Use of Yoga in Physical Therapy & Training; Sports Injuries in Young Athletes

Episode 14.21

Segment OneLisa Hua, PT from ATI Physical Therapy talks with Steve Kashul and Dr. ATI Physical Therapy's Pasadena clinic director weighs in on the benefits of yoga.Charles Bush-Joseph from Midwest Orthopaedics at Rush, about the uses and benefits of Yoga in Physical Therapy, Sports Training and Fitness. Lisa graduated from the University of Illinois in 2008 with a degree in Biology. She went to PT school at Washington University in St Louis and graduated with her DPT in 2011. She has been a practicing clinician for ATI Physical Therapy for 3 years and is currently the Clinic Director at the ATI in Oak Park, IL. Her focus and passion is in orthopaedic rehabilitation of post-op and non-operative patients, athletes, and sports rehabilitation.

Segment Two
– Steve Kashul and Dr. Charles Bush-Joseph, Head Team Physician for the Chicago White Sox, discuss the symptoms and how to recognize concussions in young football players; overuse injuries in young female cross country runners; dealing with overuse injuries in MLB in view of the approaching playoff season. Dr. Bush-Joseph has been long involved in the care of high school, collegiate, and recreational athletes and is the head team physician for the Chicago White Sox Major League Baseball Club and Associate Team Physician for the Chicago Bulls. Thru his experience with high profile professional athletes, Dr. Bush-Joseph was elected to the Major League Baseball Medical Advisory Board and president of the Major League Baseball Team Physician Association for 2012. This exclusive group of team physicians advises the Major League Baseball Commissioner on medical policy and emerging trends in training and the medical care of the elite athlete.


Play Podcast – 30 minutes

ABC Interview with Dr. Cole on the Dramatic Rise of ACL Injuries in Young Athletes

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ABC-ACL InterviewDr. Cole Speaks with Judi Hsu from Channel 7 – WLS Chicago about prevention of ACL injuries in young athletes, particularly girls. This is part of a campaign that the Illinois Athletic Trainers Association is doing in collaboration with Midwest Orthopaedics at Rush.  It’s called “Knees for Life” and it stresses the need for screenings for athletes who are vulnerable to ACL injuries and ACL injury prevention warm-ups for all athletes before practice and games. Check out the website: …you can get free prevention tags for your athlete’s gym bags.

Mobilizing the Healing Process

Rebound® Cartilage

The success of an articular cartilage repair is dependent upon patient compliance during the rehabilitation process and the protocol is based on restricted cartilage load combined with gradual increase in activity. Many rehabilitation protocols suggest partial weight-bearing as the standard of care for successful outcomes. However, patient compliance to partial weight-bearing instructions with crutches has been shown to be inconsistent.

The Rebound Cartilage is a protective functional solution designed to support regeneration of the knee cartilage after repair procedures such as Microfracture, OATS and (M)ACI. Based on the clinically-proven 3-Points of Leverage System and patented Cartilage Protection Straps,™ joint unloading is maintained in flexion for protection of the cartilage during the healing process.

Key Benefits:

  • Unloads the affected knee compartment
  • Limits ROM where required
  • Provides proprioceptive control


Articular cartilage defect repair needing unicompartmental load reduction or range of movement restriction. Cartilage knee trauma benefiting from unloading or movement restriction and needing pain relief.

May also be beneficial for other unicompartmental knee conditions that require unloading, movement restriction and pain relief such as:

  • Meniscal repair
  • Avascular necrosis
  • Condylar bone marrow lesions (i.e. bone bruises)

5 Ways You Can Avoid Running Injury

There is nothing more upsetting to a runner than suffering an injury. Weeks, months, and even years of training and fitness can be jeopardized by a slip on the ice, a turn of the ankle, or a chronic overuse injury. As runners get closer to their goal race, a paranoia starts to build. Here are some simple ways you can avoid injury and stay sane.

Running Injured

Running InjuryAccording to the Harvard Gazette, between 30 and 80 percent of all regular runners are injured in a given year. The American Academy of Physical Medicine and Rehabilitation narrows it down a bit more, reporting that nearly 70 percent of all runners will become injured. Let’s think about that for just a second. Seven out of every 10 runners are suffering from injury on an annual basis. Chances are, if you’re a runner, you’ll be injured, too. The most common running injuries are those caused by repetitive movements and stresses on the joints and tendons. You may recognize some of these more frustrating running injuries.

Runner’s Knee
Pain near the kneecap, especially after sitting for extended periods of time with knees bent or while walking down stairs or downhill.

Iliotibial Band Syndrome
Pain or aching on the outside of the knee, usually occurring in the middle or at the end of a run.

Shin Splints
Pain occurring in either the front or inside portions of the lower leg.

Achilles Tendinitis
Pain that begins as a mild ache in the back of the leg or above the heel after running.

Plantar Fasciitis
The pain is most noticeable when the foot flattens during weight-bearing or when pushing off with the toes during walking or running, and it is usually located near the heel.

Causes of Running Injury

There are two main causes of running injury: structural imbalance and training volume. Both can lead to injury, and many times the cause of the injury is not easy to diagnose. For example a foot problem can cause a problem in the knees, hips, or back. Finding, and treating, the cause of a running injury is the job of a trained expert.

Structural imbalance occurs when the body is misaligned, or when a certain muscle group is weak and requires other muscle groups to compensate. Structural imbalances can be caused by physical attributes like uneven leg length or severe overpronation of the foot. These physical problems will cause running injury unless diagnosed and treated.

The body adapts to stresses and becomes stronger. This is the basic principle of training. But, if you push too fast or run too far, you can stress the body in such a way that it never has time to fully recover and weakens instead. Training progression and temperance are the keys to avoiding overuse injury.

5 Ways to Avoid Running Injury

  1. Prepare your body for running by walking. If you’re a new runner, or returning to running after a long hiatus, you’ll want to start slowly and condition your muscles with a regular walking program. Cross-training activities like swimming, rowing, or cycling will help with the cardiovascular aspect of running. But, walking will strengthen the muscles, joints, and tendons where running injury often occurs.
  2. Understand your body type and be patient. For every pound of weight a person carries, they have four pounds on the knee when running. In other words, if you weigh 180 pounds, there are 720 pounds of force on the knee with each foot strike.
  3. Follow a sensible training plan or find a coach. Your training plan should consist of mostly easy days. The progression of a decent training plan accounts for rest in daily, weekly and monthly cycles. Remember that a generic plan is nothing more than a good suggestion. You can, and should, deviate from the plan if your body is sending you signals that something isn’t right. If you’re lucky enough to have a running coach, communicate openly about any concerns you have.
  4. Wear the right shoes. There are all kinds of shoes out there. Find a pair that feels good on your feet and compliments your running style. Replace your shoes when they no longer feel good. Specialty running stores can help you find the right type of shoe, but always ask about their return policy.
  5. Practice injury prevention. Always warm up slowly for 10 minutes before running. Do some dynamic stretching before your runs and some static stretching after your runs. Foam roll tired muscles before and/or after runs. Ice and elevate any potential injury spots as soon as you feel them. Incorporate some strength training in your weekly routine to help strengthen your core and stabilize your body to prevent injury.

Seek the advice of medical professionals before your injury stops you from running. And, most importantly, listen to your body and recognize the signs of over training so that you can avoid running injury.

- Competitive masters runner, RRCA Certified Coach for The Huffington Post


Leaders of Chicago healthcare: 75 people to know

Beckers Hospital Review recently listed 75 people, including health care executives, physicians and others, who have, through their dedication and expertise, contributed to the shape of healthcare in Chicago. Midwest Orthopaedics at Rush is proud to see two of its own on this list.

Charles A. Bush-Joseph, M.D.Charles A. Bush-Joseph, MD, is an orthopedic surgeon and sports medicine physician who performs the majority of his cases at Rush SurgiCenter in Chicago. Dr. Bush-Joseph is head team physician for the Chicago White Sox and an associate team physician for the Chicago Bulls.



Brian J. Cole, M.D., M.B.A.Brian Cole, MD, is the head of the cartilage restoration center, a multidisciplinary program specializing in the restoration of articular cartilage and meniscal deficiency, at Midwest Orthopaedics at Rush in Chicago. He has developed several innovative techniques for the treatment of shoulder, elbow and knee conditions. Dr. Cole has published more than 1,000 articles.

View the Complete List

ACL Injury Prevention

According to the American Academy of Pediatrics, athletes with ACL injuries are up to 10 times more likely to get knee osteoarthritis early and 50 percent of ACL patients will develop knee arthritis in 10 to 20 years. The AAOS confirms iStock_000006719049Mediumthat knee arthritis is one of the five leading causes of disability in older men and women. That’s why the Illinois Athletic Trainers Association (IATA) and Midwest Orthopaedics at Rush (MOR) are stressing the importance of ACL injury prevention programs and exercises. Research shows that by strengthening the muscles around the knee and improving strength, agility, balance and flexibility, athletes can reduce their risk of ACL injuries.  As part of the Knees For Life prevention program, the Illinois Athletic Trainers Association and Midwest Orthopaedics at Rush (MOR) sports medicine physicians, are offering a downloadable brochure of prevention exercises and complimentary gym bag tags that provide easy-to-understand instructions for warm-up exercises that any athlete can do before play.  This program will focus on providing exercises to improve strength, agility, balance, coordination and flexibility, and will decrease the risk of an ACL injury.  To obtain your free gym baggage tags with ACL prevention exercises, log on to:
How can you prevent an ACL injury?
Besides the exercises provided in the downloadable brochure, the IATA and MOR also recommend the following prevention tips:
  • Always engage in pre-season endurance training.
  • Rest and recover between workouts.
  • Wear proper protective equipment, including footwear.
  • Always hydrate before, during and after practice or game.
  • If pain occurs, discontinue sport and see a board-certified physician.

ACL Injury Treatment

From: Knees for Life

iStock_000007464012MediumHow are ACL injuries treated?

Most ACL tears are treated with reconstructive surgery in order to prevent collateral damage later in life. Patients should find a board-certified orthopedic surgeon who has completed more than 100 procedures. Surgery is a valid option for patients because it protects the overall stability and function of the knee. Surgeons use either an allograft (ligament tissue from a cadaver) or an autograft (the patient’s own tissue). Usually, surgery to reconstruct an ACL is performed arthroscopically through small incisions. The benefits of minimally invasive arthroscopic surgery include less pain and less recovery time. In most cases, the surgery is followed by physical rehabilitation to strengthen the joint and regain full range of motion.

What the Research Tells Us

Many studies report a high success rate after athletes undergo ACL reconstructive surgery. The studies prove that most athletes are able to return to their chosen sport once their ACL has been surgically repaired. Research has been conducted to test the return to sport (RTS) rate in many physically demanding sports, and in one particular study, researchers concluded that there is a 77 percent RTS rate in Major League Soccer after ACL reconstructive surgery. So, for those ACL patients who hope to continue playing at competitive levels, surgery is the best option.

About ACL Injuries in Children

ACL reconstructive surgery is usually standard treatment for adult athletes who tear an ACL. But what happens when a child sustains an ACL injury? Experts say the biggest concern about surgery for children is the knee’s growth plate at the end of the femur and tibia. This growth center is directly in the path of the drill holes, screws and staples that are typically used during ACL reconstruction. Studies show that a growing child who undergoes ACL reconstruction is at greater risk of having future knee problems. Therefore, physicians need to carefully consider those risks when deciding on surgery for younger children.


About ACL Injuries

From: Knees for Life

What is an ACL?

The anterior cruciate ligament (ACL) is one of four main ligaments in the knee joint. The ACL is a ligament in the center of the knee joint that connects the bottom of the thigh bone to the top of the shinbone and provides the knee with stability.

How does an ACL injury occur?

The ACL is commonly injured by a hit to the knee (contact) or when an athlete is stopping suddenly, pivoting, slowing down quickly after running or landing from a jump (non-contact). Athletes who tear their ACLs often hear a popping sound, accompanied by knee pain and instability.

Who is at risk?Football

Any athlete can be injured, but ACL injuries are more prevalent in those who participate in high demand sports that require pivoting and cutting movements or quick planting of the feet, such as soccer, lacrosse, hockey, basketball, football, skiing, volleyball, cheerleading and gymnastics.

The gender bias

Studies show that teenage female athletes are at higher risk of ACL injuries than teenage male athletes. Young women athletes are anywhere from two to 10 times more at risk of an ACL tear because of differences in biomechanics and body shape. Female hormones can also cause an increased looseness in ligaments, making girls more vulnerable to tears.

iStock_000021194481MediumWhy are ACL injuries on the rise?

The number of ACL injuries is skyrocketing – especially in young people. Nationally, nearly half a million injuries occur in the U.S. every year, and physicians in Philadelphia have reported a 400 percent increase in ACL tears in 10 years. The number of ACL patients seen by Midwest Orthopaedics at Rush (MOR) physicians has more than doubled in the last five years. Still, what concerns physicians the most is the increase in ACL injuries among athletes under 25 years of age. MOR noticed that the number of ACL patients in this age group tripled over the past five years.

Physicians agree that the rise in ACL injuries has to do with stiff competition and year-round play of one sport, without breaks or resting between seasons. The numbers are also high because more girls are playing competitive sports.


Teaming up to prevent ACL injuries!

Knees For Life

An ACL Injury Preventiion Program from the Illinois Athletic Trainers Association in collaboration with Midwest Orthopaedics at Rush.

Anterior cruciate Ligament (ACL) tears are among the most common injuries in young athletes today. National studies show a dramatic rise in ACL injuries — especially in female athletes — over the past 10 years. ACL injuries can lead to arthritis and other knee problems in aging athletes. Studies show that athletes can reduce their risk of injury as much as 72 percent by adhering to a knee strengthening and conditioning program. The Illinois Athletic Trainers Association (IATA) and sports medicine physicians at Midwest Orthopaedics at Rush (MOR), have teamed up to help prevent ACL injuries from occurring. Their public awareness program, “Knees for Life,” urges coaches and athletic trainers to institute ACL injury screenings and prevention programs for athletes at risk.

IATA and Midwest Orthopaedics ACL Injury Prevention Program PSA


Are Pro Golfers Too Bulked Up?

Tour Players May Be Working Out Too Much, Leading to Injuries

Maybe this is just a midsummer rough patch, but injuries among pro golfers have never been so much in the news, or of so much concern for the players themselves. “It’s not a football game. We are not taking hits out there,” Jim Furyk said last week. “But we’re doing a very awkward motion at a high speed and it’s repetitive, that same motion, over and over and over again.”


Tom Watson, the U.S. Ryder Cup captain, characterized the golf swing as a “violent” move. “They’re falling like flies,” he lamented, after watching Matt Kuchar and Jason Dufner, two potential members of his squad, drop out of the PGA Championship last week. Four other players also withdrew because of injuries. “The question you have to ask,” he told me Monday, “is whether the workout ethic of players today is causing these injuries.”

The answer is almost certainly yes, although other, interrelated factors are also involved. The Tour these days attracts bigger, stronger players than it used to, and their athleticism brings more torque to bear on their joints. Many of today’s players started focusing on golf exclusively at a younger age than formerly and thus accumulate more lifetime stress on their bodies. Seasons run longer, and players feel compelled by the increasingly competitive nature of the game to push ever harder for any advantage, particularly distance. Gym work itself may be part of the problem. “In the past, there were very few injuries because there were fewer professional golfers exercising,” said nine-time major champion Gary Player, a pioneer in golf fitness who said he never had to withdraw from a tournament because of injury. “While this might not make sense to an average golf fan, what you have to understand is that many of these professionals today are becoming injured because they are exercising incorrectly,” he emailed from South Africa.

Proper training seeks to reduce muscular imbalance to combat the one-sidedness of golf, increase mobility in the joints that need to be flexible such as the hips, shoulders and upper back, and strengthen muscular control in the core, glutes and legs. What’s incorrect training? Striving to look like Arnold Schwarzenegger. Greg Rose, a co-founder of the Titleist Performance Institute in Oceanside, Calif., acknowledges that Tour players’ intensely competitive nature sometimes works against them in the gym. “If you want to train like the Green Berets or the Navy SEALs, where a lot of the purpose is mental, to see how much you can handle, of course it’s high risk,” said Rose.

Most top golfers train directly with well-educated physical therapists and avoid this trap. “Working out properly has kept many, many more golfers on the golf course than it’s kept off,” said Rose, who works frequently with pro golfers. But over time, even the best training regimens wear down the body. “If you’re training harder, working out harder, it’s going to make you stronger and maybe help prevent some traumatic injuries,” said Joshua Dines, an orthopedic surgeon at the Hospital for Special Surgery in New York City who counts numerous professional golfers among his patients. “But every time you do a push-up or a lat pulldown or a biceps curl, you are risking an overuse situation. So it’s a constant balancing act between letting the body recuperate and making it stronger.”

Early specialization in golf adds to the toll. Jack Nicklaus, Hale Irwin and many other stars from previous generations played multiple sports through high school. Far fewer of today’s Tour pros did. “This is a problem across the board in sports,” said Dines, who is a team doctor for the New York Mets and has also worked with Davis Cup tennis. “We’re seeing a whole different spectrum of overuse injuries now, and in a lot younger population.” In baseball, for example, one study found that oblique muscle injuries rose dramatically between 2005 and 2012, even as players became more diligent about training. In golf, Tiger Woods, a physical mess at age 38, might be considered Exhibit A for the dangers of early specialization and intense training. Rory McIlroy has a golf timeline quite similar to Woods’s and is a recent gym-rat convert. Although McIlroy is still sound at 25, he could easily have problems down the line.

The new wraparound schedules that top international pros follow don’t help, either. Even if they don’t play in many more tournaments than they used to, many pros now have essentially no off-season and continue to train year-round. Then there’s the issue of the so-called modern golf swing, characterized by keeping the lower body planted and comparatively stable while generating power for the swing through the torque created against that platform by the rotating upper body. It can be murder on the vulnerable lower back.

Rose at TPI has worked extensively with professional long drivers like Jason Zuback. Their swings, designed for maximum distance, more closely resemble old-fashioned swings. They lift their left heels off the ground, rotate their hips more, and “jump” at the ball, relying far less on the lower back for power. “The modern swing, with fewer moving parts, is designed primarily for accuracy,” Rose said. “When you take that technique, and add power to it, as the modern pros have to do, you put extremely high stress on the body.”

So what’s a modern Tour pro to do? First, they have to accept that, increasingly, injuries are part of the business. Second, treat the injuries they do get appropriately and give them time to heal. Many seem to be getting the message, which may also contribute to why we’re hearing so much more about injuries. “Seven years ago, I would have tried to play through this injury,” Michelle Wie said last week after announcing she would be missing three to five weeks because of a wounded finger. In 2007, Wie suffered a serious wrist injury but unwisely played on. “It is important to me not to make that mistake again,” she said.

Furyk has had injuries to both wrists over the years, but in general has enjoyed a healthy career. At 44, he is ranked No. 6 in the world. “Any nicks and bumps and bruises I’ve had, I’ve done a good job of getting out ahead of them instead of waiting until I was hurt or had a hard time playing. I’ve tried to be preventative,” he said.But that’s not his only secret. “A lot of it is good luck,” he said.

-John Paul Newport for the Wall Street Journal