By Brian J. Adams, PT, DPT, OCS, CSCS
“Winter is not a season, it’s an occupation.” – Sinclair Lewis
Old Man Winter…For some athletes, the wintery landscape that encapsulates the Midwest from November until March is considered “off-season.” For others, the change of season brings forth new sporting adventures, both indoors and out.
And while the seasonal change affects these athletes, for therapists and other clinicians working in the sports medicine and rehabilitation world, a query of new training strategies arises and new orthopedic injuries begin to flow into the clinics.
A specific view of winter sporting activities can be broken down into three categories: outdoor winter sports, transitional sports, and the traditional off-season. Each of these activities comes with its own risk for injury and specific equipment demands. Traditionally, wintertime outdoor sports expose athletes to a higher risk of acute traumatic injuries, along with some overuse injuries. A slip on the ice or a fall on the slopes can result in an orthopedic injury that commonly is treated in the physical therapy clinic. Poor technique performing repetitive exercise can lead to a painful winter season. So take a moment to consider your own off-season preparation as a clinician, and determine the best strategy for your athletes this winter.
During winter months in the Midwest and areas where temperatures drop below freezing, many athletes turn to the snow and ice. Ski resorts attract many to their slopes. Golf courses morph into cross-country ski tracks, wooded hiking and mountain biking trails become cross-country and fat bike venues, lakes and ponds become hockey rinks and broom ball courts. Likewise, downhill skiing, snowboarding, Nordic/skate skiing, and good old-fashioned pond hockey all emerge, each requiring sport-specific training. In preparing athletes for these activities, therapists must consider the specific demands of each.
For cross-country skiing, technique and endurance are king. As the fall becomes winter, it is important to condition athletes for the demands that will be placed on their upper extremities and core. It is well-documented that fatigue leads to poor form, and poor form leads to injury. Utilizing the Concept 2 SkiErg (www.concept2.com/skierg), we can work on technique as well as cardiovascular fitness. Time spent in the clinic focused on endurance and technique will prevent future injuries.
When working with downhill skiers, rhythm and timing of weight transfer and edge control can be a significant focus. Skiers Edge, Park City, Utah, offers a line of clinical tools designed specifically for the downhill skier. The company’s T5, QS5, and LT Carver technical ski conditioners simulate the rhythmic movements of skiing, can replicate eccentric loading, and develop the athlete’s anaerobic system. The devices are designed to develop balance, proprioception, foot and ankle positioning, and cardiovascular endurance. Another device engineered to provide conditioning for skiers is the Pro Fitter 3D Cross Trainer from Fitter International Inc, Calgary, Alberta, Canada. The Pro Fitter 3D features independent flexing rotating foot pads, an instantly adjustable tension system, and an attachable soft ankle board for sitting, standing, and upper body work.
For more fanatical endurance athletes, the colder temperatures and snow do nothing to quiet their spirit. Runners keep running. Cyclists keep riding. Many cyclists now choose to remain outside riding large-tire fat bikes that tolerate snow, slush, and ice much better than a traditional bicycle. Runners often remain outdoors with appropriate clothing and footwear. These athletes need to take special care to prevent overexposure and frostbite. Equipment choices to prevent falling and traumatic injury should be discussed.
The following companies also provide products for fitness, training, and rehabilitation:
Clarke Health Care Products
Fitter International Inc
Madd Dogg Athletics Inc
NZ Manufacturing Inc
Spirit Medical Systems
Vonco Medical, Rehab & Fitness
There are a handful of fair-weather sports that can easily translate into the winter season with some equipment and venue changes. For multisport athletes, cycling, running, and swimming can all be moved indoors.
When cycling indoors, there are a few options for resistance trainers. For clinics that may want to commit to a permanent fixture, a stationary bike such as the CycleOps Phantom, Madison, Wis, provides a quiet, rugged system with a built-in power meter and computer. We traditionally use these with our athletes when conducting VO2 max and blood lactate/power testing. Another facility-based product that can be used for eccentric strength training is the Eccentron from BTE, Hanover, Md. The Eccentron is operated with the user in a seated position, resisting moving pedals at force capacity. Measurement and reporting functions can generate data to help demonstrate the user’s performance and progress. Spirit Medical Systems Group, Jonesboro, Ark, is also a manufacturer of recumbent bikes and upright bikes for the physical therapy market.
For athletes who are more interested in a system that utilizes their existing bike, the Wahoo KICKR from Wahoo Fitness, Atlanta, is a quiet and highly functional rear-mounted resistance trainer. Observing the use of this product in our own clinic, what sets this unit apart is the Wi-Fi/Bluetooth capabilities and its ability to connect to online applications that simulate real riding and racing courses.
Running athletes will focus on maintaining their mileage by mixing indoor and outdoor training, depending on weather. A serious training tool for clinics working with a high volume of runners is the AlterG Anti-Gravity Treadmill from AlterG Inc, Fremont, Calif. This device combines the efficiency of a high-speed treadmill with an air-compression system that unweights the runner with positive pressure. While we utilize this system in the rehabilitation setting, many athletes will integrate the unweighted running into their training programs. From recovery runs, speed work, and fartlek training, the AlterG Anti-Gravity Treadmill can provide the supplement to indoor training that many runners need.
Rock climbing in the Midwest is limited to certain geographical areas, and during the winter months athletes move indoors to the local climbing crags. The brave and experienced few will take their skills to the frozen rivers and waterfalls in the form of ice climbing. Oftentimes, climbers struggle with shoulder, elbow, and hand injuries. Our clinical staff members often recommend the utilization of Metolius Hangboards from Metolius Climbing, Bend, Ore, to improve grip and upper-extremity strength and eliminate technique faults. Daily use of products such as Metolius Grip Savers help to strengthen the muscles of the hand and forearm, gliding of the tendons and identify muscle imbalances of the hand. Special care needs to be taken with the pulley/tendon complexes of the climber’s hands, as the A2 pulley is often damaged during high-volume rock climbing/training.
The off-season: an opportunity for athletes to recharge and recover. There are well-documented benefits both physically and mentally to taking a break from cherished sports. When considering the winter months as an official off-season, athletes can stay productive and build toward the next season with coaching and guidance. Time can be spent identifying the athlete’s weaknesses: strengthening postural muscles, identifying and eliminating imbalances, and improving mobility.
Conducting a Functional Movement Screen (FMS) as a means to identify poor movement patterns in athletes is helpful. Gray Cook (www.functionalmovement.com) has educated countless sports medicine professionals on the utilization of the FMS as a preparticipation and injury-prevention screening tool. This can be useful in objectively identifying risk for an athlete, and streamlining a functional rehabilitation program for their off-season.
We often encourage athletes to take up the practice of yoga and Pilates to improve body awareness and control. This can be done in the studio or at home, and there are many videos and apps available, including Yoga 15 created by Abi Carver (www.yoga15.com).
The winter months can be the perfect time to identify technique flaws and imbalances in the endurance athlete. A medical-based running gait analysis or bike fit can improve efficiency and decrease stress on the running and cycling athlete. The athlete can be assessed in the clinic for movement imbalances. This is traditionally done in the clinic with video capture and analysis software such as Dartfish from Dartfish USA Inc, Alpharetta, Ga, Hudl Technique from Lincoln, Neb-based Agile Sports Technologies Inc, or Coaches Eye from TechSmith Corp, Okemos, Mich.
Oftentimes in the clinic, we utilize resistance bands, such as the Thera-Band from The Hygienic Corp, Akron Ohio, or CanDo exercise bands from Fabrication Enterprises Inc, White Plains, NY, to isolate smaller stabilizing muscles and improve neuromuscular recruitment and endurance. Another provider of resistance products for therapeutic exercise is Warminster, Pa-based Stretchwell Inc, which manufactures the Fit-Lastic therapy products line made from natural rubber latex.
The use of a foam roller as a tool for soft-tissue mobilization and joint mobility is imperative. A lacrosse ball for deep tissue massage and trigger point release is also valuable. Based on the athlete and their sport, we can develop a home exercise program utilizing these tools to help overcome muscular imbalances and poor recruitment. Massage balls and foam rollers are available from several manufacturers, including Minneapolis-headquartered OPTP, and Fitter First, based in Calgary, Alberta, Canada.
There is significant value in allowing the body time to recover during the off-season, and many products are available to assist with this objective. Two key concepts are improving circulation and enhancing muscular recovery. During rehabilitation, we often use soft-tissue massage and different stretching strategies. One product that can enhance recovery is the NormaTec (www.normatecrecovery.com) compression boots. These are essentially sleeves that are zippered around the lower extremities and hook up to a compression device. As the air pressure increases, it stimulates lymphatic and vascular circulation. This recovery model can also be enhanced by MarcPro (marcpro.com) muscle stimulators, which are functional recovery neuromuscular stimulators that provide a pulsation and relaxation mode to stimulate muscles, decrease muscle spasm, and improve local circulation.
Wintertime is a feature that sets the Midwest apart from the rest of the country. Seasonality brings change, and change brings a fresh new perspective. The cold and snow should not hinder athletes from training and enjoying the sports they love. In the sports medicine world, physical therapists are strategically positioned to help athletes reach their potential. By utilizing specific tools of the trade and removing variables, therapists can enable the athletes with whom they work to improve performance and reduce the risk for injury. PTP
Brian J. Adams, PT, DPT, OCS, CSCS, is a practicing physical therapist and owner at Adams Sports Medicine & Physical Therapy, P.C., Novi, Mich. He is an orthopaedic clinical specialist and a certified strength and conditioning specialist. Adams also is a Certified BikeFit Pro/Instructor, USA Cycling Coach, and Elite Level cyclist, focusing on the needs of the cyclist/triathlete. He routinely makes presentations directed at evaluation and treatment of the upper and lower extremities as they relate to endurance athletes. For more information, contact PTProductsEditor@allied360.com.