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.

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.

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. 

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.  

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.

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

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.