Coach and Athletic Director

September/October 2017

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Page 46 of 53

C O A C H A D . C O M 47 fractures start in a similar way. Microscopic failures occur in parts of the bone, and the bony construction crew of the body (osteoblasts) comes to the rescue and repairs damaged structures. A quick "patch" prevents it from worsening, while other parts of the construction crew start transforming or smoothing out the patch. If the body can smooth and cure the patch before starting to overload the area again, the patch can last for a long time until the bone cyclically replaces itself. Normally, this process happens every day without knowledge or troubles along the way. But the small details that coaches and medical staff consider throughout the season can have a dramatic impact. Let's take blisters, for example. I've had many athletes walk through my door who accepted blisters as an inevitability of preseason training, and some even wear them with a sense of pride. Every year, I have to talk with them and explain how failing to condition the feet to expected workloads is what leads to blisters, and this is a major factor in overuse injuries. Whether from ill-fitting shoes or a dramatic increase in workload, blisters usually change how the biomechanical forces get transmitted up the kinetic chain, starting at the foot and ankle of the athlete. Blisters, even small ones, behave very much like those shallow potholes that are barely visible on the road. Driving over the same area only worsens potholes and risks damage to your tires, so drivers switch lanes to avoid them. On most roads, the problem is solved because there's not enough traffic to cause a second pothole while the construction crew fixes the first one. On a few major roads where there is significant traffic (training loads), construction crews (osteoblasts) are so busy that they are forced to make a quick patch before they're pulled away. Suddenly, large trucks (preseason) are driving over the area and tearing out the freshly laid asphalt. It's only a matter of time before the damage resurfaces or worsens. A blister underneath the big toe causes loading patterns to shift laterally and increases the risk of peroneal tendonitis and stress fractures of the fifth metatarsal and fibula. The opposite holds true with lateral blisters and posterior tibialis tendonitis, or potential stress fractures of the first or second metatarsal or tibia. Blisters on the plantar area of the heel shift the loading to the tarsals and mid-foot, while blisters underneath the metatarsal heads stiffens up the foot and increases risk of stress fractures in the foot, ankle and lower leg. Blisters on the posterior area of the heel/Achilles cause the athlete to alter the amount of plantarflexion and dorsiflexion, generally stiffening the entire foot/ankle complex as a result. All of these may be a conscious or unconscious effect. Small details, like proper foot care, may seem inconsequential to many and the consequences may only seem like a slight bump in the road. But if you hit enough potholes, or hit one just right, it can ruin the day and have a big effect on the upcoming season. Corey Dawkins is the practice administration manager at The Micheli Center for Sports Injury Prevention in Massachusetts. Learn more at Circle #114 or text CADSEP 114 to 41411 Circle #115 or text CADSEP 115 to 41411

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