Do Compression Stockings Prevent Athletic Injuries and Increase Performance?

By Stephen Karam PT, DPT

This is a great question and makes for great conversation with Physicians, Physical Therapists, Athletic Trainers and Personal Trainers. The answer is…”maybe and probably not”.

 Let’s first establish some necessary uses of compression stockings.  The post-surgical patient may be required and need a compression stocking or TED Hose Brand stocking to serve as a fluid pump for blood and lymph in prevention of a deep vein thrombosis (DVT) which could be life threatening.  Another necessary use is for the individual with a significant lymphatic drainage pathology.  They need the compression to help pump the lymph/edema back to the heart and into the circulatory system from the limbs.

Compression stocking manufacturers for athletes have a litany of claims:

  • Enhanced blood circulation to limbs
  • Reducing blood lactate concentration
  • Increased vertical jump (what!?!)
  • Reducing the effects of delayed onset muscle soreness (DOMS)
  • Enhancing warm-up through increased skin temperature
  • Prevention of both acute and chronic injuries

What we know is that there is numerous research examining the physiological effects of compression stockings with athletes and performance.  There are a few studies that consistently demonstrate that compression stockings help to reduce blood lactate concentration during tests on both treadmill and bicycle ergometers.  This would potentially result in improved performance with short-medium distance high intensity sprints and bike rides by allowing the athlete to perform at a higher intensity slightly longer.  There is also research that states there may be improved vertical jump height and improved repetitive jump performance by reducing muscle oscillation at landing impact.   This research regarding the improvements in vertical jump needs to be approached with caution as most of the studies have a limited number of participants.

Most of the research strongly suggests that the results they found need to be studied further which is a very fair statement.  They also suggest that there may be no performance improvement in elite or well trained athletes.  It appears wearing compression stockings in colder environments may help keep your skin temperature increased, which may improve some of your joint awareness, but does not provide joint stability.

There does not appear to be any negative performance attributes to wearing compression stockings other than maybe a hit to your wallet, but for me personally it is still a hard sell.

Image from: mypypeline-triathlon.blogspot.com/2009/06/low-down-of-compression-socks.html

KORT Physical Therapy 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. www.kort.com

 

 

 

 

ACL Injury in Children, Adolescents or the Skeletally Immature: Diagnosis and Treatment

 

By Stacie L. Grossfeld, M.D.

The ACL injury is difficult to manage in children, adolescents and the skeletally immature.  An excellent review article was published in the Journal of the American Academy of Orthopaedic Surgeons,  in February, 2013.  Drs. Frank and Gambacorta were the authors.
Listed below are key facts regarding the incidence, diagnosis and treatment of the ACL injury in the pediatric athlete:

– In the past 20 years sports injuries in the pediatric and adolescent population has significantly increased
–  Approximately 38 million young athletes compete per year in the US.
– 2 million a year are injured to the point that they require medical attention. A large percentage of those injured are under age 14.
– Increased injuries are thought to come from increased emphasis on year round sport competition , single sport focus and more intense training.
– The incidence pediatric / adolescent mid substance ACL tears has significantly increased as the amount of sports participation has increased.
– The highest rate of the ACL injury in high school athletes is first in female soccer players and second in male football players.
– Management of the ACL injury in the skeletally immature athlete is challenging because of their open growth plates in both the tibia and the femur. A standard ACL reconstruction would pass right through the growth plate and could potentially cause damage to the growth plate. It  damage occurs it could cause premature closure or partial  closure of the growth plate. If that occurs the leg could grow crooked or become malaligned or shortened.
– Presenting signs and symptoms are similar to the adult ACL injury. Swelling typically occurs within 12 hours of the jury, there is usually a pop heard or felt at the time of the injury, and the athlete is unable to finishing playing the game.
– 70% of the injuries occur as non contact injuries.
– MRI imaging as a 95% sensitivity for detecting ACL tears in the pediatric patient.
– The doctor must determine the pediatric patient’s skeletally maturity.

This is key to decide what type of ACL surgical reconstruction can be performed. The there are several different ways this can be determined. The use of the Tanner Stages of Maturity which unitizes the athletes physiologic maturity. The other common way to determine skeletally maturity is the use the Greulich and Pyle atlas. This requires an x-ray of the hand of the patient be obtained and then it gets compared to other x-rays in the atlas to determine their bone age.

Historically non surgical treatment options for the skeletally immature patients has consisted of activity modification, functional bracing and physical therapy . Unfortunately this does not work well in most athletes. There is a high noncompliance rate in this group of patients. They want to return to sports and do even if told not to return.  They end up sustaining secondary injuries secondary to their unstable knee that is irreparable: meniscal tears and articular cartilage damage.

The only group that surgery is not recommended is the patients that have only a partial ACL tear, are highly compliant, low demand person with no additional intra-articular pathology such as meniscal tears.
Surgery is recommended for all complete ACL tears or partial tears in activity patients with other intra-articular pathology . Surgical technique will be based on the age of the pediatric athlete. The younger the patient with an ACL tear the less invasive the procedure needs to be to the growth plate. The surgical procedures are divided up into physeal sparing  with extra articular and intra articular construction, transphysesl reconstruction with small graft and metaphysical fixation  or an adult type reconstruction with autograft. Post operative rehab will be based on the type of construction that is performed.

Image from:  www.chsolutions.typepad.com/elevatingathletes/acl_injury/

Stacie L. Grossfeld, M.D., is an orthopedic surgery with Orthopaedic Specialists. She is Board certified in Orthopaedic Surgery and Sports Medicine. For more information you can call Dr. Grossfeld at 502-212-BONE (2663) or www. louisvillebones.com.

 

 

Can Balance Affect Your Back Pain?

By Chris Kaczmarek, PT, DPT, OCS, CSCS

 Do you or someone you know deal with chronic low back pain?   You are not alone.  In theUnited States, next to the common cold, back pain is the second leading cause for seeking medical attention.  It can be caused by numerous structures in our body and the symptoms can be very devastating.

Treatment strategies over the years have focused on restoring flexibility, improving overall core strength and stability, improving spinal mobility and helping to properly perform correct sitting postures and lifting mechanics.  Could there be something else to help those who have not responded well to these treatments?

In a recent article published in the Journal of Orthopaedic & Sports Physical Therapy1, a missing component to the overall spectrum of treatment for those with chronic low back pain may have been uncovered.   One of the hypothesized reasons for back pain could be improper sequencing of muscle activity.  Essentially some muscles fire and work when they are supposed to but others do not.  A person can have great physical strength, but if the timing is off the forces that go through our back with activity do not get transferred correctly and can lead to pain.

What these researchers looked at was constructing a treatment program that included core trunk balance stability training.  Balance training causes all the muscles to work simultaneous to achieve a specific movement, stability or activity.  They took two groups of individuals all with low back symptoms greater than 3 months duration and put both groups through the same treatment consisting of treadmill walking and general flexibility training exercises.  The control group performed in addition to that 15 minutes of general strengthening exercises while the experimental group did 15 minutes of trunk balance exercises.

Their findings demonstrated significant improvements in the group that performed the core balance training program.  The improvements were a reduction in  level of disability (meaning they feel they have less impairment and activity limitation due to their back pain),  increased self reported overall physical quality of life, and had reduction in pain with certain positions.   These findings show some positive support that individuals with chronic low back pain can still improve their overall quality of life and function better with daily activities as a result of improving trunk balance.

Not all treatment programs are effective for everyone.  It is critical to get examined by a trained therapist to see which program is right for you.  Contact your KORT Physical Therapist to determine if you could benefit from this treatment intervention.

1Gatti R, Faccendini S, et al.  Efficacy of trunk balance exercises for individuals with chronic low back pain: A randomized clinical trial.  J Ortho Sports Phys Ther. 2011;41:542-552

 

Chris Kaczmarek PT, DPT, OCS, CSCS and KORT Physical Therapy Regional Director earned his Doctor of Physical Therapy degree fromRegisUniversityin 2008 and a Master’s in Physical Therapy degree fromThomasJeffersonUniversityinPhiladelphia,PAin 1999. In practice since 1999, he is experienced in treating all areas of orthopedics and is a Board Certified Specialist in Orthopaedics (OCS). In 2008, he became the Regional Director for theLexingtonmarket. Chris has been the Regional Director for theLexingtonmarket since 2008. Chris currently serves as a Member of Kentucky Physical Therapy Association Public Policy and Research Committee.  www.kort.com

Morton’s Neuroma (No, it’s not cancer!)

Dr.  Chad Garvey, PT, DPT, OCS, FAAOMPT

It has been said that “When your feet hurt, you hurt all over.”  Despite these true to life words, foot pain is a very common problem.  Intertarsal neuralgia, more commonly known as Morton’s neuroma, is one of these problems that is often described as:

          “I feel like I am walking on a marble!”

“There is a sharp/burning sensation from the ball of my feet to my     toe”

Morton’s neuroma is caused when the nerve that lives between the ball of the feet, known as Metatarsal heads, gets squeezed and/or pinched.  This usually happens during walking and occasionally standing.

Neuromas occur 4x more often in women (uncomfortable shoes anyone?) and usually between the ages of 30-50.  One major theory behind why this happens is the breakdown of one or more of the supportive arches of the foot that provide space for that nerve to live.  When these lose their shape, the foot becomes flatter and risk of nerve pinch increases.

Morton’s neuroma is treated in several different ways, with the least invasive methods being tried 1st:

  • More comfortable shoes with a wider toe box
  • Over the counter or custom fitted orthotic shoe inserts
    • These inserts may also have pads or cushions to unload the nerve
  • Antiinflammatories, either by mouth or within a Physical Therapy session and/or ice
  • Manual Therapy to the foot and ankle, coupled with strengthening of the foot muscles, and even the calf or hip

If these treatments fail, steroid injections and/or surgery to remove the affected nerve may also be considered.  If you experience this or any type of persistent foot pain that is interfering with your life, consult your physical therapist, podiatrist, or physician to get (your feet) on the road to recovery.

Image from: http://www.footsolutions.com/foot-problems

 

Chad Garvey,  KORT Downtown Clinic Director, PT, DPT, OCS, FAAOMPT earned his Doctorate of Physical Therapy from Regis University as well as a post-Doctoral Certificate in Manual Therapy. He is a Board Certified Specialist in Orthopaedic Physical Therapy (OCS) and is a Fellow in the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). In addition, Chad is a certified Strength and Conditioning Specialist (CSCS). Chad is the clinic director. He is a lead instructor for KORT’s orthopaedic residency program in addition to being an instructor to practicing physical therapists and physical therapy students at both the local and national level. He regularly conducts and shares his own research at national physical therapy conferences. www.kort.com

Preventing Injuries While Training for a miniMarathon or Marathon

By Stephen Karam, PT, DPT

Now that New Years has come and gone, many of you are sticking with your resolutions of staying active.  Some of you have begun training for the next marathon or maybe your first marathon coming up this spring or summer.  If you have been running a long time you know that aches and pains throughout your legs and feet are a part of the process, but they do not necessarily have to be if you train smart and listen to your body.

There are a variety of running injuries that may afflict runners.  These include patellofemoral syndrome (runners knee), iliotibial band syndrome, tibialis tendonitis also known as shin splints and may vary location depending on which tendon, achilles tendonitis and plantar fasciitis.  All of these injuries may be caused by a source of either chronic movement dysfunction or an acute event while running such as surface change, ankle rolling/twisting, inappropriate shoewear for your foot, and vast change in mileage or pace.  The good news is that most if not all of these injuries associated with running is preventable.  Most of these injuries can be alleviated by having gait analysis performed and functional strength assessments in order to address any hip and core strength deficits or asymmetries within your mechanics.  Here are some tips for starting and maintaining an injury free running program.

  • Stretch lightly before running using a dynamic warm-up series that helps warm your muscles up in a manner that is similar to the exercise.
  • Do not initiate a program running more than you are capable of, consider your pace, your environment and your surface.  Ten miles on a treadmill feels a lot different than 10 miles on the road.
  • Do not wear old running shoes or shoes that are not made for running.  Contact your local KORT Physical Therapist to make sure that your shoe is appropriate for your foot.  Buying an expensive shoe does not mean it is the best for you, it must be appropriate for the shape of your foot and your individual running mechanics.
  • Do not ignore any running pain.  Please address the pain immediately so that it does not become a chronic pain or a real injury.  You are guaranteed not to finish your marathon training or finish with the PR you were looking for.
  • Strengthening your hips and core can greatly reduce the likelihood of you sustaining a preventable running injury.  A strong center/core allows for improved mechanics down the movement chain into your legs and feet.

 

If you are interested in beginning a running program or have already started one, feel free to contact your local KORT Physical Therapy Clinic to have your shoes, feet, strength, and mechanics assessed and addressed.  This will ensure that you are running at your best and running happy!

Image from: www. thecatholicbeat.sacredheartradio.com/5k-races/

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 www.kort.com.

 

 

 

 

Instrument Assisted Soft Tissue Mobilization (IASTM)

By Regina Durbin, PT

Chronic musculoskeletal conditions (“-itis”), or not so chronic, but slow to heal musculoskeletal conditions are the targets for IASTM (instrument assisted soft tissue mobilization).  This treatment technique, which has a growing popularity with physical therapists, has sound medical evidence backing its use as a treatment for the source of the pain, and not the symptoms of pain. Conditions that are frequently treated with IASTM include epicondylitis (tennis and golfer’s elbow), plantar fasciitis, patellar tendinitis  (jumper’s knee) and hamstring strains.  In addition, pain that persists post operatively in total joint replacement patients can be improved and/or relieved with IASTM.

When the body is injured the immune system works quickly to close the wound. The resulting tissue is scar. The scar tissue is irregular in nature and has very poor functional strength and flexibility.  The result of the scar restricts the tissue both in and around the wound, leading to pain and alteration of function.

IASTM uses tools to create a mild inflammatory response in the tissue which brings circulation into the tissue in order to remodel the scarred area into functional tissue.  This combined with appropriate stretches and corrective strengthening, restores the injured tissue to a functional, pain freestate.

While the treatment is frequently very uncomfortable during the actual process, most patients feel some sense of improvement almost immediately. Literature says seven to ten treatments is standard care, though frequently, less can be very helpful. Mild bruising is a frequent, not unexpected consequence of the treatment, which actually means that the patient’s body is having the appropriate immune response to the treatment.

Providers use a variety of forms of IASTM (SASTM, ASTYM, Graston and Gua Sha), but all are based on the same physiological response, often leading to complete resolutions of conditions that have been an aggravation for the patient for many years. Seeing a physical therapist, who is familiar with these techniques, even if previous physical therapy had been tried, can often lead to significant resolution of the chronic conditions.

Regina Durbin, PT, has over 25 years of experience as a physical therapist. She has a strong manual therapy background, with interests in orthopedics, at all levels, but especially in shoulder, spine and feet. She has over 20 years experience with orthotic fabrication. She has been the primary physical therapist with the Louisville Ballet Company since 2005. She has extensive experience in job analysis and industrial medicine for the injured worker. For more information visit us at www.kort.com

 

 

Frozen Shoulder: Beyond just REALLY Ignoring Someone

By Chad Garvey, PT, DPT

          Imagine living your life with only 1 arm.  You can’t reach overhead into a cabinet and even getting your shirt on over your head or into a jacket is a pain. For women, this also means not being able to latch their bra behind their back.  For those with shoulder pain, a very common problem bringing people to the doctor, these are just some of their complaints.  However, many times shoulder pain can disappear and their function will improve within a month or so.

For those with frozen shoulder, otherwise known as adhesive capsulitis (AC), these problems can drag on for up to 1 year, and sometimes even longer.

Frozen shoulder characteristics:

  • Affects about 2% of the population, mostly between the ages of 40-60
  • Occurs more often in women than men
  • Occurs more often in folks with diabetes or thyroid dysfunction
  • Can occur after prolonged immobilization from an injury or surgery, but also can occur without injury

 

AC happens in 3 stages:

  1. Freezing:  The shoulder starts out as achy and stiff, and the pain can rapidly progress where the shoulder is very painful to move, with sleep being lost.
  1. Frozen:  At this point, the pain has stopped worsening, but the shoulder is stiff enough where any overhead or behind the back or head movement is very difficult.
  1. Thawing:  The shoulder gradually becomes less painful and range of motion is slowly restored, sometimes taking up to 1 year.

AC is typically managed best if caught early, as the process is thought to be inflammatory in nature, getting a heavy dose of anti-inflammatory medication, steroids, and/or a steroid injection, can really help manage the early inflammation and pain.

Pairing this with early physical therapy after the medicine kicks in, specifically hands on therapy and exercise to the shoulder, shoulder blade, and spine, can rapidly improve a person’s function early on before the frozen phase sets in.

Remember, it is important that if you begin having an achy and stiff shoulder that isn’t better in 2 weeks, see your physician or physical therapist to avoid the otherwise long road to recovery!

Image from: swim.isport.com/swimming-guides/how-to-prevent-shoulder-injuries-from-swimming

Chad Garvey, PT, DPT is a physical therapist at KORT.  For more information, contact Dr. Garvey at www.kort.com.

 

 

Injured Athletes: Nutrition Tips to Hasten Healing

By Nancy Clark MS RD CSSD

Being injured is one of the hardest parts of being an athlete. If you are unable to exercise due to broken bones, knee surgery, stress fracture, or concussion, you may wonder: What can I eat to heal quickly? How can I avoid getting fat while I’m unable to exercise? Should I be taking supplements? This article will address those concerns, plus more.

Don’t treat good nutrition like a fire engine

To start, I offer this motherly reminder: Rather than shaping up your diet when you get injured, strive to maintain a high quality food intake every day. That way, you’ll have a hefty bank account of vitamins and minerals stored in your liver, ready and waiting to be put into action. For example, a well-nourished athlete has enough vitamin C (important for healing) stored in the liver to last for about six weeks. The junk food junkie who gets a serious sports injury (think bike crash, skiing tumble, hockey blow) and ends up in the hospital in a coma has a big disadvantage. Eat smart every day!

Don’t diet

A big barrier to optimal fueling for injured athletes is fear of getting fat. Please remember: even injured athletes need to eat! I’ve had a runner hobble into my office on crutches saying, “I haven’t eaten in three days because I can’t run.” He seemed to think he only deserved to eat if he could burn off calories with purposeful exercise. Wrong! Another athlete lost her appetite post-surgery. While part of her brain thought “what a great way to lose weight”, her healthier self realized that good nutrition would enhance recovery.

Despite popular belief, your organs (brain, liver, lungs, kidneys, heart, etc.)—not exercising muscles—burn the majority of the calories you eat. Organs are metabolically active and require a lot of fuel.  About two-thirds of the calories consumed by the average (lightly active) person support the resting metabolic rate (the energy needed to simply exist). On top of that, your body can require 10% to 20% more calories with trauma or minor surgery; major surgery requires much more. Yes, you may need fewer total calories because you are not training hard, but you definitely need more than your sedentary baseline. Your body is your best calorie counter, so respond appropriately to your hunger cues. Eat when hungry and stop when your stomach feels content.

Here are two other weight myths, debunked:

Muscle turns into fat. Wrong. If you are unable to exercise, your muscles will shrink, but they will not turn into fat. Wayne, a skier who broke his leg, was shocked to see how scrawny his leg muscles looked when the doctor removed the cast six weeks later. Once he started exercising, he rebuilt the muscles to their original size.

Lack of exercise means you’ll get fat. Wrong. If you overeat while you are injured (as can easily happen if you are bored or depressed), you can indeed easily get fat. Joseph, a frustrated football player with a bad concussion, quickly gained 15 pounds post-injury because he continued to eat lumberjack portions. But if you eat mindfully, your body can regulate a proper intake. Before diving into meals and snacks, ask yourself, “How much of this fuel does my body actually need?”

When injured, some underweight athletes gain to their genetic weight. For example, Shana, a 13-year-old gymnast, perceived her body was “getting fat” while she recuperated from a knee injury. She was simply catching up and attaining the physique appropriate for her age and genetics.

Do eat “clean”

To enhance healing, you want to choose a variety of quality foods that supply the plethora of nutrients your body needs to function and heal. Don’t eliminate food groups; they all work together synergistically! Offer your body:

Carbohydrates from grains, fruits, vegetables. By having carbs for fuel, the protein you eat can be used to heal and repair muscles. If you eat too few carbs—and too few calories, your body will burn protein for fuel. That hinders healing.

Protein from lean meats, legumes, nuts and lowfat dairy. Protein digests into the amino acids needed to repair damaged muscles; your body needs a steady stream of amino acids to promote healing (especially after physical therapy). You need extra protein post-injury or surgery, so be sure to include 20 to 30 grams of protein at each meal and snack. A portion with 20 to 30 grams of protein equates to one of these: 3 eggs, 1 cup cottage cheese, 3 to 4 ounces of meat, poultry, or fish, two-thirds of a 14-ounce cake of firm tofu, or 1.25 cups of hummus. While you might see ads for amino acid supplements including arginine, ornithine, and glutamine, you can get those amino acids via food.

Plant and fish oils. The fats in olive and canola oils, peanut butter, nuts and other nut butters, ground flaxseeds, flax oil, and avocado have an anti-inflammatory effect. So do omega-3 fish oils. Eat at least two or three fish meals per week, preferably the oilier fish such as Pacific salmon, barramundi, and albacore tuna. Reduce your intake of the omega-6 fats in packaged foods with “partially hydrogenated oils” listed among the ingredients, and in processed foods containing corn, sunflower, safflower, cottonseed, and soy oils. Too much of these might contribute to inflammation.

Vitamins. By consuming a strong intake of colorful fruits and vegetables, you’ll get more nutrition than in a vitamin pill. Fruits and veggies have powerful anti-oxidants that knock down inflammation. Don’t underestimate the healing powers of blueberries, strawberries, carrots, broccoli, and pineapple. Make smoothies using tart cherry juice, PomWonderful pomegranate juice, and grape juice.

Minerals. Many athletes, particularly those who eat little or no red meat, might need a boost of iron. Blood tests for serum ferritin can determine if your iron stores are low. If they are, your doctor will prescribe an iron supplement. You might also want a little extra zinc (10 to 15 mg) to enhance healing.

Herbs, spices and botanicals. Anti-inflammatory compounds are in turmeric (a spice used in curry), garlic, cocoa, green tea, and most plant foods, including fruits, vegetables, and whole grains. For therapeutic doses of herbs and spices, you likely want to take them in pill-form. Yet, consuming these herbs and spices on a daily basis, in sickness and in health, lays a strong foundation for a quick recovery.

Image from: http://www.active.com/running/Articles/How-to-Prevent-and-Treat-Common-Running-Injuries

 Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her Sports Nutrition Guidebook and food guides for new runners, marathoners, and soccer players offer additional information. They are available at www.nancyclarkrd.com. See also sportsnutritionworkshop.com.

 

A Journey from Athlete to Athletic Trainer and Sports Performance Coach

By Nick Sarantis, ATC, CSCS

August 2001 in Drexel Hill, Pennsylvania and I just left my first physical therapy appointment for low back and adductor (groin) pain. This was my first experience in sports medicine sadly it was not my last, and now thankfully I can say that I am involved in sports medicine every single day.

My name is Nick Sarantis and I am the Director of Sports Performance for Baptist Sports Medicine. For the coming months I will be writing articles on sports medicine, sports performance, and personal training topics.  This first article will describe my journey from a high level athlete to athletic trainer and now to my current role on the sports performance side of things, while giving a background and what made me the clinician/coach I am today.

I was a soccer player, I did not just play soccer, but I was a soccer player I was consumed and defined by the game.  School was not my favorite thing in the world, but it was something I knew I must succeed in to further my soccer career. I played high school soccer in a suburb of Philadelphia where the softball and baseball fields intersected with the soccer pitch.  The center circle was used each November for the huge bond fire held before the big Thanksgiving Day football game.  Needless to say facilities were not up to par from a soccer standpoint, but not up to par from an injury prevention standpoint either. I played club soccer for various clubs throughout the area, traveling, and playing 3-4 times per week.  Soccer was life and I was ok with that. My junior year of high school is when I first started to feel pain in my adductor as well as my low back. Various doctor and physical therapy appointments told me nothing more than a strain and should clear up in a few weeks’ time.  Eventually it felt good enough for me to play, and I was able to have a very successful high school and club career.  Before my freshmen year in college my parents got me a personal trainer at a local gym to get me stronger.  This is 10 years ago now so the training was based on body building principles with muscle group splits each day.  Movement patterns were not trained, and come to think of it I cannot even remember doing a squat yet alone a hang clean.  This was my first introduction to the weight room and strength and conditioning.

College soccer took me to Farleigh Dickinson University in Teaneck, NJ. It was a 2 hour drive from family and friends, and they had made it to the elite 8 of the NCAA tournament the year before, the fact that they wanted me to play there, I was sold.  Made it through my first and only preseason camp of my career healthy and that transferred over to a starting position the first week.  It was a highly successful year from a team standpoint having a national ranking as high as #8, however we were upset in the NCAA tournament.  By the end of the year my adductor and lower abdominal region were feeling weak and painful. I went to multiple doctors referred to me by my athletic trainers and they told me nothing more than a strain or maybe some tendonitis.  Back to physical therapy weekly as well as rehab with my athletic trainers daily.  This was during the offseason so the combination of rest and rehab I felt back to normal after 2 months, perfect timing because spring soccer was starting soon.  Due to my injuries I never had time for strength and conditioning, and it was not a huge priority at the University at that point. Played very well the first few games, and then again the pain returned rendering me to 75% of the player I could be.  During this time I started to realize that FDU was not the school for me, so I started to explore my transferring options.  The University of Louisville and I immediately made contact and I was on my way there for my recruiting trip. After standing in the middle of Cardinal Park’s field I was sold, and was enrolled for summer class starting in July.

 

Preseason camp was about to begin and we had to get our annual physicals.  I revealed I had pain in my adductor area, and after being poked and prodded by a few doctors I got my first anti –inflammatory injection (cortisone). Due to the trauma of the shot I was held out of the first week of preseason practice, which left me playing catch up to the rest of the squad.  It was not until about a month into the season and after daily rehab with my athletic trainer did I start to feel close to 100%.  With my physical conditioning improving and pain decreasing my play was getting back to where I felt like it needed to be and my playing time started to increase.  My first game back was 60 minutes against Ohio State in an overtime tie, which led me to be packed in ice for the next 2 days.  I recovered in time for the next match and played well, but the maintenance of keeping my body going was starting to become overwhelming.  The season ended with me in pain and frustrated with both my body and my play.  Spring season led me to another round of doctors visits, MRI’s, X-Rays anything that could potentially lead to a diagnosis.  An arthrogram MRI of the hip was ordered to look for an acetabular labrum team.  An athrogram MRI is when contrast dye is injected into the joint in question which can help show a potential cartilage tear.  I remember standing in the athletic training room HOPING that it was torn! I just wanted to know what it was, I really did not care how bad it was, I just want to know.  But alas it was negative and I was devastated.  My mind started to wonder am I just being a wimp?  Am I really in pain? Do my coaches and team mates think I am just faking this whole thing? So off to the next doctor and we started to talk about a potential athletic puablga or “sports hernia” injury, and all the symptoms were right on target.  Pain and weakness in the aductors, pain in the lower abdominals, pain only during exertion, pain subsiding when at rest but would return with activity. Check, check, check, check, check.  However at this point there were 2 surgeons in the world renowned for this procedure, one was in Munich, Germany, and luckily the other one was in Philadelphia, Pennsylvania.  To Philadelphia I went to be examined by Dr. William C Meyers who had operated on many of the best athletes in the world.  He had already reviewed my diagnostic pictures and he did a quick hands on exam of me and he was convinced that I was suffering from an athletic pubalgia on the right side. I was scheduled for surgery the very next day. I was elated, excited, thrilled, happy anything you can think of that someone had found what was wrong with me.  I could have cared less about the surgery, I was just excited to be fixed.  Surgery was a breeze he made a 3 inch horizontal incision in my lower abdominal wall and proceeded to fan out internal sutures over the micro tearing put a band aid over the cut and I was going home.  Standard rehabilitation protocol would allow me a full recovery in 3 months, just enough time to get back in shape for preseason.  The rest of the spring and summer was spent rehabbing and trying to get back in shape for the season.  I had an offseason strength and conditioning program provided to me from the strength and conditioning coaches at Louisville which is very comprehensive. However the biggest issue for me that I was still limited from many of the exercises due to pain, or due to doctors recommendations.

Preseason camp was upon us and I was not back to 100% yet.  I spent preseason still mostly rehabbing and training on the side trying to get back to 100% without further injuring myself.  3 games into the season we were playing the University of Cincinnati and I was inserted into central midfield at half time, and I would never leave the field again that season.  I felt great, I was playing great this is what I had worked so hard over the years to get, to be playing Division 1 soccer at a high level.  It was a fantastic season personally and I was so excited to build upon my junior year to have a great senior year.  We went through a coaching change which brought many good things, but lots of adjustments for all involved.  Our weight training programs were becoming more functional and more soccer specific.  I was getting myself in great physical shape in the weight room while also staying on top of my groin injuries.  Spring season rolled around and about a week in a felt a similar feeling in my right groin that I was all too familiar with.  I tried to play through the pain which left me unable to perform well, in pain the compensation led to pain in my left side as well.  After communicating with Dr. Meyers again, back the to the surgeon I went.  This time he cut open both sides and repaired athletic pubalgia injuries on both sides.  This time however the rehab protocol was advanced so that I could try and be back playing in one months time.  Dr. Meyers and I communicated daily on my rehab plan, and although I started running sooner, and passing a soccer ball sooner, it was still 3 months for me to feeling anywhere near 100%.  So again I missed most of preseason camp which as the senior team co-captain I hated more than usual.  However this time the pain never really went away.  So I started to receive monthly cortisone injections into the scar tissue in my groin to help me deal with the pain.  It helped me get back on the field and was able to play at high level for a few games.  As the season wore on my body continued to break down and I was unable to perform close to where I thought I should be.  Then finally in a practice about half way though the year I fell on my outstretched arm, heard a pop, a crack, and a crunch and my senior season was finished.  Tests revealed a torn labrum in my shoulder which would require surgery.

My soccer career was a love and hate relationship on a daily basis.  I loved the game so much and everything it had given me, but I also hated it because of everything it had done to me.  The amount of time it took me to get my body ready for a practice or game left me burnt out. However in my junior year I finally realized what career I wanted to follow: Athletic Training.  I completed the appropriate pre requisites and off to the University of Arkansas I went to complete my masters degree in athletic training.  It was at this time that I was able to match the book knowledge that I was reading about with all the experiences that I have had in the past.  I worked with multiple sports while I was there and saw a variety of injuries and techniques to dealing with them.  I also observed the strength and conditioning coaches work on a daily basis as well which again showed much different techniques then I used back in high school.

 

With my degree in hand I accepted the job to be the athletic trainer for Oldham County High School employed through Baptist Hospital Northeast. I was responsible for over 500 athletes on an annual basis to fix injuries, implement rehabs, everything and anything the athletes would need to be able to perform.  During this time however I quickly realized that as a high school athletic trainer that I did not have time to implement injury prevention techniques.  Once I got the athlete healthy enough to practice, he or she was back at practice and we would never get the chance to find out what truly caused that injury.  This frustration led me to complete my Certified Strength and Conditioning Specialist test (CSCS), and I started to do strength and conditioning training on the side for athletes that were looking for extra work.  Great results led me to work with Baptist Sports Medicine on implementing a sports performance area in the new clinic located in Baptist Eastpoint. Now I am the Director of Sports Performance for Baptist Sports Medicine building faster, stronger, quicker, more powerful and healthier athletes.  Through all my experiences and education I am able to connect with athletes and their current experiences based on my past.  My goal is to give athletes all the information and techniques that I did not have and really was not even around 10 years ago.  Continue to check for articles and posts related to all sports medicine, sports performance, and personal training topics.

Nick Sarantis is the Director of Sports Performance at Baptist Sports Medicine. He is a certified Athletic Trainer (ATC) and a certified Strength and Conditioning Specialist (CSCS) through the National Athletic Training Association and the National Strength and Conditioning Association. He earned his Master’s degree from the University of Arkansas and his Bachelor’s degree from the University of Louisville. While obtaining his Bachelor’s degree, he was a co-captain and starter for the University of Louisville Men’s Soccer team. For more information: www.BaptistSportsMedKy.com.

 

 

Preventing and Treating Dehydration in Healthy People

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

To determine how much fluid you need each day, knowing how many calories you need is helpful You can divide that number by 30 and that will give you how many ounces of fluid you need to drink each day. In addition to knowing that number you can also check the color of your urine. You should urinate about every 2 to 4 hours throughout the day.  Your urine should be clear. If you urine in not clear  after the first void in the morning than you need to drink more.

Example: Fluid Needs = 2000/30 = 66.6 ounces of fluid per day.

Online Hydration calculator: http://nutrition.about.com/library/blwatercalculator.htm

You can get fluid from an assortment of foods. Check out the list below.

Fluid Contact from Food and Other Fluids

Food                                                     Portion             Fluid (g)                       Calories

Popsicle                                                   1 each              90                               varies

Ice cream, ice milk                             1/2 cup             45                               varies

Gelatin                                                     1/2 cup             120                               varies

Soup                                                         1/2 cup             120                               varies

Pudding                                                    1/2 cup             50                               varies

Gingerale                                        12 fl oz                        334                              124

Coffee*                                                         6 fl oz             176                                 4

Cranberry juice                                        6 fl oz              162                               108

Lemonade                                             12 fl oz                 443                              200

Tea*                                                                6 fl oz             177                                 2

Water                                                            8 fl oz              240                                0

Orange juice                                              8 fl oz              219                               112

Tomato juice                                            8 fl oz              226                              51

Grape juice                                                8 fl oz              213                               155

Cantaloupe                                               1 cup                144                               57

Grapes                                                        1 cup                129                               114

Orange                                                     1 medium          122                               65

Watermelon                                            1 cup                146                               50

Milk lowfat 1%                                         8 fl oz              220                              102

Yogurt low fat                                         8 fl oz              194                               127

Chocolate low fat milk                          8 fl oz              211                               158

Cream of celery soup                            1 cup                214                               165

Clam Chowder                                          1 cup                211                               163

Gatorade                                                      8 fl oz              240                              50

Water from a fountain                         1 mouthful        30                                0

 

SOURCE: Adapted from J.A.T Pennington, Bowes and Church’s Food Values of Portions Commonly Used, 15th ed. (Philadelphia: J.B. Lippincott, 1989).

*Contains caffeine which may have a dehydrating effect.

Strategies for Hydration: Pre and During and Recovery Exercise

  • Drink about 17 ounces of fluid 2 to 3 hours before exercise.
  • Drink about 8 to 10 ounces of water 10 to 20 minutes before exercise.
  • Drink about 5 to 10 ounces of water every 15 to 20 minutes or so during your workout. You may find sipping water throughout your workout works as well (a mouthful is about 1 ounce).
  • If you exercise for more than an hour, consider a sports drink.
  • In hot weather you can weigh before exercising & weigh after exercising. For every pound you lose during exercise drink 20 – 24 ounces of fluid per pound to rehydrate.

HOW TO DETECT DEHYDRATION DURING TRAINING**

#1        Adequate Urine Output on a daily basis, you should make sure that you drink an adequate amount of fluids.  You can determine if you’ve had enough to drink by your urine output: the amount, color and smell of your urine.

1. Your urine should be clear.  Your first void of the morning is usually  yellow but as the day goes on it should be pale to clear.

2. If your urine is dark and has a bad odor, it is concentrated with metabolic wastes, and you are dehydrated.  You need to drink more fluids.  Drink until your urine is pale to clear.

#2       Weight Loss Indicator of Mild Dehydration: Weigh Yourself Before and After Long Runs.

Note: For each pound of weight loss during your long runs, you should drink 20 to 24 ounces of fluid to become rehydrated.

#3       A throbbing heart beat may be indicative of dehydration.

#4       Experiencing a mild headache in combination with the other  symptoms like chills, nausea, and/or “cotton mouth”.

#5       Chronic fatigue.

SIGNS AND SYMPTOMS OF HEAT INJURY DUE TO DEHYDRATION

There are three different levels of heat injury: heat cramps, heat exhaustion, and heat stroke (this being the most serious).  Be sure to weigh yourself before and after each long run and drink back 16 to 24 ounces of fluid for rehydration.

HEAT CRAMPS

Clinical Symptoms:

  • Excessive sweating
  • Fatigue
  • Thirst and cramps in stomach, arms and legs

 

What to do:

*  Drink water or fluids containing electrolytes like Gatorade or Powerade

*  Rest and get to a cool spot in shade or air-conditioned

 

HEAT EXHAUSTION (occurs if you don’t treat heat cramps!)

Clinical Symptoms:

  • Cool, moist skin with goose bumps when in the heat
  • Heavy sweating
  • Faintness
  • Headache
  • Dizziness or lightheadedness
  • Nausea
  • Muscle cramps
  • Weak,  rapid pulse
  • Low blood pressure upon standing

What to do:

*  Stop exercising and try to get in a cooler environment.

*  Drink cool water or sports drink

Note: symptoms should improve within an hour, if not seek immediate medical attention.

 

HEAT STROKE (if heat exhaustion is not treated it can lead to heat stroke. This is life threatening!)

Clinical Symptoms:

  • Excessively high body temp (over 104 F)
  • Lack of sweat
  • Nausea and vomiting (or feel sick at your stomach)
  • Flushed skin
  • Racing heart rate
  • Headache
  • Confusion
  • Unconsciousness
  • Muscle cramps begins then may go rigid or limp

What to do:

*  Call for emergency medical treatment. This is serious!

*  Move to a shaded location & remove excess clothing.

*  Until help arrives, place ice packs or cold wet towels on the person’s head, neck, armpits, and groin.

*  Get into a cold shower, if possible,  use cold water sprays or use a fan with cold water sprays.

**Information adapted from www.mayoclinic.com

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, www.DayByDayNutrition.com, 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, www.KentuckianaHealthWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com 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 12 grandchildren.