There are three types of heat illnesses, all of which can be prevented with proper hydration and recognition of the signs and symptoms listed below.

Heat Cramps: Caused by fluid loss and electrolyte imbalance.  Signs and symptoms include extreme sweating and muscle cramping of the extremities and/or abdominal muscles. Treatment for heat cramps is fluid, electrolyte replacement, rest in a cool area, and light stretching of the muscles involved.

Heat Exhaustion: Caused by continued fluid loss with extreme sweating, lack of fluid intake and/or vomiting. Signs and Symptoms include extreme sweating, weakness, extreme thirst, light headedness, headaches, skin can be cold and clammy, and a body temp up to 103̊. Treatment; fluid and electrolyte replacement, rest in a cool area with fans blowing, ice towels or ice bags to help with cooling.

Heat Stroke: A medical emergency call 911. Signs and Symptoms include hot dry skin, no sweat, glassy eyes, rapid pulse, and falling blood pressure. Treatment; call 911,  extreme cooling with ice towels, ice bags and fans (place ice bags in armpits and groin area) transport to hospital emergency room.

It is important to make sure you are drinking enough fluids throughout the day. Everyone has different needs and you will know you are properly hydrated when your urine is a pale yellow to clear color.  Remember if you feel thirsty you are already partially dehydrated make sure you drink extra water on days that you will have an increased activity level.

A good rule of thumb is to weigh in before and after activity then replace your weight loss with an equal amount of fluids.

Kevin Taylor, MS, ATC
Head Athletic Trainer
Idaho Stampede-NBADL

• Injury Prevention

• Balance & Coordination

• Core Strength

• Proprioception

• Speed

• Agility & Reaction Time

• Power

• Endurance

 Who: Athletes ages 7-14

When: Boise Camp June 8- July 1  /  Nampa Camp July 13-August 5

Camps will meet Tuesday and Thursday with the option of : 9am-11am or 6pm-8pm

Cost: $115 a late registration fee of $25 after May 28 (for Boise Camp) and July 2 (for Nampa Camp).

To register, contact Lorie Allison @ 484-0730 or email lallison@elksrehab.org

What does this mean?

Let’s go through some anatomy first. Your spine is comprised of a few different levels to include the Cervical (neck), Thoracic (mid back), Lumbar (low back) and Sacral (pelvic/tailbone).

We will concentrate on the Lumbar, or low back area, in this particular blog.

There are five segments, or levels, that make up the Lumbar spine. From the top down, they are numbered 1 – 5. Each spinal segment is comprised of a vertebral body with a corresponding disc in between those two vertebrae. Exiting off of the spinal cord at each level will be a pair of nerve roots which eventually form the nerves that innervate the muscles of your lower body. The openings that these nerves pass through as they exit from the spine are called the foramen. There is a foramen on each side and at each level of the spine.

The disc is comprised of an outer area called the annulus. The annulus consists of several concentric rings of fibrocartilage that encompasses the inner portion called the nucleus pulposa. The disc essentially acts as a shock absorber for the spine.

By definition the following diagnoses are the most involved progression of discal pathology. (See diagrams below for anatomy)

-         Bulging Disc:  A disc that extends out past its normal position. On an MRI these often look like a tire that is going flat.

-         Disc Herniation / Protrusion: The inner portion of the disc (nucleus) is pushing out through the outer layers, but is still retained to within the disc. These often look like a bubble sticking out from the disc.

-         Disc Extrusion / Prolapse: A progression of the previous Disc Herniation / Protrusion where the inner disc material (nucleus) actually physically exits through the outer rings of the disc almost as if it was squirted out of the disc like a jelly doughnut.

As diagnoses, there is typically a progression with the above disc pathologies in regards to the severity of symptoms. In each of these pathologies they can vary from quite mild to rather significant/severe in their nature. As a general rule the more significant the pathology, the more severe, (or significant) the potential symptoms.

• Disc Bulges are most often asymptomatic and quite normal within the general population. In severe cases, they can have an effect on the spinal cord or the nerve roots at times.
• Disc Herniations / Protrusions are more significant, but can, at times, be asymptomatic as well. Typically, there can be mild to severe symptoms in the back and into the legs.
• Disc Extrusions / Prolapses are typically the most significant, often causing more severe pains and leg symptoms than a disc protrusion.

Now that we have a little background in the area of anatomy we can talk about what these definitions mean to you and your Physical Therapist.

With a good patient history along with a careful physical examination, your Physical Therapist should be able to gain a good prospective as to what is going on with your spine in regards to not only the amount of pathology, but also to which levels of the spine are involved.

As a note, humans and their anatomy can be wildly variable from one individual to the next. Likewise, how an individual responds to pain and injury is quite variable as well.

From my experience, I have seen patients with very minimal pathology in the spine who, have had significant pain and other symptoms. Conversely, I have seen individuals with a great amount of damage to the spine that are very minimally affected.

As a note on the variation in an individual’s anatomy and their response to the potential pathology at hand, I would like to speak on imaging of the spine. In particular, I would like to talk about the limitations of MRI’s (Magnetic Resonance Imaging).

The MRI is often considered the most telling diagnostic test in regards to looking at one’s anatomy. In particular, it is very good at seeing soft tissue such as discs and nerves. With the skyrocketing costs of health care MRI’s have come under more and more scrutiny due to the shear number of MRI’s performed, their cost, and the frequent lack of conclusive results.

A recent study was published in the New England Journal of Medicine titled “Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain”. 

Jensen et al had collected 98 subjects for this study, all of which reported having zero low back pain.

They performed MRI’s on these 98 individuals and came out with rather astonishing findings.

-      Only 36% of the 98 individuals were considered to have a normal spine.

-      52% had at least one disc bulge.

-      27% had at least one disc protrusion.

-      1 % had a disc extrusion.

So, this begs the question, whose spine is actually normal? The answer is, probably very few of us. This is why it is important to realize that MRI’s can be very useful, particularly in finding abnormal anatomy in one’s spine. But an MRI is limited in the fact that it is just a snap shot in time. It is only a still picture of anatomy. An MRI does not always qualify or quantify one’s symptoms.

With so many people (even those of us without back pain) having some amount of pathology in the spine, your Physical Therapist becomes quite important in determining which pathologies in the individual’s spine may be the significant culprit. With this, your PT should be able to educate you and get you on the road to recovery from this injury while decreasing the likelihood of you having another episode in the future. 

 Kelly Jorschumb MPT, CSCS

Spine Specialist

Site Manager, Cloverdale/McMillan Clinic

The hardest part of being an athlete is suffering from an injury.  Do I tell the coach?  Should I sit out of practice?  Will I still have my spot when I get back?  As a physical therapist, deciding whether someone is capable of playing is probably the most difficult aspects of my job.  To start, I look at strength and range of motion of the individual.  Then, I assess the functional needs of the athlete in relation to the sport that he/she is participating.  When the athlete is able to actively go through full range of motion and has good strength, we usually begin functional training.  This may include lunges, squats, agility drills, or even a throwing or running progression.  Making sure the athlete is strong enough to return is a big concern which is why these functional progressions are so important. 

 When rehabilitation has concluded, I try to insert the athlete back into practice while keeping a close eye on him/her to ensure that the injury doesn’t flare up again.  I encourage my athletes start with a good warm-up:  1. Jog and stretch.  2. Gradual increase to full speed running.  3. Agility exercises with gradual increase in intensity.  4. Gradual increase in sport specific movements.  Following those steps, the athlete can partake in regular practice.  Even when practice concludes, the athlete is still not done.  A cool down routine is necessary.  Usually, I ask athletes to cool down with jogging then stretching.  I also instruct the athlete to ice the injury following all activity for 15-20 minutes.

A good rule of thumb for returning to sports after an injury is:  If your injury is sore and swollen the day after practice, you should take the next day off, then lighten your workload for the next practice.  Coming back from injury too soon may cause you to miss more time. 

Athletes are also at risk for hamstring and knee injuries when the gluteal muscles are not functioning properly or strongly enough. Tight hip flexor muscles are usually accompanied by weak gluts, which are responsible for shock-absorption during activity, but when not utilized, can lead to overuse of the hamstrings. Unfortunately the hamstrings are not structured to handle this type of workload, which results in injury to the hamstrings and even the knees, such as the ACL. In sum, it is also beneficial to have well stretched hip flexors prior to engaging in sports.

Here is a brief list of stretches and exercises to do as injury prevention.

Bridges – good for the gluts. Lay on your back with your knees bent, feet flat on the ground. Raise your hips off the ground so your torso and thighs make a straight line. Repeat this exercise until your feel a good burn in your buttocks. Remember you can always further challenge yourself by bridging with one leg.

Hip flexors stretch – Lunge forward with one leg and position the foot beyond forward knee. Straighten your hip of the rear leg by pushing hips forward. Hold this stretch for 30-60 seconds. Repeat with opposite side.

Walking lunges – To increase the challenge, start by bending your knees further to the ground or add dumbbells. Repeat until there is a great burn in your buns, hamstrings, and thighs.

If you are more experienced, other great hamstring strengthening exercises include dead lifts, good mornings, physioball hamstring curls, and many others.

Tyler Williams, SPT

Kristi McMahan, DPT

Your outfit should be snappy, not your hips.  Unfortunately with marathon season underway that is exactly what ends up happening in many recreational runners.  Robie Creek anyone?

            Many runners begin feeling a snapping, popping or sometimes a painful sensation in their hips whenever they run, squat or stand up.  This is because tendons of the hip begin to swell and become irritated.  They swell up and become painful because they are constantly rubbing against part of the leg bone (femur).  The swelling can eventually become permanent if left untreated.

            There are many reasons why this happens, but most of the time it is from too much running and/or poor running form.  Stretching, icing, resting and contacting a physical therapist for more information will help you get rid of that hitch in your giddyup and back on the trails.  Happy running.

Tyler Jepson, PT, DPT

Other ways to cut back on injuries include

·        Make your trampoline ground level by placing it in a hole

·        Have spotters while kids jump

·        Avoid putting the trampoline near trees or walls

·        Do not let animals on or near it while jumping

·        Set up the trampoline on soft grass (instead of hard packed ground)

·        Balance the trampoline so it is level

Spring time is a great time of year to begin enjoying the outdoors again, but always make sure you have the proper protective equipment and children have adult supervision – and enjoy the weather!

Tyler Jepson, PT, DPT

Emergency Department

If you have shin splints, you will notice pain on the inner edge of the tibia and this area will be tender to touch.  Mild swelling is possible but less likely.  In the early stages, the pain begins immediately but often goes away when you are warmed up.  As the condition progresses, the pain lasts throughout your run and usually into the next day during normal activities. What can you do to treat shin splints?

• Select the correct running shoe! – The folks at the Pulse can help you find the right shoe for your foot type. If excess pronation is a problem for you, shoe inserts or foot orthotics may be necessary to support your arch and maintain proper alignment of the foot/ankle. Running shoes should be replaced after 300-400 miles to ensure the ability to absorb the shock/stress created when the foot hits the ground.
• ICE! Apply ice for up to 20 minutes on a regular basis (2-4x/day) to decrease pain and inflammation. Use a compression bandage with the ice to reduce any swelling and provide support for the soft tissues of the lower leg.
• ‘Relative rest’ – Rest until there is no pain with normal daily activities. Increase days of rest between running days, maintaining cardiovascular fitness with stationary bike or pool running which have less impact on the legs. Stop hill training. Reduce speed and mileage to 50% of preinjury level, increasing gradually over 3-6 weeks.
• Anti-inflammatory medications – Talk with your physician regarding the short-term use of over-the-counter meds like Motrin, Advil or Aleve to control pain and inflammation.
• Stretching of calf (gastrocnemius & soleus) and anterior tibialis muscles
• Strengthening of the anterior tibialis muscle
• Run on a softer surface, such as grass, dirt or outdoor tracks
• Strengthening of the gluteus medius, hip abductors and core muscles

Try these self-treatment techniques for 2-4 weeks.  If your symptoms continue, consult a physical therapist to determine if faulty skeletal alignment or muscle imbalances contribute to your condition.   Your therapist will recommend a re-evaluation by your physician if they suspect the pain is related to other pathologies, such as a stress fracture or compartment syndrome.

Dean Myers, PT