An Inside Look at Iowa State’s Sports Medicine Dept.

The average year-round temperature in Ames, Iowa, is just under 50 degrees Fahrenheit, certainly nothing to prepare Iowa State University student-athletes for the cryotherapy chamber the athletic department installed in November. Wearing gloves, slippers and little else, athletes are surrounded from the neck down in air mixed with liquid nitrogen — and temperatures dropping to below minus-180.

How does it feel? "Cold," says Mark Coberley, who's been in such a chamber only once in his life.

When Coberley, Iowa State's associate athletic director for sports medicine, realized Cyclone student-athletes were seeking cryotherapy treatments elsewhere in Ames, he felt it was worth the investment to bring the anti-inflammation equipment on campus. "We're going to use it a little bit for injury management and a little bit for recovery," says Coberley, a National Athletic Trainers' Association board member who has been at Iowa State for 25 years. "Quite honestly, we're still in the process of learning the ins and outs of what this is going to do for us."

Few schools do more for their student-athletes' health and wellbeing than Iowa State, which boasts three main sports medicine centers and four satellites. The majority of ISU's advanced rehab technology is located within 6,000 square feet of the Bergstrom Football Complex — the only part of that facility accessible to all Cyclones regardless of sport. Here's a quick tour.
 

Digital diagnostics
It's within the Complex location that one can find a digital squat machine designed to measure concentric and eccentric movements in the lower body in order to address areas of weakness and chart recovery.

An isokinetic testing system performs similar functions on a variety of joints, providing computer readouts on strength imbalances and strength levels in relation to bodyweight. "As they go through a rehab, we can do knee tests or shoulder tests or ankle tests, and then get some values and strength levels that are very objective, and that gives us guidance on how we may want to tweak the program," Coberley says, "or if we're making the gains we want to, to stay on it."

The system can be used to assess athletes as a means to prevent injury, as well. "We will test athletes when they come in to get strength balances, particularly between the quadriceps and the hamstrings, and we look at that from a knee- and hamstring-injury-prevention standpoint," Coberley says.

Within the past year, Iowa State added a digital eccentric leg-training device that provides feedback on leg strength balance while enhancing proprioception, or the ability of athletes to know where their body parts are in space as they move them. The goal is to prevent injury during deceleration. "Nearly every non-contact ACL injury is a deceleration injury," Coberley says. "We actually spend a short time generating power and accelerating in sport and the rest of the time slowing that down and changing its direction. Eccentric exercise is being pushed quite a bit in both the strength and conditioning world and the sports medicine world because of its importance in injury prevention and also performance."

Another system, adopted within the past three years, performs biomechanical analysis of a given joint's range of motion. Individual movement correction programs are then designed on a computer and shared to the athlete's phone for use during daily exercise, and Coberley testifies to its benefits in both prevention and recovery. "We see that any mechanical deficiencies are really going to rear their ugly head when athletes get to the major college sports level, when they're training 12 months a year," he says. "By getting them to move correctly, we'll head off a lot of overuse injuries."

When asked what percentage of new recruits have been inadequately trained upon their arrival at ISU, Coberley laughs. "Eighty percent or more."

Bringing them up to speed means identifying deficiencies the athletes likely didn't even know they had so that strength coaches can address them in the weight room. Improvement is universal, according to Coberley. "For instance, some kids will have low back pain, but they actually don't move well at the ankle, and because of that they put an excessive amount of stress on their low back," he says. "Once we correct the ankle problem, the low back problem gets better and they'll come in and say, 'Man, I can squat a lot better. I can push a lot better. I bend deeper when I'm playing.' The athletes will tell you. They'll sense it and they'll feel it. And then when we talk to the strength coaches, they'll say, 'Yeah, they are moving quite a bit better,' and that just enhances their performance. It all goes hand in hand."
 

Hydrotherapy
Iowa State employs three pools from two manufacturers. All are capable of generating a current, while two of them have floors that can double as treadmills. "If we want to put you neck-deep in the water, you're only 10 percent weight-bearing," Coberley says. "If a kid's got a stress fracture, and we only want him to weigh 20 pounds instead of 200, we can put him in the water and let him run, and he'll be fine. He'll be pain-free. And we can generate a current in there for more resistance."

Beyond its forgiving effects on bodyweight, water holds the natural ability to control swelling. Says Coberley, "If you're standing in water that's five feet deep, you physically cannot swell in that water, because the hydrostatic pressure is greater than your blood pressure. Even if the water is relatively warm, we can put somebody in there and have them do movement exercise, and not only will they not swell, the swelling usually will diminish because it's being mechanically squeezed out by the pressure of the water."

Combined, both advantages make hydrotherapy irreplaceable. "We're kind of cheating rehab from the back end," Coberley says. "We're controlling all the symptoms and keeping a lot of these things to a minimum so that when the athletes do have their tissues heal up, which only Mother Nature can control, we don't have to address things such as range of motion and loss of balance, because we can work on those types of things in the pool."
 

Concussion management has gotten increasingly computerized, with the latest diagnosis and recovery tools employing eye tracking. [Photo courtesy of Iowa State University]

Concussion management
The issue of the day in football, as well as other sports, concussions are diagnosed and treated at Iowa State using three separate computerized programs. The latest technology found at only a handful of colleges in the country employs virtual-reality glasses containing cameras that track the wearer's pupils as they follow a moving dot.

"There's huge promise in that in terms of identifying another area where the brain has function," says Coberley. "If you have any kind of brain injury, your eye tracking will be thrown off. This allows us to gauge that. It allows us to use it for diagnosis. It also allows us to use it to track recovery. As we continue to test them and their symptoms get better, their eye tracking tends to coincide with that. And it's one of the areas in which we really haven't had a great ability to do any kind of objective measurements. You do baseline testing to see what's normal for the person, and then if it's thrown off it will be thrown off consistently, and then you know you have an issue. That's really new technology, and we're still learning about that."
 

Manual manipulation
As technologically advanced as Iowa State's facilities are, Coberley points out that within the past decade the sports medicine industry at large has returned to an emphasis on manual therapy after relying heavily on such things as ultrasound and electric stimulation to expedite recovery. "Everybody does continue to use those modalities, we just don't use them in isolation as much as we used to," he says. "We've learned what those things can and can't do, and we've also learned some of the huge benefits of the manual therapies that are available and different techniques that continue to evolve."

All 13 certified athletic trainers at Iowa State are capable of performing such therapies as massage and dry needling (essentially acupuncture), "so there's equal access for all of our athletes in all of our sports," says Coberley, adding that ISU's newest facility was designed three years ago with this trend in mind. That meant specifying four hydraulic tables that move up and down, facilitating more effective therapy while minimizing physical strain on the therapist. "If I'm going to work on somebody's hamstring issues, I can lower that down so I have a really good position for my body to be effective," Coberley says. "If it's a shoulder, I can raise that table all the way up so they're right next to me, so that I'm on the same level as them."
 

As treatment philosophies come full circle, the tools used in rehabilitation continue to evolve. Whether it's virtual-reality-assisted concussion recovery, cryotherapy or manual massage, Coberley and his staff learn and look ahead for the most effective ways to care for the student-athletes in ISU's 16 varsity sports. "We are obviously thinking ahead to the next iteration that we're going to do," he says, referring specifically to his team's hands-on renaissance. "It's one of the things we have to plan for in terms of space and equipment to be able to afford to do that."

This article originally appeared in the January|February 2018 issue of Athletic Business with the title "What’s hot — and very cold — in collegiate rehab." Athletic Business is a free magazine for professionals in the athletic, fitness and recreation industry. Click here to subscribe.