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On Saturday, April 17th at 1pm EST we will be hosting an Instagram Live session with The Basketball Doctors (@basketballdocs ). This will continue our conversation on ACL injuries from our last session, now focusing on the rehabilitation of these injuries. Additionally, we will briefly break down the mechanism of injury of the recent case of NBA star, Jamal Murray and answer questions from the floor in a Q&A session at the end. Make sure to tune in and learn all about ACL re...habilitation. @basketballdocs ' mission is to empower the basketball community with evidence-based information relevant to injuries, injury prevention, and rehabilitation, as well as, movement re-training to optimize performance of all skill level athletes. Marco Lopez was born and raised in Los Angeles, California. He is a graduate of the University of Southern California’s (USC) - Doctorate of Physical Therapy (DPT) program. Prior to this he also attended USC where he earned his Bachelor’s degree in Human Biology with an emphasis in Applied Physiology. From 2011 to 2014, he was a Student Athletic Trainer and a Physical Therapy Aide. He worked alongside the USC basketball, football, and volleyball teams. Marco has a strong interest in ACL reconstruction rehab due to his own ACL reconstruction, which occurred in December 2017. Marco currently practices at Beach Cities Orthopedics & Sports Medicine in Manhattan Beach, California. Gabe Ignacio was born and raised in the Bay Area in Northern California, and currently resides in Orange County. He played basketball and golf competitively as a child and into high school, and had the opportunity to play on the D1 practice/scout basketball team at the University of the Pacific. Gabe received his Bachelor’s degree in Sports Medicine and a minor in Psychology. After completing his undergraduate degree, Gabe entered USC’s Doctorate of Physical Therapy. Gabe currently practices at ProSport Physical Therapy & Performance at their Newport Beach/Costa Mesa location. #KinectMD #TheBasketballDoctors

Los Angeles Lakers star LeBron James sustained a high right ankle sprain in the second quarter of the Lakers’ loss against the Atlanta Hawks. The high ankle sprain is an uncommon form of ankle sprain with a variable recovery time. For example, Golden State Warriors shooting guard Klay Thompson suffered a high ankle sprain in Game 1 of the 2018 NBA finals and returned for Game 2 while New York Giants running back Saquan Barkley was out for several weeks. Overall, ankle sprains... are the commonest form of acute sports trauma, accounting for 14% of all sports-related injuries. (Fong et al, 2009). Syndesmotic joints, like the one joining the tibia and the fibula, are fibrous joints held together by multiple ligaments. The distal or inferior tibiofibular syndesmosis is comprised of four ligamentous structures: The anterior inferior tibiofibular ligament (AITFL; sometimes referred to as the anterior tibiofibular ligament), The posterior inferior tibiofibular ligament (PITFL; sometimes referred to as the posterior tibiofibular ligament) The transverse ligament, and the interosseous membrane (IOM). Unlike the lateral ligament, the high ankle sprain is due to damage to the distal tibiofibular syndesmosis as a result of forceful external rotation of the ankle. They typically occur in contact sports, especially football and hockey, and even downhill skiing. The syndesmotic joint plays a major role in ankle stability, thus any injury to the joint results in prolonged instability and increased risk of re-injury. Isolated grade 1 injuries are treated with physical therapy. Management typically follows a three-phase rehabilitation program. The acute phase, subacute, and the advanced training phase. Injuries of grade 2 or 3 and those associated with fractures or other significant soft tissue injury are referred to a surgeon. Prayers up for a quick and safe recovery for Lebron. #KinectMD #anklesprain #ankleinjury #lebronjames #anklemobility

Concussions in athletes are a well-known phenomenon and widely studied across the globe. But what about dance-related concussions? A new study by Russell et al. (2021) helps us dive into the mechanism of injury and concussion management principles in dancers to bridge the gap of knowledge in this population. Dance-related concussions can occur during class, rehearsal, or performance. Causes: unintentional drops while partnering, direct blow to the head with other dancers or ...on the floor, and stunting falls, multiple small impacts to the head (eg. the repetitive practice of somersault dives) Barriers to concussions management in dancers 1. The performing arts, unlike many sports, often do not have sideline therapists and qualified coaches ready to administer a standardized sports concussion protocol (eg. SCAT-5) if a concussion is suspected. 2. Dance culture, in general, tends to silence or downplay the magnitude of injuries (due to fear of losing a performance role, pressures to returning to dance quickly, pushing through the pain culture, and lack of education). *As per the data: dancers who do not report their symptoms right away risk, on average, an additional 5 days of recovery. General care principles -Concussion management in the performing arts is similar to traditional concussion management, with adjustment to the cultural and psychological aspects taken into consideration. -All artistic athletes should see a licensed professional if a concussion is suspected. Any symptoms for more than 2-3 weeks, history of previous concussions or unclear diagnosis should be addressed with a concussion-specialized physician. -Return-to-play sport protocols have been adapted to performing artists. The artist can progress to the next stage after a minimum of 24 hours in the current stage if there is no exacerbation of symptoms. Return to full performance should take no fewer than 5 days. Performing artists often push through concussion symptoms despite the clinician’s advice, therefore communication and a good therapeutic relationship are crucial to minimizing harm to recovery. #KinectMD #concussion #dancephysio #dancephysiotherapy #dancerehab

On Wednesday, March 24th at 2pm we will be hosting our very first Instagram Live session with Dr. Jihad Abouali (@torontosportsdoc). We will be discussing everything about the ACL and answering questions from the floor. Make sure to tune in and learn from one of the best in the game. Dr. Jihad Abouali is an Orthopaedic surgeon at Michael Garron Hospital in Toronto, ON and an Assistant Professor at the @uoft Department of Surgery - ranked one of the highest surgery programs globally. He is currently the Orthopaedic Surgeon for Rugby Ontario. He previously acted as the Co-Orthopaedic Surgeon for the Toronto Argonauts, the Medical Examiner for the Basketball Canada Men’s Senior team, and the Team Orthopaedic Surgeon for the Toronto F.C. Also, he was appointed the role of Lead Physician for the 2015 Toronto Pan Am Games. #KinectMD

In the 2000-2001 season Philly 76er Allen Iverson unknowingly changed the fashion game on the basketball court. One of the lesser-known joint structures is the bursa - a fluid-filled sac made of synovial membrane that lies close to areas of high-wear and friction. Its sac-like quality affords cushioning that helps dampen repetitive forces from affecting underlying structures. There are 2 types of bursae: synovial and adventitious. Synovial bursae are the most common type and... commonly found near joints. Variants of synovial bursae are distinguished by their position: subcutaneous, subtendinous, subfascial, and submuscular (Mercadante 2020). Subcutaneous bursae include the olecranon, prepatellar, and subcutaneous calcaneal bursa, which offer cushioning to the elbow, kneecap, and heel, respectively. When muscles contract, tendons that connect them to bone structures will move accordingly. Bursae lie underneath tendons and muscles reduce friction in these high-wear areas, allowing for smooth movements. Subtendinous bursae include the subacromial, iliopsoas, and retrocalcaneal bursae. Adventitious bursae are reactionary, non-native structures that form in response to repetitive forces. For example, a crooked big toe can develop a bursa as a protective measure; this bursa is more commonly known as a bunion. As with any tissue, bursae can get swollen. Repetitive stress or injuries are common causes of aseptic bursitis. The so-called student’s elbow is olecranon bursitis. When spurred by repeated stress forces, such as constant elbow pressure applied to a desk, the bursa fills with fluid, creating swelling and redness at the tip of the elbow. Non-surgical treatments of bursae, much like non-surgical treatments of any sports-related injury focus on the use of NSAIDs, activity modification, compression, ice, well-padded splinting, and physiotherapy. (Reilly & Kamineni, 2016). Tissue fluids are passively absorbed into the lymphatic vessels and re-enter the circulation. By surrounding the swollen area with a compression fitting, fluid is forced into the lymph system. Elevation of the affected joint adds the force of gravity into the mix. #KinectMD #bursitis

You’re playing a game of pick-up basketball with your friends. You get a pass, drive the net, but miss the lay-up! As you turn to run the other direction, you feel excruciating pain for foot-sake, you’ve suffered a Jones fracture. Although no universal definition exists, Jones fractures are typically described as any fracture within 1.5 cm of the proximal fifth metatarsal, distal to the tuberosity. Significant inversion of the hindfoot or adduction of the forefoot can lead... to injury of the fifth metatarsal, including Jones fractures (Dean et al., 2012). Jones fractures arise when the foot is subject to a significant amount of force towards the midline, while the ankle is in plantar flexion. Such a force can result in trauma to the metaphyseal-diaphyseal junction, and ultimately, a Jones fracture (Den Hartog, 2009). Jones fractures are seen across a variety of different sports, including football, dance, and basketball. For example, NBA star Kevin Durant missed part of the 2014/2015 NBA season due to a Jones fracture that required surgical repair (Price, 2014). Patients with Jones fractures typically report pain in their lateral midfoot. Upon further examination, patients may also display swelling and tenderness (Den Hartog, 2009). Injury management depends on the properties of the fracture and the needs of the patient. In some cases, Jones fractures may be managed non-surgically. Specifically, patients are placed in a short leg cast for 6 weeks and instructed to avoid weight-bearing activities. In this case, the mean time to union is roughly 16 weeks. Jones fractures may also be managed surgically, especially in high-performance athletes. A variety of surgical techniques exist, including tension band constructs. There is a clear benefit to surgery, however, as the mean time to union is only 7.1 weeks! But, with reward comes risk, as the complication rate is nearly 20% (Dean et al., 2012). While most Jones fractures heal with proper management, non-unions are not uncommon. Therefore, it is critical that Jones fractures are properly diagnosed and treated to limit potential complications. #KinectMD #jonesfracture #footandankle #footinjury #podiatry

If you’re a Dallas Stars fan, you might be anxiously awaiting Tyler Seguin’s return from the Injured Reserve after undergoing surgery to repair a torn labrum of the right hip. Hip labral tears are injuries sustained to the acetabular labrum of the hip. The acetabular labrum is the cartilaginous structure that surrounds the acetabulum (Lewis et al. 2006). The labrum is critical for our mobility, as its position in the hip joint enables it to stabilize the femoral head, abso...rb shock and lubricate the joint. Acute or chronic trauma, femoroacetabular impingement (FAI), and hip hypermobility can lead to injury of the acetabular labrum (Groh & Herrera, 2009). It is theorized that there are at least 5 broad causes of hip labral tears (slide 4). In athletes, labrum tears often result from traumatic events, hip dislocations, or acetabular fractures. Consequently, sports that require athletes to regularly pivot and rotate, such as hockey, golf, and dance, see higher rates of acetabular labrum tears (Bharam 2006). Patients with hip labral tears typically report pain in their groin, anterior hip, and occasionally their buttocks. Patients may also describe experiencing ‘clicking’ or ‘locking’ of their hip during movements (Hunt et al. 2007). In most cases, labrum tears are initially managed non-surgically. Patients are instructed to rest and undergo physiotherapy for 10-12 weeks (Groh et al. 2009). If non-surgical interventions are unsuccessful, or for high-performance athletes, labral tears may be managed surgically. Surgery is commonly performed arthroscopically and the current gold standard technique is labral repair (Hunt et al. 2007, Wenger et al. 2020). Prognosis following surgical repair is generally positive (Robertson et al. 2007). Interestingly, golfers have the fastest return to sport, at roughly 6 weeks post-op (Bharam et al. 2002). Given that femoroacetabular impingement (FAI) is a common cause of acetabular labrum tears, surgical repair of labrum tears is often concurrent with FAI repair. Proper management of labrum tears is critical, as the labrum plays an important role in preventing early arthritis (Kelly et al. 2005). #KinectMD #labraltear

Regardless of whether you are just starting out with your training or are an avid gym go-er, unilateral leg strength training is important to take your training to the next level. Here’s a quick lowdown of what unilateral strength training can do to improve your lifestyle and performance! 1. Single-leg training can improve interlimb asymmetries and prevent injuries (Gonzalo-Skok et al, 2019) Interlimb asymmetries can impact performance and have been shown to quadruple the ri...sk of ACL injuries in high risk athletes. The results of an eccentric unilateral program show a decrease in interlimb asymmetry for all functional tests. The asymmetry improves at a greater degree for groups that trained with double the volume on their weaker leg. 2. Single-leg training can increase strength in the untrained leg (Manca, Dragone, Dvir & Deriu, 2017) The phenomenon of cross-education, where the untrained leg improves in strength after training the contralateral leg, has been widely studied since the late 1800s. Unilateral strength training of the leg muscles induced an average increase of around 15% of the contralateral leg. Eccentric training allowed for greater cross-education effect, followed by concentric training and isometric training. 3. Unilateral training enhances sport performance requiring explosive muscle actions like for jumping, sprinting and speed. In a study of preadolescent soccer players. The unilateral strength group had better outcomes for hamstrings strength, double leg squat, single-leg outcome measures, and the 5m sprint time. Unilateral strength training had better outcomes in performance vs. double-leg training alone. (Drouzas et al, 2020). Stern et al. (2020) adds that unilateral training increases split squat strength, single-leg broad jumps, and the change-of-direction speed test, vs. bilateral training in elite soccer players. 4. Unilateral training increases balance (Youssef et al, 2018) A unilateral training program for chronic ankle instability who performed single-leg static and dynamic tasks showed significant increases in antero-posterior, medio-lateral and overall ankle stability and coordination post study. #KinectMD

Over the past year, many of us were looking for excuses to go outside and get some exercise. Golf became one of the most popular activities of the year. Consequently, many of us may have dealt with bouts of golfer’s elbow. Golfer’s elbow, also known as medial elbow tendinopathy (MET, previously called medial epicondylitis), refers to a tendinopathy of the elbow’s medial common flexor tendon (Kiel et al. 2020). The medial common flexor tendon is responsible for stabilizing ...the elbow joint. Recurring flexion of the wrist and/or pronation of the forearm can produce stress on the elbow joint, which may result in trauma to the tendon (Alrabaa et al. 2019). MET is commonly reported by golfers. It is thought to result from the movements made between the top of the backswing and ball impact (Shiri et al. 2006). During this time, there may be eccentric loading of the muscles attached to the flexor tendon (Kiel et al. 2020); repetitive loading of the muscles can lead to medial epicondylitis (Alrabaa et al. 2019). MET can result from playing a variety of sports, such as baseball (called pitcher's elbow), football, and tennis. Most cases of golfer’s elbow are not even related to athletics. It is commonly reported by individuals engaging in intense physical exertion with repetitive motions, such as plumbers, mechanics, and construction workers (Shiri et al. 2006). Individuals typically with MET experience pain, numbness, and tingling on the medial side of their elbow, but normal range of motion. Symptoms become worse following gripping, wrist motion, or forearm movements (Amin et al. 2015). Most cases are treated non-surgically with physical therapy and splinting/counterbracing. Individuals who continue to report symptoms may require surgical repair. Surgery typically involves debridement of the common flexor tendon followed by reattachment of the tendon to the medial epicondyle. Patients are then placed in a splint with physical therapy beginning 6 weeks thereafter (Ciccotti et al. 2003). Outcomes for golfer’s elbow are generally favourable, but proper diagnosis and treatment are critical to avoid chronic pain (Kiel et al. 2020). #KinectMD #golf #golferselbow

As a female athlete, you might work out multiple times per week in various jumping or running activities. And sometimes, you can find yourself in awkward situations while at the gym...Did I just pee a little?. Mortifying, I know! Stress urinary incontinence (SUI) is defined as any involuntary loss of urine due to sneezing, coughing, or physical exertion. SUI happens to nearly 50% of physically active women (Pires et al. 2020)! SUI and its prevalence in female athletes The p...elvic floor is the floor of our core, as it acts as a support for our abdominal and pelvic organs. It also allows for continence, and acts as a sump-pump for proper circulation and lymphatic drainage. During physical activity, our intra-abdominal pressure increases greatly as we contract the abdominal muscles. To counteract this effect, the pelvic floor muscles must contract to close up the urethra, anus, and vagina. These pressures can put physically active women at risk for SUI if their pelvic floor is not adequately activated. Over time, the perineal muscles can become injured and have increased neuromuscular fatigability (Yang et al. 2019). Some factors can contribute to the likelihood of developing SUI in female athletes. Intensity of training: Intensity of symptoms is proportional to intensity and frequency of training (Yang et al. 2019). Ground impact: Sports like gymnastics report the highest prevalence for SUI as it demands extensive training in running during floor events, and jumping from high surfaces such as landing from the vault, uneven bars or beam (Lourenco et al. 2018). Abdominal wall activation for spinal stability: Ground impact may not be the sole contributor of increased intra-abdominal pressure leading to SUI. Swimmers have a 15% prevalence of SUI due to long bouts of abdominal contractions to stabilize the spine as they swim (Lourenco et al. 2018). What can be done? Consulting a physical therapist or a pelvic floor therapist can be helpful in addressing symptoms and their triggers. Therapists are qualified to use a variety of treatments such as pelvic floor muscle training (PFMT), which has been proven to be an effective way to reduce SUI symptoms. #KinectMD

Over the past few years, KinectMD has served as interactive tool to promote multi-disciplinary learning and collaboration on various topics within the field of sports medicine. To kick off 2021, we want to set the tone for our future plans by introducing you all to our website www.kinectmd.ca This website will be the homebase for KinectMD as we continue to grow. ... We hope to foster open communication and allow for the exchange of multi-disciplinary knowledge. KinectMD.ca offers a clear, consolidated resource for everyone from the first-time gymgoer to the avid athlete to the healthcare professional. Check out the full versions of our evidence-based articles from our team of writers and verified contributors, and reinforce the knowledge with our high-yield, engaging quizzes. www.kinectmd.ca #KinectMD

Plantar fasciitis is one of the most common causes of foot pain in adults. The plantar fascia plays an important role in normal foot biomechanics. The plantar fascia is firmly anchored to the calcaneus (heel bone) and extends forward as a thick band of longitudinally arranged connective tissue fibers. The fibers diverge and as they pass anteriorly, they form individual bands that enter the toes and connect with bones, ligaments, and the skin. This fascia provides static supp...ort for the longitudinal arch of the foot and acts as a dynamic shock absorber. Despite ‘fasciitis’ being the accepted description, the pathologic changes are actually more consistent with fasciosis/fasciopathy (degenerative process) than fasciitis (inflammatory process). The etiology is poorly understood and is probably multifactorial. Possible risk factors for plantar fasciitis include: obesity, prolonged standing or jumping, flat feet, and reduced ankle dorsiflexion. The condition is commonly seen in runners indicating that it is likely the result of repetitive microtrauma. However, it is also seen in ballet dancers and individuals with autoimmune conditions such as rheumatoid arthritis. Samples of the plantar fascia obtained during surgery show a spectrum of changes, ranging from degeneration of the fibrous tissue to fibroblastic proliferation, with or without evidence of chronic inflammation. The diagnosis is clinical; athletes complain of tenderness and pain near the calcaneus that is usually worse after a period of inactivity. It is crucial that individuals see professional help. Treatment of this plantar fasciitis involves exercises for the plantar fascia and calf muscles, avoiding the use of flat shoes and barefoot walking, proper fitted shoes with good arch support, decreasing activities that aggravate the condition, NSAIDs to help with the pain, and corticosteroid injections. The vast majority of patients with plantar fasciitis will improve spontaneously. However, a small portion may require surgery after 6 to 12 months of no improvement. #KinectMD #plantarfasciitis #plantarfascia #footpain #podiatry #footandanklesurgery

Cupping Therapy Explained If you watched the 2016 Summer Olympic you would have probably noticed that Michael Phelps had red circular marks on his shoulders and triceps. These marks are called cupping marks and are sometimes confused with bruising, however, that is not the case. In fact, these big red circles are caused by cupping therapy which does not cause any bruising if done correctly. Many athletes use cupping therapy such as the British-Nigerian, two-time unified heav...yweight champion, and Olympic Gold Medalist boxer, Anthony Joshua, and 2 NBA Most Valuable Player, Giannis Antetokounmpo. Cupping therapy is a technique that involves cups placed over the skin to create negative pressure. It has been practiced for thousands of years in Asia and the first records of it date back 3500 years to Ancient Egypt (Furhad et al. 2020). There are a variety of ways cupping therapy can be performed. The general technique involves placing glass or plastic cups placed on the target area then creating a vacuum with a pump or open flame. Cupping is able to to improve blood flow through body tissues, promote lymph drainage, loosen muscles, and create a mild immune response. Increased blood circulation helps waste and toxins enter the lymphatic system for excretion from the body (Lauche et al. 2012). It can also bring fresh nutrient-rich blood to help muscle fibres repair faster. Cupping eliminates pools of stagnant blood and lymph in the body and helps return them to regular circulation. The suction of the vacuum stimulates blood flow to the target area and leaves behind the red, painless marks as seen on Aaron Gordon. A true cupping mark does not change colour like a bruise. Proper cupping marks only fade away but improper cupping can leave bruises. There is limited research on cupping therapy and one should be wary that cupping therapy alone has not been scientifically proven of any benefits. #KinectMD #cuppingtherapy #cupping #michaelphelps #giannisantetokounmpo

Warming up and stretching are considered essential to athletic activities ranging from a morning run to the World Cup Final. With a variety of exercises and stretches used in the modern athletic environment, two major categories of stretches have formed: static and dynamic. Static stretching (SS) refers to stretches which require holding a single position near the end of a muscle’s range of motion (ROM) anywhere from 30 seconds to over a minute (Plack 2019) whereas Dynamic st...retching (DS) refers to stretching by repeatedly moving the muscles through their full ROM (Behm et al. 2016). The stark contrast between SS and DS begs the question: which one is better? Static Stretching: Increases joint ROM SS for >60 seconds: 3.7% decrease in average performance SS for <60 seconds: 1.1% decrease in average performance Greater decreases in strength-based movements (eg. 1 rep max) compared to power-speed movements (eg. jumping and sprinting) Dynamic Stretching Recent shift to DS could be because the movements are similar to common motions in the activity Increases the athlete’s core temperature while stretching If each rep is >90 seconds: 7.3% 5.3% increase in average performance If each rep is <90 seconds: 0.5% 2.3% increase in average performance These results were the conclusion of a systematic review by Behm et al. (2016). Currently there is significant heterogeneity in the data which makes conclusive findings difficult. Further research should be conducted with regards to dynamic stretching as it has not been studied in as much detail. The current recommendation is to incorporate DS with reps lasting >90 seconds into your warm-up routines as they have been shown to have a positive impact on performance. SS should be reserved as a tool to increase an athlete’s ROM over time. These recommendations are especially relevant to strength-based activities and sports like powerlifting as the negative effects of static stretching are especially detrimental in these cases. #KinectMD #stretching #staticstretching #dynamicstretching