Athletes need to be strong and well prepared for the demands of their sport, by understanding what type of demands are placed on their body, such as lumbar endurance, coordination of lumbo-pelvic movement, and postural control. These factors should be taken into account when creating effective strategies for training. Transcript: "Athletes need to be strong and they need to be well prepared for the demands of their sport. There are many different types of sports which place many different types of demands on the body. Repetitive strain versus frequency of games or competition versus intensity of training versus phase of the season. So the effective strategies are first of all understanding what type of demands are placed on the spine during the sport and then what levels of intensity ebb and flow during the season. Once you understand that there are certain basic things that you can look at such as the lumbar endurance, the Soroson's test where we effectively ask the individual to support their body weight for a given period of time and there are certain benchmarks. So they would be lying face down and supporting themselves from the pelvis up in an extended position. That would be one example. Another would be coordination of lumbopelvic movement. Do they have good postural control? Those would be some of the key things we would want to look at. And then we would look at how the lumbar spine can expand."
Flow Restriction Training is mainly focused on hypertrophy, which can increase an athlete's strength and resilience, as well as decrease the amount of weight used in exercises to reduce strain on the spine. Transcript: "Blood flow restriction training is predominantly actually focused on hypertrophy, which is increasing the cross-sectional area of a muscle, and as a consequence of that should be a concomitant increase in strength and perhaps also strength endurance, depending upon the type of exercise that we're doing. The protocols don't specifically imbue additional strength or resilience or spinal health per se, however, a stronger athlete is going to be more resilient and they're going to be more capable of resisting the types of forces that are going to be placed through the body. In addition, we can also mitigate overload. So for example, when we use blood flow restriction training, we can decrease the amount of weight to get the same hypertrophy effect, which means that for example, on a back squat, the type of load or compression on the spine, the forces may be less. So it would be protective rather than preventative."
New official training refers to eye movement training, which helps improve the efficiency of eye movements and coordination. This can lead to improved spinal health, as it allows for faster processing of visual information and a quicker response time to prevent injuries such as concussion. Transcript: "Neurovisual training refers to a technique of using classic optometric type exercises or eye movement training. These focus on using the ocular motor muscles in a way to improve efficiency of eye movements, accuracy of eye movements, and coordination of eye movements. The reason that this may be beneficial to spinal health if you could make a direct connection is that the eyes are, or perception rather, is the speed with which the brain can process visual information coming in and then produce an appropriate reaction. So the faster you can process information coming into the brain, the more efficient it is, the more quickly you can produce an appropriate response. So for example, it might be head up in hockey, it might be avoiding a tackle in football. So those would be some of the benefits of neurovisual training and we particularly use it for concussion risk minimization."
TBI, especially the second, third, and fourth instances of it, are complex due to the metabolic cascade that can occur after a brain injury, which can affect any part of the brain. This means that some treatments may fall outside of what I as a musculoskeletal practitioner can do, so it is important to have a neurologist or nurse practitioner on staff to help with medical needs and psychometric effects. Transcript: "Because TBI, particularly second, third, fourth instance of traumatic brain injury, are such a complicated condition, in part because of the metabolic cascade which can occur after a brain injury, and the effect that can have the brain tissue is that it can affect any part of the brain, which means that whichever part of the brain or whichever part of function is given over to that area of the brain can be impeded or interfered with. And for that reason, some of those things will fall outside of the scope of what I can do as a musculoskeletal practitioner. And it's useful to have a neurologist, for example, on staff to get the appropriate conditions ruled in and out. It's important to have a nurse practitioner, family practitioner, and staff to assist with some of the other medical needs of these individuals, particularly the psychometric effects of TBI."
The most effective rehabilitation technique is the right one for the individual, as spinal injuries can range from localized irritation to a radiculopathy or disc issue. We take into account the physical and psychosocial components of the injury to create a well-rounded approach that focuses on getting the individual moving well and back to their daily activities. Transcript: "There are many different approaches to rehabilitation and the easy answer to give would be the most effective rehab technique is the right rehab technique for the individual that presents. And the reason for that is that spinal injuries can represent a broad spectrum of effects. It can be something very localized, an irritated segment to a radiculopathy where a spinal nerve is affected and can be particularly troublesome and complicated. It could be a disc issue. The individual may have certain movement tolerances or intolerances. So we take all of that into account as well as consider the psychosocial components of the injury as in loss of ability to perform daily activities, loss of ability to participate in sport and try to take a very well-rounded approach. But the key is to get the individual moving well and moving often."
The biopsychosocial model is a prevalent model in musculoskeletal care, which focuses on psychological and social wellbeing. Spinal injury and chronic pain can have a major impact on an individual's ability to process emotion, cope with stress, and overall outlook on life. For this reason, it is important for healthcare professionals to closely monitor their patients who are dealing with chronic pain, as they are at risk of developing neuropsychiatric issues. Transcript: "There's a prevalent model currently in musculoskeletal care and practice called the biopsychosocial model. The model has been around for a long time, but what it refers to are the different dimensions of wellness, one of which is the psychological component, and another of that which could be considered broadly similar would be the social aspect. So what impact can spinal injury and chronic pain have on the individual's ability to process emotion, to cope with stress, to their general outlook on life? Because chronic pain is closely associated with depression and anxiety, and for that reason we monitor these things very closely with our more complex chronic pain patients, because we want to make sure that they are not falling into a neuropsychiatric."