ProClinix Sports Physical Therapy & Chiropractic is Named The Official Physical Therapy and Athletic Training Provider for FC Westchester Armour

Westchester County, NY – ProClinix Sports Physical Therapy & Chiropractic and the FC Westchester Armour announces today a partnership that designates ProClinix as the official healthcare providers for this premier U.S. Soccer Development Academy. Through this affiliation, ProClinix will be providing physical therapy, athletic training coverage for games, and strength and conditioning needs for this prestigious youth soccer club.

“We are excited to announce our partnership with FC Westchester Armour,” said Dr. Brian Dombal, Owner of ProClinix Sports Physical Therapy & Chiropractic. “With US Soccer placing a greater emphasis on player safety by requiring Certified Athletic Trainers to be present at every game, and new regulations on head injury evaluations, we look forward to supporting this elite youth soccer club and their families by providing the highest quality of medical coverage, rehabilitation, and athletic conditioning.”

ProClinix is privately owned with 3 locations throughout Westchester. The practice integrates many disciplines to ensure the best patient outcomes while providing a high level of care to all patients. Our experienced Physical Therapists and Certified Athletic Trainers provide the best level of sports and orthopedic care, offering individualized treatment programs that are based on personal goals and needs. Other members of our interdisciplinary team include Chiropractors, Massage Therapists, Acupuncturists, Nutritionists, and Personal Trainers.

FC Westchester, designated US Soccer Development Academy by US Soccer, is a premier level soccer club based in Westchester County, NY. FC Westchester provides a unique opportunity for serious, skilled, and dedicated players to develop in a safe and constructive environment, while participating at the highest level of youth soccer competition. They attract players from Westchester, Rockland, Putnam, Dutchess, and Fairfield Counties, as well as from New Jersey. (

We at ProClinix are very excited about this partnership and looking forward to the Fall 2018 season!

Concussion In Youth Sports- Ever Changing Care

By: Justen Lopez, MS, ATC/L, NASM-PES, GTS

As we prepare for the fall sports pre-season, it is important to revisit a major topic in youth sports; concussions. The CDC defines a concussion as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or by a hit to the body that causes the head and brain to move rapidly back and forth.” The incident rate of concussions continues to increase in youth sports, despite rule changes and equipment to make sports safer. This trend could be from new rules not being properly enforced, youth athletes are playing more sports which leads to an increased risk, and increased education leading to more athletes coming forward to report signs and symptoms when they occur. However, to continue to combat the upward trend, more schools are participating in baseline concussion testing, revised concussion evaluations, and an updated return to play progression.

Many schools and youth leagues take part in baseline concussion testing for their athletes ranging from paper evaluations to online-based programs to help determine an athlete’s baseline cognitive function. By having a baseline examination, medical professionals can compare a “normal,” athlete-specific exam to the athlete’s post-injury exam to determine if there are any deficiencies. This promotes more individualized, higher quality of care. One of the most popular programs is the ImPACT test. Baseline testing should be conducted by a healthcare professional, which is most often a Certified Athletic Trainer (ATC) who can help facilitate care between the athlete and the treating physician. ATCs also play a vital role in the initial stages of a head injury.

As society becomes more concerned with sports safety, particularly with regards to concussions, it is becoming more important to have ATCs attending sporting events. ATCs are able to provide a wide range of services including baseline concussion testing, sideline concussion assessment, and facilitate the return to play progression, while keeping up to date with the latest research.  In 2016, the new SCAT5, which includes medical red flags, observable signs, revised cervical spine assessment, a more in-depth background information section, and a revised cognitive and neurological assessment. Also introduced is a version of the SCAT5 for children under 12 years old, which provides a more age-appropriate examination. The New York State Public High School Athletic Association, or NYSPHAA, also has a concussion assessment form to serve as a basic evaluation, particularly useful in schools that may not have an ATC. Beyond assessments, NYSPHSAA and SCAT5 also provide guidelines for a safe return to play, which have also been revised for the coming school year. The NYSPHSAA recently released its updated policy regarding gradual return to play (RTP). The policy has been that an athlete must be symptom-free for 24 hours before beginning the RTP progression. Research has now shown that there are some symptoms that are acceptable while completing a RTP progression. These specific symptoms will be addressed only by the athlete’s treating physician, and relayed to the ATC. This is an important development that will alter how certain athletes are managed following a concussion. The RTP procedure takes five days to go from symptom-limiting activity to full contact/normal practice. In recent years, there has also been a greater emphasis on returning to academics.

Having the appropriate healthcare providers is essential in correctly managing an concussed athlete. Certified Athletic Trainers are often the first line of contact, conducting baseline testing or sideline evaluations, who then refer the athlete to a physician familiar with up to date concussion management protocols.

The Importance Of Exercise In The Aging Adult

By: Rachel Amarosa, ATC

As most of us know, there are countless benefits from exercising. However, did you know as we age, the benefits of physical activity can be significant and life-changing? In fact, regular exercise can help prevent or delay chronic diseases, extend your lifespan by years, reduce your chance of injury, and improve your overall physical and mental health. Some individuals have to exercise more carefully than others, so it is highly recommended that you see your physician first before starting a new physical activity program. Your doctor can make sure your body is ready, provide program recommendations, and list any limitations that you may need to be aware of. Below are some of the key benefits of how exercising can greatly impact the effects of an aging body.

Prevent Or Delay Disease: Exercise can be an effective tool for prevention and management of several chronic conditions. Exercise can lower your risk of developing a serious condition and it can minimize symptoms after certain conditions have already developed. Studies have shown that people with heart disease, diabetes, high cholesterol, osteoporosis, and arthritis can all benefit from regular exercise. Heart disease is one of the leading causes of death in the US. Regular exercise can reduce your blood pressure, your blood glucose levels, and decrease your LDL cholesterol.  These specific benefits will remarkably lower your risk of heart disease and your chances of having a stroke. Exercise can also improve your bone, joint, and muscle health. Exercise can be the most crucial and conservative option for arthritis management. Regular, low impact activity helps lubricate the joints and reduce your overall pain and stiffness associated with arthritis. Research has also shown that strength training and weight-bearing activities can help protect against bone loss, help rebuild bones, and reduce the threat of developing osteoporosis and fractures.  

Prevents Falls: Exercise will improve your overall muscle strength, balance, functional reach and coordination, therefore, reducing your risk of falling. Reducing your risk of falling, as we age, can significantly reduce the risk of fractures and other injuries that can require a lot time and energy to heal.

Extending Lifespan/Living Longer: A sedentary lifestyle is one of the leading causes of death and disability. A healthy heart and lungs make the body run more effectively and efficiently as we age. Research has shown, that the effects of regular low level exercise can increase your lifespan by around three to five years.

Other key physical and mental health benefits: Your mental health can greatly improve with physical activity. Exercise helps reduce the symptoms of anxiety and depression and can help reduce the risk of developing serious conditions, such as dementia. Exercise can also enhance your immunity and boost your gastrointestinal function. A healthy, strong body can fight off disease and infection more swiftly and rapidly. Lastly, exercise helps enhance your metabolism, promote the elimination of waste, and can stimulate better overall digestive health.

Now that you are ready to get started, here are some professional tips. As mentioned above, see your doctor first! Once you have consent from a medical professional, take things slowly and start safely with 15 to 20 minute intervals of low to moderate activity then gradually build from there. These activities can include walking, swimming, or cycling for cardiovascular health. Then incorporate endurance and strength training, along with stretching and flexibility exercises. Stretching improves your circulation, flexibility, and muscle tone. Stretching prevents injury to your muscles, tendons, and joints while accelerating your recovery and enhancing your overall performance. Stretching will give your joints the range of motion required to perform more dynamic movements with the proper form and without restriction. Last but not least, since our bodies can take longer to repair themselves as we age, give yourself a day or two rest in between workouts and gradually work up to exercising 4 to 7 times per week.

Are You Concerned About ACL Tears? Here’s How To Protect Against Them!

By: Dan Steinberg, MS, CSCS, CISSN 

Each year over 2 million ACL tear injuries are reported worldwide, with the greater risk in young female athletes. While a lot of families enroll their children in sports for the many benefits of organized activity, the inherent risks of injury are always present. As the seasons change, summer leagues and sport camps begin to poke their heads out of the covers. This means more activity, and thus more risk. However, don’t be alarmed, be prepared. While there are some indicators for injury risk that cannot be changed (ex. Gender and Hormonal) there are ones that can be (ex. Movement Patterns). Therefore, there should definitely be a healthy dose of general physical preparation before starting any explosive physical activity like sports.

The ACL, as it is commonly known, stands for the Anterior Cruciate Ligament of the knee. Without getting too technical, it is a ligament that provides stability to the knee, protecting the shin from sliding forward and rotational forces on the knee. The most common mechanisms of injury without contact are rapidly changing direction, abruptly stopping, and incorrectly landing from a jump. All of these movements are prevalent in almost every sport. Therefore, preventative measures should be taken in order to prepare the body better to play.

With the ACL, the science has been tested, retested, and solidified. While there are no ways to stop ACL and other injury from occurring, there are plenty of ways to reduce the risk of all knee injuries. Preparatory comprehensive strength, agility, proprioception and conditioning programs can prepare you and your loved ones for a successful summer season. Understanding the need for these interventions is vital to staying healthy and strong with the influx of activity.

First off, before starting any physical activity, you should consult your doctor to make sure you are able to withstand the stresses. After medical clearance, you should slowly increase the amount of work your body is doing. That is where the following physical preparation comes in. If available, the best way to accomplish these goals without extensive self-research is to hire a sports performance personal trainer. Professionals with high levels of education and experience should have ample knowledge to better prepare your young athlete with the tools they need to compete.

Essential parts of all of these programs are addressed in different ways but can happen concurrently.  Strength training programs should be well-rounded, assessing every need of an athlete. Concerning ACL and other knee injuries specifically, strength of the hips and leg muscles are vital. Movements included in any resistance training program should include ground-based movements on both legs (ex. squatting) and one leg (ex. lunging) in all different planes of motion. Competency of movements, fully understanding where the body should be when performing resistance movements, is imperative. As performing resistance training improperly, will likely lead to a higher risk of injury when training and playing sports.

Agility and proprioception preparatory programs allow for a better understanding of were the body is in space without external load. For beginners, simply jumping rope and skipping can provide a small stimulus for the muscles, tendons and ligaments to begin applying stress. After competency with basic plyometric drills, deceleration is the next step on the preparation model. Being able to stop the body after movement is a contributor to knee injury, therefore practicing in controlled environments will allow the body to be aware and adapt to the stress of explosive sport movement.

Conditioning programs are fairly simple to devise but take a focus, patience and consistency to properly implement. Start slowly and work into it. Longer jogs, repeated runs/sprints and other techniques can be used to increase cardiovascular endurance. Slowly increasing the frequency, intensity, duration, density and volume will provide a stimulus great enough to prepare the body for longer games and tournaments.  

 Performing these exercises under some sort of supervision (either from a knowledgeable certified sports performance coach or other source) is highly advised. If the best athletes in the world have coaches, you probably should too. Have fun, good luck and don’t break a leg!

Acupuncture & The Treatment of Rheumatoid Arthritis

By: Jaime Marks, L.Ac.  In western medicine, Rheumatoid Arthritis (RA) is considered an autoimmune disease caused by unknown factors. The onset is usually gradual, affecting inflammation of several joints, mainly small joints in the feet, wrists, elbows, and ankles. These joints will be tender to the touch, and can also become stiff, painful, and swollen. RA is diagnosed by an elevated Rheumatoid Factor through a blood test and X-ray, which will indicate a narrowing of the joint spaces and erosion. The usual treatment is non-steroidal anti-inflammatory medication (NSAIDS), such as Ibuprofen, corticosteroids, exercise, physical therapy, and rest.

Patients are often frustrated with the lack of relief provided solely by western medicine, and seek alternative and complementary treatments, including acupuncture, to manage their symptoms. Traditional Chinese medicine classifies Rheumatoid Arthritis as “Bi Zheng,” an impediment syndrome caused by the invasion of wind, cold, damp, and heat. These external evils are diagnosed according to the characteristics of how the symptoms are presented in the joints of the body.

If the pain and swelling comes and goes and travels from one area to another, the cause is wind. If the affected area is red or hot, with early morning stiffness, heat is to blame. If the joints are typically cold, pale, and stiff, with symptoms worse in the cold weather, cold weather is to blame. And if you’re experiencing swelling and heaviness, stiffness, and restricted movements of the joints often worse in the damp, humid, and hot weather, dampness is the culprit. These patterns will usually appear in a combination of the four evils and will present themselves in a variety of ways depending on the stage of RA. The condition may also affect proper functioning of the organs, including the liver, kidney, and spleen, as well as blood and overall energy (qi) levels.

By inserting thin needles around the inflamed joint areas, acupuncture can work at a deep level by promoting blood flow and movement, to unblock any energy blockages and stagnation that may be creating the uncomfortable, swollen feeling about which many patients complain. Acupuncture provides many therapeutic benefits: alleviate joint pain, reduce inflammation and swelling, provide relaxation to the body, and promote a general anesthesia and lessened pain by stimulating the release of endorphins — the body’s natural pain killers.

Additionally, acupuncture strengthens the immune system to help prevent any other associated illnesses and balance the nervous system to relax the body and mind. In so doing, it helps minimize the stress that often appears simultaneously to disease.

Lastly, acupuncture does not provide any harmful side effects that prescribed medications often present.

There have been many studies conducted on the efficacy of acupuncture on RA, and the results have been mixed. Many of these studies were inconclusive in finding significant benefits of acupuncture on pain, or how to measure a reduction on swollen joints as compared to controlled treatments. However, some studies showed two factors associated with chronic inflammation decreased; Tumor Necrosis Factor- alpha (TNF-α,) and Vascular Endothelial Growth Factor (VEGF). The mechanism of how this occurs is still unknown and needs further evaluation. Researchers and physicians believe acupuncture works deeply on both the peripheral and central nervous systems affecting the immunological, neurological, hormonal, and psychological systems. The more studies that are employed showing the reduction in inflammatory markers will provide evidence-based medicine to support the use of acupuncture in the treatment of RA.

Acupuncture and the relief of RA symptoms is often experiential and anecdotal. Patients report a great deal of relief with the associated inflammation, swelling, and pain attributed to RA. If you are experiencing any of these uncomfortable symptoms, acupuncture is a good adjunct therapy to help manage the discomfort.

A treatment strategy will be designed according to your specific needs and symptoms, including the use of needles, electro acupuncture, and often herbs or supplements, and dietary changes will be recommended to help alleviate symptoms. The number of treatments vary on the severity and stage of the disease.

ProClinix Celebrates National Athletic Training Month

By: Megan Smithuysen, LAT, ATC

Happy National Athletic Training Month! Each year during the month of March Certified Athletic Trainers take pride in promoting their profession through a national campaign put on by the National Athletic Training Association (NATA). A different theme is adopted each year during the month long campaign to provide a platform for Certified Athletic Trainers to showcase their knowledge, skills, and the role they play in providing compressive health care.

If you have a student athlete in your household you may already be familiar with the role of an athletic trainer. As defined by the Health Resources Services Administration (HRSA) athletic trainers are highly qualified health care professionals under the allied health professions category who provide a vast array of services. Athletic training services are compromised of prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions. Additionally many athletic trainers have an educational background in nutrition, psychology, and strength and conditioning. ATs work under the direction of physicians, within their state licensure statutes, and follow the NATA Code of Ethics. While athletic trainers most commonly work in athletics, whether that is at the secondary school, collegiate, or professional level, the profession has expanded beyond the traditional realm of athletics. Athletic trainers can be found in the performing arts, the health care clinical setting, the military, the industrial industry, and beyond.

The field of athletic training is highly regulated but not commonly well understood. Athletic trainers tend to wear many hats within their position and commonly get mistaken for other professions. The main goal of National Athletic Training Month (NATM) is to promote and spread awareness about the important work of athletic trainers. The 2018 theme is “Compassionate care for all.” The NATA provides many tools for athletic trainers to use to increase awareness. The NATA provides logos, posters, and public service announcements that organizations such as schools and private clinics can print and post throughout their facilities. The NATA has taken full advantage of social media during NATM. They have created a professional pride Facebook photo frame that one can use to identify himself or herself as an athletic trainer. They also have started the #ATShoutout campaign. #ATShoutout is designed to celebrate the positive impact ATs have on work, life and sport. Student athletes, patients, coaches, and anyone impacted by an athletic trainer are encouraged to film a short video or take a creative picture showing their appreciation and gratitude for their very own AT. They then are to post it to any social media platform using the tag #ATShoutout. No matter how you are showing your appreciation, the recognition for what they do and the understanding of a commonly misunderstood profession will mean a lot to your athletic trainer. If you are lucky enough to know an athletic trainer take a moment to show them your appreciation. Visit for more information on NATM and creative ways to show your gratitude.

Direct Access to Physical Therapy. What Is Direct Access and Why You Should Care.

By: Dr. James H. Cassell IV, PT, DPT

In the past, patients were required to see a physician to receive a prescription for physical therapy prior to attending physical therapy. As of January 2015, all 50 states have adopted “direct access” in various shapes and forms. Direct access allows patients to see a physical therapist without seeing a physician for a prescription beforehand, thus directly accessing physical therapy services.

Direct access is a great achievement by the American Physical Therapy Association (APTA). The APTA argued against the medical boards that having the physician visit was an unnecessary and costly step in the health care process. This visit not only delayed treatment for the patient, but placed the cost of an additional co-pay on the patient, and the cost of a physician visit on the insurance companies. The medical boards, obviously wanted the visit to be required and argued that physical therapists didn’t have the education to make a diagnosis. Nowadays, physical therapy students must attend 3-3.5 years of graduate school, depending on the breakdown of the courses, following 4 years of a science-based undergraduate degree. Upon completion of the curriculum, students graduate with a Doctorate of Physical Therapy (DPT) degree. The students then need to pass a licensure exam in their respective state.

The DPT curriculum has progressed greatly over the years, as the degree was originally a bachelor’s, which progressed to a master’s and is now currently offered as a doctorate. The curriculum at each school varies slightly, but all accredited programs are governed by the Commission on Accreditation in Physical Therapy Education, ensuring that all programs cover what is necessary to be an entry-level physical therapist. The curriculum includes: cadaver dissection, movement analysis, kinesiology, pharmacology, examination and interventions, among other topics. This knowledge base prepares students to be autonomous practitioners.

New York is typically one of the more stringent states with regards to health care law, and it is no different with direct access. New York did not begin allowing direct access until 2006, whereas many states made this change in the ‘80s and ‘90s. Further, New York requires that a physical therapist have a minimum of three years full-time experience before they are allowed to see patients without a referral. Many states have no experience requirement, as the DPT students receive after 3 years of graduate school more than adequately trains providers to treat patients without further instruction from a physician. Lastly, patients in New York may only be treated for 10 sessions or 30 days, whichever comes first, before they are required to have a prescription.

Patients may be wondering if using direct access will place an extra burden on them financially. Most health insurance companies in New York do not require that a patient have a prescription on file before seeing a physical therapist, and these insurance companies will reimburse for the visit regardless of whether or not the patient has a prescription on file. There are a few cases where a prescription is required, mainly Medicare and Worker’s Compensation; these prescriptions need to be updated regularly. Additionally, a small percentage of insurance policies do require a prescription, though it is not consistent from one insurance company to another, so it is advised that patients check their benefits prior to attending physical therapy. Some practices, such as ProClinix Sports Physical Therapy & Chiropractic, will check health insurance benefits for the patient.

Direct access has been a giant step in the right direction of getting patients timely health care and decreasing financial burden on the health care system. As a patient, do not be afraid to seek physical therapy treatment without a prescription, as the time spent waiting could be time spent healing.

Turning Resolutions into Lifestyle Changes

By: Dr. Maria Cuomo, PT, DPT

For many people, incorporating regular exercise into a daily routine is one of the most common New Year’s resolutions. New year, fresh start  – makes sense to start anew and focus on becoming a better version of you.  However, now that we are several weeks into the New Year, has your resolution become a lifestyle change? Research performed by The University of Scranton has found that only ~8% of people who make New Year’s resolutions are actually successful. The better question is: how can you be one of them?

Anyone and everyone can exercise, but busy lifestyles, injuries, and medical conditions can interfere, especially for anyone who is attempting to start exercising for the first time. If you have been unsuccessful in fulfilling your New Year’s resolution and we are only a few weeks into 2018, now may be the time to regroup.  The list of benefits one can experience from regular exercise continues to grow. Improved cardiovascular health, decreased risk of diabetes, heart attack, and cancer just to name a few.  With this in mind, the timing of when we start exercising is less important than whether we start at all. Here are a few tips on how to safely turn exercise into a part of your life that you look forward to for its many physical and psychological benefits.

Preparation/planning is key. Research on establishing lifestyle change has found that the planning phase of establishing a new habit is important for it to be successfully incorporated into your life. Creating short-term, realistic exercise goals is essential. This will help you measure progress and avoid discouragement while also preventing injury. Based on your goals, you should consider whether or not to purchase a membership to a gym or any specialized equipment to begin your regimen. Will you be exercising alone or as a group? You should also determine how many days per week you will need to exercise in order to achieve your goals. The American College of Sports Medicine (ASCM) guidelines recommend 30 minutes of exercise 5x/week as the minimum effective dose to experience the benefits of exercise. Most of the time you will need to explore several options to determine which form of exercise works for you.

Start slow! Progression is key to any exercise program. If your friend who exercises regularly invites you to an intense/advanced, hour-long indoor cycling class and you have never clipped into a bike or exercised before, this is probably not the best way to start your journey.  While exercising with friends is great and encouraging, it might be better to start a different routine together first. Gyms and studios offer beginners classes for a reason. It is important to begin with the basics. Focusing on form and proper biomechanics will help you get the most out of your workout and avoid injury. Most group fitness classes encourage participants to take as many beginners classes as they need before advancing to avoid injury. Once you have a strong foundation, then you can incrementally increase either the frequency or intensity of the exercise. This will help you see results.

Listen to your body! Recovery and cross-training should be part of any well-balanced exercise routine. Pushing your body to the limit and beyond is a recipe for injury and feeling defeated. When exercising, you may feel sore for 24-48 hours post-workout, which is completely normal. If soreness persists greater than that time period, then it is definitely time to give your body a break. Establishing a regular rest-day or an active rest day that emphasizes more restorative forms of exercise including stretching, walking, or yoga will help you stay on the right path and avoid injury.

If establishing an exercise routine for yourself has not produced the results you expected, then you may consider the assistance of a qualified healthcare or fitness professional. An assessment provided by your local physical therapist can help identify any muscular and biomechanical imbalances that may be resulting in pain or predisposing you to injury. If appropriate, physical therapists can create a plan individualized to your needs and prescribe therapeutic exercises that you may need to incorporate into your exercise routine. Physical therapy is intended to be a short-term, medical necessity-based program that will educate you and transition you to exercise independently. After discharge from a physical therapy program, you may also be recommended to consult a personal trainer and/or nutritionist to achieve your fitness goals.

Let’s make changes in 2018 that will lead to a healthier life!

Dr. Maria Cuomo is the Physical Therapist for ProClinix Sports Physical Therapy & Chiropractic in our Ardsley office.

Shoveling Injuries

By: Dr. Ryan Chevrier, PT, DPT

Winter has arrived, which means snow is here as well. For those without a snowblower or plow, it is important to make sure you shovel appropriately to avoid injury. Common injuries include lower back, shoulder, head injuries and heart attacks. Over 25,000 people are treated in emergency rooms each year for shoveling injuries. Understanding some of these injuries and tips to help prevent them are important to make sure you do not become another number in this statistic.

Lower back injuries are common when it comes to shoveling snow. They are usually caused by excessive twisting and bending when clearing snow. It’s important to not try and throw snow over your shoulder or behind you to avoid excessive twisting. Twisting itself will not cause injury, but repetitive twisting under load while clearing your entire driveway will start to wear you down over time. Try to keep snow clearing in front of you and clear in a straight path. You can also try pushing the snow if there is not too much on the ground and you have space to move it to.

Shoulder injuries are also common with shoveling. Many people try to lift too much snow at once and throw it far, which can place excessive load on your shoulders after many repetitions. Rome wasn’t built in a day, so there is no reason to feel the need to throw as much snow as possible with every shovelful. With large amounts of snow, start at the top and work your way down to decrease the overall weight you are clearing. Don’t be afraid to take breaks along the way as well. This will allow your shoulders to relax for a couple of minutes before having to work again.

Head injuries can be caused by being hit by a shovel or slipping on ice.  Everyone who goes outside to shovel snow should take precautions to make sure that no one else is in the area where they are shoveling. Additionally, wearing appropriate footwear and putting sand or salt down can help prevent slipping on ice. If someone hits their head, either by a fall or by being hit, then they should seek medical attention to be evaluated for a concussion.  

One of the more serious shoveling injuries are heart attacks. Shoveling snow can be very intensive work and adding the extreme cold temperatures increases the chances of having a heart attack. Those in poor cardiovascular shape should take extra precautions when shoveling snow. Ease your way into shoveling to help bring your heart rate up slowly. Then when you have completed all your shoveling, it is best to walk for several minutes to help lower your heart rate safely. Use this time to admire your clean driveway.

Although most people don’t want to spend extra time in the cold, don’t rush with shoveling, make sure to take breaks as needed, utilize proper shoveling techniques and outdoor footwear, and ease into it so as not to increase your heart rate too quickly. Following these simple tips will help reduce the risk of shoveling injuries.  An extra five minutes without pain in the cold is much better than five hours with pain in a warm house. If you think you may have a shoveling related injury, or want to make sure your body and heart are prepared for the demands of shoveling, it is best to see you local physical therapist, physician, or qualified healthcare professional.

Dr. Ryan Chevrier is the Physical Therapist for ProClinix Sports Physical Therapy & Chiropractic in our Pleasantville office.

The Importance of Hydration

By: Justen Lopez, MS, ATC/L, NASM-PES

As sports seasons get back into full tilt at the end of summer, there are many things that need to be taken care of in order to be prepared and have a successful season. Pre-participation exams, registration forms, buying equipment, and countless other tasks occupy our thoughts, but something that often gets overlooked is how to maintain hydration throughout the whole process. Hydration is one of the key factors that contributes to an athlete’s success, especially during this transition out of summer when temperatures can range from 60° to 105°.

There are several ways the body keeps itself from overheating during exercise. One of the most obvious ways is through sweating, where heat is removed from the body through evaporation. In order for this process to function properly, as well as keep other bodily functions going, the body needs an adequate amount of water. When heat dissipation is impaired and/or dehydration is settling in, an athlete is at increased risk of suffering from a heat illness. Coaches, athletic trainers, and athletes should be monitoring for signs and symptoms of heat cramps, heat syncope, heat exhaustion, and heat stroke. These symptoms include, but are not limited to, fatigue, headache, thirst, fainting, cramping, confusion, dizziness, and nausea/vomiting. While many of us have experienced feeling tired and a bit lightheaded from exercising, most of us do not have experience dealing with heat stroke, which is a medical emergency. Taking steps to adequately hydrate before, during, and after exercise, acclimatizing into training sessions, having medical staff present, and monitoring weather conditions to adjust practices accordingly can reduce the risk of these heat-related illnesses.

Proper hydration is also important for athletic output. In preparation for exercising, athletes should consume between 16 and 24 fluid ounces of water within the 2 hours before the practice or game, with an additional 7 to 10 fl. oz. of water 10 to 20 minutes prior. This helps ensure that you have a sufficient amount of fluid already circulating in the system before beginning to train.

During training, athletes should be consuming between 6 and 12 fl. oz. every 10 to 20 minutes, though this may be adjusted based on rules of competition. This may be a combination of water and a sports drink, as carbohydrate and electrolyte supplementation benefits performance, especially in training lasting longer than 60 to 90 minutes of continuous activity. If you are thirsty, you are already dehydrated, so a steady intake of fluids is important in maintaining hydration. It is important to note that in choosing a sports drink, it is important to avoid beverages that have a carbohydrate concentration greater than 8%, such as fruit juices, sodas, and carbohydrate gels. Caffeinated and carbonated drinks should also be avoided, as they stimulate excess urine production.

Following activity, it is recommended to replenish what was lost during exercise within the 2 hours following training. By monitoring an athlete’s weight before and after exercise, we can determine how much fluid needs to be consumed. This difference in weight is from a loss of fluid, not fat, and needs to be replaced for recovery and preparation for the next training session. Athletes should consume 16 to 24 fl. oz. per pound lost, and may include water, sports recovery drinks, and chocolate milk.

It is important for an athlete to find where they lie in these recommended ranges, as each athlete has different needs based on metabolism, body type, sport/position, type of training, etc. Drinking too much water can lead to problems as well, so it is helpful to have a balance of water and beverages with carbohydrates and electrolytes, and to keep track of the amount of fluids being consumed. A simple trick to proper hydration is to clearly mark a bottle in 100mL/3-4 fl. oz increments. This provides a visual reminder of how much to drink throughout training.

Measuring body weight can provide insight into an athlete’s hydration status. Studies have shown that a decrease in body weight greater than 2% may negatively affect athletic performance, as well as cause headache, dizziness, weakness, nausea, irritability, or muscle cramps. This makes proper hydration before, during, and after exercise even more important.

When weight monitoring is not practical, you can monitor the color and volume of your urine. If you are well hydrated, your urine should appear clear to light yellow. Dehydration leads to darker yellow urine, often with a decrease in volume as well. This is a sign that you are not consuming enough fluids, or that you lost a lot of fluid during exercise that needs to be replaced.

In the world of sports, coaches often preach the mantra, “control the controllables.” While we cannot control the weather, field conditions, or the opposition, we can control what we put into our bodies to maintain proper hydration and optimal athletic output. Be sure to discuss any questions you may have regarding heat illness and hydration with your healthcare provider.

Justen Lopez is a Certified Athletic Trainer for ProClinix Sports Physical Therapy & Chiropractic in our Armonk office.