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MUSC Health Blog

Keyword: sports-medicine

By Brittney Lang MS, ATC
Athletic Trainer
MUSC Health Sports Medicine
www.MUSCHealth.org/sports

Summer workouts for athletes have started and with temperatures and humidity rising daily as we get closer to summer we have to be aware of making sure our athletes are properly hydrated. Athletes should have access to water during any weights and conditioning sessions and given breaks during sessions as needed. It is also necessary to educate athletes on the importance of hydrating well before and after physical activity to maintain good health.

An athlete needs to be properly hydrated if they want to be able to perform at their highest level. Physical activity, heat, and humidity increase the amount of fluid your body needs to stay hydrated.  Below are recommendations for how much fluid one should be drinking to maintain adequate levels.

Everyday
Drink adequate fluids. Roughly 1 ml for every calorie consumed. For example, if you eat 4000 calories, drink 4000 ml of fluids (4 L).

2 to 3 hours before training/competition
7 oz of fluid

Immediately prior to training/competition
6 to 12 oz of fluid

Every 15 to 20 minutes during training/competition
6 to 12 oz of fluid

Exercise longer than one hour
Be sure to include a carbohydrate source in the form of solid, gel or sports drinks. Consume roughly 30 to 60 grams of carbohydrate per hour. 600 to 1200 ml of a sports drink will fulfill this need.

After exercise 
16 to 24 oz for every pound lost from the training session or competition.

It is good practice to do a pre and post workout weight check to make sure the athlete has been consuming enough during the workout; and to see if they have lost any weight and determine how much extra they may have to replenish.

Staying well hydrated will help decrease the risk of heat illnesses such as muscle cramps, heat exhaustion and heat stroke by helping with body temperature regulation and cooling efficiently.

Dehydration

The body loses fluid through the skin as sweat, through the lungs while breathing, and through urination. When the body loses more fluids than is being taken in to replace what is lost we have dehydration. There are some common signs and symptoms of dehydration to look out for during training:

  • Headache
  • Nausea
  • Dizziness
  • Thirst
  • Fatigue
  • Muscle cramping
  • Low output of urine/dark coloration

If an athlete is experiencing any of these symptoms, they should stop what they are doing and drink fluids. An athlete should not completely rely on their thirst mechanism to tell them to drink. If the athlete feels thirsty, it is too late. The body has begun to feel the effects from dehydration and their performance will suffer along with their body. One should not wait that long.

Over hydration

While dehydration is more common in athletes, there is a very real possibility of over hydration. This is when the athlete intakes more water than the body has released i.e through sweat. This can lead to low sodium levels also known as hyponatremia and cause very severe health problems if the athlete does not seek the necessary help right away. Drinking some sport drinks during longer or intense workout sessions can help with keeping sodium levels up and eliminate the possibility of hyponatremia during training.

Hydration is one of the most important things an athlete can do to maintain mental and physical performance. Educating the athlete on proper hydration techniques is the best way for them to stay healthy.

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/

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

When I was growing up, children were not allowed to work out in the weight room of my local gym until they turned 12. There were fears that resistance training would damage undeveloped joints and that there were no actual benefits. Research has shown that was false. Participating in sports generally puts more stress on joints than lifting does.  We also now know that while kids naturally gain strength as they grow older, the strength gains from resistance training go beyond that of natural growth and development.2

Benefits

There are many benefits for children who weight train including improved athletic performance, muscle strength, bone strength, decreased risk of injury while playing sports, decreased body fat, improved insulin sensitivity, and enhanced cardiac function.1, 2

Is My Child Ready?

Don't go setting your kids loose in the weight room just yet! Check these boxes off your list to see if your child is ready to start resistance training.

  • My child listens and follows directions well.
  • My child wants to resistance train.
  • My child is not participating in too many other activities.

Getting Started

If your child met the above requirements, there are precautions to take to keep them safe in the weight room. The biggest key word here is supervision. The person who is designing and supervising these workout sessions should know and follow guidelines for strength training children. Kids should be taught proper technique and should be corrected with every lift until their form is perfect. A breakdown in technique will lead to an injury, which is especially true when the weights start getting heavier. Be sure to also teach them about general safety including avoiding pinched fingers and dropped weights.

Big Muscles!

Big muscles should not be a goal with children who are weight training, because it's just not realistic. Increases in muscle mass will start to be possible once they start going through puberty and have more hormones.2 Until then, you can still expect to see gains in strength, but this will be due to improvements in coordination and muscle fibers learning to contract more efficiently.

Injuries

Injury can still happen, even when you tried to do everything right. Be prepared to recognize and respond to a possible injury. Some signs of an injury include pain, swelling, loss of motion, and weakness. Ask yourself why this is happening. Was it the technique, too much weight, a growth spurt, poor program design, or something else? Don't be afraid to ask a medical professional for help.

With all of this in mind, letting your child resistance train can be a positive and beneficial experience. Once again, please make sure they are supervised by an appropriately trained professional.

For more information visit MUSC Health Sports Medicine.

References

1. Faigenbaum, A. D., & Myer, G. D. (2009). Resistance training among young athletes: Safety, efficacy and injury prevention effects. British Journal of Sports Medicine, 44(1), 56-63. doi:10.1136/bjsm.2009.068098
2. Haff, G. G., & Triplett, N. T. (2016). Essentials of Strength Training and Conditioning. Champaign, IL: Human Kinetics.

Guest Post by:

Lindsey Clarke, MS, ATC, CMT
Athletic Trainer
MUSC Health Sports Medicine

“You work in athletics?  Awesome…that’s so cool!”

This is often the response I get when people learn that I am a Certified Athletic Trainer(ATC). It’s an understandable reaction, as most of the population will only ever see the glitz and glory of the bright lights, sidelines, and athletes from the TV screen or stands. It seems very exciting from those seats, but what they don’t see is the time spent in the training room doing treatments long before and cleaning up after the event has ended, packing sideline kits and bags for travel, arranging appointments, or prepping both lunch and dinner for the day as you’ll most likely be eating those meals on a bus, sideline or in your office while updating your athletes’ files. While being an ATC is immensely gratifying, it can also be a source of great stress. We are expected to be selfless, often putting other’s needs first, work long hours over nights and weekends, and perform at high levels to help our athletes recover and return to play. While all these demands are inherent to the job, these expectations can result in work-related stress. It is difficult to control work-related demands in any profession, but especially so with the constant flux of working in athletics; the game was rescheduled, practice ran later than anticipated, weather delays…the list goes on and on. In addition to scheduling, there is the ever-present threat of injury or emergency. While most of the time it may seem we are standing around observing, we are constantly scanning and taking note of hits to the head, mis-steps, and collisions. More often than not, the ATC is taping, evaluating and responding to manageable injuries, but sudden cardiac arrest, gross trauma or spinal injury are very real possibilities that are always at the back of our minds. The uncertainty of managing an ever-changing schedule, in addition to the emotional drain of providing care, can leave the ATC little time, opportunity or inclination for a life outside of their job.

To provide the appropriate care, an ATC’s training includes primarily academic and practical skills; unfortunately, the ATC does not commonly receive sufficient preparation for the emotional reality of their responsibilities and its impact on their personal functioning and self-fulfillment. If not managed properly over time, these constant stressors can create feelings of apathy, depression, chronic exhaustion, depersonalization towards your athletes, and reduced accomplishment towards one’s work or ineffectiveness in one’s role/performance.

This culmination of stressors and the resulting inability to effectively deal with them can lead to burnout; a very real psychological health concern among professionals working within dynamic, fast-paced environments. According to Merriam-Webster, burnout can be defined in a number of ways, but it all boils down to the exhaustion of physical and/or emotional strength and motivation; it is very common amongst service-related professions such as teachers, public servants, and health care providers. Occupational burnout is typically measured using the Maslach Burnout Inventory (MBI); one of the most commonly used tools to assess burnout in human service professions. In 2008, the Athletic Training Burnout Inventory(ATBI) was created to examine specific characteristics within the profession such as: emotional exhaustion & depersonalization, administrative responsibility, time commitment, and organizational support.

There are three hallmarks of burnout:

  • Overwhelming emotional and physical exhaustion from being overextended; the ATC feels drained, “used up”, barely able to face another day, practice, game or athlete presenting with a problem.
  • Reduced personal accomplishments at work; feelings of frustration, anger, cynicism, and inadequacy can lead to a sense of failure or ineffectiveness in helping their athletes or enhancing their work circumstances
  • Depersonalized attitude toward others; the ATC may adopt a callous or emotionally detached response to their athletes and co-workers.

Certainly, stress is felt differently for each individual, but this sense of burnout, caused by the prolonged response to chronic interpersonal stressors on the job, can impair social and personal functioning. This may cause the ATC to feel less than professional with these negative feelings, and may begin to question their ability and commitment to their profession, leading some to actually leave athletic training to pursue other careers. The specter of mental health disorders is constantly lurking in the background whenever the dynamic of burnout is present. Being a health care provider does not provide immunity from developing a mental health disorder. Rather, their very responsibilities may be putting them at a higher risk if they are unable to effectively deal with the inherent stressors that lead to burnout in the first place; this may put the ATC at risk for developing a mental health disorder, or exacerbating a present mental health disorder that is under control.

An ATC is exposed to stressful events on a daily basis. Knowing how to recognize how stress might affect you, and learning effective stress prevention and management strategies is extremely important. Below are a few preventative measures on how an ATC can help prevent and avoid burnout, and/or the possibly of developing a psychological disorder.

  • Workout, meditate or practice yoga on a regular basis.
  • Practice good nutrition. Be sure to eat; don’t skip meals. Be well hydrated.
  • Get enough sleep.
  • Don’t abuse alcohol or drugs.
  • Even if you are busy, try to establish a daily routine; disruptions of routine may cause stress.
  • Take time for yourself; even if for a short period of time, make time for a hobby or period of relaxation daily. Spend quality time with friends and/or family as they are your greatest support.
  • Try not to dwell on fleeting negative emotions or experiences. Doing so gives them momentum to negatively take over your day. It is OK to have a bad moment or day, but concentrate of moving forward to the next day or opportunity to make something positive happen.
  • Be candid with your departmental manager or supervisor. They know you work long and hard. When possible, they may be able to help arrange your schedule, by scheduling mornings and days off, working remotely for administrative work or reduced work hours for you during a less competitive season or on team off-days.

Talk to others you trust about your feelings in a safe and productive way. Know your resources. If an ATC feels the signs and symptoms of burnout or a mental health disorder, seek professional assistance through your place of employment. A good resource for learning about mental health and wellness, and steps to address stress to prevent mental health disorders can be found at Mental Health America. Knowing your limitations and acknowledging when you are struggling will not only make you a better healthcare provider, but it will set both you and your athletes up for long-term success.
 

 

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