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Injury Care and Prevention

Achilles Tendinitis	Ankle Sprains	Cold vs. Heat Therapy
Fashion and the Painful Foot	Golfer's Elbow / Little Leaguer's Elbow / Medial Epicondylitis	Heel Pain & Sever's Disease
Osgood-Schlatter's Disease	Overuse Injuries in Children	Plantar Fasciitis
Shoulder Bursitis / Impingement	Shoulder Injury Treatment Basics	Tennis Elbow
	Treating Overuse Injuries with Aquatic Therapy

Achilles Tendinitis 

The Achilles tendon — a strong fibrous cord that connects the muscles in the back of your lower leg (gastrocnemius and soleus) to the back of your heel (calcaneus).This large tendon helps you point your foot downward, elevate on your toes and push off your foot as you ambulate. Every time you move your foot, chances are you are utilizing your Achilles tendon. Under too much stress, the tendon can become overworked. This generally leads to inflammation or tendonitis. If not addressed this inflammation can produce scar tissue thus decreasing the range of motion in the tendon. This can lead to more problems. If you overstretch your Achilles tendon, it can tear (rupture). A rupture can be partial or complete. Usually the rupture occurs just above your heel bone, but it can happen anywhere along the tendon. A couple other common problems that can occur at the Achilles Tendon include Bursitis . The bursa is a fluid filled sac that secretes lubricant to make movements at the joint smooth and frictionless. Think of it as WD–40 for the body. Inflammation can occur in the bursa between your heel bone and your Achilles tendon. This type of bursitis is called retrocalcaneal bursitis.

Achilles tendinitis is inflammation of your Achilles tendon. 

Symptoms include:

• Pain along the back of the tendon, frequently closest to the heel
• Decreased R.O.M. at the ankle
• Heat or redness over the painful area
• Bump or build up of scar tissue that can be palpated at the tendon
• Snapping noise from scar tissue when movement at the ankle occurs 

Common Causes

• Tight, weak or fatigued gastroc muscles
• Too much, too soon with hill runs or speed workouts
• Worn out or inflexible running shoes
• Individuals who overpronate
• Flat feet

In addition, injuries can often result from taking part in an activity involving quick directional changes for which you're not conditioned or for which you haven't stretched properly. Playing tennis, racquetball or basketball for the middle–aged weekend warrior is very common for this particular injury. 

Treatment

• Stop running (if you are a runner)
• Apply cold therapy 15 minutes several times a day until inflammation subsides with compression and rest.
• Continue use of cold after exercise to prevent re–occurring injury
• Consider short term usage of aspirin or ibuprofen for inflammation and pain only if approved by M.D.
• Massage the knotted area several times a day
• Stretch the gastroc /soleus area

Work your way back slowly. Do not begin running until strength and flexibility have returned to the area. This is the hardest part for the avid runner and most athletes to swallow. The good news is that the cardiovascular or aerobic component of exercise can still be addressed, only in a more protected temporary environment. Consider swimming or aquatic running /exercise in deep H20 progressing to shallow water along with calf stretching and raises in the pool. Balance training, and directional hops can be added with increased weight bearing as tolerated.Consult your local physical therapist for a complete exercise program. Last but not least, a gait analysis is a vital piece of the rehabilitation puzzle with foot injuries. Along with the initial pain treatment listed above, the use of custom orthotics and/or motion controlling shoes should be evaluated. This can prevent your injury from returning to haunt you in the future.
*2001 Article by Shawn J Hickling B.S. P.T.A*   This article may not be re-printed without proper permission.

Ankle Sprains 

Immediate Care 

The immediate care of this injury encompasses the first 24 hours post–injury. The goals of this first stage are to limit the amount and severity of any swelling, limit any pain, and, by immobilizing the joint and having the athlete use crutches, prevent any further injury. Immediately after the evaluation of the injury, treatment consists of ice (cold), compression, and elevation (I.C.E.). This consists of repetitive bouts of cold for 15 to 20 minutes, with 30 or so minutes without ice between applications. Compression should be applied and the leg elevated. When the player is sent home for the day or night, he should continue this routine. At this time, it is also important that the joint be immobilized and the player is weight bearing to tolerance on crutches. Immobilization can be accomplished with a bandage, brace posterior splint, or tape. Open–gibney ankle taping in particular provides compression and allows the damaged tissue to begin healing in an approximated or shortened position. The tape can then be removed during icing to better facilitate the transfer of cold to the injured area, but after the ankle has been iced, it should be rewrapped or taped.

Post Immediate Care

This stage of treatment usually includes the time period of 24 to 96 hours post injury. During this stage, there is still bleeding and swelling occurring within the joint, and the chance of re–injury is still high. The goals for this phase are to decrease any pain the athlete is having, decrease or hold steady the severity of swelling, and begin to restore range of motion. All of these can be accomplished simultaneously. It is important to continue the repetitive bouts of I.C.E. for 15–20minute periods. Gentle active R.O.M. in combination with the cold treatment may also be used along with the start of gentle calf stretching. Positive galvanic stimulation (bouts of 10–30 minutes at a tolerable setting), interferential current (20–60 minutes high pulses/second {pps}) and microcurrent (30–60 minutes high pps) have been shown to be successful in limiting pain and swelling post–injury. In addition a portable TENS unit can be used to help with the athlete's discomfort while away from the treatment room. A splint and crutches should be continued for ambulating with continued weight bearing to tolerance.

Early Care The early care phase usually runs from 96 hours post–injury to roughly 7–10 days. During this phase, the goals continue to be to control and reduce swelling, regain ROM, and facilitate healing, with the added goal of beginning to strengthen the area. Because the active bleeding in the joint has decreased, you can now introduce heat into your treatment regime. This can be in the form of a “contrast bath” or “contrast treatment," where the athlete will alternate between heat and cold exposures. The contrast will act to pump the swelling out of the joint. Alternating bouts of hot and cold in a 1:3 or 2:5 manner, sandwiched between 10 minutes of cold, are the most common (that is, start with 10 minutes cold, then 1 to 2 minutes warm followed by 3 to 5 minutes cold. This cycle should be repeated 6–8 times, finishing with 10 minutes cold. The athlete should perform passive stretching and active ROM while treating to help pump the swelling from the joint. Use of negative galvanic stimulation, microcurrent and interferential, can also be used to facilitate swelling reduction, pain control and tissue healing. Since there is still a chance of injury outside the treatment setting, it is important that the athlete continue using the splint and crutches with weight bearing as tolerated. Reprinted with permission from Training and Conditioning Magazine, April, 2001. By Rick Guter, ATC, PT, Head Trainer with the MLS's D.C. United.

 Cold vs Heat Therapy 

Written for Inside Gymnastics Magazine Coaches Guide 2006 

Much of today’s use of cryotherapy in the gym is in the acute or early stage of injury. We have all seen young athletes running around the soccer field or gymnasium juggling a dripping bag of ice, stopping only momentarily to slurp a little drink from the corner of the bag in youthful naivety.

Let’s face it…it’s tough enough to get an energetic youngster to sit still, let alone strap an uncomfortable bag of ice to them as well. However, the simple routine of utilizing cold wraps or ice wraps can go a long way in keeping your athletes healthy. But when do you use cold and when do you use heat on an injury? Well most of us agree that heat generally feels better on the surface. Heat is frequently used for pre-activity to help relax stiffness in joints and the chronically injured. Heat can play a nice role in improving muscle stretching prior to exercise, hence, the term warm-up.

A fun little demonstration is to show your athlete a frozen rubber band and a warm rubber band and demonstrate what stretches longer without breaking. The use of cold therapy is designed to physiologically block pain. How, you ask? Well when a muscle is in its shortened state, it can program a repeating process to influence nerves in the area to continually spasm. These spasms can be painful but eventually broken with the use of cold therapy.

We can dive into a complex discussion on the physiological process known as the gate theory of pain here but we’ll save that for another day. In a nutshell, the cold pack application is used to bring the muscle back to a more natural resting state without producing more pain.

The common acronym R.I.C.E. is still the best rule of thumb for immediate onset injuries and ice application, otherwise known as Rest, Ice, Compression, and Elevation. R.I.C.E is very effective in the initial treatment of soft tissue injuries such as sprains, strains, and contusions. The use of cold therapy following a tough workout can assist in recovery and help prevent the many overuse injuries that plague the sport. An ounce of prevention can really go a long way for a young athlete. Remember that a proper cool-down is just as important as a proper warm-up. Cold therapy can come in many forms. Ice cubes, cold baths, gel packs,ice wraps and topical gels have all been utilized at one time or another. When dealing with young athletes, I tend to steer clear of any toxic-chemical based instant packs for the simple reason of safety and curiosity. My experience is that if a cold wrap is easy and comfortable for a youngster to wear then they will actually follow through with the treatment and eventually make a habit of doing it for prevention.

The first couple minutes of cold may be tough to swallow for the young athlete but once they’ve made it past the initial stage it becomes smooth sailing for the remaining duration. The cold does not have to be teeth-chattering and should be applied for no more than 15 minutes at a time.

Just remember, too much cold can be damaging to the injury and the underlying tissue, so time duration is very important. Some individuals can be very sensitive to cold so make sure your athlete has a barrier (paper towel or thin layer of fabric) between the skin and cold treatment. Cold is generally applied during the first 48-72 hours or until swelling has subsided.

By Shawn J. Hickling BSc, PTA, CSMT Shawn received his degree in Exercise Physiology from Chapman University. He has worked in the field of Sports & Orthopedic Physical Therapy for over 15 years He is the founder of ActiveWrap Inc-2003-2004 Official Therapy Wrap of USAG and United Spirit Assoc.

Fashion and the Painful Foot 

Although high heel and pointed toe shoes depict fashion they can cause irreparable damage to the feet. As young girls move into finding their own style of dress, shoes are often at the forefront. Replacing comfort and function, for trend and uniqueness is a receipt for future foot problems. At an early age (under 13) where the bones are still fusing together, proper shoes can make a huge difference. If the foot is treated properly early on the arches should maintain their longevity well into our elder years. So lets take a quick peek at the high heel for example….When we stand flat-footed on the floor(in most cases)- the majority of our weight is over the heel where our anatomy is designed with extra padding and the supporting structures to withstand this kind of pressure. When the foot is moved into a High-Heeled shoe the weight is pitched forward onto the anterior arch of the foot below the toes. This area is the worst qualified for the job as it is the weakest structure of the foot. Pointed toed shoes stuff the big toe toward the center of the foot often producing bunions (or hallux valgus). When this occurs the individual experiences inflammation, redness and pain. In addition, the tapered pressure of pointed toe shoes can produce ingrown toenails and corns both of which are very incomfortable. Most individuals will find relief with arch supports, custom orthotics and even special shoes. Although, they may not be the most glamourous,they just may keep you grooving on the dance floor for years to come.

Golfers Elbow/ Little Leaguers Elbow/Medial Epicondylitis 

Golfer’s Elbow (Medial Epicondylitis) is similar to that of Tennis Elbow. The difference? Golfer’s Elbow occurs on the inside aspect of the elbow where muscles attach to the bone. Golfer’s Elbow is generally caused by overuse or overload of the muscles along the inside of the forearm. These muscles act as flexors of the wrist. In addition to the aforementioned area, it is good practice to examine the Ulnar Nerve to rule out nerve entrapment in the groove behind the Medial Epicondyle.

Signs and symptoms of Golfer’s Elbow include pain and local tenderness over the medial epicondyle. Golfer’s Elbow may also be caused by other sports and activities that involve the wrist, such as racquetball and use of a computer mouse. Athletes with strong overhead motions, like baseball or tennis players, may also experience this pathology. Mechanical adjustments to a particular motion can certainly improve your problem. A swing that has too much wrist movement can flare up a case of medial epicondylitis. Consult a qualified golf pro to analyze your swing and help you change it if needed. If it’s your computer that flares you up, then a ergonomic assessment or newly designed mouse may be just what the doctor ordered. A physical therapist can recommend specific treatments for golfer’s elbow. These may include:

• Application of ice several times a day for pain relief (see Activewrap product)
• Stretching and strengthening your wrist and forearm muscles (consult your local therapist)
• Keeping your wrist in a stabilized neutral position when lifting objects
• Using a forearm strap

The above information is informative only and designed to educate the patient on various options and conservative methods to become familiar. ActiveWrap Inc. recommends consulting your local orthopedic specialist for a complete evaluation.

Heel Pain & Sever's Disease 

As sport specific training intensifies and children spend countless hours perfecting leaps, dismounts, running, or other high impact activities, over–use injuries become more prevalant. One such overuse, inflammatory condition is Sever's disease .

Sever's disease generally affects children between the ages of 10 and 14 years of age, which corresponds to the growth spurts associated with puberty. Take into consideration, that the foot is one of the first body parts to reach full size. Further, combine that with maturing leg bone growth and you now have tendons and muscles involved in a game of soft tissue catch up. The Achilles tendon (or heel cord) becomes tight and less flexible due to the increased tension to the insertion area located at the back of the calcaneous (heel bone). This area of insertion known as the calcaneal apophysis is still maturing and more prone to injury.

Symptoms

Sever's disease tends to mimic Achilles Tendonitis and shares similarities to Osgood–Schlatters disease of the knee. Symptoms include pain in one or both heels with running and weight–bearing exercise. Swelling and tenderness on the heel to the touch. Painful gait pattern (limping). A tendency to walk on tippy–toes to ease pain. Tight gastroc muscles in the morning.

Diagnosis

Physical Examination, x–rays (to rule out growth plate injury) and medical history.

Treatment

• Rest or reduced weight bearing activities.
• Apply ActiveWrap® Ice Wrap to target back of heels for 15' after any physical activity or long period of walking.
• Over–the–counter Anti–Inflammatory Med's for severe pain (consult MD)
• Stretching for upper and lower legs (hamstrings, gastroc, soleus etc.) 2–3 times daily.
• Consider Orthotics.

Prevention

If your child has already recovered from Sever's, stretching and putting ActiveWrap on the heel after activity will help reduce the risk of your child getting this condition in the future. Continued stretching, consideration of orthotics, arch supports, heel cups are also very beneficial. 
 

Osgood-Schlatter’s Disease 

Injury Care

Osgood-Schlatter's Disease (OSD) is a painful condition occuring in children,adolescents and young adults. The pain is located at the knee which can be brought on by repetitive motions such as jumping, squatting and high impact activities. Location of pain is often focused a the insertion of the patellar tendon onto the tibial tubercle (see diagram 2003 (R) A.D.A.M., INC). OSD Symptoms usually begin during periods of increased growth and tend to subside as bone maturity is reached. Bone abnormalities at the patellar tendon insertion area can be detected with routine x-ray. Often without x-ray, the bony insertion area will be identified with an increase in size and will form a "bump" on the front of the knee. Treating OSD is generally always conservative with emphasis on reducing pain and swelling with cold compress therapy, anti-inflammatories (NSAIDS). Once pain and swelling have been controlled, increased flexibility and strengthening exercises for the hamstrings and quadriceps are installed in a pain free range of motion (ROM). In some cases, soft bracing and activity adjustment may be prescribed.
 

Overuse Injuries in Children 

The competition bar continues to rise. Kids are now specializing in sports year round and turning professional at record ages. However, one thing remains the same. The fact that growing bodies are particularly susceptible to overuse injuries, especially in growth plate areas.

All sports can cause overuse injuries, but the most common problems come from excessive conditioning, running and contact in football, basketball, gymnastics and soccer. Overuse injuries are a serious problem for several reasons however the most important is that they are painful. They can also cause permanent injury to a growing body, especially when young athletes “play through the pain".

It is important for parents, coaches and health professionals to emphasize that there is no such thing as good pain and that playing hurt can lead to further injury. Although a physician can provide the initial diagnosis and perform the surgery, it’s the therapist who works directly with the injured children on a regualr basis.

Once injury has occurred, three phases of recovery exist:

PHASE 1 GOAL: Control pain and inflammation

1. Remove the athlete from the injury-causing activity, but do not allow complete inactivity. The athelte should cross-train (avoiding usage of the injured area) to maintain fitness levels and avoid de-conditioning.
2. Use cold therapy, compression and wrapping along with other modalities, such as e-stim and Ultrasound.

PHASE 2 GOAL: Increase or Regain R.O.M. and Strength

1. Gradual return to sport (walk-thru only) such as only shooting foul shots (basketball) after flexibility and muscle deficits are corrected.

PHASE 3 GOAL: Gradual full return to sport

1. Ensure that the athlete possesses correct form and biomechanics to prevent repeated injury. This may be postural, balance or the athletes gait pattern.
2. Ensure adequate flexibility and strength prior to return to sport.

Growth plates are the weakest link between bone, muscle tendons, and ligaments. These are the most-common areas for injuries. Growth plates that attach to the large muscle tendons (such as the proxial tibia, the heel, elbow and pelvis) are particulary at risk.

2005 Article by Shawn J Hickling B.S. P.T.A. 
 

Plantar Fasciitis 

Many people can hardly say it while others have trouble spelling it. Regardless, many people suffer from Plantar Fasciitis and is one of the most commonly treated foot injuries. The Plantar Fascia is a fibrous band of tissue running from the heel bone(calcaneous) to the metatarsal bones (at the base of the toes). Its purpose is to keep the structure of the longitudinal arch at the bottom or plantar aspect of the foot.

“Fasciitis” is inflammation or even tearing in severe cases of the fascia tissue. Avoidable factors such as repetitive stress form jumping activities or running on hard surfaces can contribute to this condition. Furthermore, having “high arches” or “very flat arches” can place increased stress to the fascia tissue resulting in excessive strain.

Once this tissue is “irritated” the body attempts to repair itself by sending Calcium to protect the area and plaster over the spot so to speak. This is often times how a “heel spur” is created.The Calcium forms a hook like spur on the base of the heel to maintain its connection with the fascia that is being pulled away.

Treatment is best prescribed by your physician. This often times includes rest, cold therapy (see ActiveWrap), stretching, arch exercises, orthotics, and night splints. Avoid suddenly jumping out of bed in the A.M. on your unprotected, stiff arch. This will further set back any healing from the previous night’s treatment.

2004 Excerpt by Shawn J Hickling B.S. P.T.A
 

Shoulder Bursitis/Impingement 

Terms:

• Rotator Cuff - Supraspinatus, Infraspinatus, Teres Minor & Subscapularis 
• Acromion - Extension or tip of shoulder blade.
• Bursa - Fluid-filled sac that acts as a lubricant for smooth joint movement.  Think WD40 for the joint. 

This particular injury develops if either of the following occur : the four muscles of the rotator cuff  (which act to depress the humeral head) are injured, the patient was born with a type II or III downward hook of the acromion, development of a bone spur under the acromion process generally with age. The rotator cuff injury or bony abnormalities wind up taking valuable space typically reserved for pain-free shoulder movement between the head of the humerous and the acromion. The result is rubbing or pinching on the tendons and the sub-acromial bursa between the the tendons and acromion. 

This injury is not reserved for throwing or overhead athletes although it is a typical culprit. It is fact very common in middle-age individuals. as bone spurs tend to develop with age the rotator cuff muscles become more suceptible to impingment.

Steps to treat shoulder impingement/bursitis or tendinitis involve the initial steps of using ice therapy , modalities and anti-inflammatory medications to reduce pain and swelling. Once swelling and pain are under control, physical therapy goes to work to regain lost range of motion and strength to the shoulder. In more difficult cases arthroscopic shoulder surgery (Subacromial Decompression) can be performed to clean up the spur and create more joint space. This increase space allows for improved movement within normal limits and less irritation resulting in a reduction of future inflammation and pain with activity.

Shoulder Injury Treatment Basics 

Shoulder injuries commonly involve throwing athletes or individuals that utilize continuous overhead motion. Sports such as baseball, tennis, volleyball,swimming and weightlifting are but a few examples. The shoulder is capable of many motions these include: flexion, extension, ab/adduction, internal rotation/external rotation and horizontal ab/adduction. Unfortunately, with these many movements there is a trade off for stability which leaves the shoulder joint more susceptible to injury.

Strain or Sprain?

A strain is damage to the muscle or tendon (the tissue that connects muscle to bone).

A sprain is an injury that occurs to the joint or ligament (connects bone to bone)

Principles of P.R.I.C.E. 

P.   Prevention or prehab involving flexibility and strengthening pertaining to your activity

R.   Rest - Pull out of practice, game or training until the pain subsides

I.C.  Ice & Compression - Our specialty at ActiveWrap . Apply an activewrap to reduce inflammation and swelling 

E.    Elevation - (Most injuries lower than the heart limit swelling by using gravity to drain fluid. (N/A for the shoulder as           most injuries are held in a sling position

Hot and Cold Therapy 

ActiveWrap ice compress wraps can be applied immediately after an injury for up to 72 hours to help discomfort and swelling reduction.

The use of heat should not be used early on as this will cause blood to pool in the affected area resulting in more swelling. 

Tennis Elbow 

Tennis elbow or lateral epicondylitis occurs on the outside aspect of the elbow where the extensor muscles attach to the bone. Tennis elbow is generally caused by overuse or overload of the muscles along the outside of the forearm. These muscles act as extensors of the wrist.

Signs and symptoms of Tennis elbow include pain and local tenderness over the lateral epicondyle. Tennis elbow is frequently caused by other activities that involve the wrist, such as racquetball, squash and job environments such as a mechanic, plumber, painter and even meat cutting... . Repetition is a common thread here. Pain can start gradually and increase as time goes on. Lifting objects, gripping items and shaking hands can generate the pain cycle. Lifting your fingers and wrists against opposition can test positive for Tennis Elbow as well. Mechanical adjustments to a particular motion can certainly improve your problem. A swing that has too much wrist movement can flare up a case of lateral epicondylitis. Grip size and racquet head can also be a culprit of this injury in sports. Consult a qualified tennis pro to analyze your swing and help you change it if needed. If it isthe use of your computer that causes this ailment, then an ergonomic assessment or newly designed mouse may be just what the doctor ordered. A physical therapist can recommend specific treatments for Golfer’s Elbow. These may include:

• Application of ice several times a day for pain relief (See ActiveWrap Elbow product)
• Stretching with arm extended out and wrist in flexed position (consult your local therapist)
• Keeping your wrist in a stabilized neutral position when lifting objects
• Using a forearm strap

Non-operative treatment is generally successful in most cases with only a small percentage requiring arthroscopy to regain function. The above information is informative only and designed to educate the patient on various options and conservative methods to become familiar. ActiveWrap Inc. recommends consulting your local orthopedic specialist for a complete evaluation. 

Treating Overuse Injuries with Aquatic Therapy  

Many athletes are required to participate in extensive forms of athletic conditioning on non-resilient surfaces.  Such surfaces include running around town on concrete, doing laps around a hard-surfaced track, and bouncing up and down on a hard floor at a local club. 

This form of training, however, can lead to a variety of "over-use syndromes" associated with soft-tissue or bony injuries.  Stress fractures, Achilles tendinitis and, the classic, shin splints are among the complications that can result from excessive training on hard surfaces. 

One way around this problem is the use of aquatic training exercises. The use of aquatic cross training exercises enables the athlete to train at various levels of intensity while minimizing the effects of body weight and gravity. It is not only helpful for treating over-use syndromes, but is also effective for athletes who want to maintain a level of fitness during rehabilitation of an injury.

To a runner, for example, an injury such as shin splints can be terribly frustrating due to the restrictive nature of the injury. The idea of "rest is best" keeps the athlete away from the repetitive pounding that increases the problem.  However, runners, like most athletes, have a hard time accepting the concept of rest.  This is where aquatic therapy plays a significant role.

Through alternative training methods in the aquatic environment, today's athlete can remain at a conditioned state while allowing the injury to heal.

To decrease the overall impact on the body, an increased water depth may beutilized to reduce the athlete's weight-bearing factor.  For example, standing in neck-deep water reduces body weight up to 90 percent.  Standing in chest-deep water cuts body weight down to 75 percent and then to 50 percent when the body is waist-deep. In addition, buoyancy assistive devices can be incorporated to further reduce the forces on joints. These devices are often wrapped around the ankles and/or wrists.

Here's a typical rehabilitation/ conditioning sequence that helps athletes with shin splints:

    I. Beginning Phase for shallow water: forward walking, calf/hamstring stretching (as tolerated). Range Of Motion at the hip, active ROM at the ankle, step-ups (low step). 

    I. Beginning Phase for deep water: cross-country ski, half jacks (shoulder width range hip ab/adduction).

    II. Intermediate phase for shallow water: walking forwards/backwards, side to side walking (short-stride length), step-ups (low or high as tolerated, calf raises (double/single leg) or off low step for increased ROM, split jumps (with varying stride length or double leg jump squats (both as tolerated)), hip ROM, active dorsi/plantar flexion or calf pumps with fins.

    II. Intermediate Phase for deep water: cross-country ski with increased active dorsi/plantar flexion, jogging progressing to running (progress to buoyancy resistive devices), half jacks, scissors, begin circuit training (alternating arms and legs, combining deep water running with upper extremity paddle movements).

    Even more advanced deep and shallow water exercises are available. Aquatic therapy and aquatic training can have positive benefits for all athletes, whether you are injured or not.

Article by Shawn Hickling BSc, PTA (Article feautured in Student Sports Magazine)