be a multiday conversation, but my attempt is to explain the basic shoe spectrum that starts with no support(barefoot/running sandal) to motion control(high degree of pronation control).  There are many variations within this spectrum that attempt to meet the needs of the runner, but the question we are trying to answer is can we reduce injury by pairing the runner with the right running shoe?   What does the research say?

Theisen et at 2014 Br J Sport Med completed a study looking at over 200 runners.  They found:

1.      Midsole Hardness and Injury rates: no different.  The amount of cushion had no significant difference in injury rates.

2.      Energy absorption and injury risk have no scientific correlation.  A shoe that absorbs energy does not reduce injury rates.

3.      Shoe wear does not appear to have an effect on biomechanics.  You cannot correct your biomechanics by running with a shoe.

4.      1% increase in metabolic cost for every 3.5 ounces of shoes.  Heavy shoes require more energy.

The recommendation:   Promote light shoes.  Refrain from claiming that shoes reduce injury through cushion or biomechanical changes.

Ryan et al. (2011) Br J Sport Med found;

• Shoe assigned by foot posture index(match the shoe with the foot type).  Static foot type should not be the determining factor for shoe selection.  The highest rate of injury was in runners wearing a motion control shoe that were appropriately matched based on foot type. 

The recommendation: Don't use the algorithm alone in an attempt to match foot type and shoe type to dictate the choice of running shoe.

Nielsen et al. (2014) Br J Sports Med.

• Foot pronation was not associated with increased injury risk in novice runners wearing a neutral shoe.  The “Over pronator” did not experience a greater rate of injury when left unsupported versus supported.

The recommendation: Let comfort dictate.  Give the runner a starting point in shoe selection, but do not feel locked into a shoe, especially motion control. 

Conclusion

Shoe type may offer a good starting point for a new runner when selecting shoes.  Based on the current literature I would recommend starting your search with a shoe that matches your foot type, but don’t feel boxed into a certain type of shoe.  Look for something that is comfortable when you run.  In more recent literature motion control shoes have been associated with higher rates of injury which gives rise to concern for recommending a motion control shoe.

Also, a lighter shoe consumes less energy.  The weight of the shoe does matter.   

One of the questions I often ask in the clinic is, “Do you run to get stronger or get stronger to run” (Dr. Chris Powers, USC).  I see a lot of runners try to compensate for bad mechanics through shoes and more running, but the truth is many people lack the strength to support the activity of running.  A physical therapy running evaluation can be a great tool as you begin or return to running.  Injury reduction comes from improved biomechanics something that we are all capable of with the right instruction.  Like many things in running, there are no short cuts.  Consistent effort = results.  The right running shoe may do a lot of things for the athlete, but with the exception of protecting the bottom of the foot and toes, there does not appear to be evidence supporting the claim that they reduce injury rates in runners.