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Keyword: sports medicine

By T. Ryan Littlejohn, ATC, CES
Certified Athletic Trainer
MUSC Health Sports Medicine

Does your son or daughter play sports? According to the Open Access Journal of Sports Medicine, three out of every four families have at least one child playing school sports. This leads to another very important question: does your child have adequate medical coverage at their school? Having an athletic trainer or other qualified medical person onsite to address athletic injuries is essential for every school. According to the American Orthopedic Society for Sports Medicine, high school injuries account for an estimated: two million injuries; 500,000 doctor visits; and 30,000 hospitalizations a year. Furthermore, the CDC reports more than half of these injuries can be prevented and, many of these injuries are overuse injuries. Overuse injuries are caused by athletes not resting enough from their sport causing repetitive trauma to their body. A certified athletic trainer is a highly-qualified medical professional that can address these issues and many other athletic injuries. They are able to treat a variety of sports injuries and help keep the cost of medicine down, reducing hospital and doctor visits. Athletic trainers are trained in areas of prevention, rehabilitation, evaluation assessment, immediate care, and organization administration. This includes responding to emergencies by providing CPR and calling 911 when necessary. The statistics for injuries are alarming; however, it can be addressed by having adequate coverage for these athletic events. Hiring an athletic trainer is essential for every school’s athletic program and if there is some doubt look at these statistics; providing coverage alone, could bring a lot of peace of mind to many parents.

By Ethan Konoza, ATC
Athletic Trainer
MUSC Health Sports Medicine

Post workout muscle soreness? Use these tips to speed up recovery and reduce soreness.

Summer is around the corner, and now it is finally time to get the gym and start chasing that beach body you’ve always wanted! So you’re at the gym crushing your workout feeling great. By the time you wake up in the morning you’re feeling aches, pains, and soreness! This is known as delayed onset muscle soreness (DOMS). DOMS is a common problem for almost anyone who partakes in intense or unaccustomed exercises. Here are some tips you can implement to your post exercise routine that will help combat DOMS and get you back to normal function as rapidly as possible.

Understanding DOMS

Delayed-onset muscle soreness is a common experience for all individuals who partake in exercise at one time or another. There are many types of physical activity that cause delayed soreness.

  • Strength training exercises
  • Running
  • Jumping
  • Walking down inclines/declines

Delayed soreness tends to begin 12 to 24 hours after exercise. This pain and soreness can linger around for days making working out impossible and lifting normal things or taking stairs dreadful tasks. Current literature suggests that eccentric muscle contractions are thought to be the main culprit in resulting soreness.1 Eccentric muscle contractions are those actions in which the muscle is being lengthened. An example would be the lowering phase of a bicep curl or getting into a squat position.

Initially DOMS was thought to be a result of lactic acid build up in the muscle, similar to acute muscle soreness, however we now know that this is not the case. DOMS seems to be a by-product of the repair process occurring after microscopic muscle damage.1,2 While no one enjoys being in pain or feeling sore, it is important to remember that this soreness you are experiencing is temporary and is leading to a stronger you.

Starting slow

When starting a new program, starting slow can help reduce the effects of DOMS. Slow progression in a new program allows your muscles time to adjust to the new demands being placed on them. Allowing this time for adaptation will help in reducing the amount of soreness experienced in the first couple of sessions.

Warm up

Although there is little evidence to suggest that warming up is effective in reducing DOMS, it is always important to prepare your body for stresses that you are about to place upon it. It is important to break a mild to moderate sweat while warming up. Make sure to incorporate dynamic stretching to prepare your muscles and joints for the exercises you are about to perform.

Active recovery

This is a technique used by many athletes to help with recovery time. Active recovery can be extremely beneficial in reducing muscle soreness, but be careful not to over do it. Active recovery can include cross training like bike riding, swimming, or jogging at a lower intensity than normal. The goal with this isn’t to increase strength, power, or endurance. It is to increase blood flow to muscles bringing in necessary nutrients to enhance the recovery process.2,3

Massage

Massage is used to decrease muscle soreness, pain, and stress, and improves circulation and lymphatic flow.2 Massage can help promote and aid in the recovery process, but it is important not to be too aggressive. Easy does it in terms of massage and its role in recovery.

Foam rolling

Foam rolling is a self-myofascial release (SMR) technique that can provide improvements in flexibility, movement efficiency, and muscle recovery.3 During the recovery process our muscle fibers can become knotted and misaligned causing a reduction in muscle elasticity, soreness, and stiffness. SMR can be used to release the knots in the muscle aiding in the recovery process. This can be done prior to exercise as well as post.

Ice

While icing injuries remains a debated topic in the sports medicine world, it can be beneficial for the analgesic effects. While physiologically the literature remains to be seen on ice having any effects on the inflammation process, there is no question that it can be used to help temporarily relieve aches and pains.

Try implementing some of these things into your post exercise regiment to combat DOMS and improve recovery. It is important to remember that some techniques may be more effective than others and each individual may respond differently to the next. It is important to find what works for you and your needs.

For more information visit MUSC Health Sports Medicine

References

  1. https://www.acsm.org/docs/brochures/delayed-onset-muscle-soreness-(doms).pdf
  2. https://magazine.nasm.org/american-fitness-magazine/issues/american-fitness-magazine-winter-2017/exploring-the-science-of-recovery
  3. Ahmaidi, S., et al. 1996. Effects of active recovery on plasma lactate and anaerobic power following repeated intensive exercise. Medicine and Science in Sports and Exercise, 28 (4), 450–456.
  4. https://www.myofascial-pain-syndrome.org/myofascial-release-as-an-effective-post-workout-recovery/

Special guests visit Health Sports Human Physiology, Psychology Classes

Alecia Good and Savior
Athletic trainer Alecia Good and Saviour

November 14 was, for Pinewood's Head Athletic Trainer Alecia Good, a member of the MUSC Health Sports Medicine Team, "a wonderful reminder" of why she is a teacher. Good scheduled her friend Maurice Johnson, CO, BOCO, C.Ped, a certified orthotist and certified pedorthist from Floyd Brace Company (and Pinewood parent), to guest lecture in her Human Physiology and Psychology classes. Johnson asked to bring a model to help explain what he does for a living. The model was Saviour, a 10-year old boy from Ghana, Africa, who was born with cerebral palsy.

In Saviour's tribe, if babies are born with an anomaly (birth defect, maternal death, disease, or even twins or triplets), these babies are considered "spirit children" and are thought to have evil spirits that will be bad for the rest of the tribe. The parents are forced to make a difficult decision of moving the entire family to a "witch camp," where food and water are scarce, or getting rid of the "spirit child" and poisoning the baby.

Saviour was rescued by a local nun, Sister Stan, who cares for 57 other spirit children. Saviour could not walk or talk and got around by dragging himself by his hands. The scars on his knuckles mark the daily struggle he endured.

Sister Stan, through her charity, reached out to a retired nurse, Joan Tucker, who traveled to Ghana and advocated for surgery for Saviour. A long and difficult process finally brought Saviour to Shriners Hospital in Greenville, where he underwent a major reconstructive surgery at the end of June. He worked with a physical therapist to help build his strength and mobility. The physical therapist then referred him to Johnson for ankle foot orthotics.

Johnson, his assistant, Tucker, and Saviour all visited Good's classes that day. "Saviour spoke few words, but his smile lit up the room," said Good. He donned traditional attire as worn by chiefs in his tribe. He also had specially made New Balance shoes that provided a lift for a shorter leg. He had some orthosis on, but Johnson wanted to mold him for a new pair.

During Physiology class, Johnson explained the process of fitting, fabricating, and molding orthoses. He made casts on the ever-smiling Saviour and explained how they would help him walk. Saviour demonstrated his ability to walk across the room with one crutch and assistance from Tucker.

During Psychology class Johnson talked about the ability to allow his patients to participate more fully in life. Through the orthosis and a crutch, Saviour would now be able to move around and will not have to be carried or crawl.

Saviour's smile got even bigger when Tucker spoke about how excited he was to show his brothers and sisters in the orphanage how he could walk. Saviour plans to head home to Ghana in January, and Tucker will stay with him for a month while he learns to transition back into his regular life.

During the visit, the class also discussed the challenges Saviour will face after returning home. He will continue to grow, which creates the need for new shoes, braces, and longer crutches. Saviour and his team are hopeful these needs will all be met in time.

Said Good of the experience, "I'm not sure who learned more yesterday, my students or me. I thought that I was bringing in a guest lecturer to talk about a healthcare profession, but it was so much more. Instead of being the model, Saviour became the teacher.

"His story moved many of us to tears. His smile spoke volumes. His faith that has been instilled in him through Sister Stan was unshakable. The few words that he did speak brought joy to all our hearts. Saviour's presence was more impactful than any textbook could ever describe, any guest lecturer could ever explain, or any lesson I could ever plan."

Anna King, '18, also reflected on the visit: "It was an eye-opening experience that I will never forget. It was awesome to see how the things we are learning right now can help so many people in need."

For more information about Sister Stan's work, visit www.sisterstanschildren.org.

Every new year, many people are tempted to try the newest fad diet to either help lose weight or enhance athletic performance or both. Many of these diets call to restrict certain food groups such as carbohydrates. While this may help with weight loss temporarily, if not monitored carefully, a low-carb diet can lead to decreased energy and athletic performance. Carbohydrates are the primary energy source for the body, and thus are important especially in an athlete’s diet. Once the body depletes its stores of carbohydrates, the body switches to use alternate fuels such as protein or fats.

Carbohydrates often get a bad name because they are often found in simple form in processed foods including refined sugars and white flour. These commonly are seen in cookies, sodas, pasta and white bread. These foods are generally not satisfying to the appetite and cause spikes in blood sugar. Complex carbohydrates, however, are digested more slowly, leaving you feeling fuller and having less effect on blood sugar levels.  Complex carbohydrates include whole grains, vegetables, fruits, nuts and legumes (beans, lentils and peas).

Dietary Guidelines for Americans recommends that carbohydrates make up 45 to 65 percent of a daily calorie intake. For an individual on a 2000 calorie per day diet, that would mean 900 to 1300 calories in the form of carbohydrates. Rather than having these calories come from “empty sources” such as processed foods, carbohydrates should come from nutrient-dense foods that are naturally occurring. My favorite diet tip is to stay to the outside of the grocery store when I am food shopping. On the outside you will find the fresh produce, meats, and dairy. Most processed food is in the center aisles. Natural foods will provide a better fuel for the body, improving overall health and athletic performance.

Rather than limiting a certain food group, the best nutrition advice is to ensure that your diet has variety, balance and moderation. A diet rich in nutrient-dense foods from all food groups will allow for the best result in the New Year and for many years to come.

For more information:

https://www.choosemyplate.gov
https://health.gov/dietaryguidelines/2015/

Athletic trainers are essential in triaging various types of athletic injuries on and off the field prior to allowing an athlete to return to play. It may be necessary to refer to a physician for clearance, particularly in head injuries in order to safely return the athlete to physical activities. Concussions are constantly in the media these days, with a great deal of discussion regarding health risks, both short and long term, in various sports; so it is very important to make the correct call when allowing an athlete to return to play. As a certified athletic trainer, I would like to share an interesting case about an athlete’s experience with a concussion. Hopefully, by sharing these types of experiences, it will help health care providers determine when it is appropriate for an athlete to return to play after a head injury.

In this case, a high school football player was hitting a pad in practice then fell down, hitting his head face first on the ground. He somehow bounced off the pad and then hit the back of his head on the ground. The player immediately experienced dizziness and headaches. However, he had no loss of consciousness, so I directed him sit out of practice and then evaluated him. I used the SCAT5 concussion assessment exam, which is tool that is used at all levels in order to evaluate a concussion. The score on test was slightly elevated due to his symptoms, which helped me promptly diagnose a concussion, so I instructed him to see his doctor for a formal evaluation. His mother took him to his primary care pediatrician and the doctor performed a basic exam where he only checked his eyes and asked about his current symptoms. The doctor subsequently wrote a note to clear him return to play. When I received the note, I was concerned because his symptoms had not completely resolved. I put him through intense running exercises and his symptoms immediately returned. Because I was concerned about the athlete’s persistent symptoms, I sent him to one of our sports medicine physicians, Dr. DeCastro, who commonly treats many of our concussions with MUSC Health Sports Medicine.

It is essential that physicians and athletic trainers to work to together when dealing with head injuries, so an athlete does not fall through the cracks. This head injury could have been more serious or even fatal if it had not been caught and the athlete held out of sporting activities. Currently this athlete continues to recover, but it has been nearly three months since the injury and this athlete continues to experience post-concussion symptoms. I would like Dr. DeCastro to share his experience from a physician’s point of view.   

Dr. Alec DeCastro, Chief of Primary Care Sports Medicine, MUSC Health:

Concussions have garnered a lot of media attention over the past few years, and are prevalent in football but even in non-collision sports. The Center for Disease Control (CDC) recently estimated that 1.7 million people in the U.S. suffer some form of traumatic brain injury every year, which is twice the number of heart attacks that strike Americans each year. About 75 percent of those brain injuries are considered concussions or other forms of mild injury. And 80 to 90 percent of people will recover from a concussion within a seven to 10-day period, according to the National Institutes of Health (NIH).

The hype regarding concussions has caused a lot of trepidation in sports, particularly after the recent movie starring Will Smith. Actually, the condition discovered in the movie by Dr. Bennett Omalu is called chronic traumatic encephalopathy (CTE). Education regarding concussions is the key, and recognizing early signs and symptoms may make all the difference for athletes, parents, and coaches. The CDC has created an initiative called Heads-up Concussion, which has resources and tools to help recognize, respond to, and minimize the risks of concussion.  

It is important that the physician and athletic trainer to work together and apply an individualized approach to the diagnosis and care management of athletes with these types of head injuries. One of the most valuable factors in managing concussions is the athletic trainer’s comprehensive knowledge of the individual athlete. It may be imperative that whoever works most regularly with the athlete reviews his or her treatment. The athlete’s history, behavior, and risk factors need to be included as well in order to figure out the best patient-centered care plan for speediest recovery of the athlete’s concussion.

 

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