 Philly.com Sports Doc
Posted: Friday, February 27, 2015, 5:30 AM istockphoto.com If you’ve joined a gym recently, you were probably offered a free fitness assessment. There are numerous different assessments available to exercise professionals. One of the more popular screening tools is the Functional Movement Screen (FMS). The FMS was developed as a tool to identify movement asymmetries or major limitations in movement patterns. The underlying principal of the FMS is that movement quality is essential to reducing injury and optimizing performance. It is used to identify limitations or asymmetries in 7 fundamental movement patterns. The screening places an individual in extreme positions where weaknesses and imbalances become noticeable if appropriate mobility and motor control is not utilized. The focus of the FMS is movement quality and to identify any movement deficiencies or limitations. Individuals must not have current pain or musculoskeletal injury. The Functional Movement Screen consists of 7 specific tests and 3 clearing exams. The 7 tests are the hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push up, and rotational stability. The scoring system used is a 0-3 scale with 0 being a painful test and 3 being the highest score possible. 5 of the 7 tests are performed bilaterally looking for side-to-side differences as well as a combined score for the test. The 3 clearing tests are the active impingement, spinal extension, and spinal flexion tests which are scored positive or negative for pain. The FMS is used to assess an individual’s movement quality and asymmetries to help better design exercise or training programs which should allow a safe progression to higher level exercises/training. The theory is that by addressing any dysfunctions noted on the FMS, one can reduce their risk of injury and improve their performance in sports. Let’s look at the published research on the FMS and see what it says. Reliability There are numerous studies looking at the reliability of the FMS screen with varying results. Overall, the studies show good to excellent intrarater reliability (the same assessor) for both experienced and novice assessors. There is generally fair to good interrater reliability (between assessors) in most published studies as well. Movement Dysfunction A study by Frost in the Journal of Strength and Conditioning Research from 2013 questions the ability of the FMS to assess dysfunction. They looked at 21 firefighters who initially performed a standard screen followed by a repeat screen 5 minutes later. The participants were provided with a verbal description of the grading criteria immediately before performing each task during the second screen. All firefighters improved their scores within minutes of being told what movement patterns were required. The authors conclude that it may be inappropriate to assume that movement patterns are the direct result of a specific “dysfunction” or “impairment” that could be rectified via “corrective” exercise. Injury risk Keisel has published two studies involving NFL players showing that a total score of less than 14 or an asymmetry on any of the bilateral tests place players at a higher risk of injury. Players’ having both a total score of less than 14 and one or more asymmetries are at an even greater risk of injury. Lisman published in the journal Medicine & Science in Sports & Exercise in 2013 that military recruits who had a 3 mile run time less than 20.5 minutes and scored less than 14 on the FMS were 4.2 times more likely to experience an injury. These two studies support an overall score of 14 as the cut off for increased injury risk. However, a study by Warren in the Journal of Sports Rehabilitation in 2014 showed a poor correlation with scores and asymmetries for both contact and non-contact injuries. In another article by Dossa in Journal of the Canadian Chiropractic Association in 2014, they concluded that the FMS couldn’t be recommended as a pre-season screening tool for injury prevention in major junior hockey players. Lastly, McCall gave a recommendation of “D” for the FMS as a screening test to identify professional football players (soccer) at risk of injury in the British Journal of Sports Medicine 2015. Sports performance A 2011 study by Parchmann in the Journal of Strength and Conditioning Research found that there were no significant correlations between the FMS and on the field sports performance tests whereas the 1 rep max back squat showed a significant correlation to these field tests. Lockie in the Journal of Strength and Conditioning Research in 2015 found few significant correlations between FMS scores and multidirectional speed and jumping tests. Lastly, Okada published in the Journal of Strength and Conditioning Research in 2011 that core stability and the FMS are not strong predictors of sports performance. All this research shows that the FMS is a reliable screen able to score movement patterns and assess for side-to-side asymmetries. It may not truly assess movement dysfunction and may just be showing unfamiliarity with the activity, which may be easily improved with verbal cuing and repeat performance. The research shows conflicting studies on whether or not it can predict injury risk in a variety of sports. Lastly, the research shows little correlation with specific sports performance tests and FMS results. So, what does this all mean? Does the FMS truly screen for movement flaws or is there a spectrum of what constitutes “normal” movement? The FMS still shows potential for assessing an individual’s risk of injury but it should not be the only criteria as risk is multi-factorial and the FMS may not be specific enough to detect all of the underlying components. Although research doesn’t show any significant relationship between the FMS and specific sports performance tests, there may still be a correlation between FMS scores and how well and individual does in a specific sport. Sports performance tests, such as the 40-yard dash, do not show a high correlation to specific indicators of success in sports (ie batting average, points per game, touchdowns scored, etc). My personal experience with the Functional Movement Screen is that it is a great tool to quickly assess “healthy” athletes for “abnormal” movement patterns that may be secondary to limitations with mobility and stability. However, it should not be the only assessment used and should not take the place of a more detailed individual assessment looking at specific areas such as joint ROM and mobility, specific muscle strength testing, on-the-field testing (ie pro agility), and fitness testing (ie beep test).
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 Phill.com Sports Doc
POSTED: Thursday, August 15, 2013, 6:00 AM Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation Gatorade, Powerade, Accelerade, Lucozade, Sqwincher, EFS, Recharge, All Sport, Levelen… as you can see there are endless sports drinks on the market. These drinks say they can increase performance, decrease cramping, and speed recovery. What does the research say? Pre-activity sports drinks There are numerous pre-activity sports drinks on the market that claim they improve performance through numerous methods including increased energy, maintaining hydration, and adding to carbohydrate stores. Let’s look at the main components, (caffeine, carbohydrates) and see what the research shows. Caffeine We all know how that our morning cup of coffee helps start the day off on the right foot. But does it help to run faster or cycle longer? A 2012 article in the Journal of Strength & Conditioning Research showed “that acute ingestion of a caffeine-containing energy drink can enhance resistance exercise performance to failure and positively enhance psychophysiological factors related to exertion in trained men.” There are numerous articles that support the use of caffeine performance enhancing supplement. Keep in mind that more is not better when it comes to caffeine and there can be negative side effects of excessive caffeine consumption. So please speak with your physician or a nutritionist about how much caffeine is safe and effective. And for NCAA athletes please consult your school’s athletic trainer as you can test positive if you’re over a certain limit. Carbohydrates Carbohydrates are thought to have a role in pre-, during, and post-exercise performance and recovery. Pre-activity carbohydrates are thought to top off one’s energy stores. A study in the Journal of Strength and Conditioning Research in 2013 showed that pre-activity “sports drinks allow higher stroke frequency during play, with decreased rates of perceived exertion” in tennis players. What we don’t know is what is the optimal amount of carbohydrates and where do we get them from. Is there one drink that’s better than another or can we just get them from a healthy pre-activity snack? There is also concern for how an athlete feels eating and drinking prior to activity. Will it make them feel bloated? Can they tolerate a sports drink but not an energy bar? The general guideline is to have some form of carbohydrates pre-activity that your GI system can tolerate well. During Activity Drinks These can be broken down into two categories: energy replacement through carbohydrates and electrolyte replacement to limit cramping and dehydration. Carbohydrates Carbohydrates during activity are thought to supplement the body’s energy stores helping to maintain performance levels over longer periods of exercise. A 2011 article in the Journal of Sports Sciences recommends “Carbohydrate intake during exercise should be scaled according to the characteristics of the event. During sustained high-intensity sports lasting about 1 hour, small amounts of carbohydrate, including even mouth-rinsing, enhance performance via central nervous system effects. While 30-60 grams per hour is an appropriate target for sports of longer duration, events greater than 2.5 hours may benefit from higher intakes of up to 90 grams per hour.” Once again, the type and amount of carbohydrates is still unknown with recommendations of what the athlete tolerates from a GI perspective being most important. Electrolytes What causes cramping in athletes? Is it dehydration, sodium loss, or something else? An article in the British Journal of Sports Medicine 2013 states “Significant and serious hypohydration (dehydration) with moderate electrolyte losses does not alter cramp susceptibility when fatigue and exercise intensity are controlled. Neuromuscular control may be more important in the onset of muscle cramps than dehydration or electrolyte losses.” For cramping, the majority of sports drinks are isotonic or hypotonic meaning they have the same or fewer electrolytes than what is in your body normally. So not only do these drinks not replace lost electrolytes but they can pull electrolytes out of the body. Exceptions to this are sports drinks like Levelen that are based off of sweat testing and replace specific electrolytes lost by the individual. So what’s the bottom line? For the average athlete who is working out for 60 minutes or less water is just fine. If it’s greater than 60 minutes or in a hot and humid environment, a sports drink comprising of both carbohydrates and electrolytes may be beneficial. Otherwise, these sports drinks tend to be nothing more than empty calories. Post-activity Drinks Post activities drinks are comprised mainly of carbohydrates and protein. The goal is to replenish what is lost immediately post-exercise. It is assumed that this helps in recovery. However, two studies dispute this common thought process. A 2006 study in the Journal of Sports Medicine and Physical Fitness showed that “supplementation with a sports drink during recovery showed a significant short-term subjective positive effect compared with placebo. However, no effects were seen on physical performance or signs of overtraining.” Another study in International Journal of Sport Nutrition and Exercise Metabolism 2008 concluded that ”consuming a carbohydrate + protein or carbohydrate beverage immediately after novel eccentric exercise failed to enhance recovery of exercise-induced muscle injury differently than what was observed with a placebo drink.” What we thought was common knowledge regarding carbohydrate replacement post exercise may not be backed up by science. Conclusions Pre-activity, caffeine can have positive benefit and one should have some sort of carbohydrates 30-60 minutes before activity. During activity, most people are fine with just water unless you’re competing for greater than 60 minutes, are in a hot and humid environment, or are prone to cramping. Lastly, for post-activity recovery you can probably skip the protein drink and just head home for a healthy well balanced meal.  Philly.com Sports Doc
POSTED: Wednesday, July 17, 2013 Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation Every athlete wants an edge. What’s the newest thing out there that will help me run faster, recover quicker, and play longer? How do I know which claims are fact and which are fiction? Let’s take a look and see what the research says. Compression garments 2XU, Skins, CEP, CW-X, 110%....They’re everywhere. Running stores, basketball players’ elbows, and even on athletes during plane flights. They feel good. To some they look cool. But are they really doing anything? The claims: reduced muscle fatigue, reduced exercise induced muscle damage (EIMD), accelerated recovery processes, faster lactic acid removal, increased strength and power, improved endurance, etc. Let’s look at the two main reasons for wearing them: sports performance and sports recovery. Recovery A 2013 study in the European Journal of Applied Physiology stated that “none of the blood or physical markers of recovery indicates any benefit of wearing compression garments post-exercise. However, muscle soreness and perceived recovery indicators suggest a psychological benefit may exist.” The majority of research articles support this saying any benefit from a physiological standpoint is trivial but the perceived benefit may be significant. Anyone who has worked with professional athletes knows that it’s as much mental as it is physical. If they think something is helping then they’ll play better and in the end that’s really what matters. So the rest of us have to decide if a $100 pair of recovery tights is worth the placebo effect. Performance A January 2013 article in the International Journal of Sports Physiology and Performance showed that “results indicated small effect sizes for the application of compression clothing during exercise for short-duration sprints (10-60 m), vertical-jump height, extending time to exhaustion (such as running at VO2max or during incremental tests), and time-trial performance (3-60 min)." Another article in the May 2013 edition of the same journal showed that “Wearing compression garments during cycling may result in trivial performance improvements of ~1% and may enhance oxygen delivery to the exercising muscles.” As these two studies show, there is conflicting results to date whether compression garments show performance enhancement benefits. But once again, if you think it works and you don’t mind paying for it then go for it. Magnets Magnet therapy is a $500 million annual business in the US. Some of the touted benefits include improved blood flow and decreased pain. Much of the theory is based on the magnetic principles of iron. However, iron in blood is diamagnetic which means it is actually repelled by magnetics. An article in the Journal of Orthopedic and Sports Physical Therapy in 2002 showed no difference in blood flow of the forearm with magnets compared to placebo. Another claim is that magnets help with swelling by attracting water molecules in the body. This can be disproven by the simple fact that even during an MRI scan there is no change in water dynamics in the body. Some companies claim that magnets can help with nerve conduction but once again even the strong magnets used in MRIs are not powerful enough to effect nerve conduction. Regarding pain, research does show mixed results. A study in the Archives of Physical Medicine and Rehabilitation showed significant pain reduction in post-polio patients using magnet therapy where another study in the Journal of the American Medical Association showed no benefit in the treatment of low back pain. Many of the studies showing positive benefit had small sample sizes, lacked true control groups, and used magnets that were more powerful than the magnet necklaces worn by most individuals. So to sum it all up, there seems to be no real benefit from magnets other than possible pain relief, which may be just a placebo effect. But if it helps with your pain and you think they look stylish, then give it a try. Next time: Kinesiotape, vibration plates and more. |
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