Recreating the Unthinkable: The Stevens Point Mass Casualty Event

Even when you know it’s a simulation, you’re a bit on edge. Maybe it’s because everyone is.

Or it might be the card they handed you to identify your role in the simulation, which reads “ACTIVE SHOOTER MOCK VICTIM INFORMATION.”

Advanced Physical Therapy’s Lynsey Hansen was ready for her role as a shooting victim nonetheless.

“I was hit but still responsive,” Hansen said. “I just followed what was on the card and did my part.”

The mock disaster, held in Stevens Point for Central Wisconsin first responders, required that exact mindset from everyone involved: be prepared to do your part.

The active shooter event is known as Rescue Task Force Training (RTF). Conducted annually by the Stevens Point Fire Department, Police Department and Emergency Medical Services Team, RTF provides the training ground for multiple agencies to respond to a simulated disaster scenario. The collaborative effort identifies opportunities for enhanced coordination among the agencies tasked with stabilizing a complex situation and triaging victims at a time when every second matters.

While this was Hansen’s first participation in the event as a member of Advanced PT, her boss has been there a few more times.

“Advanced has been working with Stevens Point Police and Fire for 13 years, so this was my 13th,” said Traci Tauferner, Director of Industrial & Tactical Medicine. “I go every year to RTF training, and every year I learn something new.”

Often assisting as a victim in the dress rehearsal, Tauferner recently has taken a step back to view things as an observer.

“As the provider of onsite rehabilitation for Stevens Point Police and Fire Departments, it’s a perfect time for us to educate ourselves about the physical aspects required by personnel to effectively do their jobs in a high stress mass casualty event,” said Tauferner. “With that knowledge, we will understand how we can best rehab them if they have an injury.”

In previous drills, Tauferner focused on her role as victim, viewing the triaging interactions she had with first responders tending to her injuries. This year’s perspective afforded her the opportunity to see department interactions, triage tools, deployment, and the results of public safety partners who have planned and trained together.

Scrutinizing the approach of first responders in managing a large-scale crisis assists Advanced onsite tactical providers.

“We aren’t police officers or firefighters,” said Tauferner. “If we don’t study how they do their work, we won’t understand how to strengthen them, condition them, rehab them, and protect them if they have an injury.”

Hansen, fresh from her first acting stint, appreciated the combined efforts of those who pitched in to coordinate the event.

“You’ve got staff members and groups from multiple locations—Stevens Point, Plover, Portage, etc.—that participate, which is so important because each situation will be unique and you’re going to need to pull from every available area,” Hansen said. “So getting that experience is so beneficial for all parties.”

Afterwards, departments held debriefing sessions, both individually and jointly; those wide-ranging conversations help drive next year’s training. All participants acknowledge the intricacies of fine-tuning the rapid deployment of resources among multiple groups, but their overarching goal is simplicity itself:

To create a unified response that saves lives.

Clinician Spotlight- Ryan Bailey, PT, DPT.

Meet Ryan Bailey, PT, DPT.

I distinctly heard him say “Central Waters.”

And when a physical therapist gets invited to Amherst, WI to share his expertise, then we’re talking about more than just tapping into the body’s internal mechanisms to relieve pain.

Oooh. Tell me more.

“No, Central Woggers,” he said. “It’s a running group in Amherst. Think the name’s a play on words, a combination of walk and jog.”

Oh, gotcha. I’m guessing this will be more about pain relief than beer.

“Well, those topics aren’t mutually exclusive,” he said.

I like this guy already.

Meet Ryan Bailey, physical therapist at Advanced PT. Recently he was invited to share some of his knowledge with the Central Woggers before they took off for a run.

“So, what topic did they want you to focus on?” I asked.

“Oh, they let me choose,” said Bailey.

Golly, that narrows it down. Bailey’s experience and specialties include working with high-level athletes and orthopedic injuries, foot and ankle dysfunction, pre and post-operative joint replacement and general rehabilitation including ACL reconstruction, sports medicine and biomechanics, just to name a few.

“I decided to give a talk on exercise and pain relief, and why we feel good when we walk and run and exercise,” Bailey said. “More or less about the natural substances within our body to relieve pain that we can tap into instead of relying on medications. Then into anterior knee pain many runners can experience and what the research tells us about strengthening the knee.”

Bailey was under some pressure from the assembled group of several dozen runners to hit the presentation out of the park, as the week prior a nurse and wellness coach named Martha Bailey did just that.

“Yeah, Martha is my wife. She’s pretty good,” said Bailey. “I understand they are inviting her back.”

While he is a frequent runner, Bailey considers running more of a cross training component for some of the many other sports on which he focuses, one of which is surf ski racing. Designed for ocean paddling, surf skis are sit-on top kayaks that are sleek, fast and very tippy. Bailey competed in the sport, a popular pastime with lifeguards, while living in Hawaii and California. Even though it’s tough to find anywhere near the surf ski racing opportunities here in Wisconsin, Bailey still manages to keep his skills sharp.

“There’s actually a very good 17 mile race here called ‘Race the Fox,’ which goes from Berlin to Omro,” he said. “It’s something I’ve done since moving back to Wisconsin.”

Bailey met his Wisconsinite wife in California, where he lived for 30 years, when she went out west for a nursing job. They got married in San Diego and returned to Wisconsin to start their family. They and their three daughters now reside in the house Martha grew up in, located in Fremont. Not surprisingly, their children are into sports and activities just as mom and dad are, and the family takes full advantage of the gamut of outdoor activities Wisconsin has to offer.

And he insists he doesn’t miss the ocean and the beaches.

“I love it here in Wisconsin,” Bailey said. Bailey coaches a number of area teams and is committed to being a resource for youth sports and being there for families after an athlete’s injury. He’s also committed to helping community members stay active and healthy, hence his visit to the Central Woggers.

It seems as if the transplanted Californian has found the perfect place to be.

Learn more here: https://www.advancedptsm.com/ryan-bailey

Quick Access to Quality Care

The Zoom connection was spotty.

“So you said you’re from the Twin Cities? I love Minneapolis,” I stated.

“Not Minneapolis,” she said. “Leopolis!”

Wait, what?

“And now I live in Pella.”

After the reconnect, I had Sally Egan of Advanced Physical Therapy & Sports Medicine (APTSM) begin anew.

“As an onsite provider at three companies and a municipality in Northeastern Wisconsin, it’s my job to help create and maintain healthy environments for employees,” said Egan. “And the best way to do that is to provide quick access to quality care.”

Egan is a veteran of APTSM’s industrial rehabilitation team, a group of licensed athletic trainers and physical therapists dedicated to keeping employees healthy, safe, and on the job. Like many of her colleagues from the athletic training world, she began her career in the high school setting, as the athletic trainer at nearby Shawano High School (about 15 minutes away from what she refers to as the “Twin Cities”) for nearly a dozen years.

She stresses the similarities between the two environments.

“What we do as industrial athletic trainers is bring the sports medicine model of immediate, consistent care to the workplace,” said Egan. “And we do this at no cost to the employee.”

Which is so important to her clients, everyday people who are just trying to make a living and put food on the table.

Egan understands that concept well.

“I grew up in this area on a very small dairy farm. I know what it's like for a family to live paycheck to paycheck and not able to get healthcare when you really should, because you just can't afford it,” said Egan. “So being able to provide that service—literally in my hometown—is just an amazing opportunity for me.”

Interesting that she and her chiropractor brother (“two tiny farm kids”) both pursued careers in health care. It makes complete sense, though, as she describes it as a simple transition from fixing tractors or boards on a wall to fixing people.

The similarities don’t end there, as Egan quickly points out.

“You have to be adaptable and inventive because you don't usually have the resources. That's what onsite rehab is. You don't have a lot of equipment, so you have to work with what you have,” she said.

The companies and organizations she works with rely on Egan to deliver services known as “rapid response,” where direct access to care means employees will be seen in 24-48 hours for an evaluation. That kind of quick care creates the opportunity for an improved healing timeframe, as the onsite provider can swiftly address and manage issues that, if left untreated, could become a recordable injury.

“We can prevent that from occurring,” said Egan. “So you’re keeping the employee healthy and keeping them at their job, and you’re saving the employer money by reducing direct and indirect costs that result from such an injury.”

Again, she leans on her sports medicine background.

“One domain of athletic training is about reactive and emergency care, which in industry is rapid response and OSHA first aid. So we're there for that assessment, and occasionally wound care and emergency care,” said Egan. “For injuries, we’re able to assess and make appropriate decisions if this is something that you can rehab or treat, or make that decision for a proper referral and guide them to where they should go for the best quality and line of care.”

Developing a relationship and a rapport with her employees is crucial.

“Well, it’s on me to get out on the floor and make connections,” said Egan. “You need to show them that you're there to know them as a person, not just a patient.

Forming such bonds requires a level of trust, something Egan says comes naturally when employees get treated right away and feel better. Whether it’s Egan making the rounds on a factory floor or working with a patient who scheduled an appointment in a (usually) small treatment room, the brief interactions are the sources of the best kind of marketing there is word of mouth.

“One employee will say, ‘Sally has done great things for my shoulder. Go see if she can help you.’ And that keeps my days full,” said Egan.

Egan highlights additional services she can provide if companies so choose. One company, for instance, wanted to offer their office personnel some strategies to improve general wellness. So, every week at the scheduled time, staff members stop what they are doing, grab a chair, and join Egan at the center of the office, where she leads them in fifteen minutes of stretching and body mechanics.

“It’s just a special need that the company felt strongly about, and we can do those types of things,” said Egan. “We individualize services based on the company. I meet with HR every single week at my companies just to keep the lines of communication open. We’re there to prevent health issues as much as possible, so that kind of collaboration ensures their needs are being met.”

The stability of the Wi-Fi connection notwithstanding, someone needed to get going. Technically her “day off,” Egan was headed to a side gig, teaching chair yoga to retired adults. But she wanted me to know she hadn’t looked at list of questions I had sent her prior to the interview.

“I wasn’t going to prep for this. Because what works in this field is that we're ourselves. We're not scripted. You get the real me,” said Egan.

The small-town country girl paused, and before signing off acknowledged one final similarity between her job as an industrial rehabilitation specialist and her work with high school athletes in a previous life.

“We’re in healthcare for a reason, and that’s to help people. I get to make those personal connections with industry clients just like I did in sports medicine. And the best part is when I get somebody that comes in and says, ‘Thank you so much for helping me. I feel so much better, and I didn't know if I was ever going to feel better.’

“That’s the best part of my job.”

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Click Here to learn more about our Industrial and Tactical Medicine and Wellness programs.

Pelvic Health and You

May is Pelvic Health Month and here at Advanced, we are all about changing the narrative around symptoms/conditions that may be caused by pelvic floor dysfunction.

Did you know that 1 in every 3 women will develop a pelvic floor dysfunction in her lifetime and 1 in every 8 men* will develop a pelvic floor dysfunction in his lifetime?

While very common, it’s certainly not normal.

Pelvic floor issues may be embarrassing to admit to and even harder to talk about, but they affect the quality of your life. We understand that you may have questions; that’s why we are here.

Not all physical therapy practices have a therapist who specializes in pelvic pain/dysfunction, but Advanced PT’s Autumn Pawlowski is a physical therapist with training and experience in the management of a wide range of issues (for both women and men) that occur with compromised pelvic floor muscles.

When you are ready, please call the Appleton North clinic (920.991.2561) to request an appointment with Autumn.

In the meantime, here are a few facts that just might be the inspiration for you to take action and get back to living the life you want. 

What are pelvic floor muscles?

●     Group of muscles in your pelvis that is kind of like a hammock between your sit bones

●      Support pelvic organs

●       Maintain continence

●      Role in sexual function

What happens if there is dysfunction in the pelvic floor muscles?

●     Urinary incontinence

●     Urinary frequency and/or urgency

●     Pelvic pain

●     Heaviness/fullness feeling

●     Low back or hip pain

Are there other conditions that a pelvic health physical therapist could help out with?

●     After a prostatectomy

●     Prenatal and postpartum

●   Post-cesarean delivery care

What should I expect during my first pelvic health physical therapy visit?

Your pelvic health physical therapist has gone through extensive training in order to treat individuals who have pelvic floor dysfunction.

The first visit will allow you to discuss your concerns with the pelvic health physical therapist and they will ask you follow-up questions.

Then the provider will complete an assessment to help determine the root cause of your symptoms. The assessment may include an orthopedic screen (looking at your back/hips) to see if there are any significant findings that may be contributing to your symptoms.

If the pelvic health physical therapist feels like an internal pelvic floor assessment would be appropriate, they will explain what that would entail. The internal pelvic floor assessment would only be completed if you provide consent. Based on the findings, the pelvic health physical therapist will develop a treatment plan for you.

Treatment may include modifying bathroom habits, modifying diet/fluid intake, strengthening exercises, stretching exercises, breathing techniques, and discussing how the nervous system has a role in your symptoms.

How do I set up an appointment with a pelvic health physical therapist?

You are not alone with your symptoms.

We know how difficult it may be to pick up the phone and call to schedule an appointment, but we promise you you’ll be glad you did. The pelvic health physical therapist will be able to answer a lot of your questions during the first visit. 

Call our Appleton North clinic at 920.991.2561 to request an appointment with Autumn Pawlowski PT, DPT.

*Data is limited for our populations that do not align with the above genders; however, we recognize that every population has unique pelvic floor needs and implications.*

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References:

https://www.uclahealth.org/medical-services/womens-pelvic-health/patient-education/pelvic-floor-disorders#:~:text=One%20in%20three%20women%20will,problems%2C%20or%20bowel%20control%20problems.

https://theconversation.com/men-have-pelvic-floors-too-and-can-benefit-when-they-exercise-them-regularly-184451#:~:text=Though%20pelvic%20floor%20problems%20are,pelvic%20floor%2C%20bladder%20or%20bowel.

The Importance of the Lymphatic System and How We Can Help

Photo caption: OT and Certified Lymphedema Therapist, Allie, teaches our Clinicians about Lymphedema management after surgery.

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What is the Lymphatic System?

The lymphatic system is a part of our body that helps keep us healthy.

This system is made up of lymph nodes, lymph vessels, and lymphatic organs, like the spleen and thymus gland. Lymph is a clear fluid that flows through the lymphatic vessels and is filtered by the lymph nodes. It's like a network of tiny tunnels and filters that help remove germs and waste from our bodies.

When germs and other harmful substances enter our bodies, they can get trapped in the lymphatic system. The lymph nodes filter out these harmful substances, like bacteria, viruses, and cancer cells. They also produce special cells called lymphocytes that help fight infection and disease.

Sometimes, the lymphatic system can become blocked. This condition is called lymphedema. Lymphedema can cause swelling in the arms or legs and can be caused by things like surgery, radiation therapy, or infection.

How can We Help?

Connecting with a physical therapist, occupational therapist or Certified Lymphedema Therapist can help manage lymphedema.

These practitioners can design exercise programs that help move lymphatic fluid out of the affected area, reduce swelling, and improve the range of motion.

They may also use techniques like manual lymphatic drainage massage, compression bandaging, and skin care to manage the condition— In these situations, it may be best to connect with a Certified Lymphedema Therapist to discuss this further.

In summary, it's essential to take care of our lymphatic system so it can keep us healthy. We can do this by eating a healthy diet, exercising enough, avoiding injuries that could damage the lymphatic system, and practicing good hygiene. If we do develop lymphedema or other lymphatic system disorders, it’s best to connect with a trained provider that can help manage the condition to reduce pain, improve mobility and keep you doing the things you love to do!

Connect with one of our skilled Certified Lymphedema Specialists to learn more:

• Occupational Therapist, Allison Salm at our Touchmark location

• Physical Therapist, Lara Bleck at our Appleton West location.

Contact us here if you want to schedule a visit with our team.

What is Modern Cupping Therapy?

Modern Cupping Therapy is a form of alternative therapy that has gained popularity in recent years. It involves the use of cups made of glass, silicone, or plastic that are placed on the skin to create suction. This suction is believed to increase blood flow to the area and promote healing.

Cupping therapy has been used for centuries in traditional Chinese medicine, and its modern iteration has evolved to become a non-invasive and safe therapy.

Here's what you need to know about this popular alternative therapy:

How does Modern Cupping Therapy work?

During a cupping session, a therapist places cups on the skin and creates suction. The suction is created using a handheld pump. Once the cups are in place, they are left on the skin for several minutes before being removed. Sometimes, they are moved in a very specific pattern or sequence depending on the desired effect.

The suction created by the cups is believed to stimulate blood flow to the area and promote healing. It can also help to relax the muscles, reduce pain, and improve overall circulation.

What conditions can Modern Cupping Therapy help with?

It can be used to help many different conditions including, but not limited to, those listed below:

• Back pain

• Neck pain

• Shoulder pain

• Knee pain

• Migraines

• Arthritis

• Fibromyalgia

• Lymphedema

Is Modern Cupping Therapy safe?

Yes! It is generally safe when performed by a qualified healthcare professional. Minor side effects may include mild discomfort, bruising, or skin irritation. It is important to seek the advice of a qualified healthcare professional before using cupping therapy.

Conclusion

Modern Cupping Therapy is a popular alternative therapy that has gained popularity in recent years. It involves the use of cups placed on the skin to create suction, which is believed to stimulate blood flow and promote healing. The therapy is generally safe when performed by a qualified healthcare professional and can help with a variety of conditions. However, it should not be used as a replacement for conventional medical treatment. If you are interested in trying Modern Cupping Therapy, call today and we can chat further to determine if cupping is right for you and how to work it into your treatment program.

References:

1. Wang, Sz., Lu, Yh., Wu, M. et al. Cupping Therapy for Diseases: An Overview of Scientific Evidence from 2009 to 2019. Chin. J. Integr. Med. 27, 394–400 (2021). https://doi.org/10.1007/s11655-020-3060-y

2. Mohamed, Ayman A., Zhang, Xueyan, and Jan, Yih-Kuen. ‘Evidence-based and Adverse-effects Analyses of Cupping Therapy in Musculoskeletal and Sports Rehabilitation: A Systematic and Evidence-based Review’. 1 Jan. 2023 : 3 – 19.

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.”

Dry Needling

Autumn Paul, PT, DPT

You may have heard about dry needling from one of your friends or family members and now you are thinking, “What is dry needling? Could I benefit from it?”

Dry needling involves the practitioner using a solid filiform needle or hollow-core hypodermic needle (similar to an acupuncture needle) to place it through the skin and enter the muscle. The goal is to place the needle specifically into a myofascial trigger point (hyperactive muscle fibers).

These trigger points can be located in a tense band of muscle. For example, many people have tightness or soreness in their shoulders or necks from the tension they carry throughout the day.

These hyperactive muscle fibers (tense bands of muscle) can send signals to other parts of your body which are considered “referred pain”.

The goal of dry needling is to pierce these trigger points in order to allow these muscle fibers to relax, which can help reduce your pain levels.

“So what conditions may dry needling help with?”

● Headaches

● Shoulder/neck pain/tightness

● Lower back pain/ tightness

● Tennis and golfer’s elbow

● Knee pain

● Shin splints

● TMJ/jaw pain

● Plantar fasciitis

● Hip Pain/ tightness

“Can any physical therapist perform dry needling?”

In order to be able to perform dry needling, the physical therapist is required to go through extensive training. This training includes studying human anatomy and hands-on practice. These training sessions are often a weekend course or even several weekend courses.

“Awesome, I want to see a physical therapist who can assess and see if I could potentially benefit from dry needling. How do I make an appointment?”

First, look online to see what location is closest to you. Then, you can request to schedule an appointment with a physical therapist who is certified to perform dry needling.

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References:

Firth C, Meon J, Price M, Taylor J, Grace S. Dry Needling: A literature Review. Journal of the Australian Traditional-Medicine Society . 2020;26(1):22-28. Accessed January 14, 2021.

http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143040461&site=eds-live

http://www.kinfolkwellness.com.au/dry-needling-adelaide

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

Building Strength

Mitchell Fromm (UW-SP) and Bryan Stuettgen, MPT

Strength is a necessary component of daily living.  Our bodies are designed to respond to stresses placed on them.  The higher the activity level, provided adequate recovery, the more they will adapt to overcome those stressors.  As we age it becomes increasingly important to maintain the recoverable level of stress that will promote growth and maintain strength to reduce injury and prevent muscle loss.

Need for Strength

Within the next 10-15 years, an estimated 30% of the US population will be elderly, putting them at greater risk of health problems and loss of function.  The US National Center for Health Statistics reports the average person spends about 15% of their life in an unhealthy state due to disability, injury or disease occurring in old age (Hunter, 2004).

Age is a major contributing factor to the loss of musculature.  At age 30 muscle breakdown begins to exceed muscle growth.  At age 50 1% of total muscle strength can diminish annually and by age 65 the rate has been found to be around 3% per year (Kennis, 2013).  This age-related loss of muscle contributes greatly to the risk of falling and injury as well as muscle strains and other injuries.  Age-related strength loss is generally characterized by reduced muscle mass and strength and is manifested by preferential type II myofiber atrophy (Hunter, 2004, Van Roie 2013).  It has been considered type II fibers are not able to be activated as well in older populations due to this atrophy and denervation.  Type II muscle fiber type responds better to weight training for strength and power for growth and maintenance over type I which is characterized by its endurance properties.

There are multiple approaches to building strength.  The muscle can advance by recruiting more of the available muscle through training.  Weight lifting or similar activity teaches the muscle to recruit more of the available fibers that exist.  To recruit and utilize muscle a nerve pathway must be available.  Weight training also builds and improves this neuro-muscular connection allowing for more muscle fiber recruitment and better precision of movement.  Another training goal could be hypertrophy or the enlargement of muscle.  Creating more muscle allows for a larger pool of recruitment, which can lead to increased strength through training.  Training cycles targeting both strength and hypertrophy should be included to maximally stimulate muscle fibers and best improve overall growth potential.

Power is lost at an even faster rate than strength.  This loss is directly related to functional ability in daily living.  A study by Pereira (2012) led to findings suggesting that training cessation up to 6 weeks is sufficient to induce significant losses in dynamic strength in 1RM (1 rep maximum weight).  To some extent, functional capacity, and especially explosive force, may be preserved after high-speed power training.  As the older population is more susceptible to detraining from missed activity due to injury or illness, power training should be considered when building an exercise program.

Loss of power generation may also be attributed to the lowered ability to create creatine-kinase during aging, a fuel the body creates and uses to generate power. Calcium release also decreases with age limiting the contraction-relaxation cycle of muscle, and inadequate protein has proven to limit growth potential as it is a staple of building and maintaining muscle.  As they say, the temple cannot be created without the bricks.  Detailing appropriate nutritional adaptations is outside of the scope of this paper, however, proper nutrition must be considered to achieve training adaptations and individual recommendations should be sought by a qualified trainer or nutritionist.

Strength in everyday life

Strength is a necessary component in the completion of daily tasks. Walking, maintaining an upright posture, and balance all have strength components where failure in any of the mechanisms may lead to compounding injuries.  Motions beyond them such as bending, lifting, squatting, and transporting items have requisite strength requirements for completion without injury.  The need for strength is apparent and crucial for those seeking to maintain their independence.  Being able to complete tasks unaided reduces or eliminates the need for assisted living while reducing or eliminating those associated costs.  Strength training extends the length of time a person is able to maintain independent motion barring other complicating factors.

Implementing strength training programs can have long-lasting effects.  A long term strength study by Kennis (2013) found that increases in muscle strength and muscle power after a 1-year strength-training intervention theoretically can compensate for age-related losses over 3 to 5 years. Moreover, 7 years after their enrollment in the study, participants of the {strength training intervention} group experienced a significantly lower loss in basic strength compared with the {control} group. 

Protocol

Muscle reductions from age are found to be due to multiple factors.  Training both the nervous system as well as targeting the muscle fibers are necessary for a successful strength program.  It is commonly accepted that strength training should be conducted by lifting above 80% of the 1 rep maximum with sets of 6 or fewer repetitions, and hypertrophic training with weights between 67-80% for sets of 6-12 repetitions.  Though these current standards are accurate for those goals, they are not entirely definite and certainly are not exclusive.  Studies conducted and compiled by Van Roie (2013) have examined the growth ability utilizing low weight high rep protocols and found hypertrophy was achievable when the training sessions achieved momentary muscular failure.  Henneman's size principle of motor unit recruitment indicates that, when a submaximal contraction is sustained, initially recruited motor units will fatigue, creating the need to additionally activate larger motor units. When the exercise is repeated to the point of muscle failure, (near) maximal motor unit recruitment will occur, regardless of the external resistance used (Van Roie, 2013).  Expanding on this, one study was conducted in which a highly fatiguing protocol of 60 repetitions at 20–25% of 1RM was immediately followed (no rest) by a set of 10 repetitions at 40% of 1RM. This mixed low-resistance exercise protocol showed interesting benefits on the dynamic strength and speed of movement of the knee extensors (Van Roie, 2013).  Those studies further showed promising results on speed of movement at different resistances, even though training was performed at a moderate speed. 

Studies conducted by Schoenfeld et al (2016, 2017) led to findings indicating that maximal strength benefits are obtained from the use of heavy loads while muscle hypertrophy can be equally achieved across a spectrum of loading ranges.  This is backed by Dr. Mike Israetel when explaining the time under tension can be equal across a range of weights, so long as the muscle fibers are brought close to or achieve fatigue.  As long as all three components (concentric, isometric, eccentric) of the working muscle are achieved through the majority of the range of motion, muscular gains have been found utilizing as little as 30% of the 1RM.  Schoenfeld’s studies contrasted volume with the analysis using binary frequency as a predictor variable revealed a significant impact of training frequency on hypertrophy effect size (P = 0.002), with the higher frequency being associated with a greater effect size than lower frequency (0.49 ± 0.08 vs. 0.30 ± 0.07, respectively).

 Methods such as these or bodyweight protocols are effective for those who are adverse to weight training or unable to due to contraindications, however, volume was the decisive factor in how much could be achieved wherein multiple sessions per week were superior to a single intense session.  Factors that must be considered when using any program or weight is the proper form and control.  Utilizing improper body mechanics can put extreme stress on the joints and swinging weights around with momentum often relates to injury.  It is paramount to only use weights that can be used in a controlled fashion.  This will not only lessen or eliminate an injury risk but subsequently result in better muscular growth as each phase of the muscle contraction and lengthening phases are used appropriately through the entire lift.  Especially in newer lifters, this means that using a lighter weight for more repetitions is the most appropriate choice.  For experienced lifters, incorporating light-weight can allow for an increase in total volume, leading to additional strength gains and improving muscular endurance.  This approach also trains the nervous system to achieve precise motion to achieve a better neuro-muscular improvement.

It can be overwhelming to begin a strength program with a vast amount of information that seems to be ever-changing.  Experts exist in these areas to assist in setting and reaching goals.  Personal trainers specialize in strength and conditioning while ensuring proper form to prevent injury.  When choosing a personal trainer be alert to their credentialing as the field is largely unregulated and there are “internet experts” who claim experience they may or may not have.  Physical therapists are experts in the non-surgical treatment of injuries or conditions.  As such they are great assets in program creation while considering prevention and treatment of injuries, especially for those with a prior history of injury.  Both the physical therapist and personal trainer should have a great working knowledge of anatomy and physiology which is critical for accurate and individualized program creation.  They often work together for the best possible patient outcome.

Overall

The need to maintain strength training is clear.  It is highly transferable to everyday life, the amount of which will be directly affected by the effort put into training and the program design.  Multiple programs can be implemented to retain strength, but the secondary and tertiary effects of training must be considered for the best individual approach.  The coach-client relationship should not be overlooked as it is often the largest contributing factor determining compliance and exertion in training, as any properly implemented program will have benefits over the stagnation of not completing any program at all.

Contact our skilled physical therapy team if you’re unsure where to start. They will work with you to determine what type of strengthening program you should follow based on your needs. They may also recommend manual therapy, therapeutic cupping, or dry needling to decrease pain and improve mobility to complement your gains further.

References:

Csapo R, Alegre LM. Effects of resistance training with moderate vs heavy loads on muscle mass and strength in the elderly: A meta-analysis. Scandinavian Journal of Medicine & Science in Sports. 2015;26(9):995-1006. doi:10.1111/sms.12536.

Hunter GR, Mccarthy JP, Bamman MM. Effects of Resistance Training on Older Adults. Sports Medicine. 2004;34(5):329-348. doi:10.2165/00007256-200434050-00005.

Kennis E, Verschueren SM, Bogaerts A, Roie EV, Boonen S, Delecluse C. Long-Term Impact of Strength Training on Muscle Strength Characteristics in Older Adults. Archives of Physical Medicine and Rehabilitation. 2013;94(11):2054-2060. doi:10.1016/j.apmr.2013.06.018.

Schoenfeld BJ, Ogborn D, Krieger JW. Effects of Resistance Training Frequency on Measures of Muscle Hypertrophy: A Systematic Review and Meta-Analysis. Sports Medicine. 2016;46(11):1689-1697. doi:10.1007/s40279-016-0543-8.

Schoenfeld BJ, Grgic J, Ogborn D, Krieger JW. Strength and Hypertrophy Adaptations Between Low- vs. High-Load Resistance Training. Journal of Strength and Conditioning Research. 2017;31(12):3508-3523. doi:10.1519/jsc.0000000000002200.

Roie EV, Delecluse C, Coudyzer W, Boonen S, Bautmans I. Strength training at high versus low external resistance in older adults: Effects on muscle volume, muscle strength, and force–velocity characteristics. Experimental Gerontology. 2013;48(11):1351-1361. doi:10.1016/j.exger.2013.08.010.