CSM Daily News Highlights Issue - 2013 - (Page 6)

6 Daily News 2013 SAN DIEGO HIGHLIGHTS Extreme Conditioning Program Risks Need Special Consideration By Don Tepper E xtreme conditioning program (ECP) risks are poorly defined and often are at odds with evidence-based training practices. That was the take-away message from the CSM session “Extreme Conditioning Programs: Evaluating and Managing the Risk.” Danny McMillan, PT, DSC, OCS, CSCS, and Jason Steere, PT, DPT, ATC, CSCS, presented an overview of some of the more popular and wellknown ECP programs. They then discussed strategies for integrating ECPs with mainstream conditioning programs. They first presented a definition of ECPs developed by the Consortium for Health and Military Performance and the American College of Sports Medicine: “Extreme conditioning programs (eg, CrossFit, Insanity, Gym Jones, and others) are characterized by high-volume, aggressive training workouts that use a variety of high-intensity ex- ercises and often timed maximal number of repetitions with short rest periods between sets.” McMillan and Steere discussed the development and philosophy behind a number of programs, including Crossfit, Gym Jones, Mountain Athlete, Military Athlete, Seal Fit, Horsemen Training Program, Brass Ring Fitness, Westside Barbell, and Beachbody. They noted an “exponential explosion” of ECP popularity in the last 5-10 years but posed the following questions: • Are ECP and similar program designs problematic? • Is the purported greater injury risk over traditional conditioning programs valid? • Are these programs measurably inconsistent with accepted industry standard guidelines for safe and appropriate exercise prescription and progression? • Would a functional conditioning advantage of ECPs mitigate an increased occupational and op- erational threat? Steere, who is a physical therapist with the US Army, said, “We sometimes see excessive training in the military. But most of the injuries we see aren’t specifically from the military. It’s activities they do on their own. Some of those are sustained from extreme conditioning.” In addition to myriad injuries, Steere said, another threat is rhabdomyolysis—the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is harmful to the kidney and often causes kidney damage. Steere said that documented cases exist from many different forms of exercise and activity, but no distinct cause and effect has yet been established with ECPs. The second part of the program addressed strategies for integrating ECPs with what they called “main- Electrophysical Agents for Management of Diabetic Neuropathy By Lois Douthitt Maximize Your PT Potential Become a Board Certified Clinical Specialist Gain the formal recognition you deserve for your knowledge, skills, and experience. Doors can open for you as they have for your colleagues who have attained this very special professional distinction. The American Board of Physical Therapy Specialties (ABPTS) certifies individuals who have demonstrated advanced clinical knowledge and skills in the areas of: Cardiovascular & Pulmonary Clinical Electrophysiology Geriatrics Neurology Orthopaedics Pediatrics Sports Women’s Health Application forms are available at the ABPTS Booth #1942 & #1944. Or contact the Specialist Certification Program at 800/999-2782, ext 8520; or by e-mail at spec-cert@apta.org. www.abpts.org stream” conditioning programs. McMillan explained that the first step is defining a group’s needs. He said that identifying the relative importance of 3 biomotor abilities—strength, speed, and endurance—for each group is vital. For instance, a football wide receiver primarily needs speed. On the other hand, a 10-kilometer runner relies most on endurance. A wrestler needs all 3. A soldier needs strength and endurance; speed is less critical. McMillan and Steere then examined elements of ECP workouts to determine how well they could address those 3 abilities. They concluded that ECP risks are poorly defined and that the actual practice of ECPs often contradicts their own stated principles. They urged PTs to analyze the physical requirements for the task, assess the individual, and then design a program based on best evidence. O n January 24, Speakers Lynn Freeman, PT, DPT, PhD, GCS, CWS, Mark Besch, PT, and Sara Shapiro, PT, MPH, explained how integration of therapeutically dosed electrophysical agents (EPA)—such as electrical stimulation, therapeutic ultrasound, and electromagnetic therapy—maximize clinical outcomes in managing conditions associated with diabetic neuropathy. The session “Electrophysical Agents for Management of Diabetic Neuropathy: Comprehensive Management of Associated Conditions” also included a review of literature related to use of these interventions and clinical outcomes of actual patient/client cases. According to the Centers for Disease Control and Prevention, conditions associated with diabetes, specifically diabetic neuropathy, are the leading cause of physical disability in the United States. The impairments associated with diabetic peripheral neuropathy include diminished or altered sensation; compromised integument; and neuropathic pain, which can lead to activity limitations such as sleep disturbance, impaired Go to www.apta.org/CSM to learn more! mobility, and falls. According to the session speakers, EPAs frequently are prescribed for musculoskeletal pain, primarily because of the volume of supportive evidence and the well established mechanisms of action, such as the gate control and endorphin release theories. However, the pathophysiology of peripheral nerve damage and neuropathic pain is more complex than musculoskeletal pain, and it is only recently becoming better understood, they said. Further, EPAs are prescribed less frequently to manage the other deleterious impairments and activity restrictions associated with diabetic neuropathy, such as parasthesia, wounds, and falls. The speakers reviewed related literature, related clinical practice guidelines/protocols, and related physiological effects and clinical outcomes of EPAs for several associated conditions: • Neuropathic pain • Neuromuscular impairments • Integumentary impairments (diabetic wounds) • Sensory impairments • Range of motion, joint, and soft tissue impairments • Gait, locomotion, and balance dysfunction  http://www.abpts.org http://www.abpts.org http://www.apta.org/CSM

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CSM Daily News Highlights Issue - 2013

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