The SeatShield™ – Shields Your Car Seats from Sweating

seat shield

By Barbara Day, M.S., R.D., C.N.

I am a runner and a cyclist. All of our cars have leather seats. After I exercise, I hate to get into the car & stick to the seats! If you have cloth seats, your sweat can end up making the seat smell. Or you can buy a car seat cover that can not only protect your car seat from sweat, dirt and all the odors associated with an active lifestyle but it can be thrown in the washer when it gets dirty and only used when the need arises.  I have an EliteSport™ SeatShield™ and  I keep mine folded in my car when not being used so it’s conveniently available after I’ve been working out in the spring, summer and fall.

The SeatShield™ is a high tech, multi-layered seat cover that can be slipped over your car seat in seconds and can be easily stored when not needed.  Unlike a towel, the SeatShield stays in place.  There are three different types of SeatShields: the AllSport™ UltraSport™ and the Elite Sport™.   All are made out of a tri-laminate material which contains a waterproof/breathable middle layer. The AllSport™ top layer is made of a synthetic non-woven microfiber that becomes soft with use.  The top layer for the UltraSport™ is a velour microfiber that is very soft and durable which allows the SeatShield to fit better on the leather seats. Because the UltraSport has a mesh bottom layer it works well on leather or cloth seats.  The new Elite Sport™ has the same top material as the Ultrasport but the Elite Sport™ has a special undercoating that provides a very grippy surface made especially for leather seats.  In addition, it keeps the leather seats cool in the summertime.  All the  Seat Shields have a top surface that wicks away the moisture from you so it can evaporate quickly.


All Seat Shields are odor-resistance containing a permanent anti-microbial treatment to kill odor causing bacteria. However, if you sweat a lot after your workouts you might want to purchase the UltraSport™ or the EliteSport™ because they remain waterproof not matter how much moisture is expelled from a heavy amount of perspiration.


All SeatShields fits any car with a headrest including SUV’s and trucks with a 60/40 bench.  The AllSport sells for $19.95, the UltraSport sells for $29.95 and the EliteShield™ sells for $39.95 ( or 1-888-643-8976).  The AllSport comes in only light gray  and weighs about 4 ounces.  The UltraSport and EliteSport™ comes in two colors: light gray and beige.  They weigh approximately 12 ounces.


Allsport Seat Shield




Ultra sport


Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.    



Cyclists Should Obey the Rules of the Road


Compiled by Barbara Day, M.S., R.D., C.N.

Be Courteous and that recommendation goes both ways! When I am riding my bike or running, cyclists whiz past me, sometimes I hear them sometimes not but…if they shout On Your Left or On Your Right, it would benefit both them and the other person as well.  Safety should be your first concern.

Here are the Rules of the Road:

  1. Respect right of way of motorists.
  2. Obey traffic signals like from green to yellow light. Stop unless safety is a concern – wet pavement.
  3. Obey stop signs and stop lights. (My personal downfall is when riding in my own neighborhood – but am forcing myself to adhere to law. This makes motorists mad if you don’t obey the rules of the road).
  4. If riding with a group, look behind for another bike or car before changing position in a pace line.
  5. If riding with a group, if you see a pothole, a dog, or some debris on the road, let your fellow cyclists know by pointing.
  6. When over taking another cyclist or passing around a runner or walker, saying On Your Right or Car Up or Car Back to help ensure safety. As a runner, too, I can’t tell you have many times a cyclist has flown past me and one simple step from me could have caused a collision with the cyclist.  When riding on Rails-To-Trails, dogs are also a problem.  They don’t understand command like on your left so I am especially careful around dogs.
  7. In most states, riding two abreast is allowed unless in heavy traffic but sometimes the interpretation is left up to law officer’s discretion. Check your state’s policy.
  8. Cyclists should ride to the right in most cases but on a narrow road you should share the road without being run off the road for safety.
  9. When turning, using effective hand signals in a group will alert other cyclists as to your intention which can help with safety of both you and the other cyclist.
  10. Follow the GOLDEN RULE: ALWAYS KEEP YOUR COOL and remain courteous to other cyclists and motorists.

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers. Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.

Shin Splints: What are they really?


By Stephen Karam PT, DPT,

In the lexicon of medicine, “shin splints” is yet another phrase that has a specific and real definition.  The real name for this condition is called Medial Tibial Stress Syndrome (MTSS).  That sounds much worse and more ominous than “shin splints.”  MTSS generally presents as pain just along or right behind the shin bone (tibia).  It is pain caused by inflammation or disruption of tissue that connects the the muscles of her lower leg to the tibia.  Fortunately, MTSS is very curable and rarely requires a medical procedure other than a visit to your Physician or Physical Therapist to diagnoses it properly.  It is a common injury that is seen frequently in runners and athletes that have to play on hard surfaces or those who have to start/stop frequently.

MTSS can develop into more serious conditions such as a stress reaction/fracture or compartment syndrome.  It is also very important to rule out these 2 conditions before MTSS is ruled in.  Signs of something worse like compartment syndrome may include redness, hotness, significant swelling or feeling of pressure building in your lower leg.  Signs of a stress reaction may include pain at rest, pain for a long period of time and increased pain in a weight bearing or standing position.

Risk Factors of “shin splints” may include:

  • Tight/stiff muscles of the legs and gastrocs
  • Worn down or old running shoes
  • Runners who over pronate or who have flat feet
  • Runners who are beginning a new running program
  • Individuals participating in high impact, high intensity sports/workouts

Tips to manage or prevent shin splints:

  • Wear appropriate shoes or arch support for your foot shape and mechanics
  • Warm up before activity and stretch afterwards
  • Ice or cold treatment to shins when painful
  • Participate in less impact activities like swimming, biking, elliptical
  • Listen to your body when it is in pain

Most health insurance plans now allow patients to seek physical therapy treatment directly without a physician referral.

Image from:

Clinic Director Stephen Karam PT, DPT, earned his doctorate in physical therapy from the University of Kentucky after completing a bachelor’s degree in exercise science. He is a member of the American Physical Therapy Association (APTA). He specializes in manual therapy with a strong emphasis in orthopedics and sports medicine. In his spare time, he enjoys tennis, working out, music and football.


The Use of Prophylactic Bracing In Sports


By Stephen Karam PT, DPT

Unfortunately, knee and ankle injuries have a high incidence rate in both football and basketball.  Physicians, trainers and athletes have tried and are willing to try just about anything to prevent one of these injuries from occurring.

If you have been watching college or professional football over the past 10-15 years, it would be hard not to notice large, bulky knee braces on the entire offensive line.  These large, bulky braces come with a large, bulky price as well and are “supposed” to prevent serious knee injuries from occurring allowing these players to stay on the field.  Some of these injuries include meniscus, MCL, ACL and damage to the articular cartilage of the knee.

So do these expensive, large braces prevent these devastating injuries from occurring? 

In a 2010 issue of the Journal of Sports Health, Salata et al conducted a systematic review of 6 articles that studied the use of knee braces in football and injury prevention.  The systematic review suggests that there may be limited protection of the MCL and that there is no evidence that wearing these prophylactic knee braces prevent injuries to the ACL and meniscus.  One of the articles in this systematic review suggests that wearing these braces may even increase the risk of injury to knees, ankles and feet.  At this time there is not enough significant medical evidence that suggests wearing these knee braces prevents serious injuries from occurring in football. Due to the “ounce of prevention is worth a pound of cure” theory, college and professional budgets allow for any and all measures of prevention to be taken whether or not it has a high value of efficacy.

On a positive note there is significant medical evidence that supports that use of ankle braces in prevention of ankle sprains in basketball.  A 2011 study by the American College of Sports Medicine looked at nearly 1500 male and female basketball players from 46 high schools.  The incidence of ankle injury in the braced group was .47 per 1000 exposures and 1.41 per 1000 exposures in the control group.  Demonstrating a significant difference in those athletes wearing braces and those athletes who were not wearing the provided brace.  The study did note that there was not a significant difference in severity of injuries between the braced and controlled groups.  In contrast to the knee braces these lace up ankle braces are affordable and probably should be considered as a method to prevent ankle injuries.

Please consult your Physical Therapist or Athletic Trainer before purchasing or fitting for one of these prophylactic braces as wearing the wrong size may increase your risk for injury.

Image from:

KORT Chevy Chase Clinic Director Stephen Karam PT, DPT, earned his doctorate in physical therapy from the University of Kentucky after completing a bachelor’s degree in exercise science. He is a member of the American Physical Therapy Association (APTA). He specializes in manual therapy with a strong emphasis in orthopedics and sports medicine. In his spare time, he enjoys tennis, working out, music and football. For more information go to:

Fueling on a Budget for Traveling Sports Teams

sports teams

By Nancy Clark MS RD CSSD

“When we travel as a team, we eat at fast food places because they fit with our small budget.What’s the best fast food for athletes…?”

“After my workout, the last thing I want to do is cook dinner. Where can I buy affordable but healthy sports meals…?”

A limited food budget creates a fueling challenge for many athletes, including college teams traveling to games, students responsible for their own meals, parents of active kids, and semi-pro players hoping to get to the next level. The name of the fueling game is: How can you buy enough healthy calories with the least amount of money? These practical tips can help optimize a low-budget sports diet.

1. Encourage the team bus (or your car) to stop at a large supermarket.

Everyone can find something they like: vegetarians,  gluten-free eaters, picky eaters who want to lose weight, and chowhounds who need lots of calories. By walking around the inside perimeter of the store, you will find the makings for a balanced meal—even hot meals, if desired. Shop for:

Fresh fruit: Banana, apple, pear, grapes. Buy what’s on sale.

Fresh veggies: While you can easily create a colorful salad at the salad bar area, it might be a bit pricey. The simpler option is to simply buy: a green  or red pepper (eat it whole, as you might eat an apple), a bag of baby carrots (along with a container of hummus), or a container of cherry tomatoes. Enjoy the whole thing; a hefty dose of veggies on one day can help compensate for another day when you have none.

(To clean the fresh produce, plan ahead. Pack extra water to rinse the produce before getting on the bus. Or nicely ask  an employee in the store’s produce area if he or she could help you by giving the fresh produce a quick rinse.)

Protein: Buy a quarter-pound of deli turkey, roast beef, or ham along with a few whole wheat rolls to make sandwiches. Small or large tubs of cottage cheese, tuna packets, and peanut butter are other popular protein options. Share a rotisserie chicken with friends (or save the leftovers if you can refrigerate them within an hour.)

Grains and other carbs: Pita, wraps, baked chips, whole-grain crackers and  pretzels are carb-based options that refuel your muscles. Look for freshly baked whole-wheat rolls, hearty breads, and whole-grain bagels. You might be able to find a plastic knife at the salad bar so you can slice the rolls to make a nice sandwich with deli meat and lowfat cheese. Pop a few cherry tomatoes between bites, and you’ll have a balanced meal with all 4 foods groups: 1) lean meats/beans/nuts, 2) lowfat dairy or calcium-alternative, 3) fruit/vegetable, 4) grain.

Calcium-rich foods: You can easily buy a small or large tub of lowfat yogurt, a single milk chug—or even a whole a quart of chocolate milk if you are really hungry. For athletes who are dairy-free, soymilk is a fine alternative. Pick up some pre-sliced lowfat cheese in the dairy or deli area. (Note: Hard cheese, such as cheddar, is lactose-free and comes in convenient single portions.) Add an apple and whole grain crackers—voila, a balanced sports meal! While it may not be the hot meal your mom had in mind, it will do the job of contributing needed nutrients to refuel from the day’s event, fuel-up for tomorrow, and invest in future good health.

Beverages: You can save a lot of money (plus save space in landfills) by packing your own gallon jug of water. To spend money on plain water (void of calories, carbs, and vitamins) seems wasteful when tap water is free. Instead buy 100% juice (orange, grape, carrot, V-8) to boost your fruit/veggie intake and simultaneously boost your immune system with anti-inflammatory phytochemicals. Plus, 100% juice is a strong source of carbohydrate to refuel depleted muscles, as well as fluid to replace sweat losses. Chocolate milk is another winning beverage, with protein to build and repair exhausted muscles, as well as carbs to refuel them.

If the team bus (or your car) is pulling into a fast food restaurant, at least choose one that will support the nutritional needs of athletes. Here are a few suggestions:

• At Taco Bell, you can get the most amount of healthy calories for a bargain price when you order their bean burrito. Two bean burritos cost only $2.20 and provide 750 (mostly quality) calories.

• At a burger place, choose a grilled chicken sandwich (no fries). It will be more expensive and offer fewer calories than a burger, so plan to supplement the sandwich with some Fig Newtons, pretzels or raisins that you pre-packed from home.

•At a pizza place, order the cheese pizza, preferably with veggie toppings like mushroom, pepper, and/or onion. Nix the pepperoni, sausage and other greasy meat options, as well as the double cheese. You’d end up fat-loading with that type of pizza. It would fill your stomach but leave your muscles poorly fueled. Remember: muscles need carbs (such as thick pizza crust) to replenish glycogen stores.

• Be cautious of super salads. While they have a seemingly healthy glow, they can be unfriendly for many sports diets, particularly if you are weight-conscious.Making a substantial salad with not only colorful veggies but also grated cheese, chopped egg, diced chicken, slivered almonds, pumpkin seeds, and olives offers you a hefty dose of calories, but not enough grains/carbs to refuel your muscles. Adding even a little bit of dressing to a big salad often adds  400 or more calories. A sandwich can have fewer calories….

• Hungry athletes who need lots of inexpensive calories can do well by packing sandwiches made with peanut butter & jelly (or PB & jam, honey, raisins, banana, pickles or even cottage cheese—whatever tastes good to you). Peanut butter is versatile and a great sports food because it offers protein, B-vitamins, and good fats that knock down inflammation. It’s inexpensive, travels well without refrigeration, is good for you, and tastes great! It’s even good for dieters because it keeps you feeling fed, and curbs the urge to eat cookies. For the $2 needed to slap together a hefty 600-calorie PB&J (made with 2 slices Pepperidge Farm Bread, 3 Tbsp. Teddie all-natural peanut butter, and 2 Tbsp. Welch’s grape jelly), you couldn’t even buy a Muscle Milk ($3.69 for 230 calories). Shop wisely and fuel well!

Image from:

Boston-area sports nutritionist Nancy Clark MS RD counsels both casual and competitive athletes at her private practice in Newton (617-795-1875). Her Sports Nutrition Guidebook and her food guides for runners, cyclists and soccer players are available at For online education, visit and

Sports Nutrition: What’s Old? What’s New?

running in the snow

By Nancy Clark MS RD CSSD

Once upon a time, warriors (the original athletes) ate lions’ hearts. Today, athletes seek out energy drinks and protein shakes. Clearly, times have changed! In case you are wondering what else is old—and new—when it comes to sports nutrition, I’ve compiled this update to resolve confusion and help you fuel for success.

OLD: The lighter you are, the better you will perform.

NEW: The athlete who is genetically lean and eats enough to have well-fueled muscles has an advantage over the athlete who is genetically heavier and has to skimp on food to maintain an unnaturally low weight. Research indicates elite female swimmers who restricted calories in the pursuit of thinness lost speed (but not body fat) during a 12-week training cycle, while those who ate adequately swam faster. (1) Thin at any cost often comes with a high price tag.

OLD: Female athletes who train hard and have too little body fat will stop having regular menstrual periods.

NEW: Lack of fuel, not lack of body fat, tends to determine if a female athlete’s body will menstruate normally. That is, many very lean female athletes do have regular menses. Although they may have very low body fat, they eat enough to support both their exercise and normal body functions.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 OLD: Eat fat, get fat.

NEW: Yes, excess calories of dietary fat can easily convert into body fat. But healthful fats (i.e., nuts, olive oil, avocado, salmon) are an important part of a sports diet; they help reduce inflammation. Athletes also need dietary fat to absorb important vitamins such as A, D, E, and K. Fat also fuels the muscles; small amounts of fat get stored within the muscles and can enhance stamina and endurance. Research suggests runners had more endurance when they switched from a very low fat to a moderate fat diet. (2)

OLD: If you want to lose weight, you need to go on a diet.

NEW: Diets do not work. If diets did work, then everyone who has ever been on a diet would be lean. Not the case. Rather than going on a diet, try to make just a few basic changes, such as 1) choose fewer processed snacks in wrappers and instead enjoy more fruit (fresh or dried) and nuts, and 2) get more sleep. Lack of sleep can contribute to not only weight gain but also reduced performance.

OLD: The recommended dietary allowance for protein (RDA) is the same for athletes as for non-athletes.

NEW: The RDA for protein (0.8 grams per kilogram body weight.) is less than the 1.2 to 1.7 g pro/kg currently recommended for athletes. Most athletes eat that much (plus more) as a part of their standard meals, so you are unlikely to need protein supplements. You do want to distribute your protein intake evenly throughout the day, and not pile it all into dinner, so your muscles have a consistent supply of amino acids (the building blocks of protein).

OLD: Slabs of roast beef help build bigger muscles.

NEW: Because the body can utilize only about 20 to 25 grams of protein at one dose, you won’t build bigger muscles by eating jumbo portions of beef in one sitting (4). Your better bet it to cut that one-pound slab of beef into four pieces. Enjoy those deck-of-cards-sized pieces at least every four hours, so you get 20 to 25 grams of protein at each meal and afternoon or evening snack. Weight lifting—not eating excessive protein—triggers muscles to grow bigger. To have the energy needed to lift heavy weight, you want to eat meals based on grains, fruits and veggies (with protein as the accompaniment). Those carbs provide the fuel needed to lift heavy weights.

OLD: Don’t drink coffee before exercise; it is dehydrating.

NEW: Pre-exercise coffee is not dehydrating and it can actually enhance performance (5). Caffeine boosts alertness and reaction time, as well as makes the effort seem easier so you work harder without feeling the extra effort. If you are sensitive to caffeine (a mugful gives you a “coffee stomach” and the jitters), you’ll be better of abstaining. But athletes who enjoy drinking coffee will likely notice positive benefits.

OLD: Energy drinks contain magical ingredients, such as taurine.

NEW: The magical ingredients in energy drinks are caffeine and sugar. Although taurine has been reported to enhance performance, the limited research was done on rats. Newer research suggests taurine offers no ergogenic benefits (6). To save your money, simply add a heaping tablespoon of sugar to your coffee. You’ll get the same boost. Better yet, eat wisely and sleep more; you won’t need an energy drink.

OLD: Don’t eat before or during exercise. The food just sits in the stomach and does not get digested.

NEW: You can digest food during exercise as long as you are working at a pace you can maintain for more than 30 minutes. Fitness exercisers can benefit from a small pre-exercise snack as tolerated (such as a banana, granola bar, or packet of oatmeal) to get their blood sugar on the upswing. Endurance athletes who exercise for more than 90 minutes will benefit from both pre-exercise fuel and then carbs during the extended workout. The target is ~250-350 calories of carbohydrates per hour. That’s more than just a swig of sports drink! Be sure to practice fueling prior to and during exercise, so you can learn what works and what doesn’t.

OLD: Refuel as soon as possible after you workout.

NEW: If you do exhausting workouts twice a day, you’ll benefit from eating soon after the first bout of exercise to fuel-up for the next bout. But if you are a fitness exerciser, simply back your workout into the next meal. You’ll have plenty of time to recover before your workout the next day.

OLD: Orange slices are perfect for half-time of a youth sporting event.

NEW: While chomps, gels, and sports drinks may seem better than cut-up oranges and water for half-time fueling at youth sports events, kids actually should be taught that natural foods work well. Orange slices, pretzels, and water provide more nutrients and electrolytes (a.k.a sodium and potassium) than sports drinks. Even adult athletes can do well with real foods. While elite athletes might prefer engineered products during intense exercise, most of us can perform just fine with real food. Go back to enjoying more orange slices, please. Sometimes the old ways can be preferable to the new!



Selected References:

1. Vanheest J, C Rodgers, C Mahoney, MJ DeSousa. Ovarian suppression impairs sport performance in junior elite female swimmers. Med Sci Sports Exerc 46(1):156-66, 2014.


2.  Horvath, P, C Eagen, N Fisher, J Leddy, and D Pendergast. 2000. The effects of varying dietary fat on performance and metabolism in trained male and female runners. J Am Coll Nutr 19(1):52-60.


3.  Mah CD, Mah KE, Kezirian EJ, Dement WC. 2011. The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep. 34(7):943-50


4. Phillips, S. van Loon, L. 2011. Dietary protein for athletes: From requirements to optimum adaptation.  J Sports Sci 29(S1):S29-S38.


5. Armstrong, L, A. Pumerantz, M. Roti, et al. 2005. Fluid, electrolyte, and renal indices of hydration during 11 days of controlled caffeine consumption. Int J Sport Nutr Exerc Metab 15:252-265.


6. McLellan TM, Lieberman HR. 2012. Do energy drinks contain active components other than caffeine? Nutr Rev. 70(12):730-44.


Image from:

  Boston-area sports nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes. Her private practice is in Newton, MA; 617-795-1875. For information about her new Sports Nutrition Guidebook, 5th Edition, and her food guides for runners, cyclists and soccer players, see For online education, visit


Caffeine: Performance Enhancement in a Mug


By Nancy Clark MS RD CSSD


Whether you are looking for a hit, boost, pleasing stimulant, or excuse to socialize with your friends, coffee is the go-to beverage for many athletes. Coffee-drinkers enjoy the way a cup of morning brew enhances their feelings of well-being and their ability to accomplish daily tasks. An estimated 80% of us drink coffee daily. Why, we are more likely to drink coffee than eat fruit! Thank goodness moderate coffee intake is typically not associated with health risks.

For athletes, caffeine is a proven performance enhancer. In their new book Caffeine for Sports Performance, sports dietitians Louise Burke and Ben Desbrow and exercise physiologist Lawrence Spriet address all-things-caffeine that an athlete might want to know. Here are just a few tidbits that I gleaned from this comprehensive resource. Perhaps the information will help you add a little bit of zip to your workouts.

Note: No amount of caffeine will compensate for a lousy diet. If you choose to use caffeinated products to enhance your sports performance, make sure you are also fueling wisely!


• A cup of pre-exercise coffee can help most athletes work harder—without realizing it. Caffeine has been shown to enhance performance by about 1% to 3%, particularly in endurance sports. For example, cyclists who consumed caffeine prior to a 24-mile (40-km) time-trial generated 3.5% more power than when they did the ride without caffeine.


• Athletes vary in their responsiveness to caffeine, from highly effective to negative. Some of the side effects associated with too much caffeine include higher heart rate, anxiety, “coffee stomach”, irritability, and insomnia.


• The recommended performance-enhancing dose of caffeine is about 1.5 mg/lb (3 mg/kg) body weight. This can be consumed 1 hour before the event, and/or during the event (such as a caffeinated gel or defizzed cola every hour). For example, triathletes commonly consume caffeinated gels before each segment, to distribute the caffeine throughout the event rather than have a big pre-race jolt that might make them feel shaky and unable to concentrate. Some athletes delay caffeine intake until fatigue starts to appear, and then they ingest 0.5-1 mg/lb (1-2 mg/kg) body weight.


• Caffeine’s ergogenic effect maxes out at about 200 to 250 mg caffeine. (This is much less than previously recommended.) More is not better.  Experiment during training to learn what amount (if any) works best for your body!


• Because the amount of caffeine in coffee and tea varies, elite athletes commonly use caffeine pills or commercial products to ensure the desired intake.  A comparison of the caffeine content in 16 ounces of coffee from 20 coffee venders ranged from about 60 to 260 mg. Even when the researchers purchased the same brand of coffee (Starbucks Breakfast Blend) on six consecutive days, the caffeine content ranged from about 260 to 565 milligrams per 16 ounces.


• Research suggests the caffeine content of espresso also varies. A customer might get served 0.5 to 3.0 ounces of espresso (depending on the barista’s generosity) with a caffeine range of 25 to 214 mg. In general, the larger venders (such as Starbucks) offer a more consistent product. But this means you don’t know what you will be getting if you plan to purchase a pre-exercise espresso or coffee.


• Energy drinks are a popular source of caffeine. A study of 500 college students in North Carolina reports 51% drank at least one energy drink in an average month in the semester. Sixty-seven percent used the energy drink to stay awake; 65%, to increase energy; and 54%, to drink with alcohol while partying. Of the party-drinkers, 49% consumed 3 or more energy drinks. That makes for a wide-awake drunk who may believe it’s OK to drive a car…


• Caffeinated chewing gum is popular among (sleep deprived) soldiers. The gum effectively boosts physical and mental performance and helps maintain reaction time, vigilance, and ability to think clearly. The caffeine in chewing gum gets delivered quicker than via a pill (achieving significant levels in the blood in 5 vs. 30 minutes) because it gets absorbed though the cheeks, not the gut.


• Caffeinated colas offer not only caffeine but also a hefty dose of sugar. Colas, taken later in an event, can provide a much-needed source of fuel so the combination of caffeine + sugar can provide a nice boost! Hence, some athletes claim defizzed Coca-Cola is their preferred sports drink despite having only 35 mg caffeine per 12-ounce can.


• Caffeine is only a weak diuretic and is no longer considered to be dehydrating. A novice coffee drinker can become tolerant to the diuretic effects of caffeine in 4 to 5 days of regular caffeine intake. Even high doses (3 mg/lb; 6 mg/kg) have no significant effect on urine production in coffee or tea drinkers. Hence, there appears to be no hydration-related reason for athletes to avoid caffeinated beverages.


• Caution: Consuming caffeine might contribute to negative effects. For example, let’s say you are running, rowing, or swimming in more than one competitive event in a day. If caffeine helps you go harder in the first event, will that “fry” you for the second event? Can taking another dose of caffeine counter that fatigue? With a weekend tournament, will too much caffeine on the first day ruin your sleep, so you are unable to perform as well on the second day? More research is needed to answer those questions but for the moment, these situations provide good examples of why advice to use the smallest effective dose of caffeine is sensible.


• In 1984, caffeine was banned by the International Olympic Committee (IOC) and the World Anti-Doping Agency (WADA). But in 2004, WADA reversed the ruling. New research indicated the amount of caffeine needed to reach the threshold dose was detrimental to performance. Although caffeine is no longer banned by WADA, it is on the banned list for NCAA, the governing body of collegiate sports. Collegiate athletes can be cited for doping if their caffeine level is higher than 15 micrograms/ml urine. (A normal urine caffeine level is between 1-2 micrograms). Unlikely but possible.


• Youth athletes should be fully mature and eating an optimal sports diet before even considering the use of caffeine. Again, no amount of caffeine will compensate for lousy fueling practices.


• For even more helpful tips and tid-bits, get a copy of Caffeine for Sports Performance. You’ll actually stay awake while reading it; this book is not a snoozer!


Boston-area sports nutritionist Nancy Clark, MS, RD counsels both casual and competitive athletes. Her private practice is in Newton, MA 617-795-1875). For information about her Sports Nutrition Guidebook and her food guide for marathoners, cyclists, and soccer players, see For online education, see





Common Sources of Caffeine


For a 150-pound (68 kg) athlete, the recommended dose of caffeine is about 200 mg one hour before exercise. That’s the amount in a large mug (16 oz) of coffee. No problem for most coffee-drinkers!


Brewed coffee 250 ml (about 8 oz; small) 80 (ranges 40-110)
Starbucks Breakfast Blend 600 ml (20 oz; venti) 415 (range 256-564)
Tea, black 250 ml (about 8 oz; small) 25 -110
Tea, green 250 ml (about 8 oz; small) 30-50
Coca-Cola 1 can (12 oz / 335 ml) 34
Red Bull 1 can (8 oz / 250 ml) 80
PowerBar caffeinated gels 1 pouch (1.25 oz / 40 g) 25 – 50
GU caffeinated gel 1 pouch (1 ox / 32 g) 20-40
Jolt Caffeine Energy Gum 1 piece 33
NoDoz 1 tablet 200 (USA), 100 (Australia)



Regional Interdependence: Treat the knee without treating the knee.


By Josh Bixler PT, DPT

           Picture this: You’re an avid runner and you’ve recently ramped up your training for the upcoming mini-marathon.  In doing so, you’ve developed some nagging pain in your right knee.  Being the pro-active person you are, and aspiring to do well in the race, you decide to seek the care of a physical therapist.


During the evaluation, the physical therapist takes a thorough history from you, examines your right knee, but also assesses the rest of your body.  They end up treating your left foot and providing home exercises for your hips and trunk.  Curious as to why this was the choice of treatment, since the right knee is clearly the source of pain, not the hips or the foot, you ask the therapist for clarification.  The therapist responds “regional interdependence.”  They explain that your left foot lacks the mobility (motion) you need, your hips and trunk are weak, and it appears these deficits caught up with you during your training.


In this instance the right knee was the victim, and the foot and hips were the problem.  The therapist went on to explain the importance of looking at the body as a whole, and not chasing symptoms.  With this treatment approach, they feel confident you’ll be back to pain-free running in no time.


The aforementioned case is one example of the musculoskeletal examination model termed “regional interdependence.”  Regional interdependence is the concept that potentially unrelated impairments above and/or below the patient’s area of complaint; this is necessary to determine if those areas are contributors or not.  Intervention is then applied to those areas deemed as impaired with the expectation of producing a result at the source of complaint.  The interventions could be anything from hands on techniques to exercise.  The result could be improved range of motion, decrease pain, or improved strength just to name a few.  Now this is not to say the area of symptoms is not impaired, it very well may be, however there are often additional areas involved that may have contributed to the problem and deserve attention.


The regional interdependence model came about due to the need for a better approach to explaining and treating musculoskeletal and treating musculoskeletal disorders.  As the field of rehabilitation has progressed, so too has our knowledge of how the body works and the limitations of the old approaches to treatment.  It is important to note that regional interdependence applies to addressing impairments above and below one’s source of symptoms, and not that of referred pain, or pain being felt in a different area from the actual source.


Given this information, you might be saying to yourself, “This concept sounds great in theory, but is there evidence to support it?”  Absolutely!  The current literature has many articles referencing regional interdependence either directly or indirectly.  The literature contains thoracic spine (mid-back) interventions for the cervical spine interventions for the shoulder; cervical spine interventions for the elbow; hip interventions for lumbar spine (low back); hip, ankle, and foot interventions for the knee.


Clinically speaking, assessments of an athletic population may involve impairments even further up or down the body.  When assessing a baseball pitcher with elbow or shoulder pain, one must not only look at those areas, but also consider the neck, shoulder blade, thoracic spine, lumbar spine, hips, legs, knees, and feet.  This approach is similar for runners, where abnormal breathing patterns could also potentially contribute to impairments.


With the acceptance and growth of the regional interdependence examination model, assessments have been developed to further assist healthcare professionals.  One of those assessments is the Selective Functional Movement Assessment, or SFMA.  The SFMA is a tool that allows clinicians to assess patient movement patterns starting at the neck and working down to a body-weighted squat. From there, movements identified as “dysfunctional” can be further broken down into mobility versus stability problems.  This approach, along with best current evidence and clinician expertise, can help guide the clinician with decision making.


In a time with rising healthcare costs and with money tight, patients have come to want and expect care that produces meaningful outcomes.  In the case of the runner, the right knee was the victim and a thorough assessment using the regional interdependence examination model helped to “treat the knee without treating the knee.”


DO you have pain or just a want to take a pro-active approach like this runner?  Consult your physician, the professionals at KORT, or visit www.kort.come to learn more.


KORT Old Brownsboro Crossing Clinic Physical Therapist Josh Bixler
 PT, DPT, graduated with his Doctorate of Physical Therapy from Bellarmine University, and also has a BS in Exercise Science from the University of Indianapolis. He is currently finishing up an orthopedic residency and is trained in using both the Selective Functional Movement Assesment and Functional Movement Screen. Josh is a University of Michigan sports fanatic (Go Blue!) and also enjoys rooting for the Colts, White Sox, and Red Wings. His personal interests include anything relating to physical therapy, injury prevention, fitness, nutrition. For more information go to

What is Trigger Point Dry Needling and Can It Help Me?

By Janelle Ciolek, PT, DPT, OCS

Trigger Point Dry Needling (TDN) is a treatment technique utilized by specially trained Physical Therapists to help treat neurogenic and musculoskeletal pain of either chronic or acute nature.  Many people with pain conditions are found to have active Trigger Points (TPs) in muscles, which exacerbate their pain.  Trigger points are taut, banded, irritable spots within skeletal muscle that cause pain, especially when they are compressed.  In scientific studies, trigger points have been found to demonstrate irregular electrical activity and shortened muscle structure, along with having pain causing chemicals within the muscle tissue.  These trigger points will often cause pain referral to other adjacent areas.  For example, a trigger point on the back of the shoulder blade, when compressed, may reproduce pain in the front of the shoulder or down the arm.

During treatment with dry needling, the physical therapist inserts a flexible, thin filament needle directly into the painful trigger point. The patient can feel a variety of sensations, most notably a deep aching or cramping sensation, and often will experience a localized muscle “twitch” sensation.  These sensory experiences help guide the treatment and let the therapist know they are treating a problematic area.  Dry needling, through scientific research, has been shown to promote healing in the affected painful areas.  It does this by releasing muscle tension, quieting electrical activity in the trigger points, and decreasing the chemical factors in the trigger points that cause pain.

Trigger point dry needling, in the hands of the trained and capable physical therapist, can be used to treat almost any musculoskeletal condition, including back pain, whiplash, frozen shoulder, elbow tendonitis, and plantar fasciitis, amongst many others.  It can even be used post-surgically to treat hypertrophic or adhered scar tissue.  Dry needling is used as valuable part of the whole physical therapy “package” which can include therapeutic exercises, joint mobilization or manipulation, patient education, and modalities.  Every patient has a unique program developed specifically for them, based on their symptoms and needs.

The American Physical Therapy Association as well as the Kentucky Physical Therapy Association support the use of trigger point dry needling in the hands of trained and licensed physical therapist.  For more information, please visit

Image from:

Janelle Ciolek PT, DPT, OCS, is the Clinic Director and has been part of our KORT team since 2005. Janelle is a 2004 graduate of the Doctor of Physical Therapy program at Bellarmine University, a Board-Certified Orthopedic Specialist (OCS), a certified  IASTM therapist, practitioner of Functional Dry Needling (FDN) and is a Clinical Instructor for the American Physical Therapy Association (APTA). Janelle also serves as adjunct faculty in the Bellarmine University Physical Therapy Department. Janelle loves the fast-pace and challenges of outpatient orthopedic physical therapy and has substantial experience in this area. Her clinical interests include manual therapy, sports injuries, and knee and shoulder reconstruction.


How Many Calories Do You Need Each Day?

By Barbara Day, M.S., R.D., C.N.

There’s an App for this!

Knowing how many calories you need each day will help keep you energized while you are training for your event and doing all the things you need to do each day: work, manage a family, take care our your home or lose weight.  There are some FREE apps that you can use to help to determine how many calories you need each day.

A FREE app, My Fitness Pal, for your smart phone or online at can help to determine how many calories you need each day: and how many calories you burn when playing soccer or lifting weights: Add the calories plus the calories you burned practicing to get how many calories you need on most days.

Once you determine how many calories you need each day, the timing of your food intake is also important. Eating 5 – 6 times per day will help give you bullets of energy but keeping the calories in line with your overall calorie needs will maximize your performance. Never skip breakfast.

Other excellent apps and websites to determine calories are: LOSE IT! (, SPARK PEOPLE (

The Old Fashion Way to Determine Your Calories

To determine how many calories you need each day, you can calculate the calories the OLD FASHION WAY by using the HARRIS BENEDICT EQUATION to determine your resting metabolic rate (RMR) then choosing an activity factor to estimate the total calories per day.

Harris Benedict Equation


RMR = 88.362 + [1.889 X HT (in)] + [6.089 X WT (lbs)] – (5.677 X Age)


RMR = 447.593 + [(1.219 X HT (in)] + [(4.20 X WT (lbs)] – (4.7 X Age)

HT = height in inches   WT = weight in pounds   age = age in years

Activity Levels

Very Light-seating and standing activities, driving, no regular exercise.

Light – child care, walking on a level surface 2.5 – 3 miles per hour, some regular exercise.

Moderate – walking/running 3.5 to 4 mph, cycling, regular exercise 3 to 4 times/week -30 to 40 minutes duration.

Heavy – walking uphill with a load, basketball, soccer, regular exercise 4 times/week 40 minutes or more in duration.

Very Heavy – distance running, hiking with backpack up and down hills, regular exercise 5 times/week for at least 1 hour in duration.

TABLE 1.  Activity Factors. Choose your activity level from the table below. Then do the math.



Little to no exercise

RMR X 1.2

Light (1 – 3 days per week)

RMR X 1.375

Moderate exercise (3 -5 days/week)

RMR X 1.55

Heavy exercise (6-7 days/week)

RMR X 1.725

Very heavy (twice/day heavy workouts)

RMR X 1.9

Example, 1300 X 1.55 (moderate) = 2015 calories/day

You can also determine how many calories you burned by wearing a heart rate monitor that determines calories burned during exercise. (Not all heart rate monitors calculate calories). Then you can add those calories to your resting metabolic rate calories to get an estimate of active calories burned while exercising.  Example, 1300 X 500 calories = 1800 calories.  So, you could safely eat at least 1800 calories without gaining weight.

Again, it’s just an estimate. Weigh only once a week about the same time.  I suggest weigh after the first void in the morning before drinking anything with as few clothes as possible.

 Using Oxygen Consumption to Calculate your Personal RMR

The BodyGem Resting Metabolic Rate device is the handheld, portable and an effective tool that gives you an accurate RMR measurement result in 10 minutes or less. To perform a measurement, you simply breathe into the indirect calorimeter, which measures their oxygen consumption (VO2), the resulting RMR number is clearly displayed on the device’s LCD screen. It has been validated against the gold standard Douglas Bag, and other commonly used metabolic carts. The test costs anywhere from $75 to $150 per test. For the best results, you should take the test when you are fasted. But you still need to estimate the active calories you burn.

Body Media FIT™ On-Body Wellness Core Armband Monitor

The BodyMedia FIT CORE which is promoted by Biggest Loser is another way to determine how many calories you burn each day. The CORE’s biggest plus is that it track calories burned for 24/7. It cost about $119.  Unlike other fitness trackers, which estimate calories burned using an algorithm of steps and weight, the CORE uses special sensors to track not just your activity but also your body’s reaction to that activity. This makes it much more accurate as a calorie tracker, so you can realistically see how many calories you’re burning. But you have to buy subscription-based Activity Tracker in order to find out how many calories you have burned in the 24 hours.  The CORE Armband does not display any information on the device itself.  That will cost you  $6.95/month or you can opt to purchase a $69 optional display, which syncs with the CORE and lets you see a quick view of progress toward your daily goals. If you want to track your progress, you’ll still need to purchase the Activity Tracker.

What’s the Take Home Message?

I think it’s helpful to know how many calories you need each day so you can manage your health. In today’s world, lifestyle is the major contributor to increasing your risk of many diseases like heart disease, stroke, diabetes, and cancer.  Lifestyle includes your diet and also your daily activity.

Image from:

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition,, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, Barbara writes nutrition and health columns for as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.