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Guest Post by:

Lindsey Clarke, MS, ATC, CMT
Athletic Trainer;  Massage Therapist Charleston Battery
MUSC Sports Medicine

It’s that time of year again…no, not yard work or taxes, but time for the 38th annual Cooper River Bridge Run.  People from all over the world flock to this event to enjoy the beautiful views of Charleston, participate in a world class distance running event, and spend the better part of the day with 40,000 of their closest friends.  There is A LOT going on for this race…many uncontrollable variables that just make shake the most seasoned runner.  Paying attention to your nutrition is the one variable that day you will have complete control of.  Running a race takes preparation, strength, and energy, and how you approach your pre-race eating plan can affect all three. Throughout training, your diet plays a significant role in helping you perform and recover. In the weeks leading up to the race and immediately before the event, a correctly balanced pre-race nutrition plan will contribute towards your best performance.  If you are a professional, world class runner, or just decided to get in on the action and signed up last week, here are a few tips on giving yourself everything your body needs to have a successful and enjoyable race.

WEEK PRIOR: Moderate quantities of carbohydrate-rich foods will fill your glycogen stores throughout the week leading up to the race. Depending on the length of your race, shoot for about 3-5 grams of carbohydrates per pound of body weight per day, with foods like oatmeal, potatoes, carrots, and other vegetables. For example, a 150-pound adult would need at least 450 grams of carbohydrates per day. Many runners focus so much on getting enough carbohydrates that they don't pay enough attention to their protein consumption. Protein is used for some energy, but mostly in repair of tissue damaged during training. Again, depending on your training/length of race, you should consume .5 to .75 grams of protein per pound of body weight.  Good sources of protein are fish, lean meat, poultry, beans, nuts, whole grains, egg whites, low-fat milk, low-fat cheese and some vegetables.  Being a long distance race, you’ll want to aim for the higher amount of carbohydrate and protein per pound body weight.  This is the time to experiment with discovering which foods work best for you, and which foods you want to avoid…experimenting on race day is never a good idea!

DAY BEFORE: Many beginning runners hear that “carbo-loading” before a race is a good idea and mistakenly overindulge on enormous portions of carbohydrate-rich foods. Gone are the days of indulging in stacks of pancakes or sitting down to an all-you-can-eat pasta bowl.  Instead, continue eating as you have in the week leading up to the race, increasing your intake of up to 5.5 grams of carbohydrates per pound of body weight; a 150-pound adult would need up to 825 grams of carbohydrates. Foods with a moderate to high glycemic index are your best choices before a race. Eat foods like whole-wheat pastas, which contain 40 to 50 grams of carbohydrates per dry cup serving, and vegetables.

MORNING OF:   As a 10K(6.2m), this race is considered a long distance race.  For longer races, your body will require more fuel.  With an 8am start, a more substantial meal is warranted approximately 2 hours prior to start, so set that alarm just a little extra early.  In addition to your meal, it is good practice to have a light snack 1 hour prior to the race. While it may be tempting to run into the Duncan Donuts on Coleman Avenue while waiting for your heat’s start time, bring a granola bar, energy chews, GU, etc as a option for more sustained energy release and a lower possibility for GI distress.

In making food choices, it’s always best to stick with what you know works. No one wants any surprises waiting in cue or during your run!  A well-rounded diet of lean meats, legumes, dairy, fruits, and vegetables is a great way to set your self up for success come race day. Some foods to include in race preparation are:

*Whole grain pastas, brown rice     *Lean proteins; salmon, chicken

*Fresh fruit          *Fruit/Vegetable juice                   *Oatmeal

*Bagels                  *Yoghurt drizzled with honey       *Toast with nut butter

Some foods to avoid in race preparation are:

*Cruciferous vegetables; broccoli, cauliflower     *Sugar-free items/artificial sweeteners

*Bran; cereals, muffins     *Caffeine(unless you regularly consume)

*Fried foods     *fatty meats/high fat cheeses     *alcohol

Another extremely important and often forgotten about component of pre-race preparation is proper hydration practices. Many runners underestimate how much fluid they actually lose during their runs and don't drink enough while they're running as well as post workout/race. The result? Dehydration. This is detrimental to performance and dangerous for your health. In the days leading up to your race, you’ll know you’re properly hydrated if you void a fairly large volume of pale urine at least six times a day. On the day of, drink 8-16oz. of water one to two hours before the race, and then another 4-8oz just before. Consumption will vary depending on the length of your race.


Three to six ounces every 15 to 20 minutes. Water is usually fine. For a tougher runs over 30 minutes, consider a sports drink to replace electrolytes and glycogen.

Three to six ounces every 15 to 20 minutes. A sports drink with carbohydrates and electrolytes will replenish sodium.

Three to six ounces of sports drink every 15 minutes, after which use thirst as your main guide (drinking more if you're thirsty and less if you're not).

Replace fluids, drinking enough so you have to use the bathroom within 60 to 90 minutes after your run(approximately 8-24oz).

Whether you cruised effortlessly across or stumbled through and promptly found a nice patch of grass to flop down on in Marion Square, you’ve finally made it across the finish line!  So what comes next? Post race practices are very important in regards to recovery. Replacing fluids lost and replenishing glycogen stores are crucial and the window of opportunity is small.  It is best to consume a recovery ‘meal’ within the first 30 minutes after completion of the run. The optimum ratio is 3:1 carbohydrates to protein.  Depending on your preference, this meal can take the form of nutrition bars, recovery sports drinks, or even chocolate milk.   There are numerous sponsors that provide fantastic goodies such as yoghurt, peanut butter crackers, bananas, oranges, and more for all runners, so there is certainly no excuse in consuming your post-race snack and replenishing fluids lost.  For longer runs, you should also take in a full meal within 2 hours of completing your race that contains lean proteins, carbohydrates, and maybe even a post-race treat…you deserve it!  This attention to detail in your meals leading up to your race will definitely take a bit of planning, but getting the proper nutrition for pre and post race will not only help your performance and recovery, but will make the experience over all much more enjoyable and successful!

6 Steps to Healthier Kidneys

Step 1 - Know the Facts:

6 things healthy kidneys do: 

  • Regulate the body’s fluid level
  • Filter wastes and toxins from the blood
  • Release a hormone that regulates blood pressure
  • Activate Vitamin D to maintain healthy bones
  • Release the hormone that directs production of RBC
  • Keep blood minerals in balance (Na, Phos, K)

8 Problems Chronic Kidney Disease (CKD) can cause:

  • Cardiovascular disease
  • Heart attack and stroke
  • High blood pressure
  • Weak bones
  • Nerve damage (neuropathy)
  • Kidney failure (ESRD)
  • Anemia
  • Death

Step 2 - Assess your Risk: 

  • 4 Main Risk Factors:  Diabetes, High Blood Pressure, Cardiovascular Disease, Family History of Kidney Disease/Diabetes/High Blood Pressure
  • 10 Additional Risk Factors: African American Heritage, Native American Heritage, Hispanic, Asian or Pacific Islander Heritage, Age >60, Obesity, Low Birth Weight, Prolonged use of NSAIDs, Lupus and Other Autoimmune Disorders, Chronic UTIs, Kidney Stones

Step 3 - Possible Trouble Signs:

Most people with early CKD have no symptoms, which is why early testing is critical. By the time symptoms appear, CKD may be advanced, and symptoms can be misleading. Pay attention to these:  fatigue/weakness, difficult/painful urination, foamy urine, pink or dark urine, increased need to urinate, puffy eyes, swollen face/hands/abdomen/ankles/feet, increased thirst.

Step 4 - Get Tested:

4 Simple Tests: Blood Pressure, Protein in the Urine, Creatinine in Blood, Glomerular Filtration Rate

Step 5 - Stay Healthy:

6 Things People with CKD should do: 

  • Lower high blood pressure
  • Keep blood sugar levels under control, if diabetic
  • Reduce salt intake
  • Avoid NSAIDs (painkillers such as ibuprofen and naproxen)
  • Moderate protein consumption
  • Get an annual flu shot

9 Things Everyone should do:

  • Exercise regularly
  • Control weight
  • Follow a balanced diet
  • Quit smoking
  • Drink only in moderation
  • Stay hydrated
  • Monitor cholesterol levels
  • Get an annual physical
  • Know your family medical history

Step 6 - Learn More:

  • Do you need a kidney health check? KEEP HEALTHY- NKF offers free kidney health checks in communities across the country.  A screening will be offered in Charleston on Sat, March 20th from 9am-1pm at Mt. Moria Baptist Church in North Charleston. Learn more.
  • To learn more about CKD risk factors, prevention and treatment, visit

Guest Post by:

Stephanie Davey, ATC
Certified Athletic Trainer
MUSC Sports Medicine

Kansas Jayhawk fans held their breath on March 3 as star forward Perry Ellis was clutching his right knee after a teammate fell into him.  He was assisted off the court and taken to the locker room.  He returned back to the bench at the end of the game wearing the team warm ups.  It was reported at that time that Ellis had a MRI that showed a sprained knee, but otherwise was negative.  Ellis, a first team All Big 12 power forward, averages 13.8 points per game and 7.0 rebounds per game.  He is considered Kansas’s best player and the key to a deep run in the NCAA Tournament.

A sprained knee is a diagnosis that many teams release to the media.  It can encompass multiple different injuries of different ligaments.  The knee has 4 main ligaments that provide stability to the joint.  The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) cross through the middle of the knee from the femur to the tibia. The ACL prevents anterior translation and medial rotation of the tibia.  The PCL prevents posterior translation of the tibia from the femur.  The medial collateral ligament (MCL) and lateral collateral ligament (LCL) provide side to side stability of the knee.  The MCL goes from the inside of the femur to the inside of the tibia and prevents a valgus stress.  The LCL attaches from the outside of the femur to the head of the fibula and prevents varus stress.  Ligament strains are typically graded from 1 to 3.  Grade 1 is generally mild tearing of the ligament.  The joint is usually still stable.  Grade 2 is more severe tearing of the ligament with joint instability and moderate to severe pain.  Grade 3 is typically a complete rupture of the ligament.

In Ellis’s case, it was later reported that he sprained his MCL.  When his teammate fell into the outside of his right knee, he forcibly pushed his knee to the inside creating a valgus stress.  Coach Bill Self said that Kansas doctors were optimistic that Ellis’s injury was not severe and that he would be able to return to play for the post season.  Treatment for a MCL sprain varies depending on the severity of the injury, but typically does not include surgery.   Managing pain and swelling should begin immediately, followed later by range of motion and strengthening exercises.  An athlete should have full range of motion and strength prior to return to play.  He or she should also be comfortable with the mobility necessary for the sport.  A brace with medial support is usually used for additional protetion.  While an athlete may be fully cleared to play, it is difficult to say how effective he will be once he returns to play and what the effect of the injury will have on his skills.

Fortunately, Ellis was able to return to play in the semi finals of the Big 12 Tournament.  He missed two games.  Kansas went 1-1 in those two games.  He played in the final two games of the Big 12 tournament reporting that he felt good after the games.  Kansas will need a healthy and effective Perry Ellis to make a deep March Madness run and no doubt the sports medicine staff will be working overtime to make sure that happens.



What can young baseball and softball players learn from the pro’s training routines?

Guest post by:

Shane K. Woolf, MD
Chief, Sports Medicine
Associate Professor
Department of Orthopaedics
Medical University of South Carolina

Sunday was the first game of Major League baseball’s spring training. The excitement of the 2015 season is now in full swing. Pitchers and catchers reported to training over the past 2 weeks and the full squads generally reported about 5 days later. The drills, cardio work, flexibility/strengthening routines, and technical fine tuning over the next month will be essential to get players conditioned in time for the MLB season opener on April 5th.

Practices in the early weeks usually involve morning training routines on the fields adjacent to the spring game stadiums. Pitchers, catchers, and some position players returning from injury are usually the first to report. This enables them to work on throwing arm flexibility, strength training, core rehabilitation, throwing mechanics, or recovery from injury before the chaos of full team practices and preseason games sets in.

So, what aspects of spring training can be adopted for all baseball and softball players, from youth leagues up through elite college level ball?

General Fitness Considerations

First and foremost, players would ideally report to training already engaged in a preseason fitness program. Opening day for the Majors is only 4-6 weeks away from reporting day, so attempts to ramp up fitness from scratch in such a short period of time can be a set-up for early season injury.

Another general consideration is that an adequate nutritional program is essential to promote fitness, recovery, and improvement through the season. Most important is to balance caloric intake and include sufficient protein for recovery and healing of tissues stressed during activity. Maintaining hydration during and after practice is also essential. In particular, as athletes participate in progressively intense training or play, the metabolic and fluid needs of the body increase.  Similarly, a progressive program with ample rest is important to allow the body to adapt to higher intensity activity.

Flexibility Development

All Major League players participate in some type of flexibility program. Shoulder, back, hip, and lower limb flexibility is important no matter the position. A general daily flexibility program should be built into the training routine. One study showed that a dynamic stretching program could reduce hamstring injury risk, for instance. (1) For throwers, though, tightness of the back part of the shoulder joint (posterior capsule tightness) can alter throwing mechanics, increase impingement, and increase rotator cuff injury risk. (2) For the thrower, stretching the posterior shoulder joint capsule with ‘sleeper’ and ‘crossbody’ stretches can reduce risk of injury to the dominant shoulder as well as other structures like the elbow ulnar collateral ligament. (3) What thrower wouldn’t want to avoid an injury that could lead to Tommy John surgery?

Strength, Speed, and Agility Training

Core as well as throwing shoulder strengthening is the cornerstone of performance. Performance is improved with full-body resistance training and rotational plyometric work for bat speed. Upper body plyometric exercises are important for throwers. (4) A 2010 study showed that preseason weakness of the rotator cuff predicted higher risk for injury requiring surgery in professional pitchers. (5) So focusing on strength of the throwing shoulder can also help reduce injury rates.

Agility, speed, and lower-body power have been shown to be predictive of better performance in baseball players. (6) Thus, focusing on these areas during training and through the season can enhance performance. To develop speed, strength and conditioning coaches use form running drills. Squats, lunges and plyometrics are common core/hip programs. (7) While these specific exercises may not be appropriate for youth players, certainly box jumps, sit-ups, and plyometric hip exercises can be beneficial to players of all ages.

Metabolic Fitness

Baseball and softball are fundamentally sports that demand explosive power and speed more than aerobic endurance. Thus, cardiovascular and metabolic training in the preseason should focus on repeated sprints, jumps, plyometric, and agility work at near maximal exertion levels to enhance anaerobic performance. (8,9)

The key is to have an organized program in place and to engage the athletes in their own progress as well as injury risk reduction. To stay healthy all season, the athlete must prepare properly and early. If an unfortunate injury does develop, seek out the expertise of a sports medicine specialist, such as the team of professionals at MUSC Health Sports Medicine.


1 O’Sullivan et al: BMC Musculoskelet Disord (2009)
2 Myers et al: Am J Sports Med (2006)
3 Dines et al: Am J Sports Med (2009)
4 McEvoy and Newton: J Strength Cond Res (1998)
5 Byram et el: Am J Sports Med (2010)
6 Hoffman et al: J Strength Cond Res (2009)
7 Ebben et al: J Strength Cond Res (2005)
8 Rhea et al: J Strength Cond Res (2008)
9 Wallace et al: J Sports Med Phys Fitness (2007)

Did you know that 1 in 3 Americans are at risk for kidney disease? MUSC Health and the National Kidney Foundation are working together to increase kidney health awareness throughout South Carolina.

Kidney Health Awareness Event Calendar

National Kidney Health Awareness Month Kick-off Event

Wednesday, March 4, 2015
MUSC Horseshoe, 12:00 noon
Guest speakers and a special surprise!

Columbia Kidney Walk

Sunday, March 15, 2015
More information

KEEP Healthy Event

Saturday, March 21, 2015
Mt. Moriah Baptist Church, North Charleston
9am-1pm More information

Charleston Kidney Walk

Sunday, March 22, 2015
More information

Upstate Kidney Walk

Sunday, April 26, 2015
More information


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