Hands on care of sports injuries.


Jeffrey Alberghini, ATC

September is here. The temperature is becoming milder and the leaves are starting to fall. Also, it is the time of  year that area runners make one last ditch effort to be ready for the Portland Marathon in early October. Unfortunately, the risks associated with strenuous training do not disappear with the decreasing temperatures.

Heat related illness or hyperthermia occurs due to an elevated body temperature and the loss of fluids and electrolytes. These physiological changes can result in the following conditions (listed in order of severity) Heat Syncope, Heat Cramps, Heat Exhaustion and Heat Stroke. The conditions impact the athletes with symptoms starting with dizziness and cramping and potentially ending with seizures, coma and even death. Heat related illness and dehydration are still significant threats in the fall season, even if the causes are slightly different.

Athletes tend to take the decreased sun exposure and temperatures for granted and do not prepare for hyperthermia as they did in the summer months. Autumn in the Northwest may be cooler, but the humidity increases significantly as the summer ends. The increased humidity results in increased sweating much in the same way warmer temperatures do. Athletes may not make the same effort to hydrate before and after training as they did in the summer. Over-dressing or over-insulating can result in additional sweating and fluid loss. In addition, the desire to get one more event in before the rainy season can result in overlooking your body saying; “slow down” and get fueled properly.

Prevention of hyperthermia is within ourgrasp. Stay hydrated and replenish electrolytes lost through sweating. Hydration cannot be achieved immediately before events it must be maintained throughout the week. Pay attention to urine color, remembering that lighter is better. Wear loose fitting clothing and stay dry. The most important prevention technique is to know your individual fitness level and how you physiologically react to training. Be safe, run fast and we’ll see you at the finish line.

Adapted from National Center for Biotechnology Information.

A randomized controlled trial (RCT) carried out by researchers from the Royal Devon and Exeter NHS Foundation Trust and published in the International Journal of Otolaryngology and Head and Neck Surgery looked at the effect of regular singing exercises on the symptoms of sleep apnea and snoring. The two conditions are caused by resistance to air flow in the upper airways. Snoring can be a symptom of sleep apnea, but not all people who snore have the condition.

The current study was prompted by the observations of a singing teacher who felt that some people having formal singing training reported reduced snoring and improved sleep. The researchers thought this could be because singing training improved muscle tone in the upper airways.

The trial compared the effects of daily singing exercises with non-singers in 127 people with a history of snoring or mild to moderate sleep apnea. The study found that those who did the singing exercises for three months reported less daytime sleepiness and less frequent snoring than those who didn’t.

The common treatments for both snoring and mild sleep apnea are lifestyle changes, including weight loss, smoking cessation and limiting alcohol intake, particularly before sleeping. There are also anti-snoring nasal devices and dental appliances that can be worn at night. A treatment called continuous positive airway pressure (CPAP) is sometimes used to treat moderate to severe sleep apnea, which involves being attached to a breathing apparatus at night. In rare cases, surgery may also be used for severe snoring or severe sleep apnea.

Overall, these results show preliminary evidence that regular singing exercises may benefit people who snore or have mild to moderate sleep apnea. The effect of singing on breathing at night would ideally need to be further established by larger studies using detailed sleep monitoring. However until a larger study these exercises are many be helpful for you or thus who sleep near you.

The last thing you want to think about if you are involved in a Motor Vehicle Collision (MVC) is medical bills. However if you are injured, you want to make sure your auto insurance is taking care of the details. Being armed with the knowledge of how the billing process works ahead of time can help protect your MVC case.

If you are hurt and it is deemed the other driver’s fault, that driver’s auto insurance company is considered the third party and is responsible. However, they will not pay on a claim until the case is settled. You can choose not to file a Personal Injury Protection (PIP) claim with your own insurance and wait on the third party settlement. In that case you will be required to pay for care you receive at the time of service and submit the bill yourself to the third party for reimbursement upon settlement.

Auto liability policies in Oregon are required to provide PIP (no fault) coverage for payment of reasonable and necessary MVC medical expenses. There is no penalty to you for making a PIP claim under your own policy. However, your insurance company will seek reimbursement by the responsible person’s insurance company.

First general rule: “PIP follows the car.” It covers all occupants no matter who was at fault. By law, PIP must cover at least $15,000 worth of reasonable and necessary medical expenses occurring within one year of the MVC. Any amounts over your PIP should be covered by your personal healthcare insurance who may try to recoup any monies they pay from the third party settlement.

If your healthcare insurance policy does not cover your treatment, you are considered personally liable for any amounts in excess of your PIP insurance. This means if you are not at fault, you need to make sure that the third party gives you enough to pay your PIP back and anything over what your PIP covered so you are not left coming out of pocket upon settlement.

Even with a PIP claim filed, there may come a time during the course of your treatment where your PIP stops making payments on your medical expenses. For this reason we have all MVC patients sign an assignment and lien with our clinic. If PIP exhausts, denies and/or expires, the lien gives the clinic added protection for reimbursement for services rendered from any injury settlement awarded to you. 

Almost everyone agrees that massage feels good. After a strenuous workout massage seems to reduce pain and help muscles recover. Athletes and health professionals alike have long contended that massage eases inflammation, improves blood flow, and reduces muscle tightness. Until now no one has understood exactly why massage has this apparently beneficial effect.

According to a study published in the Feb. 1 issue of ‘Science Translational Medicine’ researchers at McMaster University in Hamilton, Ontario, believe they have found out what happens to muscles when they receive a massage. A group of eleven volunteers were asked to exercise to exhaustion and undergo five incisions in their legs, so that researchers could obtain muscle tissue for analysis.

First, each subject had one leg biopsied while they were at rest. Next, they exercised vigorously on a stationary bicycle for at least an hour. Afterwards they received massage on one of their thighs for ten minutes. The other leg was left to recover on its own. After the massage muscles in each thigh were biopsied and then biopsied again after two and half hours of rest.

Exercise can cause tiny tears in muscle tissue, leading to inflammation, an immune reaction, as the body attempts to heal injured cells. When researchers screened tissue from the massaged and unmassaged legs, they found that massage reduced the production of compounds called cytokines. Cytokines play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside the cytoplasm of cells. Mitochondria convert glucose into the energy essential for cell function and repair.

“The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,” said Dr. Mark A. Tarnopolsky, a professor of pediatrics and medicine at McMaster University and the senior author of the research. Increased mitochondrial activity helps the muscle adapt to the demands of increased exercise. Dr. Tarnopolsky believes that massage works quite differently from NSAIDS and other anti-inflammatory drugs, which reduce inflammation and pain but may actually retard healing. “There’s some theoretical concern that there is a maladaptive response in the long run if you’re constantly suppressing inflammation with drugs,” he said. “With massage, you can have your cake and eat it too—massage can suppress inflammation and actually enhance cell recovery.”

By Ron Patt, LMT

Ibuprophen And Your Workout

July 22nd, 2013

Surveys demonstrate that up to 70% of distance runners and other endurance athletes report using ibuprofen before every workout or competition, some on an almost daily basis. They view the drug as a pre-emptive strike against muscle soreness. A new study joins growing evidence that ibuprofen and similar anti-inflammatory painkillers taken before a workout do not offer any benefit and may be causing physical damage, particularly to the intestines.

Strenuous exercise alone commonly results in a small amount of intestinal trauma. Cyclists who rode for an hour immediately developed short-lived elevated blood levels of a marker that indicates gastrointestinal leakage. The research showed that within an hour after a riding, the stressed intestines returned to normal. Because many athletes take the drug for pain before and after a workout, Dr. van Wijck set out to determine the combined effect of exercise and ibuprofen.

For the new study, published in the December issue of Medicine & Science in Sports & Exercise, researchers at Maastricht University in the Netherlands recruited nine healthy, active men and had them visit the university’s human performance lab four times. During two of the visits, the men rested languorously for an hour, although before one of the visits, they swallowed 400 milligrams of ibuprofen the night before and also the morning of their trip to the lab, with 400mg being the recommended nonprescription dosage for adults  to treat headaches or other minor pain.) During the remaining visits, the men briskly rode stationary bicycles for that same hour. Before one of those rides, though, they again took 400 milligrams of ibuprofen the night before and the morning of their workouts.

At the end of each rest or ride, researchers drew blood to check whether the men’s small intestines were leaking. It was found that blood levels of a protein indicating intestinal leakage were, in fact, much higher when the men combined bike riding with ibuprofen than during the other experimental conditions, and the protein levels remained elevated several hours after exercise and ibuprofen. The absorption of nutrients could be compromised, especially after exercise, which could affect the ability of muscles to regenerate.

Researchers found that runners at the Western States 100-Mile Endurance Run who were regular ibuprofen users had small amounts of colonic bacteria in their bloodstream. This bacterial incursion resulted in “higher levels of systemic inflammation,” In other words, the runners that used ibuprofen, an anti-inflammatory, wound up with higher overall levels of bodily inflammation. They also reported being just as sore after the race as runners who had not taken ibuprofen. Animal studies have also shown that ibuprofen hampers the ability of muscles to rebuild after exercise.

So why do so many athletes continue enthusiastically to swallow large and frequent doses of ibuprofen and related anti-inflammatory painkillers, including aspirin, before and during exercise? “The idea is just entrenched in the athletic community that ibuprofen will help you to train better and harder,” Dr. Nieman said. Dr. van Wijck agrees, “ibuprofen consumption by athletes is not harmless and should be strongly discouraged.”

A version of this article appeared in print on 12/11/2012, on page D6 of the New York edition with the headline: Ibuprofen Use Before Exercise Poses Risks.

Where did this year go? It went fast, way too fast! School is finishing for the kids and I am very late with starting my fundraising for the LIVESTRONG Foundation!

This year’s Livestrong Challenge is going to be in Portland, Oregon. I am calling on everybody to join in on an incredible Bike ride: Portland Century!! Check out the routes on www.portlandcentury.com There are 50, 70 and a 100 mile routes! It matters not the distance you are riding, but more to show support for our Team Livestrong. My son Paul and I are doing the 100 miler!

I started my efforts eight years ago in honor of my friend Dale Zerrull, and in memory of my gymnastics team mate Martin Abfalter. Lots have changed since then, but one fact still remains: People are still affected by this terrible disease. So, my fight continues for allpeople with Cancer. As part of Grassroots Fundraising at LIVESTRONG, I’m making a difference in the fight against cancer and joined with other people around the globe to raise funds.

LIVESTRONG serves people affected by cancer and empowers them to take action against this disease that is now the world’s leading cause of death. LIVESTRONG is a symbol of hope and inspiration to people everywhere affected by cancer.

Please support me in the cancer fight through my participation. Click here to visit my personal page www.portlandcentury.com Thank you and LiveStrong!



Each year, the Prefontaine Classic boasts amazing performances. Just when you think it can’t get any better, it does. This year’s event was no exception. Each event posted world leading marks, national records, high school record, or fastest time on American soil.

The Prefontaine Classic hosted a “distance night” on Friday May 31, and primary meet on Saturday, June 1. NBC aired the track and field meet worldwide on Saturday with the featured events live. The Prefontaine Classic is clearly one of the biggest meets on United States soil and is rated as one of the top five meets worldwide.

One of the reasons this meet is so highly regarded is the fact that the athlete’s needs are recognized by the meet director, Tom Jordan. Athletes want to perform at the top of their ability, and at the Prefontaine Classic results show that they do. In response, to this need, medical care focuses on performance care, and I believe the meet results show it.

Event staffing began Thursday at the host hotel and continued Friday through Saturday track side. The meet was staffed with three ACA Sports Council Chiropractors, Dr. Rich Gorman, Dr. Steve DeShaw, myself and 14 licensed massage therapists. 2007 ACA Sport Council Chiropractor of the Year, Dr. Gorman has been working with the event for nearly three decades.

Three other chiropractors were on hand with “personal medical”, working for individuals or groups. ACA Sports Council member, Dr. Josh Glass was on hand while working as the USA T&F Athlete Advisory Sports Medicine Chair. Also on hand were Dr. John Ball from Chandler, AZ and Dr.  David Pascal from Raleigh, NC. As with any event you work as a team, it is a reunion with athletes and colleagues and an opportunity to learn yet more tricks of the trade.




Recently there has been a lot of talk about stretching based on new and evolving research. It’s not that stretching is bad – stretching is a good thing, however there are better times than others to stretch. Studies beginning in 1999 through 2004 by Ian Shrier at McGill University in Montréal were the first to demonstrate the controversy over the long-held practice of stretching before activity. I had the pleasure of meeting with Dr. Shrier in 2006 to discuss these findings. It is conclusive that stretching immediately before exercise not only worsens your performance but also increases your risk of injury. What is not clear is whether targeted individualized stretching would improve performance or reduce the risk of injury immediately before activity.

This is a belief held by many experts and Dr. Shrier himself. For example, if you had limited hip extension, you might target stretch to increase your hip extension prior to activity. It is thought that imbalanced motion; such as a tighter hip flexor verses a flexible hip extensor will increase the risk of injury. The concept is that balanced range of motion and stability are more important for lowering injury risk.  Stretching those targeted sites where range motion is imbalanced and limited may reduce the overall risk of injury and potentially improve performance. It should also be noted that pre-activity stretching should not be aggressive. Everyone likes to feel like you’re accomplishing something while stretching – more is not necessarily better. Pushing too hard may actually cause detrimental results as over-stretching can disrupt the muscular actin-myosin bond and create micro-tearing within the fascial layer surrounding the muscular tissue. Disruption of these tissues can interfere with various neurologic sensory organs that are protective and essential for optimal performance. It is generally preferable to utilize stretches that are dynamic rather than static immediately prior to activity.

When I worked for the PGA Tour, stretching the players was a daily routine for most of the players. Our routine consisted of stretching the players 2 to 2 1/2 hours prior to their tee time. The players would then go have breakfast followed by the driving range and putting green for practice prior to starting the tournament. Here stretching is performed well before competition to avoid detrimental effects on performance or increase the risk of injury.

For the vast majority of us one to three stretches may be all that is necessary prior to activity. The most common sites would be stretches for the chest, hip flexors and calves. Most people sit substantially during the day foreshortening these tissues. Whatever your activity may be, stretching to increase or balance range of motion can be an important factor for the treatment and prevention of injury, however the timing and intensity of stretching can significantly impact performance and injury risk.

It happens every year. The weather gets nice and the athletes come out of hibernation. You know that time when the tennis courts are no longer lakes and the running trails are more dirt than mud?  Recreational basketball is picking up and multiple soccer clubs are gearing up for competition.

So, why has there been an influx of weekend warriors in the clinic these past couple of weeks?  I mean, movement is what our body needs to survive,  right?  Most of the complaints are the normal knee, lower back, shoulder, etc., related to exercise. But, you used to be able to play an entire tournament without pain afterward and now just a couple of games have you tossing and turning all night long unable to find a comfortable position in bed. I want to discuss some of the reasons pain has become more prevalent in our lives when we try to be active, identify some of the problem areas and give some suggestions to help decrease your discomfort for the long haul. 

First, let’s talk about our day. The average commute is somewhere around 30 minutes one way. When we get to work many people have desk jobs where there are approximately 7-8 hours of sitting and possibly a working lunch. There is another commute home, dinner and a couple of hours of television before bed. So, let’s think about this for a moment. Our entire week is spent in a flexed position, hunched over a keyboard or slouching in some chair. Then on the weekend we expect our muscles to  react properly to the ballistic movements that we require of them for sport. The truth is, your muscles have memory and when you spend the majority of your time in one position they have a difficult time when asked to do something unfamiliar.

Injury occurs because our bodies are not prepared to do the tasks that are required of them and they give out at the weakest link (the tight muscle).

Now that I have your attention, I want to give a few pointers on how to work on avoiding injury altogether. As I implied earlier, movement is the key to life. There is quite a bit of truth in this as your body requires movement not only to be active, but to maintain a baseline of health and wellness. True, the commute may not be avoided, but your workday does not have to be your undoing.  At least once an hour (or more) get out of your chair and take a walk. Go to the bathroom, walk a flight of stairs or do some generalized stretching that just gets your body moving.  Lunchtime is supposed to be a break in the middle of the day. Use this time to get some exercise in so you are better able to handle the stresses of the latter part of the day. Be aware that small amounts of movement balanced throughout the work day will prepare your body for the activities you want to do later.

When it comes to the weekend undertakings, the flaw is often before the activity even begins. Many people show up to the court, trail, gym, etc. and just get to work without really warming up the muscles. Realize that injury is significantly more likely if your body is not ready for the stresses that you are about to put it through. There is a reason that football, baseball and basketball players show up to their respective arenas hours before the pre-game festivities start. Getting a muscle “warm” doesn’t take very much time and there is no downside, so there is really no reason not to do it. The best way to ensure that you are ready for sport specific movement is to perform the same motions that will be required of your body at about half speed. Take the basketball and dribble up and down the sideline, perform some arm circles with the tennis racket in hand, take a minute or two and do some calf stretches before a run with the goal to get your blood pumping enough to lubricate the system.

One final pointer is to never leave an exercise session without going through a cool down phase. It doesn’t have to be much, but the idea is to close the cycle of movement. If you start with minimal intensity, ramp up to high intensity in game and then completely drop off by getting in your car and driving home, your muscles will not know how to react. This is why we sometimes feel great during the game but way worse afterward or the following morning. Something as simple as a two minute cool down lap and some generalized stretches can save you a lot of pain and regret. By giving your body the chance to cool down you allow yourself the proper time to come to a resting state more naturally.

By now you should be just a little more informed on what it actually takes to be a healthier athlete.  Since very few of us are actually being paid to exercise, it is of upmost importance that we do the best we can to keep our bodies moving as pain free as possible so we can continue to be successful in our everyday lives.

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