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MUSC Health Blog

Keyword: orthopaedics

Guest Post by:
Lindsey Clarke, MS, ATC, CMT
Athletic Trainer
MUSC Sports Medicine

Favorite singlet? Check.
Shoes? Check.
Race number? Check.
Pre-race nutrition plan? Ummmmm.

Running a race takes preparation, strength, and energy, and how you approach your pre-race eating plan can affect all three. 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. Throughout training, your diet plays a significant role in helping you perform and recover. Whether you are a novice running your first race, or an experienced runner with countless races under your hydration belt, 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. This is the time to experiment with discovering what 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: The length of your race will determine what and when you’ll eat. For shorter, higher speed races, you’ll want to take in a lighter meal approximately 90 minutes prior to the start. This will provide you the energy to get you through the race, but will also aid in preventing any gastro-intestinal distress. For longer races, your body will require more fuel, so a more substantial meal is warranted approximately 2 hours prior to start in addition to a light snack 1 hour prior to.

In making food choices, it’s always best to stick with what you know works. 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.

LENGTH OF RACE:

ONE HOUR OR LESS
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.

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

OVER FOUR HOURS
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).

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

Whether you dragged yourself over or kicked it out with your arms raised high, you’ve 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. 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!

Guest Post by:
Stephanie Davey, ATC
Certified Athletic Trainer
MUSC Sports Medicine

bridge river run image
Runners Ready for the Cooper River Bridge Run

So you’ve decided to run a 5K or 10K race. There are a few things to consider before you start your training. First, select a quality running shoe. Find a reputable running store to have your foot properly fitted. Many shops have treadmills and will let you run in them prior to purchasing them. The shoe should fit you and your specific foot needs.

 

Second, you need to decide when and how long you need to train. If you’re new to running, you should start you’re training program eight weeks prior to the 5K race. There are many training plans available online to help guide your training. Every good running program should include running, strength training, stretching, and rest. Depending on your fitness level, you can start with a run/walk program. These programs slowly increase running while decreasing the walking until you’re running the entire time. Strength training should be balanced between lower extremity, upper extremity and core exercises. A proper strength training program will not only make you stronger and faster, but it will also aid in injury prevention.

Stretching should happen both before and after your workout. Start your workout with gentle dynamic stretching to warm up your body. These stretches should not only warm your muscle, but should also start to slowly raise your heart rate. After your workout, plan on at least ten minutes of gentle cool down stretching. Give special attention to your calves, hamstrings, quadriceps, hip flexors, and gluteus muscles. These muscles do most of the running work and are the most prone to injury.

The last part of your training program is rest. Depending on your mindset, it could be the most important part. You should have one to two non-running days built into your program. If you do two days, one of these days can be easy cross training such as cycling, the elliptical trainer, yoga, or Pilates. The second day could include some gentle stretching. Rest helps keep your body fresh and injury free.

Unfortunately, injuries are part of running. While not all are preventable, most injuries can be prevented with a proper training program. If you start to have pain, listen to your body. You can modify any program by adding cross-training or rest days. If an injury lingers, consider seeing an orthopedic doctor for a diagnosis and specific plan to rehabilitate.

Hopefully, you enjoy your training. If you don’t, find a way to modify it. That could mean finding a training partner, or finding a new location. If you normally run on a treadmill, try running outside. Running groups are popping up all over the place. These groups usually have varied interests and have runners at all levels. A group can not only make running more fun but will help hold you accountable!

Guest post by:
William K. McKibbin, MD
Assistant Professor of Orthopaedics
Division of Foot & Ankle Surgery

“Plantar Fasciitis” is the diagnostic term we use for what represents the most common cause of heel pain, localized to generally the bottom, or “plantar” aspect of the heel. Quite literally, the term can be taken to mean “inflammation of the plantar fascia”. This is probably over-simplistic, but works for the discussion of this very insidious and sometimes long-lasting problem in athletes, particularly middle aged “weekend warriors”. The plantar fascia is actually a thick, long ligament that originates at the base of the heel and attaches to the bases of the toes in rather complex fashion. Among other functions, it importantly assists in the maintenance of the foot’s arch structure.

Courtesy American Orthopaedic Foot and Ankle Society

Usually, this type of heel pain occurs without any real inciting event, such as an injury. “Overuse” is most often blamed. We just happen to notice it when we try to step down on the heel, particularly in the morning getting out of bed, or after sitting for a while. This “start-up” pain often causes us to walk on our toes, or up on the ball of the foot, until it calms down enough to walk more normally. The discomfort though can become worse during the day, particularly on concrete floors. It can be quite severe, almost feeling like a “stone bruise”, or even “knife-like”.

plantar fasciitis
Courtesy American Orthopaedic Foot and Ankle Society

Many different types of healthcare providers see patients who present with plantar fasciitis. There are several treatments out there as you might guess, and many of you will essentially on your own try things like stretching, icing, shoe inserts (orthotics), massage, OTC anti-inflammatory medicine, or even the “tincture of time” in order get this problem to go away. The internet is full of free advice, no question (a reasonable discussion can be found at the American Orthopaedic Foot and Ankle Society page). No one really knows what treatment(s) for any one particular individual with plantar fasciitis is(are) going to be ultimately effective in obtaining long term resolution – that is, the state of being pain free, without recurrence. That all stated, there are biases of opinion that I’ve formed over time, in the evaluation and treatment of plantar fasciitis.

The first bias that comes to mind is one of diagnostic “mistaken identity” – that is, the idea that the “heel spur” is the actual culprit. I disagree with that notion entirely, and am of the opinion that the spur that’s commonly found on x-rays is a manifestation of the ongoing inflammation, and not the cause of it. For that reason, I never recommend surgical removal of the spur. In point of fact, many patients with plantar fasciitis will not have a spur at all; and patients who come in for other reasons with no heel pain at all will have a spur show up on their x-rays! Finally, it is probably instructive to know that the spur, when present, “points” forward to the toes, and not down towards the floor into the heel pad tissue.

The most important bias that I hold with this diagnosis relates to what I really believe to be the most common cause for plantar fasciitis – that is, calf muscles that are too tight, too contracted. There is an emerging body of scientific literature in orthopaedics which supports this notion, but does not come right out and prove it. The idea is that calf muscles which are too tight, not stretched out enough, will result in “overpull” of the Achilles tendon at the back of the heel. This chronic and repetitive pull translates immediately downstream to the contiguous plantar fascia, which may set up a chronic inflammatory process. This bias has led me to essentially abandon many common “textbook” treatments (such as cortisone shots, frozen bottle massage, etc.), in favor of those which work on the attainment of a more supple set of calf muscles. Examples would include stretching, physical therapy, night splinting, and even casting. To be clear, there are no quick fixes as this can take some time. Patience usually wins out; I have come to realize that surgery is rarely necessary for the successful resolution of this very common, and sometimes stubborn foot problem.

Having trouble with resolving your plantar fasciitis? Schedule an appointment with Dr. McKibbin by calling 843-876-0111.

On September 5, 2014, Charleston celebrated the career of soccer defender John Wilson. Prior to the match midfielder Zach Prince presented Wilson with a Battery jersey with the number 269 on the back, representing the number of matches Wilson has played for the Battery. In his time with Charleston, Wilson wore the number 25. In the 25th minute of the game, he was treated to a standing ovation from the home crowd. This game was Wilson’s last regular season game.

John Wilson in 2012
John Wilson in 2012

 

The Sports Medicine Team at MUSC Health is proud to have been a part of John Wilson’s soccer career. Our athletic trainers worked with John in his rehabilitation before he joined the Charleston Battery and continued the relationship with the team. Mike Barr, MUSC Sports Medicine Program Manager, spoke of his work with John Wilson. “John’s dedication to his sport and profession is second to none; I have never worked with an athlete as dedicated to his body and his recovery as John. His hard work and dedication is what made him a true professional and allowed him to continue to play and have such a long and successful career.”

We join with the rest of Charleston in wishing John all the best in his retirement from the Battery and know that he will continue to spread the message of soccer joy to kids around the country.

Guest Post by:
Marc Haro, M.D., MSPT
Department of Orthopaedics
Division of Sports Medicine

Looking back as the Major League Baseball (MLB) season begins to wind down and we head into the playoffs, it seems as if there have been a rash of elbow injuries around the league this season. Major media organizations have been commenting on the increasing rate, or as some have characterized, an “epidemic”, of elbow injuries in young throwers. Based upon the media reports, it does seem that an alarming rate of young throwers are going down with ulnar collateral ligament (UCL) injuries.

Over the past several seasons, many high profile baseball players, including Stephen Strasburg of the Washington Nationals, Matt Harvey and Bobby Parnell of the New York Mets, Jose Fernandez of the Miami Marlins among many others have suffered season ending UCL injuries. So far this year alone, 29 players have either underdone or are planning to undergo UCL reconstruction (also know as Tommy John surgery). MLBreports.com has attempted to collect a list of MLB players who have undergone UCL reconstruction, starting with Tommy John himself in 1974 up to the current date (http://mlbreports.com/tj-surgery/)?1. Just looking at the list, you can see how the incidence in major league baseball players has exploded over the years. A recent study in the American Journal of Sports Medicine out of Rush University in Chicago reported that from 2010-2013, an astounding 216 MLB pitchers underwent an UCL reconstruction.2

Growing up a competitive high school baseball player, I remember occasionally hearing about players injuring their elbow and undergoing Tommy John surgery, but is certainly was not a common occurrence, and it was certainly uncommon in high school and youth level sports. This begs us to ask several questions. First what is the ulnar collateral ligament and is there really an increasing rate of injuries in baseball players? If there is, what is causing these injuries and is there anything that we can do about it. What do we need to know about ULC reconstructions?

Famed orthopaedic surgeon and a pioneer of Tommy John Surgery, Dr. James Andrews at the American Sports Medicine Institute (ASMI) has published their rate of UCL reconstructions and were alarmed by the rate of these surgeries occurring in youth and high school athletes. Over the past decade approximately 20-30% of all Tommy John surgeries were performed in youth or high school athletes.3

As you can imagine, throwing a baseball is a complicated processes that uses the muscles to generate a tremendous amount of torque arm. Studies have shown that the velocity generated around the elbow can reach as almost 3000o per second!4 During the acceleration phase of throwing, the main restraint to this tremendous force at the elbow is the ulnar collateral ligament. The ligament can be injured with a single acute injury, but more commonly it seems repetitively overloaded until it ultimately fails. Athletes will often have pain on the inside of their elbow and notice a sharp decrease in velocity and endurance. Often this causes athletes to seek medical care.

Several factors have been shown to be risk factors for UCL injuries including poor throwing mechanics, fatigue, poor physical conditioning, early throwing of breaking pitches, improper warm ups, high velocity throwing etc. However, one risk factor that has stood out the most is overuse. The sheer volume of throwing that young throwers are doing these days seems to have a direct correlation to the rate of UCL injuries. Several studies have shown that pitching year round, pitching on multiple teams, playing catcher when not pitching are linked to increased UCL injury rates. When we perform these surgeries, the ligament often does not appear as if it has recently torn, instead it appears as if it has slowly worn out over time.

Dr. Andrews recently released an excellent Youth Baseball Position Statement with the hopes of curtailing this epidemic. Among his recommendations are to watch carefully for signs of fatigue and to follow pitch/inning counts to prevent overuse. He also recommends optimizing throwing mechanics; avoid the early use of breaking pitches and allow throwers to take 2-4 months off from throwing each year. Nowadays with year round baseball, this can be a tough proposition for an athlete. If there are signs of elbow or shoulder pain, throwing should be discontinued until a sports medicine physician can evaluate them. This is an excellent position statement and should be read by all athletes, parents of athletes, coaches and sports medicine professionals. It can be found at http://www.asmi.org/research.php.

Even with careful monitoring however, these injuries do occur. Unfortunately there are also many misconceptions about the surgery.5,6 One of the major misconceptions by players, parents and coaches is think that it will allow them to throw harder after surgery. While performance may improve after surgery, this is likely due to the fact that they were under performing with the injury prior to their reconstruction. Studies have shown that almost 20% of patients undergoing Tommy John surgery will never return to their previous level of throwing7 and these are in professional athletes with a huge amount of financial resources behind them including physical therapist, athletic trainers, personal trainers and a team of physicians.

So as the MLB season comes to a close and youth summer ball transitions to fall ball, we need to pay attention to the health of our throwing athletes. Athletes, parents and coaches need to be mindful of how many pitches are being thrown throughout the year and make sure that they get enough rest during the off season to allow their elbow to recover. With proper education and awareness of everyone, hopefully we can then prevent this epidemic of elbow injuries from continuing.

For additional information visit the MUSC Health Sports Medicine website.

References:

1. Tommy John Surgery Tracker 1974 – Present: http://mlbreports.com/tj-surgery
2. Erickson BJ, Gupta AK, Harris JD, et al. Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers. Am J Sports Med. 2014;42(3):536–543. doi:10.1177/0363546513510890
3. Youth UCL Surgery “Tommy John Surgery”. AMSI. http://www.asmi.org/research.php?page=research&section=UCL
4. Werner SL, Fleisig GS, Dillman CJ, Andrews JR. Biomechanics of the elbow during baseball pitching. J Orthop Sports Phys Ther. 1993;17(6):274–278. doi:10.2519/jospt.1993.17.6.274.
5. Position Statement for Tommy John Injuries in Baseball Pitchers. AMSI. http://www.asmi.org/research.php?page=research&section=TJpositionstatement
6. Ahmad CS, Grantham WJ, Greiwe RM. Public perceptions of Tommy John surgery. Phys Sportsmed. 2012;40(2):64–72. doi:10.3810/psm.2012.05.1966.
7. Cain EL, Andrews JR, Dugas JR, et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up. Am J Sports Med. 2010;38(12):2426–2434. doi:10.1177/0363546510378100.

 

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