Wednesday, December 19, 2012

Practical management of sudden cardiac arrest on the football field

The British Journal of Sports Medicine recently published guidelines for the management of sudden cardiac arrest (SCA) on the football (soccer) field. These guidelines are certainly applicable to all sporting events.
What are the take home points?

1. Make an Emergency Plan and make sure all coaches know this plan.
2. All coaches must know CPR and how to use an AED.
3. An AED should be at every event and coaches must know where it is!

For the complete guidelines, see below.

Key recommendations for emergency planning for sudden cardiac arrest on the football field

  • Every team and venue hosting football training or competition should have a written emergency response plan for SCA.
  • Potential responders to SCA on the field (ie, coaches, referees, physiotherapists, athletic trainers, and other medical staff) should be regularly trained in CPR and AED use, and demonstrate skills proficiency in this regard.
  • An AED should be immediately available on the pitch during competitions.
  • Both teams should review prior to the match the location of the AED and details of the emergency response plan.
  • AED, automated external defibrillator; CPR, cardiopulmonary resuscitation; SCA, sudden cardiac arrest.
    Practical management of sudden cardiac arrest on the football field
    • Prompt recognition of SCA
    • SCA should be assumed in any collapsed and unresponsive athlete
    • Seizure-like activity, and abnormal breathing or gasping must be accepted as SCA until proven otherwise
    • Early activation of the emergency medical response system and call for additional rescuer assistance
    • Early CPR
    • If unresponsive and not breathing normally, begin Hands-Only (compression only) CPR—push hard, push fast
    • C−A−B (chest compressions−airway−breathing).
    • Immediate retrieval of the AED or manual defibrillator.
    • Application of the AED or manual defibrillator as soon as possible—while CPR continues. Stop CPR only for rhythm analysis and shock delivery if indicated
    • If no shock is delivered, CPR and life support measures should be continued until the player becomes responsive or a non-cardiac aetiology can be clearly established.
    • If a shock is delivered, immediately continue CPR for 2 minutes, then allow AED to reanalyse the rhythm.
    • On the discretion of the senior clinician on scene, transport of the SCA victim to a hospital facility capable of advanced cardiac life support, realising that effective CPR should be continued en route.
    • Upon return of spontaneous circulation, while still in coma, rapid cooling (induced hypothermia) for SCA victims with VF arrest has been shown to improve survival and decrease neurological complications.
    • AED, automated external defibrillator; CPR, cardiopulmonary resuscitation; SCA, sudden cardiac arrest; VF, ventricular fibrillation.

Monday, December 17, 2012

Soccer Specific Fitness

Dawn Scott, the fitness coach for the U.S. Women’s National Team, has written a great article on soccer fitness.
The key points are:
  1. The two key aspects of soccer fitness are speed and endurance.
  2.  There is a “new term called ‘repeated sprint ability,’ or RSA, which refers to speed endurance, or how you repeatedly sprint in a game. You don’t run at one pace for 90 minutes in a game. Rather, you constantly sprint and recover, or run at different speeds and recover. Players want to be able to sprint with the same qualities in the 90th minute as they do in the first minute. RSA is a measure of this.
  3. “Strength is the basis to every other aspect of fitness. If you don’t have strength, you can have a weakness when you try to develop any other type of fitness.
  4. One of the things with females that research has shown is that you tend to have a higher incidence of ACL injury in female players. With that in mind, I would make sure that female players are doing appropriate strength programs, especially strengthening the areas around the knees, to try to offset the chance of injuries like that.
  5. “At the younger ages I would be doing specific sessions focused on developing agility, balance, and coordination. It doesn’t have to be intense but it’s programming the body to move in a certain way and building up basic strength using body weight, fun games and so on. You’re doing age appropriate work at those ages and then as they get older you can develop those programs and add in other components of fitness that are appropriate.
  6. Recovery strategies are critical. Nutrition, hydration, sleep, and ice baths are important

Friday, December 14, 2012

The BioPhotonic Scanner as a Biomarker of Health

What is the BioPhotonic Scanner?
Watch this ....

Is this real science? Does the scanner really measure carotenoids?
Watch this ...

How are doctors using the scanner in medical practice?
Watch this ...

Get scanned today!

Call Dr. Steve Horwitz, D.C. at 301-254-5571 or email at:

Thursday, December 13, 2012

Getting Up and Down Of the Floor as a Measure of Health

For decades I have been saying that getting up and down off the floor was the best test for overall physical ability and health. Well. read this ..... 

Friday, December 7, 2012

Injury Prevention = Performance: The Functional Movement Screen

What does injury prevention have to do with sports performance? EVERYTHING! 

Here are the take away key points:
  1. Start with the Functional Movement Screen. ALL athletes should be screen first. The strength and conditioning program they perform is built around the results of the FMS.
  2. Build a mobile and stable athlete first.
  3. “Everybody is getting corrective work every day.”
  4. If one athlete has specific issues, that athlete must work on those issues.
  5. “Kids are bigger, faster, stronger, but they move worse.” They all need to work on basic movement patterns like stopping, starting, and changing direction.
  6.  The athletes who score poorly on the FMS are the athletes you see in the training room all the time.
  7. If you want your son or daughter on the court and field, injury prevention is key.
  8.  “Mobility, stability, and movement should supersede their [athletes] strength development in the weight room.”
  9. “The more mobile and more stable they are, the stronger they are going to end up being….”
  10. When a first string athlete gets injured, that effects the entire team. If a top receiver goes down, then a less experienced athlete must move up and may not be ready for the increased workload.
  11. The FMS is used at the NFL combine.
  12. Focus on quality over quantity.

Wednesday, November 28, 2012

Cholesterol and Saturated Fat: Part 1

The topic of saturated fat and cholesterol has been in the news a lot lately with "studies" saying meat is bad and eggs are bad. The first myth I want to dispel is that cholesterol is bad and that eating saturated fat and cholesterol raise cholesterol levels in the blood.

There is no such thing as "good" or "bad" cholesterol, all cholesterol is good! Yup, cholesterol is essential for our existence, is part of every cell membrane, and is the biochemical starting point for the formation of all our hormones. Two things must happen for cholesterol to have a negative effect on the body: (1) Cholesterol ends up in the coronary (and carotid) arteries and (2) Inflammation occurs which can cause an obstruction in the artery. This obstruction can deteriorate and small pieces can break off. That is when the trouble begins (A future article will talk about this process in more detail).

About 25% of our daily intake of cholesterol comes from what we eat and the remaining 75% is produced by our bodies. The body has a very complex monitoring system of cholesterol levels and makes sure that cellular cholesterol levels are maintained in a very narrow range. It is plasma cholesterol (blood) that is measured by your doctor. This measurement does not tell us where the cholesterol is going and has little to do with cellular or artery cholesterol (which is what we don't want).

So, eating cholesterol rich food may increase your plasma cholesterol in the short term, but not in the long term. My next article will discuss the importance of this blood cholesterol reading and what the relationship is to heart disease.

Tuesday, November 20, 2012

DOMS: Delayed Onset Muscle Soreness

DOMS - Delayed Onset Muscle Soreness. What we dread after working out and what causes many people to give up working out altogether.
Causes of DOMS
1. Eccentric muscle contractions or "negatives." For example, when you perform a biceps curl and curl the weight up, that is a concentric muscle contraction.... the muscle shortens. When you lower the weight slowly, the biceps is contracting, but it is lengthening while it contracts. When you perform lots of slow, lengthening contractions, this can cause significant post-workout soreness.
2. A brand new workout. When you perform new movments, this is stressful to the body. It is not that you are using muscles you never used, it is that you are using them in a different way. This can cause soreness.
3. Dehydration. Muscles do not like when the body is dehydrated, so drink. Use a scale before and after to learn how much you need to replace. If you happen to gain weight after working out from drinking, then back off the fluid (this is called hyponatremia - for more click here.
4. Reactive Oxygen Species. In other words the increase of free radicals is related to DOMS. What to do - LifePak or LifePak Nano!
5. Neurology. Yes, this soreness can "spread" to adjacent muscle groups via the central nervous system. That is why recovery is so important. If your movement patterns are off, then this type of soreness is much more likely to occur. Get a Functional Movement Screen!
So, why is the title of this article Overdrive? Because Overdrive is the name of the best supplement I have come across in all my years of training to combat DOMS. I have always used a recovery supplement of some type and have experimented with dozens over the years. Overdrive has been a HUGE help to me during my recovery and allowed me to get back to where I am (and their is certainly more to come). 

Tuesday, November 6, 2012


Here is a great article describing the benefits of kinesio tape by Keith Jardine, D.C.
I have been taping for 6 years now and am a Certified Kinesio Taping Practitioner. It works!

Advancements in pain neurophysiology have shed light on the treatment potential of kinesiology taping and form the basis of modern education into its use. Current research documents the negative neuromuscular consequences of injuries on a patient’s recovery following musculoskeletal injuries. This has led to an increased understanding of the importance of sensorimotor stimulation for both therapeutic and rehabilitative success.
Figure A - Neuromuscular Deficits
Figure B - Applying Kinesiology Tape
What the research has shown us is that virtually all painful conditions are associated with altered neurosensory signaling between the muscles and joints affected, and the central nervous system (CNS). The clinical presentation of this is what we call neuromuscular deficits (FIGURE A). This is ultimately where injuries result in an alteration of information coming into the central nervous system and if you have altered information coming in, you will have altered information going out. Therefore, what we are attempting to do with our treatment and rehab strategies is provide the right type of afferent stimulation in order to change the efferent output in the direction of therapeutic intent. This is exactly what we achieve with the use of kinesiology tape (FIGURE B).
The altered signals experienced by the nervous system after an injury can be normalized due to the afferent stimulation of the tape on the skin. This process occurs through a combination of mechanotransduction and mechanodisruption, leading to neuroplastic changes if prolonged. When the tape is adhered to the skin’s surface, it mechanically stimulates the touch receptors. This stimulation is converted into an electrical signal through the process of mechanotransduction. The electric impulse is then sent rushing through the nervous system. Since the impulse is traveling on A-beta fibers, touch receptors, which are bigger and faster than C-fibers and pain transmitting neural pathways, the end result is the modulation or dampening of the sensation of pain. In the nervous system, as the signaling of pain diminishes, the ability of affected muscles to activate properly is restored.
Rigorous scientific testing is still needed, but anyone who has used kinesiology taping in practice will vouch for the benefits seen in clinical practice. The introduction of pre-cut, ready-to-apply applications like those offered by SpiderTech™ now make applying kinesiology taping more clinic-friendly and time-efficient. The sound understanding of the clinical relationship between a patient’s complaint and how you apply the tape underlies the importance of an educational program. The education behind the use of kinesiology tape helps the clinician understand the multitude of conditions taping can benefit and can also help explain the different ways that the same piece of tape can be applied in order to achieve a different clinical outcome.
One of the main therapeutic benefits of using kinesiology tape in practice is the ability to extend therapeutic input to the patient beyond the office walls. As an example, we can look at something as common as knee pain. With the signals of discomfort actively transmitting to the CNS, the brain will be telling the muscles supporting the knee to “turn off,” which leads to an alteration in the timing and sequence of activation and thus a loss of function. In clinical practice, after treating the area I would apply kinesiology tape and instruct the patient to leave it on for 5 days. In this case an upper knee Spider would be applied using a neuro-sensory technique (there are various techniques that are dependent on clinical objectives) resulting in a reduction in discomfort for the patient, but more importantly, a restoration toward normal motor activation. This is crucial if movements and exercise are used as a part of the treatment plan.
Different from traditional forms of tape, kinesiology tape is designed to be flexible, so it moves with the body in motion. The tape also has a very special adhesive that allows kinesiology tape to be in contact with the skin for multiple days of continuous wear without leaving any residue or skin irritation. As seen with many of the Olympic athletes in London, the tape can be worn in very vigorous physical activity as well as during water events like diving.
Different from traditional forms of tape, kinesiology tape is designed to be flexible, so it moves with the body in motion. The tape also has a very special adhesive that allows kinesiology tape to be in contact with the skin for multiple days of continuous wear without leaving any residue or skin irritation. As seen with many of the Olympic athletes in London, the tape can be worn in very vigorous physical activity as well as during water events like diving.
The advent of kinesiology taping provides patients, whether athletic or not, an opportunity to “wear their therapy” whether demanding the most out of their bodies or simply trying to get through their day.

Sunday, July 1, 2012

Sports Injuries: Why Do They Occur?

FIFA, the international governing body of soccer, has published several studies the the causes of soccer injuries. What were the top 3 causes?

1. Number of previous injuries
2. Joint pain
3. Poor warm-up

What is the message here? 
1. COMPLETELY rehabilitate an existing injury. Simply being pain free is NOT good enough!
2. Joint pain - do NOT ignore it! Get it treated quickly. Faster treatment, better recovery.
3. Warm-up - learn a proper warm-up. If you are a baseball player, do NOT throw to warm-up, warm-up BEFORE you throw. It is INCREDIBLE to me that not one soccer coach I have asked has known about the FIFA 11.Click here for the link and use it! This warm-up can be used for any court or field sport athlete. If your child's coach does not know this, please pass it on.

Finally, please schedule an appointment for either yourself or your child for the Functional Movement Screen. This is the screening procedure used by PROFESSIONAL sports teams to analyze the injury risk of their athletes. 

Saturday, June 30, 2012


The National Federation of State High School Associations is offering two free on-line courses: concussions and heat injuries. If you, or your son or daughter is involved in sports leagues or simply outside in a playground, these two courses are a must!

Sunday, April 29, 2012

Making sense of proper diet and nutrition

Here is a great article on both the Vegan and Paleo approaches - read the comments too. My comments are below:

The bottom line is both Paleo and Vegan groups are passionate about healthy eating habits. My personal bias is Paleo because of my autoimmune disease called Achalasia. Since my esophagectomy in October 2010, I have been full on Paleo with incredible success.
A few comments:
1. Vegetarians and Vegans (at least those making up my patient base over the last 26 years) eat WAY too many grains and not nearly enough vegetables. As a Paleo proponent, I eat more veggies than most of my vegetarian/vegan patients.
2. Paleo does not have to be low carb. If you are working out with any intensity at all (more than just taking a walk daily) you will most likely need more carbs than what veggies can supply. I choose not to eat grains of any type (I can eat rice once a week) as I have experimented on myself and just don't do well with grains. I choose sweet potato, yams, turnips, parsnips. The harder I train, the more I need these foods to recover.
3. Paleo does not have to be super high protein. If you are training hard, I would argue that you will benefit from higher protein (good sources of course as per the article) and I do benefit myself. Read this post by Nora Gedgaudas about protein and Paleo
4. Here is a great article with a menu plan from the different Paleo/primal approaches
5. Most Vegans/Vegetarians are going to be nutrient deficient. These deficiencies (Mg; Zn; Vitamin D; Omega 3's - sorry, flax seeds, etc. do not convert efficiently to DHA; B12) can take time to show up.
6. Everyone owes it to themselves to do a bit of personal experimentation. Discover what works for you and get healthy!

Wednesday, April 11, 2012

Sports Injury Care = Sports Injury Prevention = Sports Performance

Chiropractor and strength & conditioning trainer says injury treatment and prevention holds key to improved athletic performance.

Sunday, February 19, 2012

Great Used Weightlifting/Powerlifting Equipment

I met Jim Gross yesterday from Sterling, VA and picked up a great set of weight plates. The money Jim makes goes to Meridians Recovery for those recovering from substance abuse. To contact Jim:

Tuesday, January 3, 2012


I was listening to this podcast today - 
Return to exercise after ACL (anterior cruciate ligament) injury, with Dr Richard Frobell 

- and I was blown away by this question and answer exchange:

Interviewer to Dr. Frobell: "You are now not so young anymore. So if you had your ACL torn in Alpine Skiing in Sweden, what would you do with it?"

Dr. Frobell: "I would most definitely wait with an ACL reconstruction. I would try rehabilitation at first [my emphasis]. If I still would experience instability because I am an active guy, I like to do sports, and if that would decrease my ability to do sports I would seriously consider a reconstruction. But I would never perform that at first. [my emphasis]"

WOW! What a change in thought. And what a first! 

Injury care = rehab = sports performance. I have been saying this for decades! Surgery is always an option.... but as a last resort if all else fails.

Sunday, January 1, 2012

Technique - It has always been and always will be about technique

Listen to Dr. Anthony Beutler talking about ACL Injury Prevention at the British Journal of Sports Medicine's podcast page - The JUMP-ACL study with Anthony Beutler

"There is no magic in the exercises....What really seems to be magic is the coaching [my emphasis]. Is actually getting people to change the way they perform these tasks, so that they do them in a more biomechanically sound [manner] with a movement pattern that is less risky for injury puts them at less risk for injury. That really seems to be the key so we emphasize good form, your knees need to be in line with your hips, your knees need to be in line with your toes, your toes need to be pointed straight forward and that you land softly."
Like I said, it always has been and always will be about technique.