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By Kathleen Choate, ATC, CSCS, CEAS
Athletic Trainer
MUSC Health Sports Medicine

Most of us have seen it or felt it. We see an athlete go down on the field with an injury during a game. The athletic trainer runs out, lifts the leg, pushes the toes back, and starts massaging the calf. This athlete is likely a victim of exercise associated muscle cramps (EAMC) and can cost players valuable playing time. Many players swear by treatments to prevent it such as bananas, pickle juice, Pedialyte, or sports drinks. For some they work, for others they don’t. My goal is to help you learn what strategies are most likely to effectively prevent and treat EAMC.

Causes and Prevention

The currently accepted theory for EAMC is called the “altered neuromuscular control theory.”1  In a nutshell, this theory means that the muscles cramp up because of muscle fatigue.

The strategies for preventing EAMC that have been backed by scientific evidence include the following:
• Training for competition by addressing neuromuscular endurance and muscle imbalances. Plyometrics could be helpful in this area.1
• Tapering workouts in the days leading up to competition.1
• Warm-up prior to exercise. I always recommend a dynamic warm-up.1
• Rest breaks during or in between competitions.1
• Start the competition in a controlled effort.1

While hydration and electrolytes are not currently accepted ways of preventing EAMC, they could help prevent a variety of heat related illnesses. For that reason, you should still plan to hydrate with water or sports drinks prior, during, and after physical activities.

Treatment

The strategies for treating EAMC that have been backed by scientific evidence includes stretching and ice.1  Please don't force the stretch since being too aggressive can cause a strain in the muscle. While ice is effective and a less painful treatment, I’ve noticed that this method usually takes the longest to relieve the cramp.

While still an unproven hypothesis, I personally believe massage or use of a foam roller or stick roller on the affected muscle are also extremely effective. Brace yourself for the pain, because this is also the most painful treatment.

In extreme cases where the cramps do not resolve, especially if multiple body parts are involved, they may have to be treated by a physician in the Emergency Room. If you have muscle cramps frequently, and nothing you’ve tried seems to prevent them, discuss this with your physician to identify any other potential causes and treatments.

References

Edouard, P. (2014). Exercise associated muscle cramps: Discussion on causes, prevention and treatment. Science & Sports, 29(6), 299-305. doi:10.1016/j.scispo.2014.06.004
 

As we finish August and head into the new school year, parents are focusing on keeping their families healthy and happy! MUSC Storm Eye Institute’s Dr. Ed Wilson shares some of his top tips for parents in honor of Children’s Eye Health & Safety Month. Dr. Wilson is a pediatric ophthalmologist, specializing in pediatric cataracts.

Vision Screenings Every 1-2 Years

Children do not always complain when they have trouble seeing and there may be no outward signs of an issue. Parents may not know that their child is having trouble. That is why vision screenings are so important.

Regular vision screenings are available at pediatrician’s offices and often in schools. The American Academy of Pediatrics recommends vision screening beginning at age 12 months and continuing every 1-2 years. These are easy and fun, instrument based screenings that provide a pass-fail result. Those that fail are directed to an eye care provider for a full comprehensive eye exam. 

What can parents can look for? If you notice an odd reflection in your child’s pupil or an intermittent crossing of the eyes, schedule an examination at a pediatric ophthalmology office.

Wear Eye Protection

Dr. Wilson recommends that all children playing sports should wear eye protection. Far too many serious eye injuries occur in youth sports including baseball, basketball, soccer and football. These are all preventable. In addition, projectiles from BB guns, paint-ball guns or pellet guns as well as sharp sticks, darts, and knives cause some of the most serious eye injuries in the 10-14 year age group. 70% of the patients with these injuries are boys.

Monitor Difficulty in School

Children with blurred vision often have difficulties in school. When near-sightedness or astigmatism is present, a simple pair of glasses can change a child’s learning achievement dramatically. Dr. Wilson gives a word of caution, however: specific learning disabilities such as dyslexia, reading or math problems are not usually caused by eye trouble and are not effectively treated with eye exercises.

Early Detection & Treatment of Cataracts

Catching serious eye problems early can preserve a child’s vision. Cataracts can develop in children as early as birth or as late as the teenage years. On the day of birth, a cataract presents as an absence of the normal red reflex (the red glow in the pupil – like the red eye in a photograph). The red reflex is checked by the pediatrician shortly after delivery. When cataracts develop in toddlers or school-aged children the presentation is often a white or grey-white reflex in the pupil, a new onset eye turn (an eye crossing inward or drifting outward) or a complaint of blurred vision and/or glare in bright light.

Early detection and treatment of cataracts in children is essential since delays can caused permanent vision loss from amblyopia (lazy eye). However, not every childhood cataract is severe enough to block vision. An experienced pediatric ophthalmologist needs to evaluate partial cataracts to see how visually significant the cataracts are. Mild or partial cataracts are often followed closely over time since they can worsen as the eyes continue to grow and develop.

Cataract surgery in children is very different than the surgery performed in elderly adults. Pediatric cataract surgeons are usually pediatric ophthalmologists with a special interest in cataracts. These surgeries are best performed by surgeons who perform these procedures frequently and have a dedicated team of technicians and nurses helping. Older children receive an artificial lens implant at the time of cataract removal. Babies, however, more often wear a special extended-wear contact lens after surgery and receive the permanent lens implant later, at around age 4-6 years.

Schedule Your Child’s Vision Screening at the MUSC Storm Eye Institute

The Storm Eye Institute offers the most comprehensive pediatric eye care services in the state. We have a team of four board-certified, award-winning pediatric ophthalmologists and two full-time pediatric ophthalmology fellows. Call 843-792-2020 or visit MUSC Children's Health to learn more and schedule an appointment for your child.

Immunizations are not just for infants and children going back to school. In honor of Immunization Awareness Month, we are shining a light on the vaccines that some may not realize are just as important – vaccines for older adults.

MUSC Health Primary Care doctors Mark Newbrough and Julianna Marwell are geriatricians, focusing on the care of older adults. Illnesses often take a bigger toll on our bodies as we age, including certain infections, such as influenza, whooping cough, pneumococcal pneumonia, and shingles. Fortunately, vaccines, or immunizations, are available that can lessen the chances for older adults to become seriously ill from these infections. 

Recommended Immunizations for Patients Over 50

Dr. Newbrough and Dr. Marwell sat down to talk through their recommendations for most patients over 50. They recommend four main immunizations for the flu, whooping cough, pneumococcal diseases, and shingles. These immunizations are covered by insurance and can be scheduled at a local MUSC Health Primary Care practice.

Flu Shots (Influenza)

Yearly flu shots are the first line of defense for older patients. Flu shots are available without a prescription at your doctor’s offices, community clinics, and pharmacies. Many employers and senior living facilities even offer the flu vaccine on site. The CDC states that getting the flu vaccination can reduce the risk of flu-associated hospitalization and death for older adults. And don’t forget — by getting the flu shot you’re also protecting those around you who may be more susceptible to the flu virus.

Can I get the flu from the flu shot? Dr. Newbrough clears up this common misconception saying, “Because the shot does not contain actual influenza virus, a person cannot get the flu from the flu shot.” There may be some side effects like soreness where the shot was given or low grade fever for a day or so, but the vaccine cannot actually cause the flu.

Tdap Vaccine

Whooping cough can be a serious disease for older adults, those with chronic lung disease, or young children. The Tdap vaccine protects people from tetanus, diphtheria, and pertussis (commonly known as whooping cough).

Although most older adults were immunized for these infections when they were younger, the CDC recommends boosters for all older adults to protect them and those around them who may be susceptible, including their grandchildren and great grandchildren. The Tdap immunization is available at pharmacies without a prescription, as well as at your doctor’s office. Tdap should be given once every ten years.  

Pneumococcal Vaccines 

Older adults are at greatest risk of illness and death from pneumococcal disease, and the pneumonia shots reduce these risks. All older adults need to take both shots, the PCV 13 and the PPSV 23, to be fully protected. The shots cannot be given at the same time, and people need to wait one year between shots. Once an adult over 65 has had both shots, they will not need to take anymore “pneumonia shots.” Pneumococcal vaccines are available at your primary care office, pharmacies, health clinics, and other locations without a prescription.

Shingles

The virus that causes chicken pox and shingles is the same virus. Most older adults were exposed to the chicken pox virus when they were young. Later in life, during periods of extreme stress or medical illness, the virus may reappear as a painful, localized rash called shingles. It can occur anywhere on the body, including in a person’s eye, and the pain may last long after the rash heals. For these reasons, the CDC also recommends the shingles vaccine for older adults. There are two different shingles vaccines including the new Shingrix vaccine. Talk to your doctor about which vaccine is best for you. 

Other Vaccines 

Your health provider can help you understand if there are other immunizations that you may need. For instance, hepatitis A and hepatitis B vaccines are typically recommended for patients with certain conditions like chronic liver disease.

People  with certain allergies or health conditions may not be able to receive certain immunizations, so be sure to talk to your doctor about any conditions or allergic reactions you may have had previously that would affect your immunizations.

Keeping Track of Your Vaccinations

No matter where you get your immunizations, whether at your primary care doctor, pharmacy, or other certified immunization provider, electronic health immunization records are stored in the South Carolina Immunization Registry. These records do not transfer to other states, so keeping your own record is helpful if you’ve just moved to South Carolina or are moving to another state.

Dr. Marwell recommends keeping a record of your vaccines for easy reference, in your wallet or purse, along with a list of medications. Understanding your history helps your care team provide the best possible treatment for your unique needs. It is always okay to ask your provider questions about your care, especially why you’re getting a certain vaccine.

Primary Care Doctors at MUSC Health

MUSC Health Primary Care doctors like Dr. Marwell, Dr. Newbrough, and many more are available to help you with your health care, from vaccines to more complex issues. Dr. Newbrough explains that healthy aging takes a comprehensive approach, not only managing your physical health, but your social, spiritual, and mental health as well. Vaccinations are just one small part of the whole and we are here to help.

MUSC Primary Care Doctor Mark Newbrough with patient

MUSC Health Primary Care appointments are available in locations throughout the Lowcountry including downtown Charleston, West Ashley, Mount Pleasant, North Charleston, Summerville, and more. Call 843-792-7000 to schedule your appointment with an MUSC Health Primary Care physician.

By Marty Travis, MS, ATC
Athletic Trainer
MUSC Health Sports Medicine

It’s fall football season. As usual, coaches, players, and parents are asking about prophylactic knee braces as soon as the first knee injury occurs. There is just no clear answer. Some studies have shown some decrease of MCL injuries on teams using the braces, while other studies have actually shown an increase of MCL injuries when braces are used. Still other studies have shown no significant changes on teams using the braces.

I used to be an advocate of braces early in my career during the 1980s and 1990s, not because of research studies but because the late, great Dr. Bob McDavid was one of my early mentors. He had one of the first patents for prophylactic lateral knee braces/guards. He also had patented many other types of sports medicine equipment. The college football teams that I covered all provided McDavid knee guards to defensive and offensive linemen. The teams had fairly low rate of MCL injuries to the linemen, but this was just a casual observation. I did not conduct any official research studies.

Today I discuss the facts with coaches, parents, and players and let them develop their own feelings on braces. Skill players were always against using braces because they thought they slowed them down, but big linemen seem to lean toward using braces. A big factor in determining whether or not to use braces is financial. The cost can range from $50 for an off-the-shelf brace from a sporting goods shop to $900 for a custom-fitted brace.

Right now I am neutral about using the prophylactic braces for a healthy knee. I recommend parents and athletes read the position statement by the American Academy of Orthopaedic Surgeons on knee bracing to help them decide.

By Amberle Phillips, MA, ATC, SCAT
Athletic Trainer
MUSC Health Sports Medicine

Adequate amounts of sleep are vital for athletic performance and mental function. This is especially true for younger athletes. Sleep deprivation among college-aged athletes can be attributed to travel for sport, stress, balancing academics, athletics, and social life. The National Athletic Trainers’ Association recommends eight hours of sleep for individuals aged 17-22 years.

Sleep deprivation may impact mental health. The body’s ability to deal with stress and emotions depends on sleep to regulate proper functionality. Without sleep the mind is unable to process situations effectively and may cause emotional instability and inability to process stressful situations. Mood and depression are also affected by lack of sleep. Sleep deprivation may cause increased depression and other mood swings. The mind is not the only thing that is impacted by lack of sleep; the body’s cells are also affected.

During sleep is when the cells in the body grow, repair and rebuild helping injuries heal and preventing further injury from occurring. Cells need the rest that sleep provides to catch up on the days’ work that the body did. The cells will repair themselves and create new cells to assist in growth, and repair. The healing of cells that takes place during sleep is also the time when muscle cells and tissue can grow. Poor sleep and shortened sleep may also lead to weight gain and obesity. This is especially true in adolescents whom require more sleep than adults.

Here are a few tips and tricks that can be done to help fall asleep and to stay asleep:

  • Turn off all devices 1 hour prior to bedtime
  • Create a bedtime routine
  • Exercise daily
  • Meditation or total muscle relaxation techniques
  • Avoid caffeine late in the day
  • Stick to a schedule, even on the weekends

 

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