Finding the Balance

We have all heard of the problems caused by sport specialization, many were discussed in our previous post The Hype Behind Sport Specialization  .   However there is a new trend occurring with youth sport, the do everything phenomenon.   This seems to be the counter balance to the specialization phenomenon.  What this is creating is a new problem that is erasing the benefits of being a multi-sport athlete.  Young athletes are participating in multiple sports in one season.  The point of children doing multi sport was to give them a wide variety of skills and mental experiences.  What is happening though is children are being shuttled from sport to sport in one day.  Indoor soccer practice to hockey game or tumbling practice to dance practice.  

Situations like increase the child's level of fatigue, increased chance of injury and burnout.  All typical outcomes for sport specialization as well.   We tend to forget about scheduling time for play, sleep and homework for our young athletes.  During a recent seminar a group of young athletes were shocked when told they should be getting between 8-10 hours of sleep a night.  They pointed out that after practice and homework, they are closer to 6-7 hours.  It is important to note that athletes who get less than 8 hours of sleep per night are 1.7 times more likely to suffer an injury.  

The goal of participating in multiple sports was to broaden the young athletes development and was geared towards year round sport.  Multiple sports should be played over multiple seasons.  This allows for our youth athletes to focus on one sport at a time, focus on school and as well as allowing them to have time to be KIDS.  

So if you are finding it exhausting from running from sport to sport, think about this is effecting the kids.  

References

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Athletic Therapist as Coach Educator

As much as we all would like to live in a perfect world where every team, school, and club carried or hired an Athletic Therapist, we haven't reached that point and unfortunately never will.  After participating in the #sportssafety chat this past week, it came to my attention that no matter how hard we try to have ATs at all levels of sport it seems that there are obstacles that will never be removed.  So what do we do?  We need to work on educating the coaches on injury prevention, recognition and basic management.

When working with a team or not one of the roles an AT takes on is educating coaches on the above topics.  Injury prevention must be something that all participants buy into.  The coaching staff are the ones that run practices, make tactical plans for competitions and are the overall guardian of what goes on with the athletes. Coaches need to learn about topics such as proper warm up, nutrition, hydration, rest and equipment as they can be a major influence if not the key influence as to athlete safety.

When it comes to injury recognition and management, by no means do I think coaches should know the difference between the laxity of a grade 1 sprain vs a grade 2 nor should they learn how to place players on spine boards.  What coaches do need to know though are basic first aid, CPR and have an understanding of basic injuries.  ATs need to share some of their knowledge with coaches.  Coaches do need to understand the difference between sprains and strains and understand the severity of each.  This knowledge will help them become a better coach, as they will understand why their athletes are out of sport while injured.  Everyone involved in sport should have first aid and CPR, so they can deal with emergent situations and have basic splinting skills.  Where ATs come into the education role is to help coaches take that first aid knowledge and apply it to sport.  

We know that at some point in their coaching career a coach will have to deal with an injured athlete, by educating them as to how to prevent injuries, we can help them decrease the number they will see.  By expanding their skill set when it comes to injury recognition and management, they will feel more comfortable when an injury does occur.  Athletic Therapists have a wide knowledge base, and by no means should coaches be expected to have the same one.  What we as ATs need to do is help the coaches expand their knowledge base, take the fear and uncertainty away when it comes to injuries.  Give coaches the ability to handle an injury until the athlete can receive more advanced care and ensure that the injury is not made worse.  If we as ATs work to empower coaches then coaches will learn that we are an integral part of the sporting community.

Please follow us on Twitter @EliteInjuryMgmt and check out our website at www.eliteinjury.com 

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.  

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. 

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.

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.

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. 

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.

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.