11/23/16. Advanced Arm Care for Baseball. Pain Generator. How Does Kinesiology Tape work? Kinesiology Tape
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1 Advanced Arm Care for Baseball Examination Sue Falsone PT, MS, SCS, ATC, CSCS, COMT, RYT Owner, S&F: Structure and Function Education Associate Professor, Athletic Training, A.T. Still University Examination Pain Generator Identify the tissue that s the issue It matters in your course of initial treatment Bursitis vs tendonopathy, for example Kinesiology Tape How Does Kinesiology Tape work? Sensory theory Gate Control theory Circulatory theory Convolutions lift skin, creates channels, promotes blood flow and reduces pressure Muscle activation theory Based on the different directions and tensions Bottom Line: We really don t know 1
2 A Mega Review of Kinesiology Taping Research (Page et al 2015) Study PAIN STRENGTH ROM PROPRIO SWELLING FUNCTION Bassett Csapo Drouin Kalron ? 0 Lim Montalvo Morris Does Tension Affect Outcomes? There is no evidence that specific tensions provide specific outcomes, however: Tension is associated with outcomes overall (Lim & Tay, 2015) More tension is associated with smaller effect sizes Mostavifar ?? Parriera Taylor Williams ?? + Trivial benefit; as effective - Harmful ++ Clinically beneficial? Unclear/ inconclusive 0 No benefit Specified Kinesiology Tape Tensions with Positive, Significant Outcomes (Page et al. 2015) Instrument-Assisted Soft Tissue Mobilization (IASTM) In wellcontrolled studies with significant outcomes, 86% of studies utilized tension <50%; The most common tension used was <25% Number of Studies with Significant Outcome, by tension 0% 0-25% 25-50% 50-75% 100% Analgesic IASTM Theoretical Mechanisms Uses gate-control theory for analgesia Vascular/Circulatory Promotes vasodilation & edema reduction Hydrates tissue and removes metabolites Neurological Mechanotransduction Muscle tone Mechanical Mobilizes fascial crosslinks (fibrolysis) & realignment Piezoelectric effect Physiological Re-creates inflammatory response by stimulating fibroblasts & collagen thru microtrauma Promotes conversion of Type 3 to Type 1 collagen Instrument Assisted Soft Tissue Reduces inappropriate fibrosis May be causing irritation or restrictions in movement Treatment must be followed by exercise Collagen remodeling to adapt the tissue 2
3 Cupping Cupping Opposite of IASTM Creates a distraction of tissue instead of compression Creates a microexplosion Loosening or destruction of adhesions between tissues Negative pressure destroys non-functioning capillaries Blood and lymph Dry Needling Examination Pain (Cagnie, 2013) Inhibits pain via gate control theory Conditioned Pain Theory Circulation Release of CGRP, adenosine and NO All are vasodilators (Butts, 2016) Mechanical Evidence of collagen and elastic fibers on needle (Kimura, 1992) Motion Segment Archetypal Postures and Erectorcises Normalize the motion segment that is involved When it comes to throwing: -1 st MTP DF - Shoulder ROM - Foot Intrinsics - Elbow ROM - Ankle DF - Wrist and hand ROM - Hip ROM - Thoracic Mobility - Hip Stability Mobility - Scapular Controlled - Lumbopelvic stability USE: ART, MWM, ASTYM, SFMA, VM, SFDN, RYT, MAT, FM 3
4 Fascial Manipulation Identifies a specific, localised area of the fascia in connection with a specific limited movement Then a specific point on the fascia is implicated Through the appropriate manipulation of this precise part of the fascia, movement can be restored Floor Slides Downward Facing Dog Examination Psychomotor Control Make sure things are firing at the right time USE: DNS, PRI, MAT, SFDN, FMS/ SFMA correctives, PMA-CPT 4
5 Psychomotor Control Let stabilizers be stabilizers Let prime movers be prime movers Let synergists be synergists Examination When a stabilizer becomes a prime mover OR A prime mover becomes a stabilizer or synergist OR A synergist becomes a prime mover THE BODY GETS MAD! Somatosensory Control Restore balance, reflexes, postural sway and control USE: DNS, VM, PRI, RYT, PMA-CPT Nervous system establishes programs that control human locomotion Comprised of posture and movement This motor control is largely established during the first critical years of life We Need Examination Postural Control Single Leg Balance Visual Manipulation Vestibular Manipulation Proprioceptive Manipulation 5
6 Fundamental Performance Basic 5/5 strength is happening throughout the system USE: FMS/ SFMA correctives, PRI, MAT, SFDN, CSCS Strength and Conditioning Perspective RIP Trainer Focus on transfer of force from lower body to upper body Consider Core stabilization vs core propulsion Reeves, Clin Biomech, 2007 Uhl, JAT, 2000 Resistance training load variables Time under tension Ropes Med Ball 6
7 Examination Fundamental Advancement Make sure the athlete has proper fundamental ability to perform athletic skill (power development, acceleration, absolute speed, deceleration, base, other MD movement skill) USE: CSCS, RKC Surge 360 RIP Trainer Med Ball Med Ball 7
8 Resistance/ Load Intensity/ Time Under Tension Examination Relative Strength 1 to 5 Reps 0-20s per set Relative Power Reps Depending on Specificity 0-10s per set Power Endurance Capacity of Wattage over time Applied/ Hypertrophy 6-8 Reps 20-40s per set Hypertrophy 9-15 Reps 40-70s per set Advanced Performance Progressive Return to Throw Program Make sure the athlete is using the fundamental athletic skill applied towards his position and sport USE: CSCS, Interdisciplinary approach with skill coaches Sequential Phasic Individualized Fluid Axel et al, 2009, Sports Health Reinold et al, 2002, JOSPT Variables to Consider Velocity/ Intensity Distance Volume (number of throws) Intensity Frequency Type of pitch thrown (if a pitcher) The clinician must realize that the ability of the pitcher to estimate throwing effort is poor Pitchers were instructed to throw at 50% effort Radar gun measurements indicated that throws were an average of 83% of their maximum speed Slenker et al., 2014, AJSM 8
9 Frequency Every other day? Two days on, one day off? Daily? Progression? Determined by volume and intensity? Flat ground progression Mound progression Simulated games Rehab games Return to competition Phases to Consider Return to Competition In Summary Arm care for the baseball player needs to take into account MUCH more than the arm! Consider the tools you have available to you for each phase of the spectrum Make friends with someone who has other skills along the spectrum in places you may lack knowledge or skill Stay in Touch! FB: Sue Falsone OR Structure and Function Instagram: suefalsone OR Structure and Function Twitter: suefalsone OR Sfdrynedling LinkedIn: Sue Falsone 9
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