MCL Injury Basics with ATI’s Hockey Injury Expert

 MCL Injury Basics with ATI’s Hockey Injury Expert

By Brian Rog with Contributions by: Andrew Grahovec and Katie Christopherson, ATC for ATI Physical Therapy.

To compete at the professional level in any sport requires the most athletic, highly skilled and mentally acute individuals in the world. With constant training, practice and exhibitions throughout a season, pushing your body to the utmost physical limits can take a toll on the body over time. In ice hockey, players, by nature, are regarded as some of the toughest athletes on a mental and physical level.

As one of the fastest sports, the conditions during play are dangerous and require sharp focus, balance and grit to compete at a high level. With the speed and physicality of the game, the risk of injury is significantly increased. It’s no surprise that one of the most common types of injuries sustained during play involve the knees.

To get a better feel for the inner workings of the MCL (Medial Collateral Ligament) and MCL injury insight, we teamed up with ATI athletic trainer and hockey injury expert, Katie Christopherson.

The role of the MCL

Considered one of the four primary stabilizing ligaments in the knee, the MCL is the innermost ligament of the knee designed to protect the knee joint’s stability and strength. It also plays a key role in preventing the leg from over-extending inward. For hockey players, the MCL is crucial in helping the knee manage the on-ice demands of skating, planting for contact and more.

Symptoms of an MCL injury

When an MCL becomes injured, you may experience pain on the inside edge of the knee, along with swelling and tenderness. Several hours after the injury, this discomfort may be coupled with difficulty moving and increased levels of pain. It’s also not uncommon to feel a ‘loose or wobbly’ feeling in the knee when walking. At this point, we recommend getting in touch with your primary doctor or local physical therapist to further assess the injury.MCL Injury assessment with ATI

Grades of MCL injuries

Since the MCL’s primary role is preventing the leg for overextending inward, naturally, it assumes a substantial amount of the body’s weight. Because of this, an athlete is more susceptible and likely to experience an injury to the MCL, rather than the LCL (Lateral Collateral Ligament), which is located on the outer side of the knee – opposite of the MCL.

MCL injuries are classified according to three different grades including:

·         Grade 1 (minor): results from a force strong enough to stretch the ligament, but not tear it.

·         Grade 2 (moderate): stretched ligament with some tearing involved

·         Grade 3 (severe): completely torn ligament – and most sever of the three grades

Which sprain is the most common among hockey players?

Given the fast-paced, high-contact nature of the sport, hockey players are at an increased risk of injuring their lower body structures. When looking at the MCL specifically, it’s more common to see Grade 1 MCL injuries resulting from less abrasive blows to the knee or mild twisting motions at the knee. For Grade 2 and 3 MCL injuries, we tend to attribute those to the more nefarious blows or extreme twists to the outside of the knee, which still happen, but not as often as the former.

Rehabbing an MCL Sprain

Among the three grades, a Grade 1 treatment is a more straightforward than the others. A Grade 1 sprain can take typically one to two weeks to heal, whereas a Grade 2 and 3 injuries may take two to four weeks and four to eight weeks, respectively.

MCL Physical TherapyIn rehabbing an MCL sprain or tear, your physical therapist or doctor first determines the grade of the injury and the effect it has on the knee during weight-bearing (the body’s ability to resist or support weight). They’ll also note how the knee joint moves through flexion (bending motion) and extension and how that force displacement is on the MCL. This will ultimately decide what treatments and strengthening methods to use.

Initially, an athlete’s treatment should consist of pain-free, range of motion exercises, such as knee slides on the table, wall slides, assisted slides and riding a stationary bike.

As pain subsides and range of motion increases, this usually indicates that an athlete is ready to incorporate flexion and extension exercises – like open-chain strengthening (hands or feet are not in a fixed position). But that’s not to say that an athlete should shy away from closed-chain strengthening (hands or feet are in a fixed or stationary position), as these are also effective exercises to build into a program.

Once an injured athlete progresses to the more advanced stages of rehabilitation, a concentration on functional activity will be introduced. This may include plyometric exercises and functional activities to ensure dynamic stability of the knee.

At this stage, a great tool for rehabbing a hockey player is a slide board, which is a slick surface that can mimic the motion of the athlete’s leg on ice.  

Dealing with a knee injury?

ATI experts strongly encourage athletes to take care of any minor aches and pains before they compound and get worse. This can be as simple as heating for 20 minutes before activity and icing for 20 minutes after activity when the athlete feels soreness in one particular area. If the pain persists, it might be a good idea to call your physician or visit your nearest ATI physical therapy clinic. In fact, at ATI, we offer complimentary injury screenings, so stop in and see what we can do for you.

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An Athletic Trainer’s Role in Helping Prevent, Assess and Care for a Concussed Athlete

An Athletic Trainer’s Role in Helping Prevent, Assess and Care for a Concussed Athlete

By ATI Physical Therapy

The role a certified athletic trainer (ATC) plays in preventing, assessing and caring for a concussed athlete is critical to an athlete’s return to play and overall health. The ATC is often the first line of defense in injury prevention, which is why it is essential they be on the field, court or arena where injuries may occur.

As injury cases such as concussions, continue to evolve, keeping up with these progressions requires a careful adaption in the injury assessment treatment methods. To that, ATI Physical Therapy ATCs put a great deal of effort in staying up on monitoring symptoms along with implementing return-to-learn and return-to-play protocols.

As far as preparation, ATI’s Sports Medicine division is pivotal in ensuring all ATCs are prepared to assess concussions by requiring them to undergo very specific and rigorous training programs that educate the team on current protocols prior to each sport’s season.

Concussion prevention

In an effort to thwart off a concussion, an ATC will continually work with their athletes to provide effective guidance and education on techniques that help with avoiding concussion-enabling situations. In doing this, an ATC will often follow these protocols:

  • Ensure: Ensure that the players’ equipment is properly fitted and the playing environment is safe to participate.
  • Educate: Educate coaches, parents and players before the start of the season about the inherent risks of a concussion and the proper protocol if a suspected head injury has occurred.
  • Assist: Assist with strengthening programs that increase neck stability, which can decrease the frequency of concussions.

Assessing concussions

In recent years, return-to-play success rates have steadily enjoyed a healthy uptick. With much help from researchers such as Dr. Ellen Shanley and her work on youth football tackling and training methods, concussion assessment protocols and tools continue to improve.

There are several neurocognitive systems that most high schools utilize, which obtain a baseline test score pre-participation. As a result, if a concussion is suspected, a post-injury test can be performed immediately. In some states, there have also been increased state regulations that all high schools must follow. This has significantly improved the landscape of how concussions are assessed and treated.

Concussion care

When an athlete is diagnosed with a concussion, an ATC is responsible for looking after the concussed athlete on a daily basis. Since every concussion is unique, each case must be handled individually to ensure the athlete is completing all the required steps and is ready to safely return to action. Traditionally, the stages ATI ATCs follow for a concussed athlete include:

  • Education: It is crucial that a concussed athlete and their family be educated on the injury, what to expect and the next steps that need to be taken.
  • Contact: After an injury occurs, the ATC is the point-person for any orders from the athlete’s primary physician for school modifications and symptom monitoring. When an athlete is symptom-free, the ATC will be in contact with their doctor, school nurse, coaches and athletic director to ensure the athlete advances on to the return-to-learn phase.
  • Return-to-Learn: The return-to-learn phase is when the athlete returns to school and begins working their way back to a full academic workload.  The ATC coordinates with the school nurses and councilors to ensure the athletes are following physician protocols and safely moving through the return-to-learn phases.
  • Return-to-Play:  Once the return-to-learn protocol is completed, the ATC completes a return-to-play progression with the athlete. This is a step-by-step process that ramps the athlete’s activity level back up. This serves to ensure that the athlete’s symptoms don’t return and that the athlete has the confidence to return to their sport they love to play.

Spotting a concussion

Spotting a concussion is a method that continues to change in the concussion climate, which is why it is crucial an ATC be current on assessment protocols. In its most common form, a concussion can be spotted when an athletic trainer sees a head-to-head collision. A head-to-head collision is the most obvious indicator of a concussion and almost always warrants a thorough evaluation provided by an ATC. It is important to note that not all concussions come from head-to-head collisions.  Some concussions come from rapid rotation or can even be caused from smaller repetitive blows to the head.

Assessing a concussion in the initial stages can be tricky, which is why it is important athletic trainers connect with their athletes and get to know them personally to spot any unusual changes in their mood and energy. An ATC will put themselves in the middle of the athletes during timeouts and breaks during practices and games to get a read on their athletes, look at their eyes and ensure that everyone is healthy to participate. While an ATC serves as the team’s primary concussion-spotter, it is also important that athletes and coaches catch potential head injuries and communicate any potential issues with the team’s ATC.

Recently, new technology in helmets can measure and notify athletic trainers when a high velocity impact has occurred. Athletes wearing this technology in their helmets will be pulled from practice or competition if an impact hard enough to cause damage occurs or if several smaller impacts have occurred and the sum of those collisions crosses a certain threshold.

Playing with a concussion

An athlete who continues to play with a concussion is putting their health at an increased risk of sustaining something called second impact syndrome.  Second impact syndrome is a condition that occurs when a second instance or injury occurs to the brain that has already sustained an injury that was not completed healed.  This has the potential to be a life-altering injury. This is why ATCs are so vital in preventing, assessing and caring for head injuries.  If you or someone you know has recently experienced a head injury, get it checked out right away. Stop by an ATI clinic near you or schedule a complimentary screening at ATI Physical Therapy today!

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The Ride of a Lifetime – Overcoming a PCL Tear

By Andrew Grahovec for ATI Physical Therapy

The Ride of a Lifetime – Overcoming a PCL Tear

The road to recovery is never without its own slew of setbacks and can often times be afflicted with challenges tougher than the ones that put us there. For Janesville, Wisc., native Evan Webster, his road to recovery saw its beginning after he collided with a deer while riding his motorcycle back in September of 2017. After the accident, Evan quickly began to lose the ability to use his left leg. Realizing this was far from normal, he decided to go see a doctor where he discovered his posterior cruciate ligament (PCL) was completely torn. Unfortunately, Evan didn’t have insurance at the time, so he chose not to undergo surgery to repair his PCL. As a professional roof inspector, this was especially tough for Evan because he relies heavily on his mobility to perform his day-to-day duties.

Performing the simplest tasks at work soon became a struggle for Evan, so much that he began losing the ability to climb a ladder, run, jump and even walk. Terrified that he’d never recover from his injury, Evan looked to ATI for help.

Evan came to ATI’s Janesville clinic and met clinic director Ryan Kluck, PT, DPT, CSCS to see if there was anything that could be done. Together, they assessed the strength and mobility of his knee, set a goal and focused on rebuilding the muscles in his leg once a week for three months. As the weeks went on, Evan slowly began to regain his flexibility and strengthen the muscles in his knee. Therapy was tougher than anticipated, but Evan remained committed to working through the pain and never lost focus on making it to the finish line. Thanks to this commitment and the Janesville ATI team’s support, Evan was able to power through this incredibly misfortunate situation and get back to doing what he loves – riding on the open road – and working, of course.

Rather than us tell the story, it only made sense to hear it from Evan and Ryan directly. Enjoy!

What circumstances led to you needing physical therapy? About a year ago, I hit a deer on my motorcycle. Upon impact, its body hit my left side and tore the PCL in my left knee. I couldn’t afford surgery so I was stuck waiting to see what would happen. Over the course of two months, I began to lose the ability to go up and down stairs or get up from a chair without feeling pain. I also began losing the knee strength to do my job, so I knew something had to be done.

What expectations did you have going into therapy?

Going into therapy, I was confident I would regain most of the strength back in my knee, however, I was under the impression that the pain was there to stay. I also thought it was going to be expensive. As fate would have it, I was very mistaken, on both accounts.

What was your treatment like? Was it tougher or easier than you expected?

We first had to determine the strength and flexibility in my left leg compared to the right, so we started with some light flexibility and body weight exercises. As the weeks went on, I slowly began regaining my flexibility and muscles strength. Working on my tissues was also a huge part of therapy and Ryan found adhesion spots to work on every session. It was a lot tougher than I anticipated, but like anyone with a body limitation, working through it with a positive mindset was the most important thing I could do. With the help of Ryan and the entire ATI staff, making progress was easy, but there’s no substitute for hard work.

In what ways has physical therapy helped you in your daily life?

Physical therapy not only gave me my job back, but it also gave me my life back. I now have the freedom to run, jump and play sports again. Work is pain free and I no longer have to worry about the future anymore.

Was there anything in particular that stood out during treatment?

I really enjoyed how involved Ryan was e during my treatment. He was up to speed on everything going on and was fully invested in my development and helping me regain my strength. I was shocked at his work ethic and the undivided attention he gave me during every visit, especially since I wasn’t his only patient. This gave me something to look forward to every time and always made my experience a memorable one.

How have things been since graduating from your PT treatment?

Since graduating ATI, I’ve gotten a lot stronger and I’m an all-around happier person. Before my accident I had no idea what physical limitations felt like, so I feel like this was a taste of it. Since I’ve left [physical therapy] I have a new found love and appreciation for everything the ATI team does – they literally save lives.

To learn more on Evan’s progressions and efforts throughout treatment, we spoke with clinic director Ryan Kluck, PT, DPT, CSCS, to get his perspective on the recovery.

What were the biggest challenges during Evan’s treatment?

Evan was only able to come in once a week, so the biggest challenge was having him keep up with weekly exercises, without me there to watch his form and make sure that he was completing what was prescribed. He also has a very unique job requiring him to walk on very steeply pitched roofs, so trying to replicate the angles he has to navigate was a challenge.

What stood out about Evan during his treatment?

Evan was very motivated to get back to his prior level of function. He learned the exercises quickly and always had a great attitude towards the challenge that lay before him.

What do you feel were the keys to Evan’s treatment successes? 

I credit much of Evan’s successes to his positive attitude, determination and ability to follow the plan I set for him. He was always into exercising, so that helped him grasp the home program he had to follow. As his function improved and he could do more exercises, he became more motivated to get back to the workouts he was used to doing before his injury.

Are aches and pains getting in the way of your daily activities?

If simple home interventions are not helping to lessen aches, pains and discomfort, it’s time to see a physical therapist. Stop by your nearest ATI Physical Therapy clinic for a complimentary screening and get back to doing you.

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Is Toe-Walking an Early Sign of a Health Condition?

By Brian Rog with Contributions by: Annie Kender, PT, DPT, C/NDT of the ATI Grand Blanc, Mich., Clinic

Is Toe-Walking an Early Sign of a Health Condition?

When a child learns to walk, instinctively, he or she will begin walking with their feet flat on the ground. But because this is a skill that takes much practice, it’s not uncommon for them to transition on and off their tip toes as their walking abilities develop.

Some children begin walking on their toes for stability, others walk on their toes for sensory reasons – these children sometimes have difficulty tolerating pressure through their heels or they prefer the sensations (or proprioceptive input) they received from their joints locking out. Children may also walk on their toes due to range of motion restrictions in their calf muscles (gastrocs).

As your child’s coordination and muscles develop, they will begin walking with a heel-toe pattern; on average around 18 months of age. However, should those heels remain ascended beyond age 2-3 as your child’s only means of getting around, this may be an early sign of a neurological condition (Cerebral Palsy, Spina Bifida, Tethered cord, etc.). Conversely research reports 7-24 percent of children who walk on their tip-toes are idiopathic toe walkers, meaning they do not have a correlated disgnosis such as Cerebral Palsy.

When to see a specialist

Research supports the idea that heel strike in children begins around 22 weeks following initial onset of walking independently. For the majority of children, this occurs around 18 months of age. Toe walking is not considered a normal part of this early independent gait. As we mentioned, if by age 2, your child hasn’t outgrown toe walking, this may be an indication of neurological immaturity or muscle weakness.

To that, ATI Physical Therapy experts suggest consulting with your pediatrician, because if left untreated, toe-walking can put your child at further risk for contractures, foot deformities and balance deficits. And in severe cases, your child may require surgical interventions if deformities or contractures are advanced. Fortunately, physical therapy interventions are an effective way to help your child overcome this.

Long-term effects of toe walking, if left untreated

As you can imagine, toe-walking places a great load on the muscles and tendons. Many children who consistently walk on their tip-toes since establishing independent ambulation, may develop foot deformities as early as the age of four. These children may demonstrate ankle range of motion restrictions, impaired balance and poor postural alignment.

Physical therapy for toe walking

Therapeutic treatment such as physical therapy can assist your child in achieving a heel-toe gait pattern as well as correcting any range of motion restrictions, muscle imbalances and postural deformities.  After identifying the child’s origin for toe-walking, a plan of care is established to address the child’s deficits. Treatment methods typically include stretching, strengthening of lower extremities and core, balance retraining, sensory integration techniques, serial casting, orthotic training and a home exercise program.

After completing physical therapy, what’s next?

Once your child has successfully completed their PT treatment, you will receive a home exercise program to further continue their treatment plan at home.

For children with an established heel-to-toe pattern, who no longer demonstrate weakness or range of motion restrictions, their home program is minimal. For children with neurological conditions as an underlying source of their toe-walking, they may require intermittent services over their lifetime to maintain gains, usually around growth spurts.

Is your child toe-walking? ATI may be able to help

If you are concerned about your child’s toe-walking tendencies, we first suggest connecting with your pediatrician to determine the next course of action. Should physical therapy be required, please don’t hesitate to contact your your nearest ATI physical therapy clinic to see what pediatric therapy options are available for your child.

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