Looking back at 2017 & beyond to 2018

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It’s that time of year to reflect on what we’ve done and a game plan on what’s to come. I’ve taken a moment to look back at some changes I made in 2017 and share it with you.

New website- LennyMacrina.com

I had been thinking about building my website for a while. Being surrounded by some of the guru’s in our field, who have used their website to share their thoughts, I had no choice but to take the leap.

Mike (mikereinold.com), Dave (shiftmovementscience.com), and Dan (Fitnesspainfree.com) are constantly talking about WordPress, funnels, and calls to action than most. As much as it’s gibberish, it made me think about why I don’t have my own calling card, so to speak, to be able to capture my opinions on rehabilitation and physical therapy.

I fumbled a bunch and had to redo the whole site from scratch after hiring someone to do it for me.  In the meantime, I had to develop knowledgeable content that people may find interesting.

Instead of just using my Twitter (@lenmacpt), Facebook (Lenny Macrina MSPT, SCS, CSCS) or Instagram (@lenmacpt) accounts to share content, I decided to centralize the process. I figured this would be my home base for content that I can control forever and not be stuck in a social media platform.

I feel like I’m winging it but the early feedback has been pretty positive.

Improve my Listening Skills

I’ve said over and over again that listening to your clients is the most important aspect of any examination.

I feel as if I do a pretty good job at listening to my clients (despite what my wife says about my listening skills.) I try to ask the right questions and let the client state their story. Too often we get ideas in our head and jump to conclusions. We try to diagnose an injury too quickly and may miss an important detail that could sway the story in a different direction.

I’ve had this happen numerous times and completely blame myself for not giving the client the platform to reveal the pertinent details. I alluded to this is in a previous post if you’re interested. The client comes first…no questions asked!

Remember, they don’t know what may be contributing to their injury. To them, the injury is often a result of a specific action. They don’t consider the other contributing factors in their lives that seem insignificant.

via GIPHY

 

I always ask them “What do YOU think is going on?” This allows me to hear their thoughts, impressions and any details that they think may be adding to their current presentation

For example, I recently had a client present with shooting and burning pain down her arm. To many, it would seem like a cervical herniated disk. Pretty clear cut, right?

Well, she had a clavicle fracture that required an ORIF 10 years ago. She didn’ think it was significant but every time I palpated at the surgical site, especially the lateral aspect, we could replicate her symptoms…Every time! Two previous medical professionals missed this detail and just brushed it off.

To me, it seemed pretty clear that some component of her ORIF or clavicle had been rubbing a portion of her brachial plexus during a specific movement. It just did not seem like a cervical spine issue and the detail of her clavicle fracture, that she thought was insignificant, seemed to be the clue we needed to hone in on the culprit.

Listen up…they may just tell you what you need to hear!

Systemize Everything

Life gets crazy. Responsibilities grow so we need a way to manage all of the chaos. What helped me to better manage my time was contained in the book “15 Secrets Successful People Know About Time Management: The Productivity Habits of 7 Billionaires, 13 Olympic Athletes, 29 Straight-A Students, and 239 Entrepreneurs“

I’ve had to block time out of my calendar to get tasks done. Like specific times to do specific tasks. Whether it’s a dentist appointment, a powerpoint or running payroll, I have reminders in my calendar for everything.

More importantly, I have to prioritize tasks, what Kevin refers to as my MIT’s or Most Important Tasks.

I have done my best to stick with this plan but he recommends working on your MIT 1st thing in the morning when he thinks you are the sharpest. As of now, I have carved this time out to be with my daughter before the day begins. I guess as of writing this, she is my most important task. Can’t argue that!

At work, including client evaluation and treatment sessions, we have begun to systemize everything we do at Champion PT and Performance. We feel as if most people present with very similar presentations.

We’ve developed internal treatment progressions that we utilize daily. It makes it a lot easier for PT’s to see each other’s clients on the rare occasion we need to cover for someone. It takes any questions out of the client’s head. They don’t need to worry why their regular PT may or may not be doing a specific treatment.

Even more than that, we MAY have a new system coming out in 2018 that will help many with their evaluation skills. I can’t say much more than that but look for a big announcement mid-2018!

Preview of 2018

Wow, 2018 is right around the corner. I feel good about it because it’s an even number. Yeah, I’m a bit weird with stuff like that. Maybe it’s my baseball background and superstitions.

  • In 2018 I hope to accomplish more vlogs…or video blogs as the kids say. I feel like a 3-5 minute snippet of my thoughts is a very effective way of communicating with the masses. Look for more vlogs as we roll into luck 2018.

I also plan on booking more speaking engagements worldwide. As of now, my calendar has me in:

I have other courses that just need to be finalized but it seems like there may be 1-2 more dates that are in the works.

2018 is shaping up to be a very exciting and productive year. It’s important that I have these plans in place to keep me on my toes and on top of the literature.

Hope you have looked back at your past year and can continue to build into 2018. What goals do you have for 2018? Hit me up in the comments below so we can discuss.

Happy New Year!!

Kids and Sports Injuries: What are we doing wrong?

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I recently had a conversation with a parent who reached out to me slightly concerned for her 12-year-old child. He’s stressed out, hurt again and she didn’t know if I could help. It made me think about kids and sports injuries… and how we could make a difference.

Real Life Story

I had seen this kid for an overuse elbow injury within the past year, a growth plate fracture of his medial epicondyle. He’s a catcher for his team, one of many teams that he plays on. He had considered converting to pitcher but I believe he was going to rethink that decision.

He also wrestles, has multiple hours of homework each night, has hitting lessons and practices with his teams…even in the dead of Winter in December. If he’s late to practice, he gets yelled at by the coaches. Not just a casual “why are you late” kinda question but a scolding that would make any 12 year old (or adult for that matter) think twice about what they’re doing. At least this is what Mom tells me.

So Mom called me recently to discuss her son’s predicament. He’s not feeling good about himself and worried about making the AAU team. He’s a decent sized kid, big for a 12-year-old, so he tends to stick out. He can throw harder than the other kids and can probably wrestle slightly better. I’m just guessing here…I’ve never seen him wrestle.

Mom is worried that he’s too stressed with all of the sports and schoolwork. I think she may be right!

I recall a 12-year-old Lenny playing my last year of Little League baseball but that didn’t start until May or June (Yup, that’s me below on the right with my brother Brian).

During the months of November and December, I was playing basketball, hockey and tackle football in the snow. There’s nothing like tackle football in the snow…trust me all of you warm-climate readers!

What does the research say & do kids need to specialize to play college or pro?

With that, I decided to dive into the literature and see what it says…

Most recently, a 2017  study in AJSM looked a 1st round draft picks from 2008 to 2015 in the NBA. They concluded that “those who were multisport athletes participated in more games, experienced fewer major injuries, and had longer careers than those who participated in a single sport. ”

Interestingly, of the 237 athletes included, 36 (15%) were multisport athletes and 201 (85%) were single-sport athletes in high school. Yikes!

This 2017 study from The Sports Health Journal looked at division 1 college athletes. They asked them to complete a previously utilized sports specialization questionnaire regarding sport participation patterns for each grade of high school.

Specialization increased throughout high school and ~ 41% had eventually specialized in a sport b their senior year. Conversely, only 17% of the freshman had specialized in a sport. Also, football athletes were less likely to be highly specialized than non-football athletes for each year of high school.

Do football players just need time off because of the nature of the sport? Makes you wonder…

A similar finding was seen in this study from 2017 in AJSM. They basically showed that 2011 young athletes between the ages of 12-18 that became specialized in a sport had higher injury rates by nearly 2 fold.

Nearly triple the rate of injuries

In another study out of Wisconsin looked at high school athletes between the ages of 13 and 18 years from 2 local high schools. Athletes in the high specialization group were more likely to report a history of overuse knee injuries.

Athletes who trained in one sport for more than 8 months out of the year were more likely to report a history of knee injuries (more than 2.3x more likely), overuse knee injuries ( 2.9x more likely), and hip injuries (2.7x more likely.) School size matters too. Kids that go to a smaller high school report playing in more sports than kids that go to larger schools. I see this daily in my own practice.

This descriptive level 3 epidemiology study in Sports Health Journal surveyed 235 athletes between the ages of 7-18 years. They showed that athletes started to specialize at the age of 8 years old, which is crazy!

They also showed that 60% played their primary sport for 9 or more months per year (which we know is already an increased risk of an overuse injury.) Nearly 1/3 of players ‘reported being told by a coach not to participate in other sports, with specialized athletes reporting this significantly more often.’ This kind of fits my kid above…an over-bearing coach that is pressuring the kids to practice all year round.

My Solution for him

So, my conversation with Mom ended by me telling her that I completely understood. I felt as if he needed more positivity in his life. That he was being pulled in way too many directions and needs a more positive role model (besides his parents, of course) to help him.

I had these studies in my head but I didn’t want to bore the Mom with statistics gibberish and big terminology. I told her that I loved that he played 2 sports although I didn’t like that he was speeding from school to wrestling practice, to baseball practice then to a hitting lesson. It just seemed like a lot…nevermind that he still had to get home to do all of his homework.

By the way, homework nowadays is a lot more than anything that I ever experienced as a child. It takes hours for these kids to complete. Maybe that’s why Massachusetts ranks as #1 in education in the US. A great feat for the teachers and students of this state!

But what does it mean to the youth athlete trying to play multiple sports or on multiple teams? How do they juggle all of this and get their hours of homework done?

It’s not just an isolated story…I hear this daily from our student/athletes of all ages. Kids in middle school and high school have more work to do than our college athletes. Or maybe the college kids are better at time management. I imagine it’s a little of both.

What Should we Recommend?

It’s becoming evident that specializing too early in one’s athletic career may not benefit the child in the long run. Remember, they are children that are skeletally immature. The stresses that they can handle are not the same as what an older, more developed and a mature kid can tolerate.

I’m always telling kids to take time off from their sport. I usually recommend 3-4 months of active rest. This means they can still work out that may include some baseball activities such as tossing/hitting but it can’t be the priority during their off-season.

They really need to go play another unrelated sport, like soccer or basketball to get stronger in their lower body. We all know the importance of a strong lower half…see pitchers like Roger Clemens below.

What better way to get stronger than to run and jump for hours at a time (and not have to throw anything with maximal velocity.)

I hope my advice helps my young friend and his Mom figure out his dilemma.  Unfortunately, this won’t be the last time I’ll be reciting the literature to a family looking for advice. We can do our part by keeping these findings in our treatment educational components as we help get our athletes back on the field.

Last Call- Kids & Sports Injuries

Because we’re beginning to see some interesting (crazy) injuries in our youth, it seems as if the literature is beginning to paint the picture for us.  Intuitively, one would think that playing multiple sports, getting enough rest and doing a little homework each night would be sufficient to allow a kid to get through high school or college (the few that do that.) Maybe this would allow the athlete to not sustain a significant injury. When I say significant, I mean an injury that requires months of rest, multiple doctor visits and rethinking if the kid should still be playing that sport.

Note: The Mom gave me permission to talk about our conversation and was excited to know that I was writing this post. In case anyone was worried…

 

Operative versus non-operative treatment for the management of full-thickness rotator cuff tears

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Rotator cuff tears can be a functionally debilitating injury for many. Surgery is often recommended to help decrease pain and return the patient back to their baseline function. But is surgery definitely needed in someone with a known rotator cuff tear? I originally discussed this for an article at Champion’s blog here and here

Photo by Piron Guillaume

Here’s my review and thought process for this paper…

Recent Systematic Review & Meta-analysis

A recent paper published in the Journal of Shoulder and Elbow Surgery attempted to clarify whether surgery or conservative treatment could deliver the best results 1 year after a diagnosis.

This group, from George Washington University Hospital’s Department of orthopaedic surgery, looked at level I and II studies to compare operative versus non-operative management of atraumatic rotator cuff tears through a meta-analysis.

After the initial search, 1013 articles remained for review. Of that, only 3 studies involving 269 subjects met the inclusion criteria and were included.

The inclusion criteria were as follows:

  • randomized controlled trial
  • full-thickness rotator cuff tear
  • age 18 years or old

The exclusion criteria included:

  • any history of rotator cuff surgery
  • follow-up period of less than 1 year.

A good beginning but I’m always curious to know the percentage of people included in any study that:

  • have diabetes
  • smoke
  • worker’s comp

…and we don’t have that information so I’m a bit skeptical already.

via GIPHY

So moving on and am curious about the variables they’re looking at in this study. Coincidentally, they’re only looking at VAS pain rating and Constant scores. Furthermore, 1 study’s data is not valid because they used a different version of the Constant score rating instead of a VAS pain rating.

So, we now only have 2 studies looking at VAS pain rating. And for the record, I am not a huge fan of pain scales anyway. Feel like patients are not always accurate and accountable when self-reporting their pain. I would imagine a study may somewhat bias someone when reporting how they feel.

Moving on…

Surgery better than Rehab

The study’s results concluded:

“A greater improvement in Constant score was found in operative patients relative to patients treated nonoperatively, and this was statistically significant. The mean difference between operatively treated patients and nonoperatively treated patients was 5.64 (95% confidence interval, 2.06-9.21; P = .002).”

“Patients treated operatively had significantly decreased pain scores at 1-year follow-up as compared with the nonoperative cohort, with a mean difference in VAS score of − 1.08 (95% confidence interval, − 1.56 to − 0.59; P < .0001).”

So what does this mean?

Well, they went on to say and this is the key: “However, both values were below the minimal clinically important differences of 10.4 and 1.4 for the Constant and VAS scores, respectively.”

Surprising to many, including myself, because I have made a career in rehabbing patients after rotator cuff repairs.  Surgery may just not be the obvious treatment choice for patients with atraumatic rotator cuff tears.

One must be concerned with the tear progressing and symptoms possibly worsening. Fortunately for the patient (unfortunate for the surgeon), the tear size does not correlate with pain and function. Surgery, although often successful, is no guarantee to restore function and pain better than physical therapy.

Study Limitations

Of course we must look at the self-proclaimed study limitations that are discussed and they definitely affect the study conclusions, in my opinion. The 3 studies included did not have a uniform grouping of rotator cuff tear types. One of the studies included supraspinatus only, while another included supraspinatus, infraspinatus, and subscapularis. Yikes!

One study also had a subset that included traumatic rotator cuff tears, which may have influenced the positive surgical outcomes reported.

Post-operative and non-operative physical therapy did not follow a standard protocol. This may affect the outcomes significantly!

Finally, the type of surgery performed varied in each study. Two of the 3 studies utilized an open or mini-open approach which is pretty outdated at this point. The other study used an arthroscopic approach to fix the rotator cuff tear.

My Conclusions

Although many had advocated for early surgical intervention for a rotator cuff tear, the literature continues to display an alternative treatment approach. Physical therapy may offer an equivalent, albeit a cheaper strategy, to atraumatic rotator cuff tears.

This paper tries to present a case for surgical intervention as a key to success but I am still not convinced. A patient with a diagnosis of a rotator cuff tear should definitely have a trial of physical therapy to see if they can get improvements in their pain and function.

I have outlined a typical rotator cuff rehabilitation progression in a previous blog post. Check it out and let me know what you think!

https://lennymacrina.com/simple-steps-rotator-cuff-rehabilitation/