Reactive vs Proactive Athletic Wellness

Depending on where you are in the country, preseason is underway for fall sports. No matter what level, most teams require some form of pre-participation exam. These annual appointments are designed “to screen for injuries or medical conditions that may place an athlete at risk for safe participation."¹ Regrettably, there is not a standardized exam in the US, resulting in a wide range of effectiveness. The National Athletic Trainers' Association Position Statement includes the following guidelines for designing an exam:

• Medical and Family Health History

• General Health Screening

• Cardiovascular Screening

• Neurological Screening

• Orthopedic Screening

• General Medical Screening

• Review of Medication Use

• Nutrition Assessment

• Heat- and Hydration-Related Illness Risk Factors

Considering all the areas assessed, it is important a medical physician (MDs or DOs) supervise these exams. Missing from that list however, is a Functional Movement Assessment. Both ATCs and PTs can be instrumental in helping you establish an athletic baseline.²

By evaluating basic movement patterns, any strength imbalances or compensatory strategies can quickly be identified. Check out our instagram post on the functional assessment I used with the Warriors Dance Team for the 2021-2022 preseason screens!

Your provider can review any significant findings with you, helping you understand how they may be impacting your performance. But if the findings from your assessment don’t correspond with pain, should you still address them?

Short answer: It depends. 

As clinicians, it is important to take the whole athlete and their goals into account. Understanding the demands of the sport and the anticipated load throughout the season is one piece of the puzzle. A rising high school freshman basketball player with lower extremity strength imbalance may have been fine playing at the middle school level 3-4 times per week. However, once introduced to the demands of a varsity squad- weight lifting, practices 5 times a week, and a heavier competition schedule- may no longer thrive. It is reasonable to anticipate that they will begin to experience lower extremity joint pain at some point during the season. By providing them a short home exercise protocol that addresses the imbalance, they may be able to avoid the scenario altogether.

A semi-professional golfer will expectedly present with a strength imbalance dominant to non-dominant side rotation due to the demands of their sport. Assuming their regular strength and conditioning includes bilateral rotational power and deceleration work, minimal changes may need to be made.

Ultimately, we believe that sports medicine should be proactive not reactive. While it is impossible to avoid injury in sports entirely, athletes can train more effectively based on their individual strengths and demands.

To learn more, check out these articles:

1. Wingfield K, Matheson GO, Meeuwisse WH. Preparticipation Evaluation: An Evidence-Based Review. Clin J Sport Med 2004; 14(3):109-122.

2. Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers’ Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions. Journal of Athletic Training 2014;49(1):102–120.

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Upper Extremity Sport Durability

For the majority of our upper extremity athletes, the toughest opponent they face is their screen. Here in the Capital of Tech, the hour or two you spend on the field may be the only break from technology. With the challenges of the last year, we’re all spending more time online and on a screen than ever before. While intuitively we all recognize that increased screentime can lead to decreased performance, this post will help break down the impact on upper extremity athletes.

Daily Posture

Start by assessing your resting posture. Look at the position of the head, neck, shoulder and arms relative to the torso. All too often when working on a laptop or handheld device we find ourselves seated with shoulders slumped, looking down, arms and hands together at chest center. Sound familiar?

This will impact your resting breathing posture, as well as your anterior chest and neck muscle tone. The closed position of the throat and rib cage requires the body to work harder and recruit different muscles to inhale and exhale, potentially overusing some muscles in the neck. Adducting the arms, or bringing them together in front of the chest, shortens the muscles of the chest causing them to tighten. The muscles in the back are put in an over-lengthened position, causing them to atrophy due to lack of use. This combination of tight and weak muscles makes it more challenging to find and maintain your athletic posture when you need it.

Finding Balance + Repetitive Behaviors

Using the body described above as our example, the strength imbalance and shoulder position will impact throwing mechanics. To rebalance the system, more emphasis needs to be placed on pulling exercises. This allows the muscles in the upper back to contract while lengthening the muscles in the chest. To compliment this work, incorporate focused dynamic chest stretching and thoracic spine mobility to re-enforce these new postures.

Looking to the back of the body, scapular control is equally essential for throwing mechanics. The scapula has limited ligamentous attachments- it’s the reason the shoulder has such a large range of motion. The catch? The scapula relies more heavily on muscular control than other joints. If you plan on throwing longer and faster, you need to have the eccentric strength to slow all that extra power down. Building a stable foundation (and maintaining it) requires regular rotator cuff strengthening- try incorporating these exercises into your pre-practice warmup or post-strength cool down.

Daily + Weekly Load

Every single athlete, no matter the level, needs recovery days. These low intensity days are the body’s chance to “recharge and download” new movement patterns and muscle fibers. Consistent optimal load to rest ratios will ultimately result in increased durability. To start tracking your load, try this simple low tech strategy:

Upon completing a workout or competition, rate the session using the scale. Multiple that number by the duration of the session in minutes. Track these numbers daily. On a weekly or monthly cycle, aim to create a soft waves rather than dramatic spikes and gaps in activity. Use this chart to plan for important competitions and heavy training days.

M.Gibala Ph.D.

Recovery is not synonymous with rest. Several of our highly competitive athletes have balked at the idea of a rest day, envisioning being confined to the couch for the day. Instead, think about recovery in the following areas:

• Getting adequate sleep following training (7 hours or more!)

• Optimizing soft tissues between sessions (massage, foam roll, stretching, etc)

• Rebalancing consumed macro + micro nutrients (Protein AND electrolytes)

• Diversifying your skills by trying new sports or activities (VR for reaction time, or swimming for reciprocal rotation)

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Daily Foam Rolling

Myofascial release is a hands-on technique using sustained pressure to the connective tissue restrictions to relieve pain and restore motion. But does it work? Dr. Betsy Webb certainly thinks so, stating “this is one of the most common modifications I suggest to patients. Maintaining soft tissue and joint mobility is so important in preserving joint health and building strength.”

According to a systematic review conducted by Beardsley and Škarabot, myofascial release can help to increase flexibility and reduce soreness. Regular maintenance helps with joint and soft tissue extensibility and mobility, will improve tissue length and pliability and its ability to accept force and load. This allows the body to do more work with less strain overall. Methods like foam rolling, gua sha and massage can improve arterial and vascular endothelial function, or the flow of blood and lymph through the tissues. Self-myofascial release allows for consistent and cost-effective management. Athletes of all levels most commonly use a foam roller or ball of varying density.

Despite being versed on the benefits, Betsy has trouble incorporating soft tissue work. “I love working on strength and cardio work,” she laughs, “but often under prioritize mobility in my own physical fitness. I know how valuable mobility work is, yet I struggle to incorporate it into my routine.” As part of our Athlete Within Challenge, Betsy agreed to spend 10 minutes foam rolling everyday for two weeks. Here’s how it went:

As with any new habit, the most challenging part about for Betsy was adherence. “I started out really strong for the first week but then the weekend hit and falling out of my daily routine made it more challenging to stay diligent,” she says. Sound familiar?

In order to stay consistent, Betsy found three different techniques to be most helpful: routine, external accountability, and increased accessibility. “I found using an alarm worked really well. I set an alarm for 9:15 every night to remind me.” (As an added benefit, myofascial release can also help to improve parasympathetic nervous system activity, allowing us to mentally and physically calm down so our bodies can regenerate. Soft tissue work in the evening can set you up for a great night’s sleep!)

Betsy shared her goals with her fiancé, finding that having “someone to hold me accountable, who knew to remind me if I hadn’t done it for the day” helped to keep her on track. The last thing she found to be helpful? Relocating her foam roller. “I ended up putting it next to the tv,” says Webb, “so that when I would sit down to watch tv at night I would see the roller and be reminded to use it.”

So is it worth the time? After the two weeks were up Betsy’s body was thanking her. “Foam rolling is something I know I should do more of, especially for my thoracic spine, but never was able to get into a routine." Like so many of our patients, Betsy saw tremendous benefit from going back to the basics: “After the first week I felt good but not too much different, but a full two weeks really started to make a difference in how I felt from a mobility standpoint.” The true payoff for myofascial release work is in the consistency. Studies have yet to show if any of these improvements in flexibility and tissue quality have longterm effects once treatment is stopped. “I fully intend to maintain this behavior. As I saw with the two weeks, the longer I remained consistent the better I felt,” states Webb.

Our vote? Yes to myofascial release!

Looking for Dr. Betsy Webb? As of July 1st, she will be practicing in the Chicago Area!

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Self-Limiting Pitfalls

Elite performance requires us to be vulnerable. It is essential to have an honest view of our skill set to grow and improve. Working with a coach, or using tools like biofeedback technology can give a clear picture. In the clinic, we use a variety of motion and force capture to enhance the assessment process. Outside of the clinic, wearable technology can track heart rate, speed, and sleep metrics to give you a more complete picture of your performance.

But, ultimately, it’s how we interpret that information that matters. Use the self-assessment below and see if you fall into any of these 4 protective strategies that may be limiting your potential:

1. Self-Handicapping:

Intentionally limiting your effort to give yourself an “out.” If you didn’t really try your best, then the results don’t matter.

2. Feedback Avoidance:

Bubble alert! By only surrounding yourself with people who flatter you, you are distort you outlook.

3. Self-Serving Bias:

Only taking credit for success, and not failure. When you win, its because of your hard work and natural talent, but if your fail it could be the refs, the weather, the astrological calendar…

4. Downward Social Comparison:

Rather than look at how everyone performed, you only compare yourself to those who did worse to protect your ego. Maybe you only scored twice, but he didn’t score at all.

Being mindful of these common mental traps helps us build awareness of the role our mind plays in performance.

Adapted from @stevemagness, author of Peak Performance

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Superbill Best Practices

Choosing to work with a provider not covered by your insurance has advantages and disadvantages. It can be gratifying to do your research and select the practice that best meets your needs, and in some ways, simplified to know exactly what you owe from the start. However, paying the full amount for services can add up.

Every patient is eligible to receive itemized medical receipts, or superbills, detailing their care with us. These receipts can be submitted to most insurance plans for reimbursement consideration, as well as qualify for select employee wellness incentives or tax credits. Because reimbursement costs the insurance companies money, the process is often tedious. We’ve put together our top four suggestions on how to maximize your returns, taking full advantage of your plan:

1. Gather your paperwork

Most insurance companies still require you fill out a paper application with your plan information to mail in along with your superbill. We recommend printing and filling out one application, leaving the date blank. Make copies of this, and reuse for each submission adding the individual dates each time. 

2. Read the fine print

Double check which payment options you select for your reimbursement. Some forms offer the choice to make payments to the providing clinician instead of the patient, aka YOU. Selecting the wrong option could require you to wait much longer to receive payment. 

3. Increase your odds

Submit your receipts individually, as soon as you receive them. It's a 6 week process, at minimum, and your insurance could require more information from your clinician.Having to resubmit decreases your chance of payment.

4. Pay it forward

Share any feedback from your insurance company with our team. Remember, they are looking for any reason to not pay out on claims. If they don't cover the services billed, we can work with you to better understand what they will cover in the future

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As the Director of Operations + Patient Success, Shannon navigates our Out-of-Network team. After pairing you with the best provider for your goals, she continues to be an essential part of your care by ensuring you have all the information you need for insurance claims.

For specific questions, or for help managing an existing claim, schedule a call