“ A dvanced C ore Stabilization T raining Clinic A.C.T. now to PREVENT INJURIES

1. “Advanced Core Stabilization Training ClinicA.C.T. now to PREVENT INJURIES Advanced Rehabilitation & Health Specialists 4707 Mill ST., Mantua, OH 44255 www.arhs.us (330) 274-2747 Owners: Edie Benner, PT, PhD, Rosalie Franek, BS, Juli Robine PTA, BS Advanced Rehabilitation & Health Specialists

2. AGENDA • 5:00 – 5:30 Registration • 5:30 – 6:00 Introduction/Overview of the Spine. WHAT Is the CORE? • 6:00 – 7:00 Common Back & Neck Medical Injuries, Emergency Issues • 7:00 – 8:00 Physical Therapy Treatment for Spinal Injuries, Prevention • 8:00 – 8:30 Core Strength Lab • 8:30 – 9:00 Life Threatening Emergencies • 9:00 – 9:30 Sports Nutrition Advanced Rehabilitation & Health Specialists

3. OBJECTIVESAnatomy of the Spine: WHAT Is the CORE? • Upon completion of this presentation you should be able to: • Describe the essential anatomy of the core • Understand the importance of the core in sport Advanced Rehabilitation & Health Specialists

4. Anatomy of the SpineBones & Joints of Vertebral Column: Movements of the Spine Advanced Rehabilitation & Health Specialists

5. Anatomy of the SpineLigaments Advanced Rehabilitation & Health Specialists

6. Anatomy of the SpineSpinal Cord and Nerves Advanced Rehabilitation & Health Specialists

7. Disc herniation rare in adolescent population: 0.5% to 6.8% 80% of adult population will experience low back pain Anatomy of the SpineDiscs (Balla & George, 2008) Advanced Rehabilitation & Health Specialists

8. Anatomy of the SpineMusculatureLatissimus dorsi, Gluteus Maximus Advanced Rehabilitation & Health Specialists

9. Anatomy of the SpineMusculatureAbdominals: External Oblique, Rectus Abdominus Advanced Rehabilitation & Health Specialists

10. Anatomy of the SpineMusculatureInternal Oblique, Transverse Abdominus (Attach to Thoraco-lumbar Fascia) Advanced Rehabilitation & Health Specialists

11. Anatomy of the SpineErector Spinae Advanced Rehabilitation & Health Specialists

12. Anatomy of the SpineTHE CORE! • Abdominals • TA, IO – EO, RA • Erector Spinae • Gluts • Hamstrings • Latissimus Dorsi • Psoas • Multifidus Advanced Rehabilitation & Health Specialists

13. WHY do athletes need a strong CORE? (Kisner & Colby, 2007) • To prevent back and extremity injuries • Greater efficiency of movement • Improved balance • Improved athletic performance • Increased power output • Improved speed and endurance • To keep the athlete on the field or court! Advanced Rehabilitation & Health Specialists

14. References • Prentice, W.E. (2003). Athletic Training (11th ed.)New York: McGraw-Hill. • Kisner, C. & Colby, L. (2007). Therapeutic Exercise (5th ed.) Philadelphia: F.A. Davis. • Magee, D. (2006). Orthopedic Physical Assessment (5th ed.) St. Louis: Saunders Elsevier. • Balla, J. & George, S. (2008) The use of a modified treatment based classification system to treat an adolescent with imaging evidence of a herniated disc. Orthopaedic Physical Therapy Practice, 20, 176-181. Advanced Rehabilitation & Health Specialists

15. Physical Therapy Treatment for Spinal InjuriesFocus on Prevention Advanced Rehabilitation & Health Specialists

16. OBJECTIVES • Upon completion of this presentation you should be able to: • Understand physical therapy management of spinal injuries • Provide basic First Aid for back pain • Understand the importance of CORE Stabilization exercises during conditioning and in-season • Incorporate a dynamic warm-up into each session Advanced Rehabilitation & Health Specialists

17. Boys: Greater waist girth Reduced and greater flexibility Girls: Less lower extremity power Reduced back endurance Back pain “ever”: 46% Back pain “past month”: 28.1% “Chronic”: 11.3% As a result, back pain is something that is common and does need further study, and better prevention and management. Adolescent Back Pain (Perry, et al., 2009) Advanced Rehabilitation & Health Specialists

18. High School All Sports (Fall, Winter, Spring) • Back pain: 23% of reported injuries • Knee: 27% • Ankle: 17% • Shoulder: 13% • Hip: 7% • Other: 11% (ie. hamstring strains, elbow, contusions, etc.) Advanced Rehabilitation & Health Specialists

19. Physical Therapy Examination • Examination • History • Observation: Posture, Curves • Palpation • Range of motion • Special tests: Neurological Exam, Red Flags Advanced Rehabilitation & Health Specialists

20. Physical Therapy Management • To calm the affected tissue • Cryotherapy, Manual therapy, Controlled rest, Gentle exercises, Possibly a modality, Kinesiotaping • To regain full function • Progressive mobility, flexibility, stability, strength and functional exercises or drills • To return to modified sport participation • Work closely with the coach • To return to full sport participation • Must pass series of sport specific functional drills Advanced Rehabilitation & Health Specialists

21. Athletic Trainer Management • If you and your school are fortunate enough to have game or practice coverage by Certified Athletic Trainers, the Trainer will perform an Examination of the athlete. The Trainer will then work with you and your coaching staff on the management of your athlete and their injury. Advanced Rehabilitation & Health Specialists

22. Basic First Aid for the Spine • RICE principles as best as possible depending on the severity. • R: Have the athlete rest in a comfortable postion • I: Ice the affected area: 15-20 minutes • C and E: Compression and elevation • As stated by Dr. Shah and in our Emergency Management section: If in doubt, the athlete should have a physician evaluation and please communicate with the family. Advanced Rehabilitation & Health Specialists

23. Injury Prevention • Alignment: Does trunk go side to side or forward or backward during drills/ sport? • Perfect practice makes perfect! • If it looks or feels “wrong” it probably is! • Quality over quantity! • Good coaching! • Pain may simply mean improper technique. Correct it! • Safe equipment. Safe field/court. Advanced Rehabilitation & Health Specialists

24. Dynamic Warm-up • Most important, but OFTEN neglected! • Why? Raise core temperature and activate the nervous system! • Prepare the body to react quickly. • Needs to apply to your specific sport. Advanced Rehabilitation & Health Specialists

25. Strength, Speed, Agility & Power Training • The customization of the strengthening, speed, quickness or agility, power and functional drills to your team and sport! • Take the time to review specific activities for your sport. Advanced Rehabilitation & Health Specialists

26. CORE Stabilization Demonstration • This demonstration will provide you with a Core routine for CORE stabilization that you can do with your TEAM pre-season and in-season. • This demonstration will allow you to work with your entire team at one time in a supervised manner with minimal equipment. • This routine is to complement your weight training, functional drills and sport specific activities that are performed during practice. Advanced Rehabilitation & Health Specialists

27. GUIDELINES for DAILY WARM-UP • The 10 minute jog should be performed as a team before the start of practice. • The entire dynamic warm-up process should take about 20 minutes. Customize to your team! Until the team learns the routine, it may take longer. • On non-game days or for conditioning the reps, hold times, and speed can be increased. Advanced Rehabilitation & Health Specialists

28. GOOD LUCK! • HAVE A HEALTHY SEASON! • Please do not hesitate to contact us should you have any questions. • Edie, Rosalie and Juli and your entire faculty for the evening. Advanced Rehabilitation & Health Specialists

29. References • Perry et al. (2009). Fitness, motor competence, and body composition are weakly associated with adolescent back pain. Journal of Orthopaedic & Sports Physical Therapy, 39, 439-449. Advanced Rehabilitation & Health Specialists