I just returned from the Sports Physical Therapy Section’s annual conference in Las Vegas. There were plenty of great presentations from various industry leaders. I thought I would take a moment and summarize a few key points from the conference that may be helpful to clinicians and consumers alike.

The conference theme was the power of innovation. Hot topics covered were blood flow restriction therapy, cupping, dry needling, eccentric loading for tendiopathy, weighted ball training, and kinesiotaping and laser therapy to name a few. Below are some takeaways worth mentioning:

  • Blood flow restriction (BFR) training can be used to help reduce muscle atrophy after surgery, improve muscle protein synthesis and provide a way to increase strength with loads as low as 20-30% of 1RM for clients unable to tolerate heavy loading
  • BFR is not superior to nor a substitute for high intensity training (need to push weight to see best strength gains), but it can be used as an adjunct to training. It also produces an increase in IGHF1 after exercise.
  • BFR should not be used before higher intensity activities such as HIT, plyometrics, SAQ, etc.
  • Clinicians and strength coaches should consider Olympic lifting derivatives as an alternative to traditional lifts if there is concern with catch phases or biomehcanical/physical concerns. Examples include high pulls/snatch pulls instead of traditional cleans and snatches.
  • Rhythmic stabilization exercises are a key fundamental exercise that should be used in throwing athletes. Form matters and they should fail about 30-40% of the time.
  • Per Mike Reinold, weighted ball training does increase velocity likely through gains in ER seen in 6 weeks (lay back) but not through increased strength and power. These gains may come at a cost as 4 players in the study group were injured with 2 olecranon fractures and 2 ulnar collateral injuries. Increased HER of 10 degrees was seen in the injured players. So, we must proceed with extreme caution with these programs and need more studies to determine best practices/application to ensure both safety and efficacy.
  • Dr. Jeffrey Dugas is pioneering a faster return to play for pitchers with UCL tears involving the proximal/distal ends using an internal brace to augment primary repair instead of a full Tommy John procedure. While the patient has to be a good candidate, this procedure allows for throwing at 10 weeks and return to full pitching around between 5 and 6 months post-op. I have worked with two athletes who have undergone this procedure.
  • Per Dr. Dugas, no longer using suture knots in SLAP repair as to avoid rotator cuff lesions. Better to leave asymptomatic SLAP tears alone in throwers.
  • The two biggest risk factor for injuries in pitchers are: 1) Peak throwing velocity 2) Mean throwing velocity
  • The best way to reduce injury risk in pitchers is to throw less than 100 innings per year, average less than 80 pitches per game and pitch less than 8 months per year
  • Long toss > 180 feet is just as stressful as throwing off the mound
  • Treating tendon pain is tough, but ultimately tendons like heavier loads as tolerated. When appropriate after acute pain management, using 4 sets of 6-8 repetitions with heavy slow loading is preferable. In addition, using instrumented soft tissue mobilization (ISTM) is effective in changing the properties of the tendon and can improve range of motion. Using both ISTM and eccentric exercise should be considered.
  • Runners often suffer patellofemoral pain related to over striding and/or excessive medial collapse. Bryan HeiderscheIt is a leading authority on running biomechanics, and he states that strengthening alone will not help these runners. Perhaps the biggest way to reduce PFP forces/pain is to increase the step rate in these runners using a metronome. This can be accomplished in just a few sessions, and this biofeedback in conjunction with proper strengthening will be the key to improving biomechanics.
  • According to Phil Page, no real science to support claims that KT tape increase blood flow in muscle. It does increase blood flow in skin. Convolutions, patterns and direction of the tape does not matter according to current research. Ultimately, taping works best with 25-50% stretch to reduce pain through a placebo effect and/or gate control theory through sensory afferent inhibition.
  • Cupping can be an effective way to increase angiogenesis in soft tissue and decompress tissue, but not a lot of science on it to date. Sue Falsone uses it to periodize her soft tissue work and can be used as alternate to foam rolling and other compressive soft tissue work.
  • Laser can be used to reduce pain in patients when applied appropriately, so it is important to know the type of laser as well as properly apply the dosage to optimize effectiveness.

These are some the highlights from the conference. Hopefully some or all of these tidbits will prove useful for you too. We recently began using the LightForce laser and BFR therapy using the Owens Recovery Science methodology in my clinic, so I look forward to sharing more about these in upcoming posts.