Dr. Nicholas M. Romansky,M.S., D.P.M.

Podiatric Surgeon at Healthmark Foot & Ankle Associates

As a podiatric surgeon in foot and ankle disorders, Dr. Romansky provides a complete service of a medical, orthopedic or surgical care. This includes diagnosis, prevention, management and treatment of disorders of the skin, nail, foot, ankle and related structures of the leg. In his practice he also provides care for people of all ages suffering from birth defects, diabetes and benign or malignant tumors. He also treats sports related injuries and impairments resulting from industrial accidents for which workers compensation is provided.

Dr. Romansky is a board-certified diplomat of the American Board of Podiatric Surgery. Since 1987 he has been a team doctor for the United States Men's and Women's World Cup and National Soccer teams. He has traveled within the United States and internationally with the teams. Dr. Romansky is a design consultant for cleat and equipment for multiple athletic shoe companies. He is a medical consultant treating players of many Philadelphia professional sports teams. Dr. Romansky is a noted author and active lecturer with recent articles on "Baxter's Neuritis" and tendon injuries. A recent book chapter on soccer injuries can be seen in a new book entitled "Sports Injuries of the Lower Extremity", second edition. He speaks to local diabetic, arthritis and sports medicine community groups.

Dr. Romansky played college soccer at Hartwick College and majored in Human and Environmental Studies. He went on to earn his Masters degree in Exercise Physiology/Cardiac Rehabilitation at The Pennsylvania State University followed by his medical degree in Podiatric Medicine. Residency and fellowship training followed.

Healthmark Foot and Ankle Associates
Nicholas M. Romansky, D.P.M.
David C. Erfle, D.P.M.

Soccer Tips From Dr. Nick

1. The #1 reason why re-injury occurs is due to inadequate rehabilitation from the first or previous injury.

3 Phases of Physical Therapy

Acute - Phase I Symptomatic management - control pain and swelling Muscle education Tape ankle or injured body part
Initial - Phase II Manual exercises Weight bearing to tolerance Strengthening, BAPS board, Dynapad, mini trampoline
Functional - Phase III Sports specific activity to return to full play

2. To Tape or Not to Tape

• Tape loses 40% of its initial support in the first 10 minutes of play
• Some things often overlooked are the type of tape and the quantity of tape. The experience of the person applying the tape is critical on the effectiveness of the tape job.
• Apply tape pre-game, change at half-time, and use after the game/shower to go home, especially if injured during the game. Remove tape in the morning before school, practice, etc.
• Using tape or a sports brace does not take the place of proper regular strengthening, balancing position sense, and reflex/proprioception training.

3. Basic Rules and Wisdom of Nutrition

• Don't get too hungry - hunger makes you eat bad things - apple pie vs. apples. Remember - food is your fuel. Eating premium foods ALL day is needed to play your best.
• Make time to eat. You make time for everything else - work, sleep, family, etc.
• Surround yourself with good food - make sure food is available at the right times of day. Good nutrition starts in the supermarket. Have foods ready to eat or drink when you are done training or when you wake up.
• Eat before you practice or play in games. Studies show that eating 300-400 calories 1-2 hours before your workout puts gas in your tank and keeps your from hunger post-play.
• Eat breakfast. Start your day by refueling because you are less likely to binge eat at the end of the day. You can't workout on fumes. Eating breakfast increases the chances that you will make smart food choices the rest of the day.
• You can't be perfect. You don't have to eat perfectly to eat better all day long. You can have an occasional cookie, cheeseburger, or other minimal junk food.

4. Light jog barefoot 1-2 times a week on level soft grass for a total of 1½ miles or more per week. Strong feet and lower legs equals fewer injuries. This is a great way to build strength, flexibility, and stability because you have to work harder to push off and land. Greater effort by your body requires greater cardiovascular demands thus a better overall fitness.

5. Kids shouldn't have back pain!! Coaches and parents should document symptoms of the player. If symptoms persist see a pediatric orthopedist, not a pediatrician or back specialist. This should be done after evaluation of a trainer or physical therapist. Get x-rays, a bone scan, MRI, or any other diagnostic study as it may be a stress fracture or a Pars fracture.

6. Leg pain - it may NOT be shin splints! The source of leg pain may be difficult to pinpoint and is a great source of frustration for the player. Pain can be coming from multiple sources and there can be a clinical overlap. Some examples are muscle or tendon injury, stress fracture, exertional compartment syndrome, medial tibial stress syndrome, popliteal artery entrapment or vascular claudication, and compensation pain for change of walking, running or training habits. Please document all symptoms SPECIFICALLY during and after play and the next day.

7. Make it routine to stretch and increase flexibility DAILY.

• Stretch the entire body 10 minutes per day but focus on the lower back and the lower extremities.
• 3 KEY POINTS
  • Don't over-stretch to the point of pain
  • Don't bounce
  • Don't hold your breath

8. Alternative Medicine at a Glance

Herbal
• Quercitin 250mg-500mg = take 3 times a day as an anti-inflammatory

Homeopathic
• Arnica Montana ( the aspirin of homeopathy) = for acute injury, bruises, pain, muscle discomfort (myositis), and overuse
• Rhus tox = sprains, strains, tendonitis, plantar fascitis
• Ruta graveolens = stiffness, pain, bursitis as well as sprains and strains
• Hypercium perforatum = crush or direct blow injuries, sharp nerve pain

9. Groin injuries are among the most common injuries in all sports, both contact and non-contact. As in any prevention or rehab program, both the injured and non-injured sides should be worked equally. Refer to chart below:

ADDUCTOR STRAIN INJURY PREVENTION PROGRAM

WARM - UP
• Bike
• Adductor stretching
• Sumo squats
• Side lunges
• Kneeling pelvic tilts

STRENGTHENING PROGRAM
• Ball squeezes (legs bent to legs straight), using different ball sizes
• Concentric adduction with weight against gravity
• Adduction while standing on cable column or against elastic resistance
• Seated adduction machine
• Standing with involved foot on sliding board moving in sagittal plane
• Bilateral adduction on sliding board moving in a frontal plane (i.e., bilateral adduction simultaneously)
• Unilateral lunges with reciprocal arm movements

SPORT-SPECIFIC TRAINING
• On-ice kneeling adductor pull-togethers
• Standing resisted stride lenghtson cable column to simulate skating
• Slide skating
• Cable column crossover pulls

10. Fluid Replacement

ACSM Guidelines
Pre-exercise
• 17-20 ounces 2-3 hours prior
• 7-10 ounces after 10-15 minutes of warm-up
During exercise
• 28-40 ounces every hour or 7-10 ounces every 10-15 minutes
Post exercise
• Replace fluids rapidly within 2 hours of ending activity.
• 20-24 ounces per pound lost due to activity

10. ACL injuries occur mostly in women.
70% of all ACL injuries occur in non-contact situations. There are 4 distinct categories that these types of injuries fall into: environmental, anatomic, hormonal, and biomechanical. Prevention is critical in women. Twenty minutes of exercise before practice can help prevent ACL injuries. Contact Holly Silvers, MPT at Santa Monica Orthopaedic and Sports Medicine Group to learn more about the PEP Educational Video (Prevent Injury and Enhance Performance) at 310-829-2663.

12. USE ICE!! Ice will penetrate 4 times faster and 4 times longer. Generally ice, especially crushed ice, is more effective than gel packs, ice baths, or ice massage. Apply ice 10-15 minutes within initial injury for optimum results. The type of tissue and time applied are 2 crucial factors. It takes 30 minutes to reduce the temperature by 5 degrees at a depth of 2-3cm. Joints with little or no fat require 30 minutes of ice every 2 hours. Deeper tissues require 45 minutes of ice every 2 hours.

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