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Intro to ThermoActive

I have always been intrigued with sprains of the foot and ankle, and especially the “high ankle sprain”. The ThermoActive appliances are great modalities to apply the basics of Ice, Compression, and Elevation and make this clinical staple an even easier and more efficient modality. See my application of this clinical modality.

ThermoActive for Ankle Injuries

As an Athletic Trainer, and more specifically as an Athletic Administrator – I dealt with the administration of health care benefits of student-athletes on a variety of athletic budgets from a Division III school (Lenoir-Ryhne College) to a FCS school (Appalachian) to an elite Southeastern Conference school in the NCAA Division I (South Carolina). Further, the NCAA now allows member institutions to cover any and all medical benefits/medical services to student-athletes.

While Congress has not created this law to deal with health care specific to student-athletes, Athletic Administrators will now have to see how this will impact what they are providing as they are faced with the challenge to cover those portions of health care charges not covered by either primary accident insurance, excess accident insurance (purchased by the institution) or managed care programs negotiated by the institutions.

I certainly have enjoyed researching this subject as I prepare to present to the Mountain West Athletic Trainers and Team Physicians at their annual conference meeting in Las Vegas, Nevada May 1st, 2010. My challenge will be to interject my thoughts specific to “The Effect of Health Care Reform on Intercollegiate and Professional Sports”. How will this significant event impact the provision of care by Athletic Administrators, and will this reform increase the responsibility for institutions and professional sports clubs.

The findings were quite interesting. As one might expect, there was radiographic change merely due to the age of the subjects. However, those patients who had good medical care seemed to have less osteoarthritis. Further, patients who had undergone open surgical procedures had much more osteoarthritis than those patients treated arthroscopically.

Remember, this was about the time of the invent and advancing of the arthroscope in orthopaedics. However, the takehome message was clear – injuries were not the culprit for osteoarthritis, but possibly either the fact that grosser injury warranting open surgical intervention or the mere fact that the patient was treated with an open procedure.

The complete article is referenced below. I enjoyed working with these professionals on this article. While I learned a great deal from these peers, I probably gleaned ever more from the research and clinical process as I continued my career at other schools.

Moretz, A., Harlan, S., Goodrich, J., and Walters, R. (1984). Twenty year follow up of High School Football Injuries. The American Journal of Sports Medicine.

Functional Brace Use
Functional knee braces provide restraining influence to control abnormal displacements of the knee and decrease anterior tibial translation without associated contraction of the musculature of the lower extremity. With the ACL-deficient patient, brace use resulted in fewer episodes of giving way and utilization of the brace gave perception of stability in the knee.

Unilateral vs. Bilateral Hinges
When deciding on style of brace to use, Liu reported brace designs incorporating bilateral hinges and rigid shells were more effective than unilaterally hinged designs in transmitting loads8.
In the 2000 edition of Biomechanics, I reported on the comparison of knee injuries from the 1997 University of South Carolina football season when players used traditional lateral braces, vs. the 1998 season when we made the shift to custom fit knee braces that are now common. While the scope of this study is limited, the results are nonetheless very revealing as the data illustrated a substantial drop in the number and severity of knee injuries incurred. The use of the newer custom fit braces resulted in a drastic reduction in the amount of time loss (performance) by athletes as well as a drop in economical impact (medical expenses for knee injuries) for our football program.
Further studies on the subject have since supported my early findings on the ability of custom knee braces to help athletes avoid injury and the coaching and athletic training community has responded by making the use of knee braces by athletes common. In 2003, we conducted a survey to quantify prophylactic brace usage among NCAA Div I and I-AA institutions and found that over two-thirds of the institutions responding reported embracing prophylactic brace principles for their offensive lineman in their football programs. With the cost of major knee surgery averaging around $26,000, the cost of a knee brace is minimal in comparison, never mind the loss of time and eligibility by the athlete and the possible drop in performance level a major knee injury can present. In 2004, 24 of the top 25 ranked NCAA Div I football teams mandated the use of knee braces to avoid injury. This rise in popularity has not happened by accident. As an athletic trainer, I believe the increased incidence of bracing has evolved both due to increased awareness and primarily due to the superior design and construction of the braces. With research from functional knee braces following anterior cruciate ligament reconstruction, we know how the braces can minimize force production on the ligaments and further apply these concepts to functional activities in rehabilitation and activity.
I think physician and health care team members need to totally understand the concepts of prophylactic bracing when making recommendations to coaches, athletes and parents relative to this subject. Why else would these teams utilize this technology if it did not work? As I watch college football each year, the players at Florida, Ohio State, Oklahoma, Georgia, South Carolina, Florida State, Notre Dame – to name a few – have embraced prophylactic braces principles, and effectively utilized this to protect their player’s knees. Today’s discussion of prophylactic bracing is totally different that the bracing concepts discussed in the 1980’s. Those braces worn in sport were lateral braces and simply diffused the forces following lateral valgus blows to athlete’s knees. Today, the braces are functional kneed braces with double upright hinges with biomechanical design to vector force away from knee ligaments.
I have had several athletes bring their brace in to me following a practice or game and the brace is bent beyond belief, and may even be fractured! The design dissipates forces effectively and these players walked away from injuries with mild sprains. This scenario often is a heralding activity for the athlete and further substantiates brace usage. I must say, it is a sickening feeling when you examine an athlete and realize that their medical collateral ligament tear and possible anterior cruciate ligament tears which were received from a clipping injury, would have been minimized and probably prevented with prophylactic brace use as the force would have been dissipated laterally, and the double upright hinge would have also resisted the force medially. Today, coaches, parents and athletes in high school sports are realizing that spending $350 on a standard knee brace, or even $600 for a custom brace, can be a wise investment in the effort to protect young athletes from significant knee injuries – injuries that not only can hamper a promising sports career, but also adversely affect a wide range of activities and lifestyle in later years. And to do their part in supporting this trend, manufacturers are making it easier and more affordable for high school coaches and parents to outfit their athletes in prophylactic knee braces with programs such as DJO Inc’s “Join The Club” program.

The Future of Knee Bracing
The bracing industry is constantly seeking newer technologies to apply to the bracing needs. Just look at how materials which are introduced rapidly make their enterance into the industry. Further, as newer and more efficient hinges and brace composite materials evolve they product is every improved. Donjoy’s new dampening hinge has been well received in the Sports Medicine community, and is now even being fabricated in a lower brace profile. Athletes seek sleek, clean designs that work. Remember the two places braces don’t work: in the locker and around the ankle!

What We Find in Studies:
It is important for physicians and athletic trainers to advise athletes appropriately relative to protective equipment. Recommendations for protection require understanding of biomechanics and anatomy. Prophylactic braces were initially designed to restrain abnormal knee motions, and the knee braces have now progressed to provide functional stability.
Proper application has shown effective with the laterally applied prophylactic lateral brace as there was a decrease in valgus force application to the knee joint, often the culprit of injury to medial knee structures Physicians and athletic trainers commonly use prophylactic knee braces to protect the knee from impact forces. The principal factors that determine the impact response characteristics of a brace-knee composite are force distribution, energy absorption, and energy transmission. Material properties and the mechanical design of the brace are important factors in determining brace response to impact. The impact response can be quantified by applying lateral loads to cadaver knees and surrogate knee models. With the knee in full extension, prophylactic braces are limited in their capacity to protect the medial collateral ligament from direct lateral stress. Laboratory studies, using a surrogate knee model, concluded that preventive braces absorb 15-30% of the energy of a direct blow.

Various authors have reported on the positive effect of prophylactic bracing on the incidence and severity of knee injuries while Grace et al., and Teitz et al. reported bracing increased knee injuries. To validate the impact of prophylactic braces on this population a retrospective investigation attempted to control many of the known biases and utilized a large sample from a variety of institutions.

In addition, flexibility after exercise is as important as pre-workouts. Encourage athletes prone to muscles strains to stretch before, during and after workouts. When stretching following activity, they return muscles to their supple elongated state. Also it aids in post recovery muscle soreness and also promotes circulation in ridding the muscles of waste products.

In summary, flexibility can be an adjunct to conditioning and rehabilitation programs. Athletic Trainers, Strength Coaches, members of the coaching staff should all encourage aggressive approaches and compliance with flexibility exercises.