Medical Support for All Kinds of Athletes

Walking into Samaritan Athletic Medicine Center, it’s hard to tell if it is a medical clinic or a gym. To the right are two-story glass windows, featuring an open space with workout equipment on the sides, a small single-line track strip in the middle, and multiple people doing lunges, lifting weights, and running on what seems to be a futuristic treadmill. To the left are offices that continue up the stairs, past the front desk.

They seem to have everything, including a small store with equipment including braces and shoe inserts, offices to treat clients, and physical therapy spaces for one-on-one, individualized care. 

Dr. Douglas Aukerman, the director of sports medicine for Samaritan Health, met with me to talk about some of the new technologies they’ve been using, and how Samaritan has been collaborating with Oregon State University to provide even better services to all of Corvallis’ athletes. And Aukerman isn’t just referring to college football and basketball players when he uses the word “athlete.” 

“I think everybody’s an athlete,” said Aukerman. “If you’re physically active, you’re an athlete.” SAM’s services are for athletes of all types.

Common Injuries
Aukerman said that the SAM is receiving more and more young people coming in with overuse injuries, so they have started ramping up their educational outreach on the issue. 

“Kids, or their parents maybe, pick a sport at a young age, and they only play that sport. Oftentimes they don’t have off-seasons or play other sports, so we are seeing overuse injuries in increasingly younger ages,” Aukerman said.

“It’s important to play different sports and use your body in a variety of ways,” Aukerman said. “Doing so makes the body use different muscle groups and movement patterns, which helps to protect against overuse.”

Common overuse injuries include knee pain and stress fractures, as well as some foot and hamstring issues. To prevent these, Aukerman suggests gradually building up when starting a new movement or sport and allowing the body to get accustomed to the movement patterns needed before maxing out.

“Risk injury is often connected to an acute load, not a chronic load,” Aukerman said. An acute load is high intensity all-at-once, like someone who goes for a 10-mile run for the first time in five years, while a chronic load is the wear-and-tear associated with constant use, like a marathon runner who goes out running dozens of miles, multiple times per week.

Movement Assessments to Prevent or Help Heal Injuries
Another way that the SAM helps local athletes of all ages, sports, and sizes is through their available movement assessment. Participants receive a screening to identify where their body may be overcompensating and how their movement may predispose them to injury in the future.

A sports specialist who is also certified as a strength coach recommends exercises and corrective movements after the screening. From your gait while walking to how you move in more nuanced ways, this service can help anyone identify problem areas and also provide them with the tools to begin correcting their movements and strengthening different muscle groups to have a better-balanced, more functional body.

Aukerman elaborated that “almost everyone has restrictions or limitations on their movement, and many people aren’t aware of them. Even runners with knee pain or shin splints can be helped. There are definite ways to work on muscles and change movement patterns to reduce the chance of injury.” 

“They’re often stability and core muscles that are lacking and causing an imbalance,” Aukerman said. “Those areas predispose people to injury,” and yet, they are often the muscles or types of movement that many people neglect in their workout and movement regimens.

The sports specialists who conduct the assessment use a variety of services depending on the needs of the individual, but everyone goes home with exercises that the sports specialist has walked them through, and this is key.

Aukerman explained that “home exercises are only as good as the person doing them.” Similar to many goals in life, the exercises must be done correctly and in a dedicated manner in order for you to be successful. Instead of handing people print-outs of exercises as they leave, participants go through them with the sports specialist.

Movement assessments are not only for those who want to prevent pain – they can also give guidance for how to relieve pain in common areas like the lower back or knees and ankles. Corrective exercises rectify biomechanical issues, which not only lessen the pain as the body learns to better move and support itself, but the improved movement also prevents that pain in the future.

Aukerman said that people’s recovery time, or the time it takes them to see significant results, varies based on the body, the length of time the problem has lasted, and the severity of the issue. However, he said people have seen results after a few weeks in some cases, and in others, it has taken months.

Importance of Preventative Care
Not all, but many people who go to the SAM are seeking treatment for an existing injury rather than trying to prevent them. Aukerman noted that “people need to pay more attention to their care and carefully consider their training program.”

It’s easy to get wrapped up in a current regimen and continue pushing too hard, blocking out what the body is saying, but Aukerman said that recovery time cannot be undervalued. “Recovery looks different for each person, so it’s important to carefully build your exercise level.” Starting slow and listening to your body will help prevent possible injury.

For instance, Aukerman suggested paying attention to the volume and frequency of your exercise. If you do one workout or focus on one muscle group one day, give it a rest the following day and work on something else. It’s also important to stagger your light and heavy days as well as your type of exercise by cross-training whenever possible.

“Everyone should do activity in a pain-free state,” he explained. “Scale back if you feel pain, and if it doesn’t get better, go to a doctor or have someone look at imbalances before starting the activity again.”

So how do you know when you have pushed too hard and actually hurt yourself? Aukerman has an answer for that as well.

“If pain stops your workout,” he began, “go get checked out. That advice doesn’t apply to soreness or an ache that improves over a couple of days, but if it continues a week or more, it’s best to get it looked at.” 

The SAM not only evaluates the severity of the injury, but they can also do a movement assessment to provide tools that would help the imbalance either in workouts or in movement to help prevent further injury in the future.

Additionally, getting enough sleep, eating a healthy diet, and wearing adequate footwear all significantly contribute to a healthy, preventative lifestyle.

For the diet, Aukerman says that while it is important to eat whole foods and have a good ratio of carbohydrates, protein, and fats, many people forget about the volume of calories and the timing of their eating. 

After each workout, it’s possible to replenish muscle glycogen by eating protein and carbs to help the muscles repair. It’s preferable to eat within 15 minutes of the workout, but eating up to 45 minutes after is still okay. 

Using the right tools, like appropriate footwear or a properly fitted bike, all contribute to preventative care as well. The SAM center has services like custom bike fittings as well as a shoe evaluation to make sure you have enough of the right kind of support for your feet.

Aukerman said the goal of the SAM is to “get people back to a lifestyle that is pain-free without medications so that people don’t put themselves at risk again.” While medications are obviously necessary for some injuries, the SAM tries to treat without them because oftentimes, patients will use the medication to the exclusion of other treatment that is equally as important.

Aukerman explained that they’ve seen many patients who stop personal exercises and go back to bad biomechanics, increasing the likelihood of a similar injury in the future. 

“We want to educate and empower community members,” Aukerman said, “so they can stay active and healthy.”

New Technologies at the SAM
In addition to their services, the SAM center has multiple tools for athletes in all different disciplines and walks of life. 

One of the most exciting tools is an anti-gravity treadmill, which looks like a normal treadmill that has an inflatable boat sitting where the handrails are. The inflatable section holds up the person’s waist as they run, reducing the stress on their legs. People with arthritis, a stress fracture, or those who want to avoid the stress on their joints but still want a good cardio workout, benefit from this machine.

They also work with a company called Phits to create custom shoe insoles. The SAM has a foot scanner that creates custom orthotics for each foot. The scanner is helpful for predicting risk of injury and creating an insole that helps offset the risk. Phits uses a 3-D printer to make the custom soles that brag about lasting three times longer than traditional insoles and come equipped with a two-year guarantee.

In the exam rooms, there are also plenty of features to help patients. They have an EKG that is specially programmed with a sports algorithm, meaning it reduces the number of false positives. They also have an ADHD machine that helps test people for ADHD as well as measure titrate medications, making sure they get the right dose of medication.

Other sport-specific technologies include a dexoscan, which measures bone density, and a musculoskeletal machine called a PRP (plasma-rich-protein). The PRP is used when an injury is not healing or when an athlete wants to speed up healing.

Doctors put the patient’s blood in the PRP, which spins the blood to get platelets (clotting agent in blood), which the machine then activates with plasma-rich-proteins. After that, the blood is reintroduced to the injured person’s body, signalling the body to send more antibodies to the injured area and heal it faster. Most insurances don’t cover the treatment, but Aukerman said it is a very prevalent treatment for sports players. 

SAM’s Concussion
Care Program
Aukerman noted that SAM is working with OSU, the Pac-12 (Group of 12 Pacific collegiate athletic leaders) cohort, and colleagues on concussion research using eye tracking software and technology.

He walked over to what looked like a moderately sized metal briefcase and opened it up. Inside were SyncThink “concussion goggles,” and they looked just like video game goggles. 

“You can’t have a direct scan of brain tissue, so it’s important to be aware when a concussion has happened,” Aukerman said.

These goggles can be taken into the field and used during a football game on players who are suspected of having a concussion. The player puts them on, and their eyes follow a line on the goggles’ screen while the device tracks their eye motion, uploading the data to a tablet that the physician can look at.

Aukerman showed me one example of a player who was concussed and used the goggles right after his concussion. The images on the tablet show two images, what looks like a circle that has been drawn over multiple times by someone with a very shaky hand and a vertical line ending in a globule. Branching out from the globule are little explosive lines.

The lines represent how on-track the player’s eyes were when they followed the screen in the goggles. What does this have to do with concussions though?

“The optic nerve is the shortest one to the brain,” Aukerman said, “so it’s helpful when looking at concussions.” Players with concussions struggle with controlling their eye movement due to the shortness of the optic nerve that connects the eyes to the brain. A player with a concussion will have images similar to the ones I saw, with the shaky nature of the lines represent how far their eyes ranged off course during the assessment.

“It shows the corrective error at the time of injury,” said Aukerman. “And there’s a big gap between the results of the test then compared to when the person recovered.”

Aukerman showed me the same patient’s results with the goggles a week or two later, and not only did the circle have significantly fewer inconsistencies, looking more like an adult drew it than a five year old, but the lollipop graph also showed a tighter circle at the top of the vertical line with no extreme line variations branching off of it.

Aukerman explained that this technology not only provides helpful results, it can also help a physician determine which of the seven sub-types of concussion a player sustained, which is beneficial for treatment and data-collection purposes.

While the images look straightforward enough, Aukerman said that only trained physicians can accurately read the results and that players still need to undergo a physical exam and clinical testing to be sure about the diagnosis.

SAM also has athletic trainers, physical trainers, and physicians working with concussed clients of all ages to provide specialized rehab.

“Our hope is that this program will support local high schools and others, augmenting what they are already doing and providing complete support to individuals who may not have those larger support systems,” Aukerman said.

When asked about if media coverage over the past few years has influenced how physicians and teams deal with concussions, Aukerman responded positively, saying that there is now more awareness and that there has been an increase in the number of people recognizing a concussion and getting help for it.

However, some players still resist the diagnosis as it will take them out of the game for an undefined period of time.

“If you downplay a concussion,” Aukerman began, “there can be serious problems if you return to activity too soon. Even after they recover, they are at risk for another type of strain/sprain as well,” making the situation worse.

Aukerman said that sometimes athletes minimize their pain or symptoms, hiding a concussion and no one might be able to recognize it. Physicians and coaches are oftentimes really dependent on the player to come forward and express that there’s a problem.

Controversial Proposed Law in Oregon Legislature
Earlier last year, a bill was proposed to the Oregon legislature that, if passed, would “allow chiropractic physicians and naturopathic physicians to provide release for an athlete who sustained a concussion or who is suspected of sustaining a concussion.”

This means that instead of a trained medical doctor, a chiropractor or naturopath could allow a player to return to a game if they think that the player did not sustain a concussion.

As explained by Aukerman above, and as widely accepted in the medical community, it can be difficult to diagnose someone with a concussion and the consequences of a misdiagnosis can be extremely detrimental. Some players might want to return to the game, thinking they are fine, and misrepresent their experience to get back on the field. Even the concussion goggles require a trained professional to interpret the readings.

While naturopaths and chiropractors have become more and more mainstream, there is extreme hesitancy in the medical community to accept their claims and grant them credibility in some areas.

For both naturopaths and chiropractors, there are accreditation boards, but the rigor and requirements of them are minimal compared to medical doctors. Likewise, the assumptions that naturopaths and chiropractors make about the human body, what they consider “evidence” to make a decision, and solutions for healing are similarly controversial.

According to the American Chiropractic Association, one of the most common treatments that chiropractors provide are spinal manipulations, or chiropractic adjustments. The ACA claims that these adjustments “restore joint mobility,” but multiple scientific reviews, including a recent 2017 report published in the Journal of the American Medical Association, with controlled trials have demonstrated that spinal manipulation therapy has little effect on many common ailments, including low back pain. 

While these “adjustments” may provide temporary relief, the reality of patients’ benefits may be purely from the placebo effect. They go in, receive increased mobility in some areas of the body, similar to what they would get from going to physical therapy with intentional movement, feel they are heard by the chiropractor, and leave feeling better.

Naturopaths, while different in services, have perhaps less evidence of their treatments working. Outside of personal experience and anecdotal evidence, the supplements they recommend to treat ailments have little to no scientific evidence backing them. 

Without scientific evidence, without using provable, replicable trials to guide an education, many in the medical community do not trust the training of either naturopaths or chiropractors.

House Bill 2390, which would allow chiropractors and naturopaths to clear possibly-concussed individuals, is currently in committee upon adjournment. To be signed into law, it would need to pass the senate and the house.

The SAM center is starting a new Sports Therapy Fellowship Training program in July. The program lasts a year and is additional training for physical therapists. All of the SAM’s physical therapists already have the training. You can also find out more about the SAM and their services at their website: https://www.samhealth.org/find-a-location/s/samaritan-athletic-medicine-center.   
By Kristen Edge