Friesen Physio-Fitness Summit Recap

A couple weekend back I had an opportunity to attend the Friesen Physio-Fitness Summit in Raleigh, NC. Pete Friesen (going on his 14th year as the Hurricanes Strength and Conditioning Coach) put together a fantastic line-up of speakers, including many members of his sports medicine network. It's rare that the default reference sport for a group of speakers is ice hockey. Some presentations resonated more with me than others, but there was a lot of interesting information on topics ranging from orthotics to imaging for specific injuries to new research on supplements.

From the Ground Up
Dr. Blaise Williams, PhD, MPT led off the presentations with a discussion on the differential responses to orthotics depending on the athlete's foot type. Interestingly, Dr. Williams noted that there wasn't a universal response to orthotics at all, even amongst people with a similar foot structure going into the same orthotic. On a similar note, he pointed out that different orthotics may have similar effects on ROM, but can have significantly different effects on muscular control. The big take home I got from this discussion was that, as with a lot of research, we still have a long way to go in understanding how to best individualize orthotics and what effects they will have on the body as a whole. 

Dr. Williams mentioned that people with a higher arch in their foot (or feet) would have more ROM at their foot during running. Intuitively this makes sense, as someone with a flat foot would not have the room for excursion. Because motion at the foot is coupled with tibial rotation (inversion -> tibial internal rotation; eversion -> tibial external rotation), the increased ROM at the foot that results from the high arch can lead to increased rotation further up the chain. Relevant to hockey, players with a high arch may experience increased hip rotation ROM during ground-based movement activities. Furthermore, because more force can be absorbed through the foot, people with higher arches tend to undergo less knee flexion during running. 

Performance Vision
Dr. Michael Peters, OD gave an interesting talk on the importance of vision in elite level athletics. Despite common belief, ideal vision is actually 20/8, not 20/20. Ideal vision becomes increasingly important in consideration of the fact that roughly 25% of your vision feeds into other systems, such as the vestibular system. In other words, the clarity at which we view the world drives other physiological and neurological systems within the body. He noted that 60% of the US ages 18-35 needs correction, and that 20.2% of the NHL uses some sort of correction (contacts, glasses, LASIK, etc.). Not surprisingly, side vision tends to suffer as a result of a fatigue.

Dr. Peters alluded to a couple different ways of improving vision for sports. The first was to “point your eyes where you're aiming.” This is a great cue that we, coincidentally, started to mix in with our med ball throws toward the end of the Summer. Instead of blindly throwing the ball at the wall, we'd tell them to pick a spot and aim for it. The other was through both 1st and 3rd party perspective visualization. Instead of just visualizing yourself performing some task/activity through your eyes, also try visualizing it through the eyes of someone watching you.

New Age Supplementation
Jennifer Ketterly gave a great talk on Vitamin C, Vitamin D, and DHA supplementation. Bulletpoints below:

Vitamin C

• 250mg-1g/day decreased cold incidence by 50% in endurance trained athletes
• Baseline Vit C status associated with beneficial strength outcomes post-ACL surgery
• Indirectly affects muscle function through effect on iron absorption
• Fruit/Veg average consumption is 1.6/3.2 servings/day, respectively
• 5 servings of fruits and vegetables provides ~200mg/day
• Optimal Vit C intake is ~400mg/day

• More of a hormone than a vitamin
• Associated with improved immune function
• Seasonal variability of flue correlated with Vit D status
• Down regulates expression of inflammatory cytokines
• Study participants that increased their serum concentrations from 10 to 30ng/mL experienced improvements in reaction time, balance, timed tests, and strength
• 93% of patients with musculoskeletal pain and weakness had serum concentraitons <20ng/mL
• 3 months of 5,000-10,000 IU/day lead to a decrease in back pain in those that were deficient at baseline
• Increase in protein synthesis and increased number and diameter of fast twitch muscle fibers
• Ideal serums concentrations are 40-70ng/mL
• Insufficient concentrations are <30-32ng/mL
• Deficient ,20ng/mL
• [25(OH)D] is best test indicator (25 hydroxy)
• Hockey players at high risk for Vit D deficiency, especially mid-season
• Get levels checked > 2x/year!

• DHA is an omega-3 fatty acid that is important for brain and eye development
• Recommendation is 1.6g/day for males and 1.1g/day in females
• Current mean intakes of EPA and DHA is ~125mg/day
• Supplements tend to be 60/40 EPA/DHA. Need to account for this when supplementing to improve DHA levels.

• Rotator cuff tears don't experience much repair between 4-8 weeks. Most healing occurs between 8-12 weeks.
• Shoulder capsulolabral healing seen at 6 weeks, but usually requires a minimum of 3 months before the athlete is ready to return to sport. The failure rate in contact sports is about 20-25% (much higher than non-contact sports)
• Platelet Rich Plasma (full of growth factors) injections are showing some promise in facilitating improved healing rates
• Meniscal repairs generally require about 12 weeks to sufficiently heal
• ACL Repairs:
• Graft-bone healing variable between 4-12 weeks
• Graft remodeling/breakdown in 1st 3 months
• Return to play varies from 4-12 months, but most athletes don't report feeling mentally “back” until 12-18 months

• 1.6-3.8 million sport-related concussions per year
• As of 2010, concussions are no longer graded on a scale of 1-3
• Management of concussions has become increasingly conservative over time. Trainers and coaches really need to stress no return to play!
• 75% and 92% of repeat concussions occur within 7 and 10 days of original incident, respectively.
• 1 prior concussion increases risk of subsequent concussion by 1.5x
• 2 prior concussions increases risk of subsequent concussion by 2.8x
• 3 prior concussions increases risk of subsequent concussion by 3.5x
• Amnesia is a better predictor (up to 10x) neurological issues than loss of consciousness
• The younger the athlete, the higher the likelihood of prolonged problems
• Emphasize that headaches are not a natural part of competition!
• A subjective feeling of “fogginess” is indicative of a severe concussion
• Visual problems secondary to a concussion are associated with neglecting vision in one eye and leads to feeling dizzy or “off”. Force them to use that eye and symptoms clear up within a couple days

• The most important thing about being a good coach is getting people to buy in. This goes for sport coaches, those involved in rehab, and strength and conditioning coaches. It's impossible to work together to pursue a common goal if there isn't collective understanding of that goal and, more importantly, the plan to achieve it.
• Emotional confrontation doesn't work. Let initial emotions subside before confronting someone about a problem.
• You have three choices when accepting criticism: Ignore it, Attach criticizer, Listen and assess validity (most favorable)
• Two worst professions for accepting criticism are teaching and coaching. Everyone thinks they know how to do these jobs!