DHMC Knee Injury Lecture Review: PART TWO

By Katherine MacPherson BS, ACSM HFS

All sport injuries should be avoided at all measures.   However at times sport related injuries are inevitable, which is why it is exceedingly necessary to practice safe and effectively to halt the unexpected.  DHMC Knee Injury Lecture Review PART ONE (find part one online at www.uvac-swim.org/fitness) covered the essentials of knee anatomy and common injury causes.  This continued piece to part one will advance to proper knee injury prevention techniques and safe ways athletes and coaches can keep knees safe.

·         Q ANGLE: Part One introduced a very common concern, the Q angle; an improper knee tort caused from a wider hip structure.  The Q Angle is generally seen in females, and contributes mostly to ACL, MCL, and Patellar Tendon injuries. 

Improper tort can be improved by strengthening the Abductors, Gluteus Maximus and Minimums, Quadriceps, and Abdominals.  

Example Exercises

                                                                Lateral Band Walks: Abductor and Gluts

Squats: Quads and Gluts

Plank: Abdominals

Ways to keep your knees safe: Major preventions

·         Proper warm-up:

Athletes and the general population will significantly benefit from a proper warm-up.  One journal study from the American Journal of Sports Medicine researched the role of warming-up and found that a proper warm-up can benefit the muscular system by increasing the elasticity of the muscle-tendon unit (The role of warm up In muscular injury prevention, 1988).  A proper warm-up will also increase the rate of blood flow, and helps eliminate lingering lactate acid.

·         Proper fitting equipment:

·         Pads

·         Helmet

·         Mouth guard

·         Well fitted cleats, or sneakers

·         Avoid overuse: gradually increase the intensity, duration, and frequency of training.

·         Stay active year around: This will decrease your risk of in-season injuries.

·         Practice proper cutting, pivots, stops, and tackles:

Resources:

www.stopsportinjuries.org

Safran, M. Garrett, W. Seabar, A., Glisson, R., & Ribbeck, B. (1988). The role of warm-up in muscular injury prevention. The American Journal of Sports Medicine, 123-129.

Pre & Post Exercise Nutrition (Covering Hydration, Protein, and Carbohydrates)

By Katherine MacPherson BS, ACSM HFS

Exercise nutrition should be just as regular as exercise itself.   Acquiring wholesome nutrition before and after you exercise will take your health progression even further.  Whether you’re training for a marathon or just for fitness food intake plays an important role in your health and in performance.  Everyone who engages in exercise will benefit from understanding and practicing the basic exercise nutrition recommendations. 

Hydration

The first major pre, during, and post exercise essential nutrient is water.  As your core temperature increases during exercise, our body’s response to heat regulation is to sweat.   The replenishment of fluid is enormously important because dehydration can decrease performance by reducing strength, coordination, and endurance.  It can also increase the risk of heat cramps, heat exhaustion, and heat stroke.

Replacement recommendations:

·         2 Hours before exercise a person should drink 12 to 24 oz. of fluid water, and then 7 to 10 oz. of fluid water 10 to 20 minutes before starting exercise

·         During any moderate to vigorous exercise 6-12 oz. of fluid water should be consumed every 15 to 20 minutes.

·         After exercise, fluid should still be consumed (E. Howley, et al., 2007).

Protein

Protein intake for athletes who take part in high-intensity and/or high-volume resistance training, and endurance activity may benefit from increased amounts of protein intakes.  Adequate levels of protein can aid in damaged muscle tissue repair and development of new tissue (American Dietetic Association, 2009).  However, seeking levels that are higher than the recommended intake are unnecessary.  There is a threshold on increased muscle mass (E. Howley, et al., 2007).  Furthermore, athletes should not seek additional sources of protein through supplements because protein requirements can be met through food choices.   Athletes who partake in intense training should consume a higher caloric intake, thus increasing their distribution of vital macronutrients (protein, fats, and carbohydrates).

Carbohydrates

The breakdown of carbohydrates after digestion creates a major energy source called Glucose.  It is highly necessary for optimal athletic performance to intake sufficient levels of carbohydrates.  Carbohydrate loading is used before major athletic events to amplify glycogen storages. This has been found to increase bouts of exercise performance (E. Howley, et al., 2007). 

Recommendations:

·         Physically active adult: 60% to 65% of diet should consist of Carbohydrates.

·         Athlete who trains heavily: 6 to 10 grams of carbohydrates per kilogram of body weight.

·         Nutrition recovery should begin within 15-60 minutes following exercise (American Dietetic Association, 2009).

                                                                                                                                                                               

Pre & Post Exercise Fluid and Food Ideas:  (American Dietetic Association, 2009).

v  Peanut butter and honey on toast + instant breakfast drink

v  Oatmeal with brown sugar and almonds + skim milk + banana

v  Turkey and Swiss sandwich + fruit + sports drink

v  Whole wheat pita sandwich with turkey and veggies + low-fat milk

v  Stir fry with mean steak, broccoli, bell peppers, carrots + brown rice

Snacks:

v  Smoothie make with yogurt and frozen berries

v  Graham crackers with peanut butter + low fat chocolate milk + banana

Resources:

(2009). Nutrition fact sheet: Eating for recovery. American Dietetic Association

(2009). Nutrition fact sheet: Eating Befor Exercise. American Dietetic Association

Dunford, M., & Doyle, A. (2008). Nutrition for sports and exercise. (pp. 141-149). Belmont, CA: Thomson Wadsworth.

Howard, E., & Franks, D. (2007). Fitness professional's handbook. (5 ed., pp. 115-117). Champaign, IL: Human Kinetics.

Sleep Deprivation and Athletes

By Katherine MacPherson BS, ACSM HFS

Hoping to increase your athletic performance, or perhaps improve your weight lifting routine? When it comes to athletes, they need their sleep. It is well established that a lack of sleep can impair one’s mental status, but did you know that there is an even greater amount of impairment happening physiologically? Our body’s response to sleep deprivation can have a larger reaction than you think.


Every age comes with a different average amount of sleep needed each night. In 1998, Wolfson and Carskadon found that the average teen needs a considerably greater amount of sleep than younger children and adults. The typical active teen needs about 9.2 hours of sleep each night (Carpenter, 2001). 9.2 hours of sleep seems like a lot but this amount of sleep will encourage a healthy state of homeostasis.

When we hear the words “sleep deprivation,” we tend to think of a long term cycle of poor sleeping habits. However, it is found that just one night of disturbed sleep can negatively alter ones’ performance. A study by The France School of Sports Science and Liverpool John Moores University took eleven healthy males and underwent testing intervals. They evaluated subjects after one night of normal sleep and after one night of disrupted sleep. The results indicted a negative impact on the subject’s mood state (mood state refers to one’s cognitive thoughts or feelings during a particular event) on exercise after their sleep disrupted night. Though the results showed no effect on muscle strength, perceived exertions, and heart rate while exercising, their mood state was significantly altered negatively(Meney et al., 1998). Another study on acute sleep deprivation and exercise found that after 30 hours of continuous poor sleep, the subject’s resting reaction time was increaseed, they fatigued faster, and their mood states where negatively changed (Scott et al. 2004). A study that included a trial of a 64 hour sleep deprivation found that muscular performance had decreased. One notable decrease was the subject’s ability to reach their previous vertical jumps heights (Takeuchi et al. 2007).
The long term effect from sleep deprivation has a harsher reaction on individuals. As described earlier, we learn what kind of an impact just 30 hours of sleep deprivation can be. In a study were 12 subject were examined during an 8 week trial, it indicated that a longer duration of disrupted sleep can be far worse than an acute experience. The results revealed a reduction in mood and performance (Angus et al. 1985). Physiologically our bodies rely vastly on the recovery cycle, which includes sleep. Today, poor sleeping habits are now being linked to diabetes and obesity. A conflicted sleep pattern tampers with normal functions of the metabolic system. A 2007 clinical review studied the relationship between three pathways that were all effected after prolong sleep deprivation. The pathways included changes in glucose metabolism, increased appetite, and decreased energy expenditure (Knutson et al., 2007).


Research and perhaps personal experience can in fact show you that seeking a regular and adequate amount of sleep at night will improve and maintain a healthy state of mental and physical well-being. For those who have trouble finding a regular sleep pattern there are great regimens to follow to help you do so. According to Livestrong.com, exercising for at least 30 minutes most days of the week will encourage better sleep (Livestrong.com, 2011). Regular exercise will also decrease stress levels, which is another barrier that affects sleep. For many individuals who struggle with regular exercise, working with a personal trainer will create a stronger foundation for fitness and motivation. Exercise is linked to better sleep, so for any athletes and the general population the matter is just getting to bed at a reasonable hour. Planning ahead and developing an after school/practice pattern are major tools. The effects of sleep deprivation can and should be avoided at all costs to ensure safe and effective athletic performance and physical fitness.


Angus, R., Heslegrave, R., & Myles, S. (1985). Effects of prolonged sleep deprivation, with and without chronic physical exercise, on mood and perforance. Psychophysiology, 276-282. Retrieved from onlinelibrary.wiley.com
Carpenter, S. (2001). Sleep deprivation may be undermining teen health. American Psychological Association, 42. Retrieved from www.apa.org
Knutson, K., Spiegel, K., Penev, P., & Cauter, E. (2007). The metabolic consequences of sleep deprivation. Sleep Medicine Reviews, 163-178. Retrieved from www.sciencedirect.com
10 Steps To Better Sleep, 2011. Livestrong.com
Meney, I., Waterhouse, J., Atkinson, G., Reilly, T., & Davenne, D. (1998). The effects of one night's sleep deprivation on teperature, mood, and physical performance. Chronobiology Internation, 349-363. Retrieved from informahealthcare.com
Scott, J., McNaughton, L., & Polman, R. (2004). Effects of sleep deprivation and exercise on cognitive, motor performance and mood. Physiology & Behavior, 396-408. Retrieved from www.sciencedirect.com
Takeuchi, L., Davis, G., Plyley, M., Goode, R., & Shephard, R. (2007). Sleep deprivation, chronic exercise and muscular performance. Ergonomics, 1985. Retrieved from www.tandfonline.com

DHMC Knee Injury Lecture Review

By Katherine MacPherson BS, ACSM HFS
On November 9th there was an excellent three hour lecture that focused directly on prevention and treatment options for knee injuries. Members of the DHMC and Dartmouth-Hitchcook Keene’s Sports Medicine Department hosted and covered a variety of knee injury aspects in athletes of all age. These participants included Michael Sparks MD, Mark Silbey MD, Charles Carr MD, James Ames MD, Tate Erickson MS, ATC, Chad Howland PT, and Olympic Gold Medalist Hannah Kearney, who suffered from an ACL injury when she was 20 years old. Knee injuries are the one of the most common injuries to occur among sports, which generates the high importance of preventive knowledge and understanding of immediate and chronic treatment if an injury were to take place. Here are the highlights and key points from the lecture:

Topic One: Knee Anatomy

The knee joint is constructed where the inferior head of femur meets the superior heads of the tibia and fibula. This large joint is filled with cartilage and synovial fluid, allowing the knee to seek a variety of ranges of motion. Ligaments play an important role in movement and support. There are four ligaments in the knee: the lateral collateral ligament (LCL), medial collateral ligament (MCL), posterior cruciate ligament (PCL), and anterior cruciate ligament (ACL). The meniscus, articular cartilage, and synovial fluid (fluid that surrounds the interior and exterior joint) acts as a cushion for the joint, which aids in smooth knee movements.

Topic Two: Facts

• Skiing/Snowboarding has a high knee injury rate.
• Not getting an ACL injury fixed can later lead to arthritis.
• Females are at higher risk of knee injuries.
• Women have a greater Q angle position than men (See photos below).

 

• Women naturally have weaker gluts, hamstrings, and abdominals creating an improper tort load on the lower extremities (Photos above).
• Knee injury prevention should start around 7th to 8th grade.

Topic Three: Most common sports related knee injuries and causes

Injuries:

• Anterior Cruciate Ligament (ACL) Tear
• Posterior Cruciate Ligament (PCL) Tear
• Medial Collateral Ligament (MCL) Tear
• Lateral Collateral Ligament (LCL) Tear
• Meniscus Tear
• Patellar Dislocation

Top Causes:

• Improper cutting, pivoting, landing from a jump or direct blow to the knee.

Topic Four: When to see the doctor

Immediately after an injury occurs, there may be visible signs and symptoms.

See the doctor immediately if the injured individual has:

1. A gross deformity. The picture below is a great example of a visible kneecap dislocation.
2. Loss of sensation. Areas of the injured extremity may be followed by a loss of sensation, or numbness.
3. Joint effusion; swelling. If the knee is immediately swollen, or swollen within a few hours to even a day or two, it is indicating there is some sort of issue taking place.
4. Intense pain.
5. Inability to bear weight. Unable to walk and/or bear standing weight.

Signs or symptoms that may indicate a fainter immediate doctor visit demand:

1. Able to bear weight: no limping.
2. Zero to moderate swelling.
3. Slightly poor to full range of motion.
4. Good disposition. The individual is talking fairly calm, not acting in a painful, anxious manor.
5. Can walk normally.

Online Resource:

www.STOPsportsinjuries.org

As to follow: PART TWO

The next installment will include proper knee injury prevention techniques, including evidence based exercises to help keep your knees safe.