NOBLES ATHLETIC TRAINING NEWSLETTER MAY 2012

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Once again, we are winding down the last week of athletics for the year. In this issue we hope to inform you of summer training tips, keeping active in the off season and general injury info. Have a great summer and we will see you again in the fall!

Athletic Training News

Boston Red Sox starting pitcher John Lackey is scheduled to have the surgery and will likely miss all of the 2012 baseball season, but what exactly does it do? Created by orthopedic surgeon Dr. Frank Jobe, the procedure that we now know as Tommy John surgery has since become commonplace among big league players -- especially pitchers. It was named after the pitcher, Tommy John, (Los Angeles Dodgers) who was the first to have the surgery in 1974.

Repetitious strain from throwing can lead to inflammation, microscopic tissue trauma and ultimately a tear in the ulnar collateral ligament (UCL), also known as the medial collateral ligament (MCL) on the inside of the elbow. A tear in this ligament creates an instability and reduces the power and control behind a pitch, not to mention the pain suffered leading up to the repair.

To regain the strength and support in the muscle and joint they perform a surgical repair. Doctors take a tendon from the patient's forearm or hamstring and graft it into the elbow to replace the torn ligament. The surgeon first drills a series of holes into the arm's ulna and humerus bones. After these holes are completed, the tendon is weaved into a figure eight pattern through the holes.

With careful adherence to the post surgery rehab program and completing the exercises daily, pitchers can get their full range of motion back in six to eight weeks. The program will progress to strength training with weight exercises. For the next four months, they can increase the weight they use and start doing exercises that emphasize all parts of their arm.

A ligament tear in the elbow used to be a career ending injury. The Tommy John surgery has saved many a pitcher and allowed them to continue pitching for another decade.

Lamb, Robert. "Is surgery changing baseball?" 11 February 2009. HowStuffWorks.com. <http://health.howstuffworks.com/medicine/surgeries-procedures/surgery-change-baseball.htm> 23 April 2012.

What is Tommy John Surgery?

NOBLES ATHLETIC TRAINING NEWSLETTER MAY 2012

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Summertime Hazards - Lyme DiseaseDefinitionLyme Disease is the most common tick-borne illness in North America and Europe. Lyme disease is caused by the bacterium Borrelia burgdorferi. Deer ticks, which feed on the blood of animals and humans, can harbor the bacteria and spread it when feeding. You're more likely to get Lyme disease if you live or spend time in grassy and heavily wooded areas where ticks carrying the disease thrive. It's important to take common-sense precautions in areas where Lyme disease is prevalent. If you're treated with appropriate antibiotics in the early stages of the disease, you're likely to recover completely. In later stages, response to treatment may be slower, but the majority of people with Lyme disease recover completely with appropriate treatment.

Signs and SymptomsThe signs and symptoms of Lyme disease are variable, usually involving more than one system. The skin, joints and nervous system are affected most often. In general, Lyme disease can cause: • Rash. A few days to a month before you

have other symptoms, a small, red bump may

appear at the site of the tick bite. Over the next few days, the redness expands, forming a rash in a bull's-eye pattern, with a red outer ring surrounding a clear area. The rash,

called erythema migrans, is one of the hallmarks of Lyme disease. Some people develop several of these rashes, an indication of bacteria multiplying in the blood stream.

• Flu-like symptoms. Fever, chills, fatigue, body aches and a headache may accompany the rash.

• Migratory joint pain. If the infection is not treated, you may develop bouts of severe joint pain and swelling several weeks to months after you're infected. Your knees are especially likely to be affected, but the pain can shift from one joint to another.

• Neurological problems. In some cases, inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell's palsy), numbness or weakness in your limbs, and impaired muscle movement may occur weeks, months or even years after an untreated infection.

• Less common signs and symptoms. Some people may experience heart problems — such as an irregular heartbeat — several weeks after infection, but this rarely lasts more than a few days or weeks. Eye inflammation, hepatitis and severe fatigue are possible as well. When to see a doctor If you know you've been bitten and experience signs and symptoms of Lyme disease, particularly if you live in an area where Lyme disease is prevalent, contact your doctor immediately. Treatment for Lyme disease is most effective if begun early. Only a minority of deer tick bites leads to Lyme disease. The longer the tick remains attached to your skin, the greater your risk of getting the disease.

NOBLES ATHLETIC TRAINING NEWSLETTER MAY 2012

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Rowing machines or indoor rowers are found in most modern gyms and are used by many people as a way to increase fitness and improve muscle tone. While originally designed to help rowers improve, they are now used by all sorts of individuals, from Olympic athletes to those trying to lose weight. Good form is one of the most important considerations when working out on a rowing machine as it will help prevent injury and maximize results.Identification Proper form involves ensuring the correct posture and sequence of movements during the recovery and the drive phases of the rowing stroke. There are three main things you should bear in mind when training on a rowing machine. Firstly, drive with your legs, rather than pulling with your back and arms. Secondly, extend your arms and rock your body over before bending your legs. Thirdly, control the speed up the slide – aiming for a 2:1 ration of time spent in the recovery phase compared to the drive phase. Significance

Poor form on a rowing machine can lead to injury, especially back problems if too much strain is placed on the spine and back muscles. Whereas other gym cardiovascular equipment relies on natural or quite simple movements – such as the treadmill or exercise bike – the rowing machine requires a more complex and unnatural motion, which is easy to get wrong. Rowing is an all-body, low-impact workout and slight changes to technique can dramatically change the effects the exercise has on your body.

Benefits Technique is a major contributory factor in

performance and scores achieved on a rowing machine. Correct form will allow you to

maximize results as it ensures optimum efficiency, so you should eventually achieve higher scores on speed, power and endurance. This in turn could help you achieve your fitness goals, as you will see greater improvements in your scores and you will avoid injury. Proper form ensures all the correct muscle-groups of the body are being used in the appropriate way.

Considerations While the basic form of the rowing stroke should stay the

same whenever you are on a rowing machine, you should adapt slightly depending on your workout session. For example, if you are doing sprints, you should ‘spin’ your hands around the finish of the stroke and rock the body at the same time so as to speed up the move onto the recovery. This will enable you to raise the stroke rate while maintaining control on the slide. For longer, more steady calorie-burning workouts you should ensure you maintain the 2:1 ratio. WaterCoach recommends a stroke rate of between 20 and 24 strokes per minute for longer workouts. Warning Any major change to your workout routine should be approached with caution. Practicing proper form on the rowing machine should be done at a low stroke rate and low intensity to begin with, building up the intensity as you get used to it.Davey-Attlee, Florence. “Proper Form on a Rowing Machine” 7 February, 2012 . Livestrong.com <http://www.livestrong.com/article/285271-proper-form-on-a-rowing-machine/> 23 April, 2012

Proper Form on a Rowing MachineFlorence Davey-Attlee

NOBLES ATHLETIC TRAINING NEWSLETTER MAY 2012

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Athletes don’t expect to be injured, but many will experience some sort of injury throughout their playing career. Whether the injury sidelines a player for days, weeks or months, adequate nutrition is important in all scenarios. When the body is repairing

and recovering from an injury, the biological needs of the injured athlete change. In the immediate or acute recovery stage, the athlete should be most concerned about reducing inflammation and soreness, potentially enhancing recovery time from the injury. For a longer-term recovery, the athlete should still focus on these factors but should also strive to prevent significant weight gain or loss.Many athletes become concerned that their muscle will turn into fat while they are inactive. The truth is that muscle may atrophy or lose strength from lack of use or

immobilization, but the muscle is not turning into fat. However, some athletes do gain body fat while they are inactive due to excessive calorie intake, so proper nutrition along with weight management is necessary to support the body throughout the healing process.Energy Needs As expected, the energy needs of the athlete decrease when injured compared to in-season training energy needs. However, it is important for the athlete not to excessively restrict calories. The body requires adequate

calories to heal.Energy malnutrition can exacerbate the inflammatory response and slow wound healing1,2 Basal energy expenditure, or the minimum calories the body requires without activity, increases during the healing process, especially in the early stages of healing. On the other hand, it is important that athletes dealing with a long-term injury adjust their diet accordingly. Returning to play can be more difficult if the player needs to focus on both losing excess weight gained as well as strengthening muscle tissues and training. It is

common for injured athletes to continue eating the same calorie load as they did while training, resulting in weight gain.Protein and Amino Acids Adequate protein intake is critical for athletes recovering from an injury. Not consuming enough protein is counterproductive to the healing process and may worsen the inflammatory processes.1,2 This does not mean that an athlete must consume exorbitant amounts of protein or amino acids.

When a muscle is immobilized, some strength and muscle mass loss will occur and is natural.Consuming excessive amounts of protein will not prevent this strength loss; however, eating adequate amounts of protein will support the healing process.Vitamins and Minerals and Healing Many vitamins and minerals assist in the healing process; these vitamins include vitamin C, A, K, and B complex, as well as minerals, like calcium, iron, zinc, and copper. (Continued on Page 5)

The body requires adequate calories to heal. Energy malnutrition can exacerbate the inflammatory response and slow wound healing.

Nutrition for the Injured AthleteLisa Heaton, MS, RD, CSSD, LDN, GSSI Sports Dietitian

NOBLES ATHLETIC TRAINING NEWSLETTER MAY 2012

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(Nutrition...Cont. from Page 4 ) Athletes should focus on consuming these vitamins and minerals through whole food before relying on supplements. There is no evidence that taking large doses of these vitamins through supplements will speed recovery. Including a variety of colorful fruits and vegetables, low-fat dairy, starches and meats supports the intake of these vitamins and minerals through the diet.

Nutrients of InterestThe following nutrients are commonly found in various foods, herbs or spices.While further research is needed to fully support their role in healing from an injury, these foods can safely be incorporated into a healthy recovery diet.

✤ Curcumin is a component of the spice turmeric and has displayed antiinflammatoryproperties.3,4 In certain studies, curcumin has demonstrated similar anti-inflammatory properties to common nonsteroidal anti-inflammatorydrugs (NSAIDs) in both human and murine (rodent) models. This is important because side effects commonlyassociated with NSAIDs, likegastrointestinal distress, are not present when turmeric is used.5 It’s important to note there has not been a specific

link between curcumin, exercise and muscle recovery.

✤Omega-3 fatty acids have received plenty of attention over the last decade for their healthful properties. Omega-3 fatty acids have displayed anti-inflammatory effects within the body.6Good sources include fatty fishes such as tuna and salmon, walnuts, and flax seeds. More recently, new evidence has suggested that consuming omega-3 fatty acids can decrease muscle atrophy (or mass/strength loss) due to immobilization.7,8 Further research needs to be done in this area, especially in athletes, but it is a very interestingconcept.

✤ Phytonutrients are compounds found within fruits, vegetables, grains, nuts, legumes, tea, wine and chocolate. The colors found in fruits and vegetables are due to the phytonutrients foundwithin them. A few phytonutrients that athletes may be familiar with arebeta-carotene, lycopene, leutine and flavonoids. Further research is needed regarding the potential anti-inflammatoryand immune-boosting effectsof these nutrients. Athletes should attempt to consume a rainbow of color within their diet to consume the vast variety of phytochemicals that exist.

Further informationFor more information on how to support your recovery with proper nutrition, seek out a registered dietitian who specializes in athletics in your area.References1 Demling RH. Nutrition, anabolism, and the wound healing process: an overview. Eplasty 2009; 9:e9.2 Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg 2006; 117: 42S–58S.3 C hun KS, Keum YS, Han SS, Song YS, Kim SH, Surh YJ. Curcumin inhibits phorbol ester-induced expression of cyclooxygenase-2 in mouse skin through suppression of extracellular signal-regulated kinase activity and NF-kappaB activation. Carcinogenesis 2003; 24: 1515–1524.4 Kang G, Kong PJ, Yuh YJ, Lim SY, Yim SV, Chun W, Kim SS. Curcumin suppresses lipopolysaccharide-induced cyclooxygenase-2 expression by inhibiting activator protein 1 and nuclear factor kappab bindings in BV2 microglial cells. J Pharm Sci 2004; 94: 325–328.5 Graumlich JF. Preventing gastrointestinal complications of NSAIDs. Risk factors, recent advances, and latest strategies. Postgrad Med 2001; 109: 117–120, 123–118.6 Galli C. Calder PC. Effects of fat and fatty acid intake on inflammatory and immune responses: a critical review. Ann Nutr Metab 2009; 55: 123-139.7 You JS, Park MN, Song W, Lee YS. Dietary fish oil alleviates soleus atrophy during immobilization in association with Akt signaling to p70s6k and E3 ubiquitin ligases in rats. Appl Physiol Nutr Metab 2010;35: 310-3188 Lee HU, Park MN, Lee YS. Effects of Different Types of Dietary Fat on Muscle Atrophy According to Muscle Fiber Types and PPAR! Expression in Hindlimb-Immobilized Rats. Korean J Nutr 2011; 44 (5), 355-365.

NOBLES ATHLETIC TRAINING NEWSLETTER APRIL 2012

Summer Training and HydrationAcclimation

The school year will be coming to a close and the summer months are right around the corner, which means training in heat and proper hydration.

When you begin to exercise you want to start gradually by increasing the intensity and duration. It will acclimatize you to the heat and decreases the risk of injuries.Start by exercising in the morning or early evening to acclimatize your self to the heat.

Have adequate rest between activity and exercise bouts.

Begin outdoor activities only after you’re properly hydrated. Drink water or sports drinks throughout physical activity in the heat.

A darker urine color is a quick indicator of dehydration. Your urine should look more like lemonade than apple juice.

Hydration Tips

• Prior to exercising in hot weather an athlete should weigh themselves before and after exercising.

• Each pound (.45 kg) lost during exercise equals 1 pint (.5 L)

• During exercise an athlete can lose from anywhere from .5 – 3 liters of water per hour.

• Two liters of sweat is equivalent of 4.4.pounds ( 1 litre = l kg = 2.2 pounds).

• Two hours prior to exercise an athlete should try to consume 1 pint (.5 L) of water.

• An individual should consume 16 ounces of water 15-30 prior to activity.

Athletic Training OfficeHours

Closed for the SummerSee you in the Fall!

Maurice Sicard, ATC(L), Ext. 7027Heather Folgert, MS, ATC, CSCS, Ext. 7029