What influences athletic performance?

• Athletic Performance– Genetic Endowment– Optimal Training– Good Nutrition

• Most common dietary sources among 2-18 year olds– Grain Desserts– Pizza– Soda

Reedy J, et al. J Am Diet Assoc; 2010; Volume 110 (Oct).

Sports Nutrition• Performance Nutrition Means:

– Fueling to boost athletic performance on a daily basis– Fueling to decrease risk of injuries, recover fully from

workouts and stay healthy– Fueling with foods that taste good that also provide

optimal nutritional benefits– For the elite athlete and casual exerciser

1) Focus More on Whole FoodsWhole Foods• Natural Grains/Starches• Fruits• Vegetables• Meats• Nuts/Seeds• Herbs/Spices

Chemical Based Foods• Foods from boxes

– Cereals, pasta, crackers, potatoes, pasta

• Bread based products• Juice/Energy Drinks/Soda• Foods with Added Sugars

and Added Salts

2) Eat Breakfast Daily• Infrequent breakfast consumption = body fat• Protein-rich breakfast meals

– Egg omelet with sweet potatoes– Cottage cheese with fresh fruit– Plain Greek yogurt with fruit and (added fun)– Breakfast burrito (homemade preferred)– Protein shake (fruit, protein powder, base)– “beefed up” Oatmeal

3) Eat Consistently• Goal is to eat every 3-4 hours

– Focus on protein and carbs with most feedings• Eating at least 5-6x/day

– Does not have to be meal/snack/meal/snack format• Going long periods of time without eating or meal

skipping – Down regulates metabolism, worsens insulin and blood

sugar control, negatively effects hunger hormones

4) Post Workout Nutrition• “Metabolic Window” is highest within 30 minutes

of workout• Increased blood flow to muscles

– High sensitivity to insulin and nutrient uptake• Enzymes that produce glycogen are most active

Post Workout Nutrition• Eat 15-45 grams of protein within 30 minutes after

workout + carbs!– Up to 20% of body weight in protein

• Avoid fat if possible = slows down absorption of AA• Eat a balanced meal within 2 hours after workout

Post Workout Protein and Carbs

5) Hydration• Drink 8-20 oz an hour before workout• Consume 4-8 oz every 15 minutes during workout• Drink 16-34 oz for every lb of sweat loss after

workout• Exercise < 1 hour = water

> 1 hour/salty sweater = sports drink• Check your urine!

Goals and Objectives• Overview of Sports Injuries• Understanding of Prevention Strategies• Components of Fitness • Age Specific Concerns

Background of Youth Sports Injury• Millions of children participate daily• Learn to improve Fitness Coordination Team Play• Risk of injury just by participation

Each year 3.5 million sports-related injuries occur in U.S. children ages 5

through 14!

Magnitude of the Problem

• 3.5 million sports injuries for children < 15 years of age treated in medical settings– ¼ of all Emergency Department visits

• For children involved in organized sports– 770,000 physician visits – 90,000 hospitalizations / year– 70-80% injuries are minor (< 1 wk of practice missed)

• Children’s physical activities today are much different than they were 50 years ago- Free play more variability

• Organized sports Today=only exercise kids get–Too much structure and pressure?–All year long?–Multiple teams ?

Types of Injuries Acute vs. Chronic

• Both may involve soft tissue or bone• Acute

– Result from a collision or sudden twist– Examples = Sprains/Strains, Contusions, Fractures

• Chronic / Overuse – Repetitive, small injuries due to repeat motions– Increased today as children strive for excellence at

younger ages– Examples = Pitching a baseball, Running cross country

Youth Sports InjuriesReasons for Concern

• Children are Still Growing• Growth Plate Injuries• Variable Size and Maturity

Children are NOT Small Adults

Preventing Sports Injuries

• Field/Equipment Changes• Rule Changes/Coaching• Individual Preparation

Individual Preparation

• Learn about the game prior to signing up• Purchase the recommended equipment• Pre-participation physical exam• Preseason conditioning• Practice and train within limits• Stay well hydrated

Why do we get injured?1. Too much load.

OR

2. Poor overall conditioning.

OR

3. Bad luck!

Load: “the cumulative amount of stress placed on an individual from a single workout or over a period of time.”

How do we control load?1. Manage weekly training load.

2. Progress loading gradually.

3. Raise our optimal zone.

Raising our optimal zone….

Injuries in Sport

•Games = Injuries (Morgan & Oberlander, 2001).

•Fatigue = Injuries (Gabbett et al., 2004).

Why is Strength & Conditioning so important?

• Injuries can be reduced with:– Weights (Askling et al., 2003).

– Plyometrics (Heidt et al., 2000).

– Sprint training (Heidt et al., 2000).

– Balance training (Emery et al., 2007).

– Core stability (Holmich et al., 2009).

– Progressive warm up (Gilchrist et al., 2008).

STRETCHING

STRENGTHENING

SMARTS

• Little league shoulder and elbow– Strength of rotator cuff and scapular muscles– 180 degrees of internal / external rotation of the

shoulder.– Pitching limitations– No year round playing!

• Pitches– 17-18 y/o 105 per day– 13-16 y/o 95 per day– 11-12 y/o 85 per day– <10 y/o 75 per day

• No curve balls under the age of 14• www.littleleague.org

“I warned you to loosen up properly before pitching or something like this would happen.”

“THROWER’S TEN” EXERCISES

www.andrewsortho.com/education/ThrowersTenExercises

• www.usaswimming• Similar principles as baseball• Shoulders instability and hyper flexibility• Tooooo much!!!

Knee Injuries

ACL Anterior Cruciate Ligament Injury Facts

• 95% 16-45 years• Soccer and basketball• Non-contact • Female 4-8 times risk

Theories of Increased ACL Injury•Anatomy•Alignment•Hormonal influence•Training factors

Can we prevent the epidemic?

We CANNOT Control• ACL size• Notch width• Pelvis shape• Knee and foot position

We CAN Control• Strength• Landing mechanics• Muscle recruitment

Multifactorial Analysis of Anterior Cruciate Ligament Injuries in the Teenage Female: A Longitudinal

StudyBy

Diane Hillard-Sembell, MD, PTTodd Duellman, MD, PT

ACL Injury Prevention Recommendations

Athletes should be trained pre-season if:• Excessive knee valgus “knock-knee”• Quadriceps dominance• Side-to-side strength/coordination differences

ACL Injury PreventionNeuromuscular Training Techniques• Strong Athletic Positioning• Good body control• Light/quiet landing dissipates force• Flexed “ready” position

Sportsmetrics© ACL Prevention • Dynamic Warm-up• Jump/Plyometric

Exercises• Strength Training• Stretching

A Program of Cincinnati Sportsmedicine Research & Education

STOP Sports Injuries

STOP Sport Injuries

S ports T rauma & O veruse P revention

STOP Sports Injury

• Get a preseason physical & be in condition• Get proper instruction• Develop age-appropriate skills• Increase training gradually• Don’t specialize in 1 sport• Don’t play year round• Warm up and cool down• Don’t play through pain

Overall Conditioning

1.

2.

3.

4.

5.

Stability / Mobility

Strength

Strength - Technique

Stability - Muscle Endurance

Rating ScorePoor <20

Satisfactory 20-40s

Good >40

Rating ScorePoor <10

Satisfactory 10-40

Good >40

Rating ScorePoor <60s

Satisfactory 60-120s

Good >120s

Rating ScorePoor <120s

Satisfactory 120-180s

Good >180s

Plank

Side Bridge

Double Leg

LowerSingle leg hamstring

bridge

Stability – Other Examples

Exercise for Successful

Aging

Exercise and “Aging”• ↑Body Fat• ↓ Muscle Mass• ↓Aerobic Capacity

– 1% YearEXERCISE IS BEST INSURANCE!!

Exercise and Aging

Don’t succumb to the “Weekend Warrior”

syndrome.

Develop a balanced fitness program

• Cardiovascular exercise• Strength training• Flexibility• Balance• Functional and variable • High Intensity• Sport specific performance

Always take time to warm up and stretch for physical activity.

• Flexibility– Many lower extremity overuse injuries can be

effectively prevented/treated with stretching• Achilles• Hamstring/Quads/IT Band• Hip flexors/adductors/abductors• Low back*Benefits of Yoga

Stretch

Exercise does NOT cause arthritis!

In fact, physiologic loading is necessary for cartilage health.

Knee Joint Arthritis

Healthy knee joint Arthritic knee joint

Exercise

• Improving the range of motion and strength has been shown to increase mobility and decrease pain in mild to moderate OA

• High impact forces should be avoided – Instead Bike, Swim, Walk, Elliptical

Exercise• Aerobic conditioning

– Moderately vigorous (70-85% max HR)– 3 times/wk– At least 30min

• People with OA who do this consistently have decreased pain and disability– Improve CV fitness 25-50%– Improve muscular fitness 100%

Weight Loss

• If we could go from:• Obese overweight• Overweight normal weight

– This would prevent 33% of all knee OA in women and 20% in men

The Only Diet Plan

• Highest incidence of overuse injuries• 70% each year will experience an injury

• Eliminate training errors– Slow and low (10% rule)– Change your shoes / arch supports– Listen to your body– Good diet – Cross Train

• Strength- don’t forget to lift weights and cross train– Core and Hip – Quads– Hamstrings– Calves

Summary

• All sports pose some risk of injury• Know the rules, equipment, and who will coach• Avoid early specialization/year round youth sports• Build in rest periods• Seek a pre-participation physical exam• Cross train, strength and stretch• Train smart, play hard, and have fun!

VICTORY!

Other Resources

• www.STOPSportsInjuries.org• www.orthoinfo.org• www.nata.org• www.sportsmed.org• www.SAFEKids.org

Stretching• Stretching is the single best way to prevent and

recover from injury • Static vs. Dynamic– Static Stretching

• Hold for 30 seconds

– Dynamic or Ballistic Stretching • Bouncing repetitive movement

Stretching• How often?– Breakfast, Lunch, Dinner

Stretching• Look above and below for flexibility– Hamstring and hip flexor stretching for low back

pain– Shoulder for elbow – Calf for feet– Bent and straight leg calf stretching plus toe down

stretch for shin splints

Ice vs Heat• Ice– Lowers metabolic rate– Vasoconstriction– Slows nerve conduction

• Decreases pain and muscle spasm

– Acute injuries and post activity

Ice vs Heat• Methods of icing – Ice packs (bags)

• 20 minutes on 40 minutes off

– Cold water immersion• 50-60 degrees • 10-15 minutes

– Ice massage– Frozen water bottle

Ice vs Heat• Heat– Increase in tissue extensibility– Vasodilation– Decreases pain– Chronic injuries and pre activity

Ice vs Heat• Methods of Heating – Moist heat pack

• 15-20 minutes

– Warm whirlpool• 98-104 degrees • 10-20 minutes

–EXERCISE!!!!

Ice vs. Heat• Contrast bath

– Mild tissue temperature increase– 3:1 or 4:1 heat:ice– 105 degrees heat 50-65 degrees cold

• 15-20 minutes

• Always finish with cold• Very low evidence that contrast bath creates a pumping

effect

Rest and its Importance• Year round obligations• Often the rest time of in-season sports are filled with

workouts, practices, or games from secondary sports

– Rest is necessary for muscles to repair, rebuild, and strengthen

Rest and its Importance• Without sufficient time to repair and replenish, the

body will continue to breakdown from intensive exercise.

– Rest time can be days or weeks depending on the training cycle

• in-season vs. post-season

Rule of Three • 1. Everything is great • 2. Maybe I’ll just finish this set, sprint, period, ect.• 3. Too late…… its injured

The two weeks rule

•Little things become BIG THINGS

• If injury occurs…

Reference• Arnheim, D. D., & Prentice, W. E. (2013). Principles

of athletic training: A competency based approach (15th ed.). Boston, MA: McGraw-Hill Education.

The End• Thank you for your time and attention if you have

any questions feel free to contact me at: jwiezorek@springfieldclinic.com

217-415-5806