Concussions in Cheerleaders: Symptoms and Treatment

By Tara Hackney, PT, DPT, OCS, KTTP for Athletico Physical Therapy

Cheerleaders are commonly seen on the sidelines of school and professional sporting events, but the sport is no longer reserved for the sidelines. Cheerleaders have their own competitions where they are in the spotlight. Competitive cheerleading participation is on the rise with teams ranging in age from 5 years old through college.

All-Star cheerleading is the name used to refer to cheer groups created for competition and not associated with any school or team. Competitive cheerleading is divided into groups according to age and each group has different levels according to experience. Cheerleaders perform tumbling, stunting and pyramids as part of their routines. As with any sport, injuries can occur.

Did you know that the most common injury in competitive cheerleading is concussions? The overall injury rate in cheerleading is low; however of those injuries, concussions account for 31.1 percent.1 You may be thinking this high rate of concussions would be from cheerleaders falling and landing on their heads. However, the cheerleading position that suffers the most concussions are the bases, the athletes who support the flyers in the air by holding them up and catching them. This position is at risk for concussions as a flyer may fall on top of them, or from a foot or elbow hitting them in the head as the flyer comes down from a stunt. In fact, it is more likely in cheerleading for a concussion to occur after contact with another athlete than with contact with the floor.

Concussion Symptoms

Any one or more of the following signs and symptoms may indicate a head injury:

  • Headache
  • Nausea or vomiting
  • Dizziness
  • Coordination or balance issues
  • Blurred or double vision
  • Light and noise sensitivity
  • Feelings of sluggishness
  • Memory or concentration problems
  • Altered sleep patterns

Signs observed by coaches or other team members that may indicate a concussion has occurred:

  • Stunned or confused appearance
  • Forgets arm motions or cheers
  • Confused about formations in routines
  • Unsure of surroundings
  • Moves clumsily
  • Loss of consciousness (long or short)
  • Personality or behavior changes
  • Forgets events right before or after a blow to the head

If a head injury or concussion is suspected, the athlete should not return to play prior to 24 hours after the initial incident and should be cleared by a physician prior to returning to sport.

Concussion Management

Concussion management is evolving through research. There is strong evidence to support an active approach to rehabilitation of concussions. Physical therapy is one way to help manage the symptoms following a concussion. Physical therapy can include management of neck pain and headaches, balance exercises, progression of exercise tolerance and cardiovascular activities, and vision training. Ideally, an athlete will complete a graded exposure program that starts with symptom limited activity, progress through light aerobic activity, and transition to sport-specific incremental intensity training. Finally, the athlete will be cleared to practice prior to being cleared to compete.

Speed of recovery after concussion is individualistic for each athlete and may be affected by severity of trauma, area of the brain injured, age, gender, past medical history, and previous history of concussions.

Please visit our Concussion Page to learn more about our services.

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3 Essential Exercises for Shoulder Stability

Brian Whittington, PT, DPT, CMTPT for Athletico Physical Therapy

The shoulder is a complex joint that consists of a “ball” on one side and a “socket” on the other. Due to this construction, the shoulder is classified as “ball-and-socket” joint. To gain a better perspective on the size of this ball-and-socket joint, think of a golf ball sitting on a tee. On one side you have a really large ball and the other a small socket. The proportions of this large ball and small socket allows for the shoulder joint to have the largest amount of motion of any joint in the body, but there is a price to pay for this amount of motion.

Because the shoulder enjoys so much freedom of motion there is a certain amount of inherent instability in it. Yet, experience tells you that your shoulders don’t fall apart whenever you try and use them. This is prevented by the surrounding shoulder musculature providing the crucial stability it needs during movement. Without this dynamic stability, your shoulders would be in big trouble.

Many of these stabilizing muscles are found on and around your shoulder blade. This means your shoulder blade has an important role in restoring or maintaining the shoulder function, and exercises focusing on this area are critical for proper shoulder stability.1 Here are three shoulder blade exercises that can help build your shoulder “core” to provide superior shoulder stability:

  • If you are currently experiencing shoulder pain, it is recommended to first have your shoulder examined before performing these exercises.

Dynamic Hug – Serratus Anterior Strengthening

Stand with one foot in front of the other and the resistance band around your back or secured behind you. Start with your elbows bent and your hands at chest height. Straighten your elbows while simultaneously reaching as far forward as you can, bringing your hands together at the end of the movement. During this exercise, your arms should be parallel or just slightly above parallel to the ground.

The key to this exercises is to make sure you are reaching as far forward as you can, performing a ”punching” motion. This exercise focuses on strengthening the serratus anterior, which is an important muscle in providing proper shoulder blade upward rotation that is needed for proper shoulder function.

Prone Y- Lower Trapezius Strengthening

Lie on your stomach with one arm off the table or bench and your hand pointed toward the ground. Raise your arm on a 45 degree angle until it is parallel to the ground. When you are performing this exercise, squeeze the lower portion of your shoulder blade toward your spine. Pause for a moment before returning to your starting position.

To advance this exercise, perform both arms simultaneously while on a stability ball. During this advanced exercise, keep your neck in good alignment by not looking forward. Instead, look at the ground a few feet in front of you.

This exercise focuses on strengthening the lower trapezius. This muscle is not only important for performing shoulder blade upward rotation, but also is involved in bringing your shoulder blade down and in toward the middle of your back.

Stability Ball High Row with External Rotation – Middle Trapezius, Infraspinatus, and Teres Minor

Sit on a stability ball (hips and knees at 90 degrees) with a resistance band secured in front of you. Start with your arms in front of you at shoulder height. Perform a row, squeezing your shoulder blades together. When your elbows are in line with your shoulders, rotate your shoulders so that your hands are now toward the ceiling. Return to the starting position by reversing the sequence.

This exercise strengthens the middle trapezius, which is important for bringing the shoulder blades together. The exercise also strengthens the infraspinatus and teres minor, which are important muscles for stabilizing the shoulder during movement.

Increasing Shoulder Stability

Adding these three exercises into your shoulder routine can assist with proper shoulder blade mechanics and help maintain proper shoulder stability. If you experience unusual aches and pains during exercise, make sure to schedule a free assessment at your nearest Athletico location.


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Plantar Fasciitis: How Physical Therapy Can Help

Plantar Fasciitis: How Physical Therapy Can Help

By Sarah Ryerson, PT, ATC, CSCS for Athletico Physical Therapy

Plantar fasciitis is one of the most common causes of heel pain. This condition impacts the plantar fascia, which is a thick band of fibrous connective tissue on the bottom of the foot that extends from the heel to the toes. Based on its location and makeup, the plantar fascia is ideally positioned to maintain and support the arch on the bottom of the foot. However, it is not designed to be the primary stabilizing structure.

Both muscles and tendons of the foot perform a primary stabilizing role, but weakness or dysfunction of these muscles can increase demand on the plantar fascia. This may lead to the characteristic heel pain experienced by those dealing with plantar fasciitis. This heel pain results from increased tension in the plantar fascia pulling on the attachment site at the heel when the foot is loaded with weight bearing. In addition, the plantar fascia can become inflamed or tight for a number of other reasons, including prolonged standing, beginning a fitness program or activity with increased weight bearing demands, calf tightness, decreased ankle dorsiflexion range of motion, increased BMI, or a high or low arch.

Poor running mechanics, change in activities or footwear, and dysfunction in the muscles of the hip or leg may also result in gait alterations and weight bearing that can lead to increased demand on the plantar fascia. Therefore, if plantar fasciitis symptoms become chronic or fail to resolve, an evaluation by a physical therapist to determine the underlying cause(s) is recommended.

Common characteristics of plantar fasciitis include:

  • Heel pain at attachment of the plantar fascia
  • Heel pain associated with initial ambulation in the morning or after prolonged sitting
  • Increased pain with walking, especially barefoot and standing

Plantar fasciitis is most prevalent in athletes, commonly runners, as well as sedentary, overweight individuals. The condition also commonly occurs in patients with either flat or high arches, and is frequently associated with decreased ankle range of motion, poor calf flexibility, and decreased foot and ankle strength. In addition, plantar fasciitis is commonly noted in populations with decreased hip strength and lower extremity stability, as well as those with alterations in gait or weight acceptance on the foot.

What can a physical therapist do for patients with plantar fasciitis?

Fascia mobilization – Mobilization of the fascial adhesions on the plantar surface of the foot is essential to remodel scar tissue and improve pliability for weight bearing demands. While ball rolling on the bottom of the foot to address muscle tension can assist with mobility, it usually is not deep enough to localize restrictions. Not only can a therapist more specifically target primary restricted regions, but he/she also can address limitations in ankle and foot mobility prohibiting the foot from adapting to the ground for even weight distribution with walking.

  • Graston/ASTYM – Graston Technique® and ASTYM® are both methods of instrument assisted soft tissue mobilization that use uniquely crafted tools designed to target connective and soft tissue restrictions in the body. A physical therapist trained in one of these techniques can directly localize restricted regions to remodel the scar tissue causing stiffness, limited mobility and chronic pain. Improving mobility and pain will serve to restore function of the foot.
  • Dry Needling – Dry needling is a form of trigger point therapy intended to release restrictions in muscles that result in pain and altered movement. While the plantar fascia is not directly treated, addressing “knots” in proximal calf and hamstring muscles provide favorable benefits.
  • Evaluation of running/walking mechanics – Physical therapists are trained to not only recognize muscle weaknesses and imbalances during a typical evaluation, but also to understand how these deficits can impair the functions of walking or running. An analysis of muscle function enables a physical therapist to prescribe exercises addressing observed deficiencies. Exercises that are functional more directly treat how the body performs as a unit during activities.
  • Low-Dye or Kinesiotaping – Low-Dye is a form of taping that prevents flattening of the arch, which can offer support and therefore pain relief to the plantar fascia during weight bearing activities. Kinesiotaping is a rehabilitative taping technique that uses uniquely manufactured tape to promote the natural healing process of the body by providing muscle support. This helps to improve function without limiting natural mobility. Patients who have an improvement with taping may also benefit from orthotics.
  • Selection and instruction in exercises to target muscle tightness and weaknesses – As the entire lower extremity chain must control and coordinate mechanics for walking, a thorough evaluation of the hip, knee, ankle and foot is necessary. Proximal hip strength and stability deficits may result in increased weight bearing demands on the foot and restrictions in tissue mobility can alter how the foot strikes the ground and therefore adapts to weight demands. Additionally, as foot and ankle strength deficits and limited ankle range of motion may be primary contributing factors to plantar fasciitis, appropriately targeting these causes is essential to long-term management.
  • Shoe wear recommendations – While individuals having either low or high arches can develop plantar fasciitis, the choice of appropriate shoe wear can differ vastly. A therapist can not only evaluate how your foot accommodates to the ground, but also offer shoe recommendations to reduce pain with walking and standing.

If you have symptoms of plantar fasciitis, schedule an appointment at a nearby Athletico clinic today so our experts can provide treatment recommendations and help you get back to doing the things you love to do.


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Outdoor Winter Workout Tips

outdoor winter workout tips

By Tara Hackney, PT, DPT, OCS, KTTP for Athletico Physical Therapy

Winter is here! As the weather turns cold, snowy and icy, it makes outdoor workouts seem impossible. Cold weather does not mean all outdoor workouts must cease, but there are ways to keep up your routine or even try a new wintertime workout. Here are some tips for working out in the cold:

Outdoor Winter Workout Tips

  • Start by warming up indoors – this can include a 5-10 minute jog in place, jumping jacks or jumping rope. By doing this, your body starts off warmer when you go outside into the cold.
  • Don’t exercise outside if the temperature is too cold – know your limits and make sure to check the wind chill before deciding to work out outdoors. In general, it is a good idea to exercise indoors if the wind chill is zero or below to avoid conditions like hypothermia or frostbite.
  • Check the weather before you leave your house – make sure there isn’t a storm in the forecast or any large change in the weather that could leave you at increased risk for frostbite during the length of your workout.
  • Try to work out outside when it is warmest, which is typically near midday – to do this, try exercising on your lunch break or leave your outdoor workouts for the weekends and supplement with indoor workouts during the week.
  • Dress in layers –
    • A sweat wicking fabric should be closest to your body (not cotton)
    • The next layer is an insulation layer such as fleece or wool
    • The outer layer should be waterproof
    • Make sure to protect the head, hands, feet and ears
    • Consider a scarf or mask that can cover the face if it is really cold
  • Beware of icy conditions, as this can increase your risk for falling during a workout –
    • Make sure you select footwear with good traction
    • There are also removable options that can be attached to shoes to give added traction on icy sidewalks or terrain
  • Know the signs of frostbite and hypothermia –
    • skin color changes
    • numbness
    • tingling or stinging
    • ice crystals on the skin
    • vigorous shivering
    • lethargy
    • amnesia
    • fine motor skill impairment

Other Options for Winter Workouts

Sometimes an outdoor workout is not going to happen during the winter months. This can be a great time to try a new workout or to change up your routine. There are several options that can be effective, including at-home workouts or gym workouts that could include using weights or joining a class. Here are a few options:

  • Water workouts – these are a great change in pace and allow you to work muscles that may not get as much attention with traditional outdoor workouts. Find a local gym with a pool to try swimming or other water based workouts.
  • Yoga – this is a great indoor activity that can help you focus on stretching, core strengthening, and can be a good compliment to your normal workout routines
  • Something new – there are many workout options that may be new to your routine, including spin, Pilates, POUND, Zumba or body pump. These classes are a fun way to work out when the weather drives you indoors.
  • Fun winter-specific workouts, like cross country skiing or snowshoeing – these are both amazing cardio and strengthening workouts for both the upper and lower body.
  • Take the time during the winter months to focus on any problem areas that may have shown during the warmer months – if you had any areas of pain or weakness during the rest of the year, now is a great time to focus on stretching and strengthening that area to prevent any aggravation when you resume your regular outdoor workouts.

Heading into the Spring Injury-Free

Regardless of the workouts you try this winter, it is important to pay attention to your body so you can head into the warmer weather without injury and ready to resume your normal routine. Should unusual aches and pains occur during or after a workout, schedule a free assessment at a nearby Athletico so our experts can help you heal.


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