2016 acbsp chiropractic sports sciences symposium abstracts

2016 ACBSP CHIROPRACTIC
SPORTS SCIENCES SYMPOSIUM
ABSTRACTS
PODIUM PRESENTATIONS
FRIDAY, APRIL 29,2016
Presentation Schedule
5:00 PM
LUMBAR FACET SYNDROME IN A CLUB ELITE LEVEL VOLLEYBALL PLAYER: A CASE STUDY
5:15 PM
AUTONOMIC HYPERVIGILANCE WITH VESTIBULO-CEREBELLAR DIASCHISIS PRESENTING AS DEPRESSION AND BALANCE
DISORDER IN THE CONCUSSED ATHLETE - A CASE REPORT
5:30 PM
ASSOCIATION OF BODY MASS INDEX AND PHYSICAL ACTIVITY WITH BACK PAIN IN 34,525 ADULT AMERICANS
5:45 PM
A RETROSPECTIVE ANALYSIS OF THE INCIDENCE OF INJURIES TREATED AT A PROFESSIONAL SURFING COMPETITION AND
THE UTILIZATION OF A MULTIDISCIPLINARY SPORTS MEDICINE TEAM
ROBERT C. REED AWARD for Best Abstract
LEONARD SCHROEDER AWARD for Best Original Research
Lumbar Facet Syndrome in a
Club Elite Level Volleyball
Player: A Case Study
Troy Holder, DC, CCSP®, CSCS, NREMT
Southern California University of Health Sciences
Whittier, CA
History
• 14-year old female with left-sided localized lumbosacral pain
beginning in July 2014 exacerbated by playing volleyball
• Mother took her to urgent care in August 2014
• Received an injection of anti-inflammatories at this time
• She presented to our clinic on December 3, 2014
History cont…
• Landing from jumping while playing volleyball exacerbates the
pain
• The pain is described as achy, becoming sharp with sitting or
standing for more than 15 minutes, and when laying on her
right side
• At onset, the pain is rated 8-9/10 NRS
• 7/10 NRS on first visit
• Experienced 25-50% of her waking hours
Physical Examination
• Active thoracolumbar ROM – restricted and painful extension,
left lateral flexion and rotation
• Yeoman’s elicits the chief complaint when performed B/L
• Taut and tender fibers in Lumbar erector spinae musculature
• Restricted motion at Left L5/S1 facet and B/L SI joints
Differential Diagnosis
• Lumbar facet syndrome
• Lumbar spondylosis
• Lumbar disc derangement
Tests and Results
• Lumbar spine x-rays taken at urgent care were insignificant
Working Diagnosis
• Lumbar Facet Syndrome
Treatment
•
•
•
•
Chiropractic manipulative therapy
Myofascial release therapy
Kinesiotape (H-pattern)
Therapeutic exercises
• Cat/camel, supine bridges, side bridges, plank, and bird dog
Results
• Pain levels were significantly reduced to 2/10 NRS, felt only
10% of waking hours
• She regained ability to play volleyball without pain
• Report via phone on November 3, 2015, her mother reports
that she has not had any exacerbations since being released
she couldn’t control herself
Thank You
AUTONOMIC HYPERVIGILANCE WITH
VESTIBULO-CEREBELLAR DIASCHISIS
PRESENTING AS DEPRESSION AND BALANCE
DISORDER IN THE CONCUSSED ATHLETE - A
CASE REPORT
M.W. Hall, D.C., F.I.A.C.N
M.A. Longyear, D.C., C.C.S.P®
J.R. Vestal, D.C.
NeuroLIFE
Institute
Authors
Dr. Michael Hall – Executive Director
Dr. Michael Longyear – Lead Clinician
Dr. Jonathan Vestal - Clinician
Purpose
Chiropractic Functional Neurology
Multiple concussions can result in neurobehavioral changes. These may
lead to learning disabilities, anxiety disorders, balance deficits, and/or
depression.
Chiropractic functional neurology provides a novel method of assessing
nervous system function and applying specific treatments aimed at
removing interferences to restore function between the nervous system
and the body.
16
History
Pertinent Facts about the Case
22-year-old male rugby player presented with post-concussive
symptoms, one year after sustaining a concussive injury. Initially the
patient reported dizziness and headache and was removed from
competition for one month. He was cleared by the team neurologist but
still reported persistent symptoms: crippling anxiety, dysphagia, photo
and phonosensitivity, as well as “pressure-like” headaches. Upon
reporting with us for management, he was medicated for anxiety taking
100mg of Sertraline daily.
17
METHODS
3 Domains of Functional Brain Health
Oculometrics
Eye movements are heavily integrated within the
vestibular system, cerebellum, and the frontal
lobes
-Videonystagmography, Visual Acuity, DVA
Balance & Coordination
Oculometrics
Balance &
Coordination
Healthy balance involves the integration of
multiple neurologic systems, such as the
vestibular system, the visual system and the
proprioceptive system with input from the
cerebellum to synchronize the output.
-Cervical X-Ray, Computerized Posturography
Cognition
Cognition
A shift toward sympathetic dominance was
apparent from physical examination findings and
history
-Depression & Anxiety Symptom Scale (DASS),
C3 Logix test battery
INITIAL FINDINGS
TEST
RESULTS
DASS Score
42
Computerized Posturography (mCTSIB)
1.
2.
3.
4.
Eyes Open, Firm Surface
Eyes Closed, Firm Surface
Eyes Open, Unstable Surface
Eyes Closed, Unstable Surface
1. 90.3%
2. 87.3%
3. 82.3%
4. 76.8%
Symptom Severity Score
Trail Making Test A
Trail Making Test B
Resting Heart Rate
64/100
23.4 seconds
50.5 seconds
77bpm
Finger-to-Nose Test
Dysmetria with left hand
INTERPRETATION
1
Cortex
2
Cerebellum
Top down control of the whole
system. Separates us from animals
Coordination of the symphony of
thoughts, emotions and movements
3
Autonomic
4
Limbic
Control of our automatic processes
such as heart rate and respirations
Regulates thoughts and emotions
MANAGEMENT
OVARD
Off-Vertical Axis Rotational
Device “GyroStim”
ADJUSTMENT
S
Coupled-reduction adjustments
while seated to cervical spine
INTEGRATION
Vibe Plate, Airex Pad, CrossCrawl Marching
21
RESULTS
TEST
INITIAL
CONCLUSION
DASS Score
42
1. 90.3%
2. 87.3%
3. 82.3%
27
92.8%
93.3%
87.5%
4. 76.8%
81.6%
Symptom Severity Score
Trail Making Test A
Trail Making Test B
64/100
23.4 seconds
50.5 seconds
32/100
22.1 seconds
39.5 seconds
Resting Heart Rate
77bpm
58bpm
Finger-to-Nose Test
Dysmetria with left hand
Accurate
Computerized Posturography (mCTSIB)
1.
2.
3.
4.
Eyes Open, Firm Surface
Eyes Closed, Firm Surface
Eyes Open, Unstable Surface
Eyes Closed, Unstable Surface
Conclusions
 Conservative Approach to Care
 Chiropractic Adjustments
 Innovative Application of Emerging Technologies
 Possible Relationship Between Functional Neurologic Ability and
Cognition Following Multiple Concussions in Male Athletes
23
Association of Body Mass Index and
Physical Activity with Back Pain in
34,525 Adult Americans
Bart Green, DC, MSEd, PhD, DACBSP
Associate Editor, National University of Health Sciences
Claire Johnson, DC, MSEd, PhD, DACBSP
Professor and Editor, National University of Health Sciences
The authors have no conflicts of interest to declare relevant to this research
This study was self-funded
Introduction
• Research has shown a potential relationship between
▫ body mass index (BMI)
▫ physical activity (PA) levels
▫ presence of back pain
• However…
▫ The results from studies are conflicting
▫ Few studies have investigated samples that represent populations
Introduction
• If back pain is related to BMI or PA levels, then perhaps the
burden of back pain on society could be lessened through the
promotion of more active lifestyles and improved eating habits!
Purpose
• This study measured the association between BMI and PA levels
with back pain in a nationally representative sample of adult
Americans
Methods
• IRB approval was obtained before the study was commenced
• Data from the 2012 National Health Interview Survey were
downloaded
▫ Randomized sample, representative of the US adult population
• Analyzed with SPSS Complex Samples v. 21
Methods
• Statistical Analysis
▫ Demographics
▫ 1-way Analysis of variance (ANOVA)
▫ Data pre-assessed for appropriate distribution (Levene’s test) and
showed robust statistics could be used for analysis
Demographics
n = 34,525 adult Americans
• Average age = 46 years
• 56% female
• 60% Caucasian, 17% Hispanic,
15% Black, 6% Asian, 1% other
• 29% had back pain
• Average BMI = 27.7 (obese)
• 55% did no PA
Results (ANOVA)
• Mean BMI for those with back pain was higher than for those
without back pain
Mean BMI
(kg/m2)
Raw data
▫ p < .001
Back Pain
31.7
No Back Pain
>
30.1
Results (ANOVA)
• Mean PA level for those with back pain was lower than for those
without back pain
Mean PA level
(min/wk)
Raw data
▫ p < .001
Back Pain
295
No Back Pain
<
350
Discussion
• So, what does this mean?
▫ On average, those with higher BMI and lower PA were more likely to
report back pain.
Discussion
▫ As chiropractic sports physicians, we are uniquely
poised to make a difference in the health of
athletes.
▫ We tend to see people who have back pain.
▫ We need to get people moving and eating better!
Discussion
• As health care providers, we can work with our:




communities
schools
patients
policy makers
…to potentially prevent back pain by counseling on nutrition, BMI,
and PA
Strengths of the study
▫ Power of the analysis was large
 34,525 subjects
 Sample is representative of the population
 Generalizable to US adults
Limitations
▫ Generalizable only to US adults
 Not to children, not to other countries
▫ Does not look at other factors that may affect back pain prevalence
(eg, occupation, strength, etc)
Conclusion
• Adult Americans with back pain have higher
BMI and lower levels of PA
• Chiropractic sports physicians can apply this
information in practice
Thank you
A RETROSPECTIVE ANALYSIS OF THE
INCIDENCE OF INJURIES TREATED AT A
PROFESSIONAL SURFING COMPETITION AND
THE UTILIZATION OF A MULTIDISCIPLINARY
SPORTS MEDICINE TEAM
JUSTIN J GRASMEYER, DC, DACBSP ®
TIM BROWN, DC
TERRY ROMINE, DC
Authors
Tim Brown, DC
◦ Surfed on 1979-80 NSSA National Championship Team
◦ 1984 began working with ASP at TDK/Gotcha Pro
◦ Helped create global onsite interdisciplinary team concept and protocols.
◦ 1998 ACA Sports Chiropractor of the year
◦ Presently Co Medical Director Northern Hemisphere, World Surfing League
◦ Medical/Performance Director Hurley
◦ Consultant RedBull Sports Performance
◦ Patented sensorimotor based support systems for injured surfers- INTELLISKIN
Authors
Terry Romine, DC
◦ Was Lifeguard of the Year 1996 Huntington State Beach
◦ Started working with pro surfers in 1996
◦ Worked as Contest Medical Director in 2006 for ASP
◦ Has covered about 90+ surf contests from 2006-Present, including Championship
tour, Qualifying tour, Junior tour, and Speciality events
◦ Currently part of the Allied Medical Team for the WSL(World Surf League)
◦ Currently a Staff Chiropractor for Hurley International
Authors
Justin J Grasmeyer, DC, DACBSP®
◦ Medical Team member U.S. Open of Surfing, Huntington Beach, CA
since 2011
◦ Medical Team member Hurley Pro, Lower Trestles, San Onofre
State Beach, CA since 2011
◦ Medical Team member Lowers Oakley Pro, Lower Trestles, San
Onofre State Beach, CA, 2015
◦ RedBull High Performance Exchange Project, 2013
“Surfing is for little rubber people who don’t shave yet… How hard could it be?”
Purpose
1. To investigate the incidence and injuries that occur in a population of
professional surfers at a professional contest
◦ GOAL- To better understand typical or atypical surfing injuries in a professional surfing
population in order to adapt training and preparation protocols for athletes and/or future
contests.
2. To identify the numbers and types of treatments rendered to professional
surfers by members of a multidisciplinary sports medicine team
◦ GOAL- To better anticipate the needs of a sports medicine team involved at a professional
surfing contest and staff future events accordingly.
Introduction/Research
2007-Nathanson et al- 32 professional and amateur contests over 6 years, injury rate of
5.7 per 1000 athlete exposures, 13 per 1000 hours of competitive surfing. Risk of injury
was 2.4 times greater in waves overhead or bigger, and 2.6 times greater when surfing
where rock or reef bottom was present
2015- Furness et al- online survey of 1348 of all skill levels, injury rate is 1.79 major
injuries per 1000 hours of surfing. Shoulder, ankle, and head/face had the highest
frequency.
2012- Pikora et al- Bigger waves and surfing over rock/reef increased risk among
competitive surfers, older age increased the risk amongst recreational surfers
1977- Allen et al- 36 hospitalized patients in Oahu, HI, 34% of surfing injures were head
and spine injuries, most frequently caused by hitting a loose board. Risk is 1 per 17,500
surfing days.
Introduction/Research
2015- Woodacre et al- UK web based survey 130 individuals, head injuries most
common followed by ankle, knee, back, hand/wrist, elbow/shoulder, trunk,
neck, and hip. 31% injures caused by surfboard, 31% cuts/lacerations, 24%
contusions, 15% sprains/strains
2009- Hay et al- UK 212 ED visits, Lacerations 38%, neck and back strains 53%
2013- de Moraes et al- 60 questionnaires, 29% contusions, 46% lower limb
injuries, 52% of injuries caused by contact with the board
1983- Lowdon et al- 346 surfers varied age and experience, analysis of hospital
and first aid records, 41% lacerations, 35% soft tissue injures- high incidence of
back and shoulder injuries, 25% of lacerations caused by surfboard
A quick look at competitive surfing…
Subjectively judged
◦ 30 minute heats with 2-3 surfers
◦ Two wave scores totaled
◦ Contest organized into 5 rounds with
eliminations, quarters, semis, and final
Judging panel
◦ High and low scores thrown out
World Championship Tour (WCT) vs
World Qualifying Series (WQS)
Surf spots
◦ 11 locations worldwide on the WCT
Waiting period vs schedule
U.S. Open of Surfing
Since 1959, largest surf competition in the world with nearly 200 athletes
and an estimated 700,000 fans/people over a nine-day contest.
◦ Mens WQS, women’s WCT, Men’s and women’s junior, men’s and women’s
longboard
◦ Additionally there are skateboard and BMX bowl and street competitions.
Held at Huntington Beach, CA
◦ “Surf City”- named by consistent surf during both winter and summer months
due to its exposure to both northern and southern hemisphere swells.
◦ Huntington Beach is in Orange County, in Southern California
◦ 9.5 miles of sand bottomed beach break- no reefs or rocks
◦ Average surf height is waist-high to a few feet overhead.
All heats are scheduled months in advance
◦ in contrast to other WSL events with a “waiting period”
U.S. Open of Surfing
Surf Sports Medical Team
Overall Team numbers
◦ 14 DCs, 5 MDs, 4 ATCs, 4 DPTs, 1 MT, 1 LAc
AM and PM shift
◦ 6am-Noon, Noon-6pm
Typical surf tent crew
◦
◦
◦
◦
◦
3-4 DCs
1-2 PTs
1 massage therapist
1 accupunture
1 MD/DO
Skate and BMX had separate staff, similar composition
Methods
•A retrospective analysis of event treatment notes from the 2015 U.S.
Open of Surfing
•107 patient encounters
•71 athletes
•IRB approval was obtained prior to the event
•Patient consent was obtained prior to treatment
SOAP note example
Event SOAP Note
Please include all pertinent information as necessary, but pay particular attention to specified BOLD categories.
DATE:
M / F:
APPROX HIEGHT:
SURFER:
AGE:
APPROX WEIGHT:
SUBJECTIVE:
LOCATION OF COMPLAINT:
DURATION OF COMPLAINT:
ACUTE
CHRONIC
MAINTINENCE
MECHANISM OF INJURY:
MANUEVER
WIPEOUT
TRAINING
TRAVEL
SOFT TISSUE
ADJUSTMENT
TAPE
ACTIVE CARE
OBJECTIVE:
ASSESSMENT/DIAGNOSIS:
PLAN/TREATMENT:
MODALITY
OTHER:
PRACTICIONER:
EVALUATED BY:
DC
DPT
ATC
MT
MD
DO
TREATED BY:
DC
DPT
ATC
MT
MD
DO
Results
Surfers
71 patients
107 encounters
Surfer Population
Female
8%
Male
92%
Male
Female
Hamstrings
4%
Foot
4%
Location of Complaint
"spine"
1%
Ribs SIJ
1%
2%
Thoracic
6%
Knee
1%
Wrist
1%
Hips
26%
Ankle
9%
Cervical
11%
Lumbar
18%
Shoulder
16%
Duration of complaint
Maintanence
19%
Acute
33%
Chronic/Maintenance
4%
Chronic
44%
Mechanism of Injury
Travel
11%
Wipeout
10%
Training/Travel
11%
Training
41%
Maneuver
27%
Treatments
(Percentage of Treatments Performed)
Tape
7%
Accupunture
2%Modality Yoga
Active Care
1%
1%
8% Mobilization
4%
STM
52%
CMT
25%
TREATMENTS
(percentage of athletes receiving treatment)
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
STM
CMT
Tape
Active Care
Mobilization
Accupunture
Modality
Yoga
Evaluations Performed By...
MT
18%
DPT
19%
MD
1%
ATC
3%
Accu
3%
DC
56%
Treatment Performed By...
MD
1%
ATC Accu
3% 3%
MT
18%
DC
55%
DPT
20%
Discussion
• 71 professional surfers treated in 107 encounters
• The most common areas of injury were:
• hips, lumbar spine, shoulders, cervical spine, ankle, thoracic, feet
• Majority of complaints were categorized as “chronic”
• Majority of injuries were sustained through training
• Virtually all treatments utilized soft tissue mobilization, and nearly half utilized
chiropractic manipulation
• Half of all treatments were administered by sports chiropractors
Limitations
Doctor compliance with accurate SOAP note taking
◦ Better athlete demographic information
◦ More consistent note taking
Number of athletes
Injury rate calculations
Scope of surfing injuries limited due to characteristics of surf spot
◦ Surf size
◦ Types of maneuvers
◦ Sand bottom
Conclusion
• A multidisciplinary team was utilized to assess and determine best
treatment options.
•This information may aid in preventing future competitive surfing
injuries and in the appropriate staffing of future professional surfing
contests.
Acknowledgments
U.S. Open of Surfing Medical team
◦Several present at the symposium
Tim Brown and Terry Romine, co-authors
Questions?