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Thursday, 19 December 2013

Female Athlete - Their Why

The why.  This is extremely important to all who participate in sport.  It is what gives athletes their drive and purpose.  They why can change from beginning to end but performance can be effected if it is not truly from within.  With the female athlete, their reasons to start participation vary especially from their male counterparts.

Friends are one of the greatest reasons for females to start sport participation.  The adage if your friends jumped off a bridge would you?  Holds true in this case.  Many young female athletes either start participating in sport as a group of friends or because their friends are already involved.  Compared to their male counterparts females are not inclined to join a sport group or team by themselves.  They also are more likely to quit if they no longer have friends at sport or if they become bullied in any way.

Both male and female athletes feel a lot of pressure from family to participate, the female athlete however more so.  Females see it as a sense of duty to their family to participate, whether they are happy or not.

Females will choose to participate in sport as a means of exercise and weight loss, especially as they grow older.  This is one of the main reasons for females past their teenage years to restart or start participation in sport.

Another difference between males and females is the desire to compete.  Females will continue in sport participation not due to the competitive drive of beating their opponents but the internal drive of accomplishing the task and improving themselves.  This is one of the main points that keep females involved.  They want to continually improve themselves.  The sense of accomplishment over weighs that of besting their opponent if there is one.

One thing that everyone involved with female athletes needs to keep in mind is that their is a higher drop out rate compared to males.  We need to remove boundaries that interfere with female participation in sport.  Be it gender biases, the emphasis on the body or sport stereotypes, we need to encourage females to participate in sport.


Monday, 16 December 2013

What is an Athletic Therapist?

I am pretty sure when I told my parents I was going to be an Athletic Therapist my dad had a heart attack.  He had no clue what it was but was pretty sure he didn't want his baby girl being one.  Since that moment I have spent a major part of my life explaining what it is I do and what an Athletic Therapist is, even to those who think they know.

So what is an Athletic Therapist?  Well we are health care professionals who are trained in the areas prevention, immediate care and rehabilitation of musculoskeletal injuries.  We work with athletes from the young hockey player and the weekend warrior to the professional and Olympic level athletes.  No matter the level or sport we are there.  Be it at the rink, field, court, studio, gym or clinic we want to support athletes in achieving their goals.  Not only do we treat athletes we can work with general public helping them overcome injuries that they receive either at work or home.

So what do we do?  Everything.  We can help with equipment, tape any joint you prefer, assess your injury on site and rehab you from there to return to play.  We are the first ones there and the last ones to leave.  The best analogy I have heard to describe us is "mom".  We know when our athletes are hurt before they do, if they are having a bad day and how to fix it.

My daughter says I fix football players owies by putting bandaids on them.  My husband laughs because I love the smell of a hockey rink.  I can fix anything with a roll of athletic tape, and hate being called "trainer".  I have slept on treatment tables, numerous buses and even bags of equipment.  The long hours, endless bus rides are worth it.  Being able make a difference in my athletes lives is worth it, because that is what we do.  

For more information on what Certified Athletic Therapists can do please check out www.eliteinjury.com and www.athletictherapy.org.

Thursday, 12 December 2013

Intro to the Female Athlete

The female is a complex being turn that female into an athlete and you have made her even more complex. The female athlete provides many challenges to the coach, parent and athletic therapist.  To fully understand the female athlete will take more than this one post.  Today will be an overview of future topics and if you feel I am missing one or want me to talk about something specifically let me know as not all athletes are the same.

Female Athlete Triad, simply it is the combination of disordered eating, amenorrhea, and osteoporosis.  It is a vicious cycle that starts with disordered eating and progresses.  No sport is exempt from this as it is typically seen as an aesthetic or performance sport issue.

Anterior Cruciate Ligament Sprains, this ligament helps prevent anterior translation of the tibia relative to the femur.  In more simplified terms it stops the lower leg from moving forward compared to the upper leg.

Disordered Eating,  detrimental effects on energy levels do not require an athlete to have a diagnosed eating disorder such as Anorexia Nervosa or Bulimia Nervosa, the slightest change in energy intake for the athletes energy output will place unnecessary strain on their body.

Physical characteristics, the differences between males and females can predispose females to injuries that their male counterparts may not experience.  These characteristics may also predispose the athlete as to what sport or position they may participate in.

Why the participate?  The reason for female participate in sport varies depending on the individual however there are some constants.  Friend participation both effects the reason to start sport participation as well as when females decide to no longer be involved.

One of the new areas of study on the female athlete is in the area of concussions.  Still in its infancy we are learning a great deal about how females react to a concussive injury and if there is differences from their male counterparts.

As a parent or coach it is important to understand how to deal with the female athlete.  Learning how to deal with them will give both you and them an advantage on their path to success.


Monday, 9 December 2013

Surviving the Holidays

"Oh the noise, noise, noise, noise"  Yep maybe the Grinch had it right this whole holiday season is just crazy.  With the hustle and bustle, the parties, cookie exchanges (don't worry we will talk about that next week), the shopping and the fact that every year the holiday season seems to start earlier and earlier.  AHHHHHHHHHHHHH.   Can we just put the whole thing on hold for just a minute, I think I am going to go insane.

So where to start, how do we survive the holidays.  Quite simply just let it happen.  Don't worry if the tree isn't perfect, or the kids made a mess decorating cookies.  That is the joy of Christmas.  When I was growing up we always had real trees, I mean Charlie Brown trees.  For years I wanted Dad to pick up the big bushy, full trees like you see on TV.  So one year he did, it just wasn't right.  It was too perfect.

Go with the flow.  Yes the kids are going to go absolutely berserk.  This year we have a 3 year old and our baby will be celebrating his first Christmas, and the 3 year old has figured what this is all about.  She discovered the Wish Book this year and can't wait to tell Santa what she wants.  I'm not sure if she will make it to Christmas and I am not sure if my tree (yes my, the tree is mine, my baby, I decorate it, I sit by it, I love it) will make it through the 11 month old.

Take time for yourself.  Each day, do something for you.  Take a yoga class.  Enjoy a glass of wine and some cookies.  Take a walk in the snow, enjoy the beauty around you.  I enjoy sitting alone, staring at my tree.  That is my down time, my time to regroup.  Tonight, involves my decorated house, Garth Brooks Live
(I love PVR), and work.  For me getting time to share with everyone how to keep their families safe, gives me joy.  Find a way to get your joy.

Enjoy it. Enjoy your family and friends.  The dressing up for parties, the shopping, and cooking.  The joy on kids faces when they see Santa, or when what they asked for is under the tree.  Enjoy spending time with people you don't get to see all the time be it family or friends.  Just enjoy it.

Don't sweat the small stuff or the big stuff.  Find time to enjoy what is going on around you.  Don't forget your daytimer, because you are going to need it and I hope to see you on the other side.

Thursday, 5 December 2013

Fighting the Cold

As the temperature keeps dropping, we all need to be aware of cold injury.  Cold injury falls under two categories, localized and systemic.

Localized cold injury involves two main types, frost nip and frost bite as well as chilblains.  Frost nip is the most mild form and typically happens to the nose, ears, hands and feet.  This is most common when outside with out protection.  Frost bite also occurs from exposure to freezing temperatures but is more severe than frost nip.  The area effected will at first be painful and progress to numbness.  The skin will appear white and waxy.  Chilblains are caused by exposure to non freezing temperatures and dampness.  The person will have lesions that are red and raised, they may reoccur over time.

Hypothermia is when the body temperature drops below 35 degrees Celsius and is also called systemic cold injury.  There are two categories, primary caused by exposure to severe cold temperatures and inadequate clothing and secondary which is predisposed by illness.  Someone with mild hypothermia will display the following symptoms; shivering, fast breathing, trouble speaking, confusion, lack of coordination, fatigue, increased heart rate and increased blood pressure.  Severe systemic cold injury displays as follows; shivering, lack of coordination, slurred speech, stumbling and lack of coordination, confusion and poor decision making, drowsiness, apathy towards their situation, progressive loss of consciousnesses, weak pulse and slow, shallow breathing.

As with most injuries prevention is the first step of treatment.  Pay attention to weather forecasts,  especially if it involves a wind chill.  The chance of frost bite increases as the windchill drops below -27 Celsius.  Wear warm layers, keep dry and keep moving, but avoid overexertion.

If a localized cold injury occurs you should do the following treatments for frost nip, gentle rewarming by putting the effected area under the armpits is most successful.  For frost bite removal from the cold is critical, place the person in warmth and have them transported to a hospital.  Never rub the effected area as this can cause further tissue damage.  For chilblains should be rewarmed and the skin needs to be kept lubricated.

If someone is suffering from hypothermia be gentle when moving or touching them.  Remove the person out of the cold and remove any wet clothing.  Gently warm with person with blankets, shared body heat or dry warm compresses. Do NOT apply direct heat such as water, heat packs or heat lamps.  Monitor breathing and contact emergency medical services.

Staying warm and dry is the key preventing cold injuries.  Monitor the conditions and the time that you are outside.

Thursday, 28 November 2013

Performance Athletes and Injuries

All athletes at some time or another will need to compete or perform in front of a crowd.  For some athletes however, they are always in the spot light.  Performance athletes such as dancers, gymnasts, and figure skaters have the added pressure of always being critiqued on how they perform.

For many performance athletes both male and female the pressure to look good as well as perform at their best pushes them to extremes that other athletes don't try to achieve.  As with many athletes the fear of losing a position is great with all performance athletes.  This fear be it real or imagined can drive athletes to try and do anything to keep their position.

When dancers, gymnasts, figure skaters and cheerleaders become injured the notion of rest and recovery is a foreign concept to them.  They will hide injuries from their coaches and parents, not wanting them to know as their coach or parent may take them out of sport for the duration of their injury.  Performance athletes are prone to over use of pain medications due to this, which now causes more health issues on top of the initial injury.  However, some coaches and instructors expect their athletes to push through all injuries no matter how detrimental it will be to them both short and long term.  In some clubs and studios it is expected that athletes will train and compete through pain and that personal sacrifice and risk taking are expected and shows how dedicated you are to your sport, teacher and studio.  These athletes also tend to feel large amounts of guilt if they do become injured as they feel they are letting their coach, parent, team or troupe down.

A change of culture needs to occur in these sports.  Somehow all of us from coaches, parents, athletes, officials and health care providers need to encourage performance athletes to properly manage their injuries.  They need to know that their place in their team or troupe is secure and that their long term health is important.  Educating athletes and coaches to see beyond the next performance is part of this change.  No matter the sport proper injury prevention and management coming from all aspects of the athletes life is important.  The more education that coaches, athletes and parents have the safer the athletes will be in the present and future.

Friday, 22 November 2013

Shoveling to Avoid Injury

For those of us living in central and northern Alberta over the last few weeks, we have had to break out the snow shovels and ice chippers.  Making sure your walks and driveways are shoveled is not only a safety factor for you but those who also use those sidewalks and steps.  When taking on the task of shoveling there are a few key steps you can take to prevent injuring yourself as well as how to be safe for everyone.

As with most everything else in life having the right tools for the job is extremely important.  When buying a shovel proper height and weight for your body will help you avoid injury and do the job more efficiently.  You should not need to hunch over when standing with your shovel.  Heavier is not always better, the shovel needs to be well built but not too heavy, lifting it in the store with no snow on it is great but you need to take in account the increased load that the snow will add.

Preparing to go outside to shovel is half of the battle.  Not only must you get yourself psyched up to do it, because lets be honest who likes to shovel snow.  Wearing the proper attire will not only make the job go quicker but also a lot smoother.  Wear layers.  Snow shoveling is a very physical activity, start layering as you would if you were to go outside and exercise.  Wear fabrics that wick away moisture and that keep a layer of warm dry air near your body to keep you warm.  Your outer layer should be wind and water resistant.  There are a wide variety of cold weather gear out there.  Find the one that suits your needs the best.  Cover your head, 50% of our bodies heat can be lost through the head.  In extreme cold weather cover your nose and mouth to help decrease the amount of cold air that is entering your lungs.  Warm hands and feet will also make your task more comfortable, use gloves that allow you to hold the shovel and will keep your hands not only warm but dry as well.  Proper footwear is key.  Wear warm socks and boots that provide warmth, water resistance and good traction.  If your winter boots or work boots do not have good grips add on some ice cleats or traction aids.

Once you are outside and ready to begin, push the snow as much as possible.  The less you lift and throw the better.  When you do need to lift make sure you use your knees and not your back.  Do not throw over your head or shoulder height as this will put unnecessary strain on your upper back and shoulders.  Take breaks as needed and keep hydrated.  If you are not physically fit take your time, no matter your fitness level take breaks as needed.  Snow shoveling is a physical activity that combines cardiovascular exercise, weight lifting, balance and coordination, and we all must take breaks and be aware of our level of fatigue.  As we tire our body will become more prone to injuries and have a harder time keeping warm.

Snow shoveling can be a great way to get some extra exercise in during the cold months of the year, however it is only beneficial if you remain injury free.  By shoveling our walks, driveways and steps not only are you making your  home safe for yourself and your family but your guests and those who use the sidewalks daily.

Thursday, 14 November 2013

Pampering your Feet

Getting pedicures may seem like a frivolous thing to do but taking care of your feet can help prevent both foot disease and musculoskeletal issues.  Without taking in account exercising people can average 3000-5000 steps per day.  Any force that you generate through movement is now being put through your wonderful feet.  The foot is comprised of 26 bones which is 1/4 of all the bones in the body and over 100 muscles, tendons and ligaments.  Making up 33 joints which provide support, balance and mobility for the whole body.

What types do injuries and conditions are you trying to prevent through proper foot care?  There are many but we are going to focus in a few that effect all types of athletes.

Plantar Fasciitis is inflammation of the plantar fascia of the foot.  The plantar fascia is a a strong fibrous band of tissue that forms the arch of the foot.  Typically pain first shows up in the morning after the fascia has had a chance to tighten through the night.  As the Achilles tendon attaches in the same place tight calf muscles can play a role in the onset of plantar fasciitis.  In addition to calf stretching, plantar massage can help decrease the tension in the bottom of the foot.  The use of tennis balls, lacrosse balls or a bottle of frozen water are great tools for self massage.

A bunion is an enlargement of bone or tissue on the big toe, if this occurs on the little toe it is called a bunionette.  Causes of bunions are the shape of your foot, excessive pronation (you walk on the insides of your feet), fallen arches and improper fitting footwear.  Bunions typically are non symptomatic and treatment can vary depending on how severe they are.  The best way to deal with them is prevention.  Proper footwear with lots of room in the feet and that provide proper arch support.

Proper hygiene will help in prevention of the following three foot conditions.
Ingrown toe nails are when the skin around the nail grows over the nail or when the nail itself grows into the skin.  It has been shown in some parts of the population have a wide nail bed and will have chronic problems with ingrown toenails without surgery.  Ingrown toenails can easily become infected.  To avoid this problem correct nail clipping needs to occur.  Cut the nail straight across and avoid leaving sharp corners.  In the event you do end up with an ingrown toenail, soak your feet in salt water, dry them completely with a clean towel, use a mild antiseptic on the area and cover with a bandaid.

Athlete's foot is a fungal infection that causes red, flaking skin that is typically accompanied by itching.  In most cases athlete's foot is contracted in locker rooms.  It can spread beyond the feet if the athlete touches other areas after touching the infected area.  Keeping your feet clean and dry is the most basic prevention technique as well as not walking around in bare feet in any public area.

Plantar warts are caused by the human pappillomavirus (HPV) entering the body through small cuts on the feet. Plantar warts typically are found in calluses on the feet and have a small black centre.  The prevention of plantar warts is primarily based on proper cleaning and care of your feet.

So what is proper foot care?

  • Wearing proper fitting shoes that breath well with a wide toe box. 
  • Washing your feet daily and keeping them dry.
  • If you have feet that tend to sweat the use of powder to keep the feet dry. 
  • Never go bare foot in public places.
  • Use a pumice stone to remove calloused areas on your feet.  If you have active warts or infection do not use the same stone on healthy skin.
  • Self massage of your feet to relieve tired muscles and reduce tightness in the arches.  
  • Trimming toe nails straight across and avoid leaving sharp corners. 
Be nice to your feet and they will be nice to you. 



Wednesday, 30 October 2013

Halloween Safety

With Halloween coming up tomorrow, we thought it pertinent to discuss some safety issues around the holiday.

Trick or Treating Safety

  1. Make costumes out of bright visible colors or use reflective tape to help make children visible.
  2. If children are going out without you, make sure you agree upon a route and to stay in well lit areas.
  3. Have the children take a flashlight.
  4. Remind the children not to eat any candy prior to you sorting through it.  
Sport and Halloween

If your child is allowed to wear their costume to their sporting event, it is important to keep in mind if it will restrict participation.  As when planning their trick or treating costume masks can restrict vision or breathing. How tight or loose fitting the clothing is will greatly effect your young athletes ability to participate fully.  Both baggy and tight fitting costumes pose safety hazards, the may restrict movement or become a tripping hazard.  Accessories such as wings, tails and head gear can throw off balance of the athlete as well as pose a risk to the other participants.  Depending upon the costume it may be wise to have two costumes, one for school and trick or treating, the other for sport related activities.  

Keeping up with Nutrition

Prior to heading out trick tor treating or to the local Halloween party, it is important to feed your young athlete a healthy supper.  This will help fuel them for the fun and excitement that they are about to participate in as well as decrease the urge to over indulge in their loot.  By no means do we think that young athletes are immune to wanting to consume the goodies they will gain from their evening of going door to door, but if they have had a filling meal before hand they will not use the candy as their meal.  Post trick or treating, moderation is key.  Having some candy each day will benefit them in the short and long term.  In regards to sport if they only have a small amount of candy each day will keep their energy on a more even level.  Long term advantage is their candy stash will last longer.  

Have a safe Halloween both at sport, school and play.  



Thursday, 24 October 2013

Antioxidants and Sport

Why is it important for all of us to eat fruits and vegetables and other plant based whole food.  Well quite simply it is the nutrients that they provide.  The nutrients from these foods are special, they are called antioxidants and they help protect your body and cells from the damages that occur on a daily basis.

Antioxidants are found naturally in food and come in the forms of vitamins, plant chemicals such as flavonoids and carotenoids, and minerals.  The role that antioxidants play in the body is to protect cells from damage.  The damage that occurs to the cells is from free radicals.  Free radicals are produced during metabolism.  Free radicals can also be caused from environmental factors such as pollution, smoking and chemicals.  So with every breath we take, stress inducing moment, and exercise we complete we are producing free radicals in our body.  For athletes who are engaging in strenuous training their levels of free radical damage is huge.  The best way to counteract this damage is through diet.  

By consuming antioxidant rich foods they counter balance the free radicals in the body.  Antioxidants can be found in fruits and vegetables, whole grains, lentils, beans, nuts, seeds, vegetable based oils, garlic and green tea.  By in large fruits and vegetables are great sources of antioxidants.  The Canada Food Guide recommends 4-6 servings of fruits and vegetables for children, 7-8 for teens and between 7-10 for adults.  The Food Pyramid recommends 2-4 servings of fruits and 3-5 servings of vegetables.  These recommendations are per day not per week, or for some people per month.  Typically raw is better than cooked when dealing with fruits and vegetables but in some cases cooked is better.  Spinach, kale and chard is better cooked as the cooking process releases more beta-carotene and lutein.

Of fruits and vegetables berries, broccoli, tomatoes, red grapes, spinach and artichokes are considered high in antioxidants.  As each food is created differently it is important to eat a wide variety of fruits and vegetables to get all the nutrients and minerals available.  A good rule of thumb is fill your plate with the colors of the rainbow.  For many people, especially athletes finding time to eat the variety and amount of is hard.  If you are having difficulty achieving this level of consumption, you can consume a whole food based supplement made of a variety of fruits and vegetables.

Providing your body with the proper nutrition it needs to grow and perform is essential.  Knowing what you put in your body is key.



Thursday, 17 October 2013

MRSA in Sport

It used to be said that cleanliness is next to godliness.  In the case of athletes and the locker room that holds true.  Methicillin resistant staphylococcus aureus (MRSA) comes in two forms HA-MRSA which is health facility based and CA-MRSA which is community based.  In the world of sport we need to pay attention to the community based MRSA.

The main cause of all MRSA is the over prescribing of antibiotics.  Even the proper use of antibiotics has lead to the increased resistance of bacteria.  In sport settings there are five C's of risk.  Contamination, lack of cleanliness, compromised skin, crowding and contact.  30% of all individuals are carriers of CA-MRSA which is why dealing with the 5C's is so important in the prevention of MRSA.  Cleanliness of both the athletes, their equipment and the facility is pivotal in the early stages of prevention.  Athletes should shower immediately after participation, soap and towels should never be shared.  Paying attention to any type of open wound is imperative.  All wounds must be cleaned properly and covered to avoid the chance of infection entering the body.  Crowded locker rooms or dormitories increases the chance of infection spreading. If you are in charge of the locker room, use a cleaning solution of 1:100 bleach to water. The use of antimicrobial cleaners can also reduce the amount of bacteria on surfaces.  Main areas that you need to be concerned with are the locker room, shower facilities, weight room, and any adjoining areas to the locker room.   Contact of an infected person onto either training surfaces or other athletes either by direct or indirect contact start the transmission process.  By having your athletes maintain proper levels of hygiene, cleaning their gear, and maintaining clean facilities will help decrease the chance of CA-MRSA being transmitted.

As a coach, parent, trainer or athlete it is key to pay attention to skin condition.  If a wound is present it must be cleaned and covered before the athlete returns to participation in sport.  If a wound does go untreated look for the following signs of infection.  Hot, red and raised area around the wound is the standard signs for any infection.  CA-MRSA will start as small red bumps similar to pimples and will develop into painful abscesses.  Early intervention and treatment is essential to the athlete returning safely from CA-MRSA.  If any athlete does have CA-MRSA the whole locker room must be thoroughly sanitized, this includes all hard and soft surfaces and all clothing.

Prevention of all injuries is important however the prevention of MRSA is even more important due to the long term dangerous health effects.

References:
Rogers, Sharon. A Practical Approach to Preventing CA-MRSA Infections in the Athletic Setting, 2008 Human Kinetics - ATT 13(4), pp. 37-41
www.cdc.gov
http://www.phats-sphem.com/newsletter/Newsletter_spring13.pdf
www.mayoclinic.org/mrsa

Thursday, 10 October 2013

Dynamic Stretching in Warm Up

This week Jasmine Eisenhaur, PT, MScPT is our guest blogger. This weeks focus is the importance of dynamic stretching during warm up.


As a physiotherapist who has been involved with sports for many years, whether as an athlete or a team therapist, it amazes me how many athletes still continue to statically stretch as part of a warm-up prior to competition. While this was previously the main way to stretch as part of a warm-up, it has long been known now that dynamic stretching is the more beneficial method. As Faigenbaum et al reported in their study, a brief period of static stretching negatively affected jumping and sprinting performance in children (2005). While static stretching can help to improve range of motion at a joint, in a muscle, and in the surrounding fascia, there is most definitely a more ideal time to do this than before a competition. McMillan et al found that the group who performed a dynamic warm-up had  improved performance on their measures of agility, functional leg power and total body power compared to groups that performed a warm-up with static stretches or no warm-up at all (2006). 
There are some basic guidelines you can use to ensure any athlete is getting a proper warm-up:
- Start with some light aerobic exercise ie. a jog, riding a stationary bike. Ideally this should be long enough that the athlete breaks a sweat. This is usually a few minutes in length and ensures that blood flow to the muscles has increased.
- Do dynamic stretching exercises for any muscles that will be used during the competition. Dymanic stretches should be controlled movement, meaning never too fast to lose control of the affected body part, and should be painfree.  The stretches should also move through as much of the muscle's or joint's range of motion as possible, ie. don't do a walking lunge and only go halfway down - get the most out of the stretch. 
- An effective stretching program will leave the athlete feeling limber and ready to participate without fear of injury during the competition.
While this may sound like a lot, there only needs to be one stretch for each muscle group. In many sports, ie. hockey, another more sport-specific warm-up is done before the competition, which emphasizes the importance of keeping the dynamic warm-up simple but effective while still preparing the athlete for the sport-specific warm-up. 
The one instance I will educate athletes on using static stretches as part of a warm-up is when they have been injured recently and they feel that they simply will not perform as well without statically stretching the affected muscle or joint. However, I will generally recommend to that athlete to follow the static stretch with a dynamic one when it is possible, to ensure the muscle is dynamically prepared for the competition ahead. 

Thursday, 3 October 2013

Proper Concussion Management

Gone are the days of returning to the game the same day you suffered a concussion.  Well it is supposed to be.  Even with all the media attention and front line education on concussions; coaches, parents, officials, athletes and trainers are still missing the message.  After a concussion has been diagnosed it is extremely important to have the athlete rest.  Not only physical rest but cognitive as well.  No matter the age of the athlete it is important to offer them this rest.

I has amazed me over the years that parents, athletes and coaches have tried to circumvent the return to play protocols because the concussion occurred in another sport. It is the parents role to inform teachers and other coaches of their child's concussion.  Concussed athletes may need to take time off work or school, to give the brain the rest it needs.  Student athletes need to be given the chance to fully recover before returning to full mental and physical activities.  Having athletes refrain from attending school while still suffering symptoms will aid in their recovery.  It may be required for the student athlete to remain home from school until symptom free as the level of concentration at school is too much.  Gradually introduce them back into school and homework.  Consultation with their teachers is important, ask for extra time to complete assignments and tests.  The other major part of cognitive rest is to take away screen time.  Put down the phones, turn off the computer, TV and video games.  That scream you just heard was every young athlete having a minor heart attack due to this.  The bright lights, sound and concentration needed for these activities do not help the brain heal.

Right after injury it is imperative that you do not give the athlete any pain medication.  Advil, Tylenol, Aspirin and Ibuprofen will only mask the signs and symptoms of the concussion.

Your qualified health care provider will complete a concussion test and compare it to the athletes baseline evaluation.  Only when an athlete is sign and symptom free do they progress onto step two of the return to play process.  A minimum of 24 hours is required between each step where the athlete must remain symptom free.
Step 1 - Rest until 24 hour symptom free.
Step 2 - Light aerobic exercise such as biking or jogging for 20-30 minutes.
Step 3 - Sport specific exercises such as skating in hockey, running drills in soccer or football.
Step 4 - Non-contact training drills such as passing drills.
Step 5 - Full contact training drills upon medical clearance 
Step 6 - Return to normal game play.

An athlete should remain at step 5 until both the athlete, parent and coach feels that the athlete is able to keep up with the play both physically and mentally.

Key points to remember are:

  • Return to learn before return to sport
  • No difference in management between elite and non-elite athletes.
  • Younger athletes may require longer to recover.  
Rushing any athlete back to sport to quickly can cause serious damage both to the brain and other areas of the body. Following proper concussion management may help to decrease the long term effects of concussions. 



Thursday, 26 September 2013

Concussion - Recognizing the Symptoms

"Coach, I have a headache", those five words make every coach grimace, dreading the worse, hoping the athlete does not have a concussion.  A headache is the most common symptom of concussed athletes, but by no means the only one.  No one concussion sign or symptom is more important than the others and all must be taken seriously. To start we will define the difference between signs and symptoms.  A sign is something that you as the coach, parent, trainer or fellow athlete will notice.  They include poor balance, slow or slurred speech, poor concentration, vacant stare, delayed response to questions and a change in the level of performance.  Symptoms, how the athlete tells you they feel, fall under four categories.  Somatic (physical), emotional, sleep disturbances and cognitive.  Somatic symptoms include headaches, nausea, vomiting, balance problems, visual disturbances, dizzy spells, sensitivity to light and sensitivity to noise.  Emotionally an athlete may be sad, depressed, nervous and more irritable.  They may sleep more or less and may have trouble falling asleep.  Cognitively, they may have difficulties concentrating, trouble with remembering, feel mentally slowed down or that they are in a fog.

If an athlete presents with any of these signs or symptoms they need to be removed from activity immediately and evaluated further.  As a coach, parent or trainer, use the Sport Concussion Recognition Tool to determine what further care is needed and refer them to a trained health professional in the area of concussions.  It is very important to rule out a cervical spine injury as well with any athlete that is displaying concussion symptoms.  Typically concussion symptoms are quick in there onset and involve short lived impairment for the athlete.  It should be noted though that in some cases signs and symptoms are delayed in their onset.

Next to knowing what signs and symptoms to look for the greatest tool you need comes from knowing your athletes.  Being able to recognize the difference in your athletes is key.  An athlete may tell you that they do not feel right and if you ask many parents and coaches who have dealt with concussions will say the athlete was not themselves.  Even though they are symptoms take notice of them.  Coaches one of your biggest indicators to watch will be how well the athlete is performing.  If a skill typically always done well can is being done poorly, something is causing it.  Remove the athlete and evaluate, it may not be a concussion but no matter what it is always better to error on the side of caution.  Parents, pay attention to how your child is acting.  They may not tell you they are suffering but you will notice changes in their behavior.  Everything from how they are sleeping, eating and interacting with the family and friends will be an indicator of how they are feeling.

Many of the former athletes when asked about concussions will say they never knew that they had one and definitely did not know what to do when did occur.  Recognize that a concussion has occurred and remove the athlete from activity, do not let them return until evaluated by a trained health care professional. Next is proper management, following the proper return to play can be the difference from a quick return to activity or the unnecessary lengthening of symptoms.

Saturday, 21 September 2013

Concussion - Where to Start

Concussions, after staring at my computer screen for about an hour trying to come up with a new and inventive way to talk about concussions and why everyone in sport needs to be educated about them, I realized that their is nothing new to say.  The message is still the same, hopefully you will gain some new knowledge or understanding after spending some time reading this.  That is my hope, that by a coach, parent or athlete reading this, they will learn something about concussions.  We can't necessarily prevent concussions unfortunately it is one of the risks of sport, but we do need to increase the awareness of signs and symptoms and proper management when they do occur.

This may seem like a redundant thing to say but a concussion is a brain injury.  I state this because I have had a coach in the past say a kid could play because the emergency physician said he had a mild brain injury.  He must have been listening to me, he knew that he could not play a kid with a concussion, and obviously I had not educated him enough. As defined from the 4th Concussion Consensus Statement from Zurich November 2012, concussion is a brain injury caused by a direct blow to the head, face, neck or an impulsive force being transmitted to the head from a direct blow to somewhere else in the body that causes a set of physical, cognitive or somatic symptoms.  It is important to say that everyone person will respond differently to a concussion both in the symptoms they show and how they recover.

Every day it seems there is something new coming out about concussions.  For a coach or parent trying to keep up at times seems impossible.  I have found Twitter to be an excellent resource.  Follow health professionals who are known for concussion research to stay up to date and informed.   It is unfortunate that most general practitioners are not up able to stay up to date on the latest concussion research and proper return to play.  When dealing with any health professional ask them questions, if they have never heard of the consensus statements or are still following the earlier versions find someone new.  A great resource is a certified Athletic Therapist in Canada or Athletic Trainer in the States.  Proper concussion management is in their scope of practice and they deal with sport concussions on a regular if not daily basis.

So as a parent or coach what do you need to know.  We are going to break it down into three posts.  First we will focus on the importance of baseline testing, secondly recognizing a concussion, thirdly proper management.

Baseline concussion testing can involve a couple of different aspects.  Depending on your health practitioner they may choose to do a different test.  The most popular and common are the Sport Concussion Assessment Tool 3 (SCAT3), ImPACT and King-Devick.  The SCAT3 has a version designed specifically for athletes aged 5-13 as well as the standard for those 13 and over.  ImPACT should be used along with the SCAT3 or King-Devick.

The importance of having baseline testing done is not to compare to other athletes but to understand the athletes normal state as well as to determine their past concussion history.  Finding out if an athlete has suffered a concussion before and if they have any medical conditions that may effect their recovery from a concussion if one should occur.  Athletes, coaches and parents always ask if the baseline test was passed.  This is where the naming can be deceiving, baseline testing is not a pass or fail, it is to determine how the athlete normally feels to a set of symptoms and to evaluate their memory recall, balance and thinking skills.  It is an evaluation.  How many of us have a headache on a regular basis?  Since headache is the number one symptom of concussion, it is good to know if the athlete regularly has a headache when trying to determine if a concussion has occurred.  When doing baseline evaluations athletes typically tell me they have a hard time with numbers or remembering months.  If we had not done the baseline evaluation I would not have known that and it could effect my evaluation of them post injury.

Education about concussions is always important but that includes the health practitioners education about each individual athlete.  Doing baseline evaluations allows us to get to know the athletes better, which in turn gives us an advantage when an injury does occur.  Have your athletes do baseline evaluations prior to each season as their physical and mental growth and development will change their outcome.  Think of a baseline concussion evaluation as an insurance policy.  We never want to have to use our insurance but are sure glad we have it when it is needed.


Thursday, 12 September 2013

Balancing the Scales: Sport, School and Life

Being a student athlete is hard work.  The amount of time and dedication it takes to compete at any level can at times leave little room for anything else.  Finding time to schedule in school work, friends and family soon leaves many athletes overwhelmed and unsure of how to deal with all that is on their plate.  The majority of young athletes that excel in their sporting venue also excel in school because of their internal drive to succeed.  It is also what makes them say yes to student council, yearbook and many other school activities.   Creating an environment for the athletes to succeed is job held by many and each of them have specific roles.

As the parent you are the master conductor and scheduler.  You shuttle the kids from school to practices and games and back home again, watching them do homework in the back seat or in the stands while waiting for their siblings to be done.  You see them texting their friends or talking to them after school.  Part of your job as master scheduler is to put time in each day for your children to complete their school work.  Try to give them uninterrupted time and space to complete their homework for the day.  When planning for weekends away, have the children speak to their teachers in advance to get their assignments and reading for that period.  Schedule time each week for them to have friend time, family time and down time. It is very easy for everyone to get caught up in the rat race of classes and sport, even young athletes need time to spend with their friends.  It may be they end up playing street hockey, a pick up game of basketball or doing cartwheels in the basement but it needs to unstructured socialization time with their friends.  Family is important, as you will be who they fall back on when things get tough in life.  Spend at least one night a week together as a family to reconnect, turn off the phones and find out how everyone's week has been.  Each person needs some me time, so let them have it.  This time will be useful as your athletes will discover how they are feeling both physically and mentally when the world slows down around them.

Coaches need to remember that sport is not their athletes full time occupation, school is.  Schedule enough time for your athletes to rest, do school work and have fun.  Athletes who are both mentally and physically fatigued will not be able to focus on the skills expected of them.  You should encourage your athletes to excel at school, as the problem solving and critical thinking skills they gain there will help improve their on field performance.

As an athlete you may feel the pressure to say yes to every request you get.  Learn to say NO and to find a way to schedule time for yourself.  Using a day timer or calendar to organize and write down when assignments, tests and games are will allow you to manage your time wisely.  You don't want to have to worry about doing the ten page essay after family supper on Sunday night.  Talk to your friends, find time to hang out with them away from school or gym.  Your friends and family will help you out when you start feeling like everything is too much, keep them close so they are their for you when it happens.

Usually as a teacher you are probably doubling as teacher during the day and coach at night.  Be understanding of your student athletes when they let you know they will be away, let them know what work they will miss so they don't fall behind. Students who exercise typically do better in class, help them excel at both school and sport.

Everyone involved in student athletes lives needs to pay attention to how much pressure they are putting them under to complete everything asked up them.  We all need to be realistic in our expectations of them and to pay attention to the signs of burn out.  If they are getting burnt out, be there for them and help them adjust as need to so they can live that balanced lifestyle where they gain the full benefits of school, sport, family and friends.

Symptoms of Burn Out
low motivation, decreased energy, concentration problems, loss of desire to play, lack of caring, sleep disturbances, physical and mental exhaustion, lowered self-esteem, negative affect, mood changes, substance abuse, change in values and beliefs, increased anxiety, highs and lows.

Friday, 6 September 2013

Preseason Anxiety

It is the first day of tryouts, your hands are sweaty, you feel queasy and if the coach looks at you and then their clipboard one more time you are pretty sure you might burst into flames.  Everyone else seems to be understanding the drill perfectly, why does it feel like you have two left feet.

Tryouts and preseason can be a stressful time for everyone no matter their age or competitive level.  Some stress is normal, it is what helps drive us.  When stress becomes too much the body starts to react negativity. The body responds to anxiety mentally, physically and behaviorally.  Being aware of the symptoms both as an athlete and parent and coach is key to starting how to deal with anxiety.

Here are the symptoms of anxiety

Cognitive
Indecision, sense of confusion, feeling heavy, negative thoughts, poor concentration, irritability, fear, forgetfulness, loss of confidence, images of failure, defeatist self-talk, feeling rushed, feeling weak, constant dissatisfaction, unable to take instructions, and thoughts of avoidance.

Physical
Increased blood pressure, pounding heart, increased respiration rate, sweating, clammy hands and feet, butterflies in the stomach, adrenaline surge, dry mouth, need to urinate, muscular tension, tightness in neck and shoulders, trembling, blushing, distorted vision, twitching, yawning, voice distortion, nausea, vomiting, diarrhea, loss of appetite, sleeplessness, and loss of libido.

Behavioral
Biting fingernails, lethargic movements, inhibited posture, playing safe, going through the motions, introversion, uncharacteristic displays of extroversion, uncharacteristic displays of aggression, avoiding eye contact, covering face with hand, incessant talking, pacing up and down.

All of these can greatly effect performance.

There are some common ways to deal with anxiety to keep you performing at your best.

1. Progressive Muscular Relaxation is the process of moving from one area of the body to another creating and releasing tension.  It is important to start by keeping your breath shallow and steady.  Start with your hands and fingers and work your way up to the head and then down through the torso and into the legs ending with your feet and toes. This technique does take some time to master so practice it before using it during a sporting event.

2. Relaxing Place is a more advanced version of finding your happy place.  The good thing about this technique is that you do not need to be lying or sitting down.  The location you visualize can be real or imaginary but must convey strong sensations of relaxation.  Take a few deep breaths and let the noises of your immediate surroundings fade away.  Start to visualize your relaxing place and let your body relax as you place yourself there.

3. Five Breath Technique removes tension and clears your mind of what is causing your anxiety.  You can use it at any time or during any situation.  It involves taking five deep breaths and relaxing a part of your body during each as you exhale.  During breath one relax your face and neck, breath two relax your shoulders and arms.  When exhaling breath three let the tension release from your chest, abdomen and back.  Breath four relaxes your legs and feet and breath five is a final relaxation of the whole body.

Learning to deal with anxiety from sport is important in forging your path of success.  These techniques can be used throughout the season and off season to put yourself in a relaxed state for competition and training.  It is important to note that if using these skills during a competition not to get too relaxed as you need to keep some level of alertness to perform.

Friday, 30 August 2013

Pre-Season Nutrition

Proper nutrition during tryouts might not be what helps you make the team or prevent injury but poor nutrition can hinder your chances of success.  During tryouts the physical demands being put on the body are greater than normal.  Typically there are more sessions at a greater intensity than during the season, the body is going to need proper fuel to compete at its maximum potential.  

You can not start eating right the night before and expect everything to work out great.  As with physical conditioning, you need to start fueling your body properly long before you step on the field for the start of the season.  When searching for an ideal diet to use for both athletics and everyday life follow the Canada Food Guide. Fill your plate with fresh fruits and vegetables, whole grains and lean meats.  Milk products can work great post activity though typically not recommend prior to activity as they can unsettle the stomach once activity commences.   Athletes need to consume all three of the major macro-nutrients; carbohydrates, protein and fat to fuel the body properly as well as providing it with the proper nutrients for growth and development.  The body uses carbohydrates to create the energy needed for physical and mental activity, eliminating them is very counter productive for any athlete.  

A common question that is asked by coaches, parents and athletes is "when should I eat prior to my event?". It is not a cut and dry answer as every person has their own perfect balance as to when and how much they need to eat prior to activity.  A general rule of thumb is that as the younger an athlete is the closer to start time they should eat.  Their metabolism is faster and will use up the energy gained from eating quicker.  As we age our metabolism slows down, instead of eating a big meal a few hours before the game, the larger meal may need to consumed quite a few hours before with a small easily digestible snack closer to game time.  During pre-season and tryouts there are typically multiple sessions in one day making it hard to find time to eat a good healthy meal and allow the body to digest it.  Eating smaller meals that are easily digestible will give you the energy to compete but not weigh you down or cause cramps. 

Prior to your sessions eat low or medium glycemic index (GI) foods such as fruits and vegetables or beans.  Your body needs carbohydrates to be active so having a bowl of granola or oatmeal, with nuts and fruits would be ideal, a non dairy based shake full of fruits and veggies is an easy digestible option.  Post activity you need to provide your body with both carbohydrates and protein, depending on how long until your next session will decide on the size of the meal.  Protein shakes made with fruits and vegetables are great at this time, just be careful of the amount of dairy you are having.  A couple of other great meals would be a peanut butter sandwich and fruit or a bagel with a lean meat, wild salmon would be a great choice, with either spinach, sprouts or kale. Always drink water to stay hydrated, you can see our previous post on the importance of hydration. You might have heard that chocolate milk is a great post exercise drink, it is as it provides you with carbohydrates, protein, and two major electrolytes; sodium and potassium to help the body rebuild and refuel. Compare other beverages to chocolate milk to see how they stack up.

As tempting as it may be to go through the drive thru for a quick meal DON"T. Fast foods will not provide your body with the nutrients it needs, as well as there is a decrease in blood flow through the arteries and veins due to the vessels constricting.  When you will ask your muscles and heart to react to the physical demands you are going to put them through, they will not be receiving the necessary blood flow to do what you ask.  You will feel lethargic and unable to perform at your best.

Take a little time to plan your meals during this hectic time of the year.  You will enjoy the benefits of providing your body with the food it needs to perform at its best. 

Thursday, 22 August 2013

Teach an Athlete to Drink

It amazes me that no matter the experience or level of competition that an athlete competes at you still must remind them to hydrate.  Proper hydration is one of the key components in athletic performance.  Dehydration not only effects the body physically but those physical side effects will effect you mentally as well.  Hydration does not start when you step into the dressing room or at the first water break, it is a continual ongoing process.  Think of your body as dam.  You need a water source coming in, a place for it to rest and somewhere for it to go.  The water you consume is like the river flowing into the dam, your body is the the reservoir, and the river flowing out is the water you lose through sweat and urination.  How well do the muscles work if they are not lubricated?  How will they receive the nutrients they need to perform?  Water is used throughout our bodies, we need make sure it has an ample supply.

If you are able carry a water bottle with you so that you can hydrate throughout the day. A 120 pound person should consume 8 - 8oz glasses of water each day if they have not exercised.  For every hour of exercise you should consume 16 oz or 2 cups of water.  It is important to hydrate before, during and after activity.  A good rule of thumb for during activity is to drink 1 to 1.5 tablespoons every 15-20 minutes. Continue to replenish after activity, for athletes who are losing excessive amounts of water replenish with the amount of weight lost during activity.  Yes, chocolate milk is a great post activity drink to help replenish liquid, protein and carbohydrates, I still recommend drinking water on top of that.

For coaches, parents, and trainers be on the lookout for the following as they are signs and symptoms of mild dehydration:


  • Dry, sticky mouth
  • Sleepiness or tiredness — children are likely to be less active than usual
  • Thirst - dulled with activity
  • Urine that is yellow or gold in colour
  • Decreased urine output — eight hours or more without urination for older children and teens
  • Few or no tears when crying
  • Dry skin
  • Headache
  • Constipation
  • Dizziness or lightheadedness
  • Decreased mental awareness
Learning how to hydrate is an something that all coaches, parents, trainers and athletes must do to keep the body performing at its peak.  Your body is 60% water and requires it for many body processes.  Replenish your stores with glorious water.  Sport drinks should not be used by children and only in certain circumstances by adult athletes.  No one should be consuming energy drinks at all and definitely not as a means to hydrate.  As a coach schedule water breaks no more than 20 minutes apart and encourage your athletes to drink.  Parents should check with your children's schools to see if they can carry a water bottle with them, it is amazing how often they will take sips if it is sitting right there.  Athletes, it comes down to you, if you want to succeed you need to provide your body with its major nutrient, so grab a bottle of water and good luck in achieving your goals.


Wednesday, 14 August 2013

A New Season and a New Beginning

For anyone who had read previous posts you are going to notice a bit of a change.  I am changing this from a personal blog to one more business centered. You are still going to receive great health tips just less about the life of being a mom, unless the children enlighten me on some sort of injury prevention tip.  Another change is that we will be adding guest bloggers, giving them a chance to share their injury prevention and management tips while giving you another perspective.

The basis will still be as our name suggests Eat Right and Ice.  Ask any of my athletes or patients and they will tell you that no matter their injury they were told to ice and if they wanted to achieve success they needed to fuel their body properly.  No matter your sport, activity or occupation the information here will help you achieve the success that is in you.

As we get closer to then end of summer and fall starts to get into full swing so do many sports and activities. Fall can be a very trying time for all those involved in sport.  Athletes are under both internal and external pressures during tryouts, you then throw in the beginning of a new school year and it can play a major factor in their on field performance.  Coaches are dealing with the expectations of their organization and parents as well as juggling work, sport and their own children's schedules.  Parents are now juggling back to school, multiple sport schedules on top of normal daily activities.  With increased stress levels and busy schedules proper nutrition typically goes out the window at a time when it is crucial for athletes to fuel their bodies properly. Proper rest and nourishment help combat mental and physical fatigue which plays a role in injury prevention.

Over the next few weeks we will be focusing on how to get through tryouts healthy and injury free.