Sports Injuries: Prevention and Treatment

vance-westernSports injuries can stop your marathon training fast.

To increase your chances of running your best race at the Modesto Marathon, you need to know how to prevent getting hurt. If you do get injured, you need to know how to recover as quickly as possible to get back out on the road.

The Modesto Marathon Medical Coordinator, Dr. Vance Roget M.D., shares his fast knowledge and experience in the field of sports injuries. Dr. Roget is a sports medicine specialist practicing here in Modesto (a great person to see if your injury needs professional help). He is also a well accomplished marathon and ultra-marathon runner.

This downloadable guide was provided by Dr. Roget during a seminar he gave to our Adult Training Group. We thought others training for the Modesto Marathon could benefit from the information.

Dr. Roget’s Sports Injury

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Blisters and Chafing

Ultra-runner Linda McFadden shares her extensive experience in the prevention and treatment of blister and chafing.

Here is the Powerpoint presentation from her recent presentation to our marathon training group.

Optimum G.I. Functioning (i.e., Preventing Upset Stomach) During Long Distance Running

  • Prevent dehydration, and get acclimated to heat;
  • Adequate electrolytes (sodium, potassium, magnesium, calcium);
  • Anti-acids: Zantac or Pepcid (before and during run; I even start the night before);
  • No diet sodas (before or during run); limit fructose (fruit – sugar drinks);
  • Stomach – soothers during run: Tum’s, ginger (e.g., gel candy), peppermint candy, sodium bicarbonate (baking soda), L-glutamine (this may be better as prevention);
  • Caffeine: increases gastric emptying (i.e., good if you tend to get bloated), and keeps kidneys working (but can increase stomach acid, therefore take Zantac/Pepcid);
  • Add ice to fluid for easier absorption (ideal is 50° F);
  • Minimal fat intake, and protein only in powdered vegetable form (especially soy);
  • Ensure is too concentrated and too much fat; HealthShakes from Costco have less fat, but would still need to dilute it significantly; Mountain Dew works well for me;
  • Empty bowels a few days before, i.e., Metamucil &/or Dulcolax tablets (e.g., 3 days before race, while carbo-depleting/high protein and fat intake before the 2 days of carbo- loading);
  • Decrease solids and increased liquid carbs towards end of run/race;
  • Solids that work well for me: rice crispy bars (digest and raise blood sugar almost as fast as sugar but last longer; light and easy to carry, not messy), boiled potatoes, bananas, oatmeal cookies or breakfast/granola bars.

My Homemade Carbo-Gel Recipe:

Water, complex carb. powder (maltodextrin), Perpetuem (from Hammernutrition.com) or soy protein powder (approx. 4:1 carbo:Perpetuem/soy powders), Chia seeds (soak in water for a while before drinking), Lite Salt (sodium + potassium), glycerol/glycerin (small amount, ~1 tsp/5 oz. flask; helps cells absorb water better/fast), chocolate or maple syrup. Mix all together in large water bottle and pour into 5 ounce flasks, shake well after water + dry ingredients, then add the syrup.

 

Food for Thought – Human Hibernation

Have you ever WONDERED??

People often wonder why we gain weight as we get older, but it’s especially because we forget to play like children, becoming much more sedentary, with the excuse that we can’t be as active because we are getting old, but actually people are getting old because they are less active: cause and effect are reversed.

Humans are also experiencing some of the effects similar to other mammals that hibernate.

When an animal hibernates it significantly decreases its activity level to almost zero, and, especially in cold climates, its body temperature and therefore metabolism significantly decrease, and they are able to survive often for several months with little or no food.

Many humans significantly limit their activity level so that their metabolism slows down and their caloric needs are much less, but they keep eating as if they were active with normal metabolism, and therefore they keep gaining weight like a feasting bear just before hibernation, except humans continue in this feasting mode year-round.

If they would fully wake up and have to forage around the forest for their food for survival like bears, then they would lose the stored weight every year, but such is not the case.

So, exercise and eat small amounts often, and remember to play like children (or active foraging bears), in order to raise your metabolism and lower your age.

Motivating Kids in Physical Activity

Motivation is defined as behavioral choice, effort, persistence, and performance.

It can be characterized by frequency, intensity, time (F.I.T.), and level of physical activity.

Why children and adolescents participate in physical activity (leisure time activity, organized sports) — 3 major motives:

  1. Youths want to develop and demonstrate physical competence/adequacy, such as athletic skills, physical fitness, and physical appearance.
  2. Gaining social acceptance and support, including friendships, peer group acceptance, and approval, reinforcement, and encouragement by significant adults (parents, teachers, coaches) is important to initiating and continuing participation.
  3. Fun derived from participation maximizes positive and minimizes negative experiences related to physical activity.

The first 2 motives improve self-esteem, which enhances enjoyment and in turn promotes physical activity/motivated behavior.

Principles for maximizing motivation:

  1. Focus on teaching and practicing skills:  maximize equipment, facilities, instructors; don’t introduce competitive play too early; make sure it’s fun — provide variety.
  2. Modify skills and activities:  sequential progressions; modify space, equipment, rules; match the activity to the child, not the child to the activity.
  3. Realistic expectations for each child:  individual learning rates and goals.
  4. Become an excellent demonstrator:  lots of “show and tell”; repeated demonstrations; multiple angles.
  5. Catch kids doing things correctly:  complement, instruct, and encourage; provide optimal challenge as a follow-up.
  6. Reduce kids’ fears of trying skills:  provide an encouraging atmosphere — performance errors are part of the learning process; reduce fears of getting hurt — show how you’ve ensured   safety; show empathy.
  7. KISS:  keep instructions short and simple; maximize practice and playing time.
  8. Be enthusiastic:  it’s contagious!  Smile, interact, listen.
  9. Build character:  be a role model; identify and take advantage of teachable moments.
  10. Let children make some choices: involve them in the decision-making process; ask questions.

Sports Nutrition

Introduction

Physical performance depends on multiple factors:

  1. Endurance: length of time a given level of activity can be maintained, or resistance to fatigue;
  2. Aerobic capacity: ability to perform despite symptoms of shortness of breath;
  3. Pain threshold;
  4. Body hydration;
  5. Temperature control.

Physical training maximizes physical performance, and quality practice equals improvement. To achieve maximum benefit of training, proper diet is required. A high-quality sports diet must:

  1. Fuel the muscles for top performance;
  2. Nourish the body;
  3. Contribute to current health and future of longevity.

To satisfy these requirements, the body must have energy, provided by:

  1. Calories and healing capacity, in the form of carbohydrate, protein, fat;
  2. Other nutrient/enzyme systems, in the form of minerals and vitamins;
  3. Circulation to muscles (for nutrients, water, and oxygen).

Carbohydrates

Athletes should eat a 60-70% carbohydrate diet daily for both training and competing. These carbohydrates get stored as muscle glycogen, needed to perform exercise (for faster use), and as liver glycogen, needed to maintain normal blood glucose level (for slower energy use).

The carbohydrates in sugary soda or sports drinks get stored as glycogen but provide little or no vitamins or minerals. The carbohydrates in wholesome fruits, vegetables, and grains also get stored as glycogen plus provide vitamins and minerals, which are the spark plugs that help the athlete’s “engine” to perform at its best.

The average 150 pound active man has about 1800 calories of carbohydrates stored in his liver, muscles, and blood, in the following proportions: muscle glycogen about 1400 calories; liver glycogen, 320 calories; blood glucose, 80 calories.

These carbohydrate stores determine how long an athlete can exercise, although with endurance exercise our bodies also burn fat for fuel, with training enabling us to burn more fat than less fit individuals. Depleted muscle glycogen results in “hitting the wall” and the associated painful muscles and difficulty moving. Depleted liver glycogen results in low blood sugar and causes the athlete to “bonk” or “crash”, feeling extremely fatigued, lightheaded, uncoordinated, and unable to concentrate. Proper daily and pre-exercise nutrition can significantly reduce the development of these problems.

Carbohydrates are important for all athletes regardless of the sport; both runners and weightlifters/body builders need carbohydrate as important fuel.

Protein

For adults the requirement for protein is 0.8-1.5 g/kilograms body weight per day (0.5-0.8 g/pound body weight for active adults; 0.8-1 g/lb. body wt. for the growing athlete). Approximately 5% of the energy cost of exercise is derived from protein.  Excess protein does not build muscle, exercise does. To have adequate energy to perform the muscle building exercise, and recovery, the diet should be approximately 15 to 20% protein.

Endurance athletes need more protein per kilogram than bodybuilders/weightlifters; dieters need more protein than athletes eating their full complement of food; athletes rapidly building muscle have higher protein needs. Vegetarian athletes can obtain adequate protein for their needs, but their diets are still likely to be deficient in iron and zinc, 2 minerals found primarily in animal proteins, particularly in red meats. Iron is important for preventing anemia; zinc is important for healing.

Fat

Fats are also essential for a healthy diet, and besides supplying energy, also supply essential fatty acids and fat soluble vitamins. However, for both cardiovascular health and optimal sports performance, athletes should reduce their intake of fatty, greasy foods such as donuts, pastries, butter, mayonnaise, french fries, and ice cream, which tend to leave the muscles  unfueled, and also may contribute to elevated blood cholesterol and associated heart disease. Dietary goals concerning fat, should provide low cholesterol, minimal saturated and trans fats, in the form of lean meats, and especially fish — fish are beneficial in lowering blood cholesterol and triglycerides. A healthy diet should consist of approximately 25% of these healthy fats.

Minerals and Vitamins

Some minerals important for muscle, nerve, and many bodily functions include: sodium, potassium, calcium, and trace amounts of iron, zinc, magnesium, chromium, and copper.

People at highest risk of suffering from iron deficiency anemia: female athletes (who lose iron through menstruation); athletes who eat no red meats; marathon runners (who may damage red blood cells through “foot strike hemolysis”); endurance athletes (who may lose a significant amount of iron through heavy sweat losses); and teenage athletes (who are growing quickly and may consume inadequate iron to meet their expanded requirements).  Iron from a supplement may be poorly absorbed compared with that found in animal proteins. People who are deficient in iron may also be deficient in zinc because these 2 minerals tend to be found in similar foods.

Vitamins are important for many biological body functions, including muscles, brain and nerves, and other internal organs, but caution should be followed to not take too much vitamins — many authorities believe that vitamin supplementation is not necessary with a proper diet.

Water / Fluids

Fluids transport nutrients to and from the working muscles, dissipate heat (prevent heat exhaustion), and eliminate waste products. Dehydration, when occurring with muscle and/or red blood cell damage, can lead to acute kidney failure. However, excessive intake of water by marathon runners (along with inadequate minerals, mainly sodium and potassium, as well as inadequate calorie intake) has led to water intoxication, which can cause restlessness, weakness, nausea, vomiting, muscle twitching, convulsions, and even death.   Drinking large quantities of water can delay gastric emptying, which can lead to bloating and reduced performance.  Dehydration is much more common of a problem.

To maintain optimal hydration, athletes should follow these guidelines:

1.   Prevent dehydration during training by replacing sweat losses during exercise:  each pound of weight lost equals 2 cups (16 ounces) of sweat. Try to lose no more than 2% of your body weight during a workout (that is, 3 pounds or 3 cups of sweat for a 150 pound athlete). If you become 2% dehydrated, then your work capacity is reduced by 10 to 15%.

2.  Before an event, drink 2 to 3 large glasses of fluid up to two hours before the start. The kidneys require about 90 minutes to process fluids, which allows time to empty the bladder prior to the event. Then 5 to 10 minutes before start time, drink another one or 2 cups of water or sports drink.

3. During hard exercise, or hot weather, ideally drink 8 to 10 ounces every 20 minutes; start drinking early in the event before you are thirsty, to prevent dehydration. 1 cup is 8 ounces, therefore drink 3 to 4 cups per hour, or every 5 to 6 miles if you run a 12 or 10 minute per mile pace, or at least 1 cup every 2 miles.

4. After exercise: the thirst mechanism inadequately indicates whether the body is optimally hydrated; monitoring urination is safer — if several hours passed before an athlete has urinated, or if urine color is dark, then he or she is still dehydrated.

For endurance athletes and those exercising for more than 90 minutes, a sports drink or diluted juice that contains 60 to 100 calories per 8 ounces is best during exercise.

Pre-Competition Meal (Mostly Carbohydrates)

3-4 hrs. before race time for a large meal to digest;

2-3 hrs. for a smaller meal;

1-2 hrs. for a blended or liquid meal;

less than 1 hr. for a light snack, as tolerated.

Eating During Exercise

Trained athletes can metabolize about 1 gram of carbohydrate per minute, at 4 cal./gram of carb. equals  240 cal./hr. of endurance exercise, or 60 cal. per 15 min. (about 8 oz., or 1 cup, of sports drink).

During intense exercise (>70% of aerobic capacity), the stomach gets only 20% of its normal blood flow;  during moderate-intensity exercise, the blood flow is 60-70% of normal, so digestion may be fairly good (e.g. for recreational marathon and ultra-marathoners).  Be sure to experiment with food and fluids during training to determine your tolerance and what works best for you.

Post-Competition / Recovery Eating

Muscles are most receptive to replacing muscle glycogen within the first 2 hours after a hard workout, therefore 200-400 calories of carbohydrate are recommended, then repeat another 2 hrs. later.  Early intake of protein helps with the muscle repair process.

For estimating caloric needs for weight maintenance, multiply the desired weight by 12-15 cal./lb. for moderate activity;  15-20 cal./lb. for higher levels of activity.

For weight reduction, a gradual weight loss (1/2 -1 lb./wk. for women; 1-2 lbs. for men) offers greater long-term success.  Each 3,500 calories lost = 1 lb. of weight lost; e.g. a combined decreased intake of 250 cal. with increase in exercise of 250 cal. per day, 7 days/wk.

Anti-Flammatory Medications: Use With Caution

Anti-inflammatory medications (also called non-steroidal anti-inflammatories, NSAID’s) are used extensively by many athletes both before and during activity, with the belief that they help prevent pain and discomfort during their sport and prevent soreness afterwards. However, studies have shown that NSAID’s did not decrease the athletes’ perception of pain during the activity or decrease muscle soreness later.

There are 3 main considerations pertaining to side effects that runners should be aware of.

(individual response and side effects are variable and may be unpredictable)

  1. Inhibiting kidney function, with possible kidney damage.
  2. Increased risk of developing hypertension with regular use of NSAID’s.
  3. Inhibiting recovery of connective tissue after exercise.

Kidney Function

NSAID’s interfere with kidney function, and especially with dehydration, can limit clearance of myoglobin (a byproduct of muscle tissue breakdown during extreme exertion, such as marathons and ultramarathons), and this large molecule then plugs up the small filtering and drainage tubes in the kidneys, resulting in damage. There have been many cases of runners who require hospitalization and sometimes even dialysis after such cases of acute renal failure, and some with residual chronic renal insufficiency.

Preventing dehydration is essential, and some caffeine can even help boost kidney function a bit, as long as fluid intake is maintained.

Risk of Hypertension

One study (of 16,000 men with no prior history of hypertension) showed those who used NSAID’s 6 or 7 times a week had a 38% increased risk of developing hypertension; aspirin use caused a 26% increased risk. Even those who used acetaminophen 6 -7 times a week had an increased hypertension rate of 34%.

Inhibiting Connective Tissue Healing / Recovery After Exercise

Studies on ibuprofen use in ultramarathoners showed significantly more inflammation and other laboratory markers of high immune system response after races compared with runners who had not taken NSAID’s. Besides the laboratory signs of mild kidney impairment, there was evidence of damage to the lining of the G.I. tract (stomach and colon), indicating bacteria leakage from the colon into the bloodstream. NSAID’s slow the healing of running-injured muscles, tendons, ligaments, and bones, by inhibiting the production of prostaglandins, which are involved in pain and the creation of collagen. Collagen is the building block of most tissues, and fewer prostaglandins means less collagen, therefore inhibited healing of connective tissue after the micro-tears and other trauma to muscles and tissues that can occur after strenuous exercise. This reaction therefore limits the desirable adaptation to exercise of strengthening tissues, and could increase injuries also.

I recommend limiting the use of anti-inflammatory medications to use with acute muscle and tendon strains, along with the use of ice and other first aid and rehab treatments.