An Orthopedic Surgeon’s Solution for Treating Soft-Tissue Injuries

About the author: Dr. Riley J. Williams III, MD is an orthopedic surgeon, academic, and clinician-scientist specializing in the field of shoulder, knee, and elbow surgery.  Since 1993, Dr. Williams has been affiliated with the Hospital for Special Surgery (“HSS”), the #1 rated Orthopedic Surgery Hospital according to U.S. News and World Report, where he is also Director of the HSS Cartilage Institute.  Dr. Williams is inventor of Therma1™ and Chief Medical Officer, Head of Product Development, and Chairman of the Board of Directors of R2T2 Laboratories Inc., the company that markets Therma1™.  Dr. Williams graduated from Yale College and Stanford Medical School, where he won top medical science research awards.  Dr. Williams is team physician for the Brooklyn Nets and NY Red Bulls, and he has been associated with professional football and baseball teams.

The Science Behind Using Hot/Cold Therapy, Compression and Massage to Heal Soft-Tissue Injuries

I am an orthopedic surgeon, sports medicine physician, advisor to elite athletes, and pro sports team doctor.  I’m also a scientist.  When I invented Therma1, I based it on the science of recovery.

It is well documented that cold therapy or compression reduces inflammatory response. Recent studies indicate that soft-tissue compression combined with local temperature alterations demonstrate significant enhancement in the healing potential of soft-tissue injuries.

It is also well known that heat therapy or compression/massage increase tissue compliance.  Studies show that controlled increases in thermal temperature have a significant effect on the tensile properties of skeletal muscle, which results in increased joint range of motion and reduced muscle tension that help reduce potential muscle strain injuries.  Other studies demonstrate that warm and more compliant muscles absorb more energy than non-stimulated muscle tissue, which results in improved resistance to biomechanical load. 

The Need for a Unique New Therapy Device Turns into an Invention

My observations of scientific evidence, decades of sports medicine experience including thousands of patients and surgeries, and dialogues with sports therapy experts such as pro sports athletic trainers, physical therapists, and chiropractors, led to the invention of the Therma1™ Hot Cold Roller.  The goal of the design was to provide all four critical musculoskeletal therapy treatment modalities (heat, cold, compression and massage) in one portable, easy-to-use device – something that no other product on the market offered.  The U.S. Patent Office recognized Therma1™’s innovative and unique qualities and granted a design patent last year.

The Therma1’s size and shape was designed specifically to make it easier to treat hard to reach spots, as well as help pinpoint trouble spots and deliver trigger point therapy. In my experience, there was a lack of products on the market with this ability.

What Makes the Therma1 Hot Cold Roller Different from...

Massagers or foam rollers?  Its ability to deliver heat and cold therapy

Ice packs and heat pads? Its ability to deliver rolling compression and massage

Continuous-flow cold therapy machines? The dynamic nature of Therma1™ Hot Cold Roller treatment modality makes the likelihood of thermal injury very low.

How to Use Therma1 in a Sports Medicine Setting

• As a natural Performance Enhancement Device (PED) – Use Therma1 before activity to increase tissue compliance.
• To treat nagging injuries, such as:
  • Patellar tendonitis
  • Calf strain
  • Shin splints
  • IT Band syndrome
  • Strains in the forearms, biceps, triceps and neck area
  • Quad and hamstring strains

Therma1™ should be used in regiments of two – ten minutes, usually in combination with static therapy.  The treatment regiments should be repeated throughout the day as desired. 

View videos that demonstrate the Therma1 in action >>

How Therma1 Benefits Athletic Trainers

• Increases patient compliance (one of the leading drags on patient recovery time is noncompliance with prescribed therapies).
• Patients can use it on themselves or athletic trainers can roll the player (patients don’t need to contort the body to apply therapy like other rollers)
• You never have to worry about frostbite or heat burns
• Non-toxic, simply rinse spills if they get on skin

Tips for Buying Therma1 Products:

Therma1™ comes in Recharge and Instant models.

Therma1™ Recharge – Comes with two rollers. The rollers can be placed in the freezer or microwave.

Therma1™ Instant - Provides portability and convenience with its Instant Hot and Cold packs.  Each Therma1™ Instant model comes with one Recharge Roller, one Instant Roller, and a dozen Instant packs. The Instant Roller has a removable end-cap that accommodates a Therma1™ Instant Hot or Cold pack.

When using Therma1 for cold therapy, keep the following in mind:

Therma1™ Recharge (freezer) achieves colder temperatures than Therma1™ Instant (cold pack).  When left in a typical freezer overnight, Therma1™ Recharge reaches sub 10 degree temperatures and holds a sub twenty degree temperature for approximately twenty minutes with recommended intermittent use (two – ten minute increments, followed by two minute “rest”).  For best results when treating acute injuries, use the Therma1™ Recharge when possible. 

If you do not have a Therma1™ Recharge handy, Therma1™ Instant with Therma1™ cold packs can be used to decrease local tissue temperatures; studies show decreases in local tissue temperatures stimulate an effective anti-inflammatory response.  However, I recommend Instant Cold packs be used only when a cold Recharge Roller is not available.

Learn more about purchasing the Therma1 Thermal Therapy Device and Watch Demonstration Videos >>

Body Composition- The Basics

How much you weigh can be a heavy problem- but have you considered your body composition?

 Body composition refers to the proportion of fat and fat-free mass in the body. Those with a higher proportion of fat-free mass (muscle, bone)  to a lower proportion of body fat have a healthy body composition.

Obesity, Thinness, Leanness. What's the difference?

• "Obesity" refers to having excessive body fat leading to serious health issues such as hypertension, type 2 diabetes, joint problems, as well as heart and breathing issues.
• "Leanness" refers to the muscle, bone, and fat composition of your body weight. Although some lean individuals may actually weigh more than their "tabled" ideal body weight, low body fat lessens the risk of health problems. 
• "Thinness" simply refers to weighing less than the recommended values in age-height-weight tables.

According to the Center for Disease Control and Prevention (CDC), childhood obesity has more than tripled in the past 30 years. The CDC states that childhood/adolescent obese children are likely to become obese adults. Eating and exercise (or lack thereof) habits learned as a child and adolescent may be difficult to undo as a working adult, stressing the importance of encouraging our students and athletes to live healthy and active lifestyles.

Many athletes may be categorized as overweight or even obese on some charts due to their muscle weight in relationship to their height. While it is mildly important to know how much you weigh, it is much more important to know how much of what you weigh is fat. Our bodies need a specific amount of fat to function, but not too much.

Ways to assess your body composition, and body fat percentage, include measurement with calipers and composition analyzers,  body mass index tables, underwater body fat tests ,and the bioletrical impedence analysis (BIA). Sports Health offers a variety of body composition tools such as body scales with BMI function, body composition analyzers, and BMI calculators.

BIA measures how difficult it is for an electrical current to move through the body. The electrical current is so small that most people cannot feel anything. The more body fat one has, the harder it is for the electrical current to flow through the body. The less fat one has, the easier it is for the electrical current to flow through the body. This means your body's fat stops (impedes) this controlled electrical current, allowing the technician to assess your percent body fat.

The body mass index, BMI, is used to calculate a person’s body fat content based on his or her weight and height. The World Health Organization (WHO) has used the tool to calculate obesity rates since the 1980s. Despite its popularity, one major shortcoming of the test is that it doesn’t take into account frame size or muscularity of the athlete. Therefore, even a professional athlete may fall into the “obese” range on the index scale because of the weight of muscle on his or her frame.  The CDC has BMI calculators for adults and children- where do your students and athletes fall on the chart compared to their body composition?

Adult BMI Calculator  http://www.cdc.gov/widgets/#adultBMI
Children’s BMI Calulator http://www.cdc.gov/healthyweight/assessing/bmi/index.html

This blog was written by Phil Hossler, ATC. Phil has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

The Case for Adding the ECG to Pre-Participation Exams

Sudden Death in Athletes – Not so Rare!

The leading medical cause of death in athletes is Sudden Cardiac Arrest (SCA). Although the purpose of the athlete Pre-Participation Exam (PPE), including review of the patient and family medical history and a brief physical exam, is to identify cardiovascular abnormalities that could progress to SCA, recent research has shown that the PPE does a particularly poor job of identifying risks. Conventional wisdom has proclaimed that including an Electrocardiogram (ECG) into the PPE to aid in finding those at-risk athletes is difficult, SCA is a rare event, and faulty initial evaluations (false positives) lead to unnecessary costs that would bankrupt the nation. But, as in most areas of health and science, technology and research can herald a new era. It’s time to take a fresh look at the value that can be garnered from the low-cost and highly sensitive ECG.

Who’s at Risk? 

Many screening organizations are reporting meaningful data on detection rates for cardiac abnormalities. It’s common to find that 2-3% of all participants actually have an ECG abnormality, compared to approximately 30 % of all participants who report abnormal findings in their medical history. Most of these abnormalities are unlikely to lead to SCA or disqualification from sports, but a significant number of them will impact the health of the participants over the course of their lives. Early detection can have a very positive impact on their lifetime health management. About 10 % of the abnormal group, or 1 in about 250 participants, have abnormalities that are strongly associated with SCA and follow-up is highly recommended.  Risks are also stratified by gender, ethnicity and sport:

Relative Risk	Higher	Lower
3x	Athletes	Non-Athletes
2x	Males	Females
3x	African-Americans	Caucasians
6.7x	Men's Basketball	All Sports

Sports that are characterized by sudden surges of energy, such as basketball, water polo and soccer, carry much higher risk than sports characterized by relatively constant effort, such as cross-country.  For an African-American male basketball player, the risk of death during 4 years of college play is about 1/1000, much higher than for other groups. These are risk levels that most of us would not knowingly accept.  It’s unconscionable to argue that high risk-athletes shouldn't be screened!

Where Do We Start?  

Available budget resources will guide how you begin a screening program that includes ECG.  We recommend that you initially gain experience and proficiency screening the higher-risk sports, with considerations for gender and ethnicity, with the goal of potentially saving the most lives possible with the available resources.  As efficiency and organizational support grow, you can extend the screening to a broader segment of your athletes.  The total cost of an ECG should be in the $10-$25 range, depending upon your providers – a fraction of the cost of a pair of athletic shoes.

What ECG system should we use?  

Most ECG systems implement automatic interpretation criteria that are outdated with respect to the best current consensus criteria for athletes, often referred to as the “Seattle Criteria,” ( Drezner, et al, British Journal of Sports Medicine, 2013). Use of these criteria have dropped false positive rates from around 12-15 % down to about 2 %, a factor of about 7x.  Although most cardiologists believe they can read an ECG correctly every time, recent blinded studies show that they are often in error 4 to 15 % of the time (reading based upon experience = 15 % error rate; reading based upon specific criteria with examples = 4 %).  An ECG device that implements the Seattle Criteria and is designed from the ground-up to deliver high-quality trace data, leveraging the tremendous data analysis capabilities of the modern PC, and with extended ECG recording time to improve beat estimates from bradycardic athletes, leads to much improved accuracy.  CardeaScreen is such a system and is being rapidly adopted in screening programs across America.

Learn more about the CardeaScreen (link includes FAQ's and video) >>

Sports Health would like to thank David Hadley, PhD, for writing this blog for us.

Dr. Hadley has over 30 years of hands-on experience blending customer needs with information technology through research and development. He spent nine years as Vice President of Research and Development for Quinton Cardiology. In this role, Dr. Hadley was responsible for rebuilding the engineering team, establishing robust new product architectures and developing the next generation of Quinton and Burdick diagnostic ECG products.

Prior to his role at Quinton Cardiology, Dr. Hadley was with Primus Knowledge Solutions and Sierra Geophysics. He earned his Ph.D. from the California Institute of Technology.