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Exercising With Your Child

Regular readers of my column know of my commitment to regular exercise and the benefits derived from this. People have many excuses to fall off the regularity that they may have once enjoyed. While work demands may be a major excuse the introduction of children into your life creates the biggest challenge. I have gone through having young children and know the committment involved but there are now many products on the market that you can take your baby and small child along with you. Exercising with your child can very enjoyable and provide a bonding experience. It also introduces your young child of the importance you place on recreation and hopefully planting the seeds for your child as they grow older. It is important nonetheless to ensure your child's safety first and foremost. JOGGING STROLLERS. If you jog on a regular basis a special jogging stroller can help you maintain your routine. Make sure as in all carriers that you buy a quality stroller which is sturdy and strong. Look for a deep seat and a secure seat belt.

A brake is mandatory as well as a wrist strap. Practice with the stroller before you attempt to jog with your baby in place. Make sure the terrain is smooth . A smooth ride is particularly important for infants less than a year. Be extra wary of cars parked and moving. Keep constantly aware of the ground and any potential obstacles. Weather is also an important consideration. In the summer make sure your child is well protected from the sun and sun screen is applied to any exposed skin. Avoid days of high humidity and heat. Children are more susceptible to heat problems than an adult. Also avoid days with a high pollution index. Pay attention to not only your own hydration but also your child's. In the winter avoid severe cold and windy days. Remember to dress and protect your child appropriately. Your child is not exercising like you are and therefore not generating any heat. The sped of your running also increase the wind chill factor for your child. A windshield can be very helpful for added protection. BIKE SEATS Bicycle seats can be bought that are either rear mounted or front mounted. While the front mounted seats are better for bicycle balance and communication with your youngster they do inhibit your steering ability and reaction time and I have not found them to be very good. Most bicycle seats are rear mounted.

These are very good but obviously affect the balance on your bike.A person should be an excellent cyclists before even considering putting a child carrier on. The child should be at least one years old to have the appropriate head control and must wear a helmet as should the cyclist. Cyclists should only cycle in areas with very low traffic areas. They should avoid cities and not ride next to parked cars. Ride extremely defensively as if you were invisible and no cars could see you. A seat must have an excellent restraint system and spoke guards. As in baby joggers make sure your child has proper skin and eye protection. BACK PACKS This is the safest option but must be used properly. They can be used at a very young age. It is important to find a pack that is comfortable for both you and your child. I only get very upset when these backpack carriers are used for inappropriate activities. These should not be used selfishly to continue an activity where your child may be in danger. Therefore you should not ski, hike in dangerous terrain, lawn mow or any other activity where there is an increased risk of harm to your child from which they have no chance to protect themselves. Child carriers are a great way to maintain your regular exercise routine and indoctrinate your child in the benefits of regular exercise and the invigoration of outdoor movement


Preventing Throwing Injuries

It is this time of the year that I start to see a lot of throwing athletes, mainly baseball players and tennis players with shoulder an elbow pain. Now while many of these problems are new ,the majority had some history. These are athletes who had pain in the last season which was ignored and not treated and low and behold has come back. The old principle of not correcting the previous problems makes the it almost certain that the pain will come back. I then have to tell this frustrated athlete that I wish I would have seen them several months earlier to treat the problem appropriately and allow them to do their sport with the intensity that they want. We know that virtually every pitcher in major league baseball will sustain a significant injury, it behooves us to try and prevent an inevitable. It is my experience it is soon after puberty that these problems manifest themselves. A few factors make this age particularly susceptible.

The body is developing and the increased lever of the longer arm and the stronger muscles put extra stress on the joints. The other important factor is that this is the age where young athletes who have some talent are asked to train and compete much more often. If they do not receive the proper coaching bad mechanics can add to this equation. While the shoulder is more commonly troublesome it is easier to treat and easy for the athlete to focus on. The elbow has to undergo much more unusual distortion and more commonly ignored. The joint damage that occurs to the elbow in an abused situation causes more problems to the joint itself and can lead to long term disability. If the elbow problem is not addressed at the crucial age of 13 -16 the affects will carry on and significantly affect their career in their 20's and pain later in life.

The key factors that lead to problems are throwing mechanics, throwing volume, and type of pitches or type of serve. It is crucial to develop proper mechanics early on in the young athletes career. It is much easier to learn it properly early o then to have to change things after they have developed bad habits. While bad mechanics may not be a factor when young the forces on the joint increase as volume and strength increase. What can be controlled early in the career is playing time and type of pitches or serve attempted. A pure fastball or flat serve allows the arm to align directly over the body with little rotational torque on the elbow while curve balls or twist serves place a lot more torque through the elbow. The question is when it is safe to learn these more complex movements. Athletes are now asked to do more at a younger and younger age.

The USA Baseball Medical and Safety Advisory Committee believe that a curveball should not be learned until 14 years of age. Volume of pitches thrown or serves attempted is a very controllable factor. Although there is no scientific data it is crucial that youngsters are limited in the amount they do put their arm through these motions. Now almost all leagues limit the number of pitches or innings thrown per week. Obviously the number of pitches is more accurate than innings. In a study in Alabama the risk of injury increased 20 percent for every inning pitched and 10 percent for every 10 pitches thrown. The last important factor is flexibility and strength. As the bones grow the muscles lag behind. Muscles become tight and do not develop the strength until later. Therefore it is crucial that our athletes are placing high demands on a particular part of the body such as a thrower or racquet player that they are placed on a sport specific strengthening and flexibility program. This program must be specific to strengthen the muscles around the joint to protect those joints as much as possible. This will not only help prevent injury but will improve performance both in the short and long term. As a sport medicine physician I encourage all coaches and athletes to pay attention to the body, to not only avoiding abuse but to protect the body as much as possible.


 

Getting Rid Of Those Extra Pounds
The summer time is the time of the year where we think more about our weight. We are wearing less clothes and with more of our bodies visible we concentrate more on losing weight. We all want to look better on the beach. With all the talk about new diet drugs it is important to talk about the basic principles of weight loss . The principle is quite simple. You will lose weight if you burn more calories than you ingest. We all have a basic need for food for us to live. If we eat too much food or do not burn enough calories we will gain weight. Now while not all of us are dedicated and disciplined enough to control both sides of the equation there are little things that you can do to subtly change things to have an impact. The more physically active you are the more calories you will burn. To be consistent you must make up these calories by a combination of necessary activities and more importantly by including activities that you enjoy.

At the end of the day you will maintain activities that you enjoy a lot longer than an activity that you do not enjoy or at the very least seems like a chore to do. It can help to set goals and try to maintain these goals over a long period of time. It is a good technique to write down your goals and then to keep a diary of how you are meeting your goals. This can be very rewarding to follow a program and have it recorded in a diary. This is also a good technique to keep you on track. To lose weight you should have a goal of burning over 2000 calories a week or 286 calories a day. This is the equivalent of an hour of golf with out a cart. Measuring your calories burned will vary from person to person. Your size, effort, muscles involved, movement efficiency, fitness, amount of body fat and environmental conditions will affect your amount of calories burned. Nonetheless there are calorie counting charts produced which can help you keep monitor your program.

The following is an example of activities and the amount of calories burned for an hour of activity. ACTIVITY CAL./HR. 180LB. CAL./HR. 130LB. Dance (Ballroom) 288 208 Golf(walking) 411 299 Hiking(hilly) 648 468 Skating 468 338 Skiing(downhill) 468 338 Skiing(cross-country) 661 481 Tennis(singles) 522 337 Tennis(doubles) 324 234 Cycling(10mph) 486 351 Jogging(6 mph) 756 546 Walking(2-2.5 mph) 288 208 Walking(3.5 mph) 432 312 Gardening 576 416 House cleaning 306 221 Power mower 486 351 Snow shoveling 702 507 Washing car 270 195 This is a sampling of activities. This would have to be modified depending on your weight and the intensity of your activity. Add up all your activities you do in the course of the day to compute the amount of calories you have burned that day.A proper diet must be implemented to complete the program. It would not be hard to extrapolate the amount of calories you would have to burn to lose weight. ""You do the math""


 

 

Children In Competitive Sports

I spent a large part of my childhood playing structured and non structured sports. Some of my fondest memories of my childhood are being part of a team. Although winning was always fun it was not the predominant factor of my enjoyment and education being involved in these sports. It taught me many lessons in life and a large part of my education. Those of you who regularly read my column will know that I am a big believer in regular physical fitness for the population especially our youth. There is no doubt that research has proven that regular fitness may be the best thing you can do to promote a healthy lifestyle and increase longevity. It seems to me that there has been a gradual change in the attitude toward children's sport. Perhaps the increase media coverage of sport has made it more glorified and there is no doubt that athletes who are successful today stand to cash into big money.

It is no wonder that children are pushed to excel when they can potentially make millions of dollars if they ""make It"" Many of us were moved by the performance of Kerri Strug at the Olympics last summer in Atlanta. Initially we all felt compassion and courage for this young gymnast who had trained so hard for this event and competes through a major injury in the event finals. Later, on reflection many felt that this young gymnast was under severe pressure to compete at all costs and maybe we as a society should not be pushing our children to commit their lives to a single activity at the detriment of not experiencing a well rounded childhood. Not only that there is concerns of injury and other medical problems to those who commit themselves to a sport at that level. When I played organized hockey as a youth we played 1-2 games per week as well as 1-2 practices a week. When the season ended there was no more hockey until next September.

Some of us went to hockey camps in the summer for 1-2 weeks but there was a rule banishing any organized hockey in the summer. Todays youth can play well over 100 games a year and that does not include practices. They can go weeks without having a day off from their sport. Wendyl Clark told me that although he was on the ice daily in the winter, he played less than 20 games a year when he was 11 years old. Perhaps it is time that we looked at the structure of organized sport and what we are teaching our children. Recently Brian Shaw a psychologist at The Hospital For Sick Children wrote an incitful article on children in Organized Sports. He said that children's involvement in organized sports is one of the building blocks for good health that can last over a lifetime, but when highly competitive parents or coaches get involved they can create an atmosphere where kids can no longer tell the difference between their own desire and their attempts to meet the expectations of a trusted authority figure. The following are the main points that Dr. Shaw stated.

1/ It is important for children to exercise for both the physical and psychological benefits. Sports give children a sense of accomplishment.

2/ Sport can become unhealthy when the child can no longer tell the difference b etween playing for themselves or playing for their parent or coach.

3/ Although committing solely to one sport may be okay, there is an increased risk of developing problems with self esteem, body image and emotional problems.

4/ If a child is being pushed too hard they may show signs of stress. This may be manifested in several ways. The child may avoid the activity or have increased anxiety to practice or competition. They may turn to alternative unhealthy behavior such as alcohol, drugs, or develop an eating disorder to try and regain control of their lives.

5/ Sport offers parents a golden opportunity to be available to their children and to teach them about the values of life, such as dealing with disappointment and unhealthy attitudes. Let us encourage our children to be involved in sport. It is an important part of growing up and developing life long habits. At the same time let us listen to our children and allow them to develop as children with out the constant structured environment that we adults tend to impose on them.


 

 

Figure Skating

The most popular winter Olympic sport for many years has been figure skating. The combination of the artistic elements combined with strong athletic moves makes this sport attractive to a large audience. Skating demands the highest priced tickets and the most popular prime television times. Eve in a non Olympic year various skating competitions and shows dominate the sport channels. In Canada skating is a way of life. Traditionally females leaned toward figure skating while boys played hockey. While these roles are somewhat changing with the equalization of the sexes there is still a large skew towards mostly young girls who participate in figure skating. It is still is perhaps the most popular sport for young females. Figure skating like most sports places high demands on the body.

The more hours a skater skates and learning harder jumps or techniques the more they will be prone to injury. While skating is certainly less dangerous than other sports it is not totally risk free. The good news is that there are very few incidences of serious injuries that will affect a skater in the long term. The biggest element in figure skating is the ice and ice is hard. It is inevitable that a skater has to fall to learn. Fortunately most of the falls lead to not much more than a small bruise to the body and maybe a slightly larger bruise to the ego.The most common spots to bruise are the buttock and the elbow. Occasionally a skater can fracture a bone but these are not common. The treatment for these bruises are ice and appropriate padding over the area to prevent further bruising.

The most common problems that I see in skaters is with their feet. The more advanced they get the more rigid the boot. The rigid boot can cause pressure on the foot. The back of the ankle is the most prevalent. These ?pump bumps? can get quite large. The other affected spots are on the inside of the foot, the front of the ankle, and the outside of the leg where the boot ends. The pain and swelling is strictly a pressure phenomena and thus the treatment is based on relieving the pressure. This can be accomplished by a donut pad of high density foam around the area. If more relief is required than the skate has to be ?blown out? to make room far the boney protuberance. It is easier to treat these as soon as they happen before they become thickened and scarred. A good skate fitter who understands the sport and the skaters needs is crucial. As in any sport that requires repetitive movement, overuse injuries do occur in skating.

The occur most commonly in the leg and especially in the knee.While various jumps require a take off from different legs, a skater usually jumps most of their jumps on one leg. Therefore, that particular leg is more prone to injury. Due to the unique position of lay backs that requires significant hyperextension of the lower back, skaters are prone to the same injury as gymnasts. Young skaters can sustain a stress fracture in one of the lower vertebrae of the spine. This is one injury that must be treated properly as it can lead to long term back dysfunction if not treated properly. As in all sports the skaters programs are becoming more physically demanding. Many injuries can be caused by the fatigue factor. It is crucial that todays skater pays particular attention to their fitness. A figure skater specific off ice fitness program is crucial not only for reducing injury but for peak performance. A balanced program to train sport specific strength movement patterns along with aerobic and anaerobic conditioning is crucial. Staying injury free while maximizing conditioning, strength, and skating technique is the key to developing into the best skater possible and possibly into those so popular prime time television skating spots.


Skating Injuries: Emergency Action Plan
Alan McCauley is hit hard into the end boards. He goes down quickly and does not get up. Evceryone in the stands holds their breath as they wait fpor Alan to move. Immediatley the referee signals the Maple Leaf therapists to come on to the ice. I realize that this is a serious injury run on to the ice soon after. When the therapist get on to the ice Alan is just coming to. He was knocked out b the hit and has sustained a significant injury. there is a definite head injury and we are noit sure if he has sustained any other sewrious injuries. We assess the situation carefully. We know there is a serious injury but he is stable and breathing well. The next step is to get hinm off the ice as safely as possible. We carefully imobilize his neck and put him on to a backboard.

We place him on a stretcher and take him directly to the ambulence in a route that has been carefully maped out.We then take him to the hospital where they are awaitong our arrival. Within an hour after the injury we have taken all the necessary scans and xrays to know that there is not a serious injury that requires further intervention. This all happened very smoothly all because we had an emergency action plan in place. The Air Canada Centre is a new venue for us. Therefore, several wees before we started playing there the doctors, therapists, and the paramedics that attend the game spent an evening at the new Air Canada Centre practcing this exact scenariuo. When we got into this real situation, we all knew exactly who was going to do what and when. We kneew whre all the equipment was nad how to acces it. Everyone was calm, controlled and confident that the situation was all under control.


 

Maintaining Old Joints
While all during the day I work on injuries and try and preserve joints, it is becoming increasingly obvious that there are alot of old joints in active people who are coming tro me with difficulty maintaining their participation in their sport of choice. I will always remember a comment from one of my teachers years ago when he said to this young active female who just had a terrible looking knee ?What is a joint like this doing on a nice person like you.? Often I will see a relatively young person in their thirties or forties who will ask if they have a knee of a seventy year old. The truth is that most people in their sixties and seventies have pretty good looking knees. On x-ray it is impossible to distinguish whether this knee is from a young or old person. There are many factors that will determine whether a persons joint will degenerate. The most common joints that I am dealing with are knees and hips which are obviously the two large weight bearing joints.

The most important criteria is a major injury to that joint. A person who sustains a major ligamentous injury or damage to the joint surface will automatically greatly increase their chances of developing arthritis in their joint. Genetic factors are very relevant in that some people are just genetically predisposed to developing arthritis. Leg alignment is also a factor. A person who is very bow-legged puts an uneven distribution of weight on the inside of the knee which can cause it to wear out. Once a joint starts to wear out the most important thing is to control the pain. While modifying activity is important to maintain the joint in the long term, most people are concerned about the short term. the traditional treatment for pain is taking acetaminophen of non steroidal anti-inflammatories. While these are very effective there is now a new remedy with less side effects that is now available. Health food stores and naturopaths have been long advising about the benefits of taking glucosomine and chondroitin sulphate for arthritic joints.

They have been saying that this combination will relieve pain. They are also reporting that this combination will preserve the joint. There has been a lot of anecdotal testimonies about this treatment, but I can not tell you how many people approach me each week with a so called miracle cure that someone claims to have spontaneously cured them. A recent study from North Carolina showed that 52% of people taking a combination of glucosamine and chondroitin had decreased pain compared to only 28% of people taking a placebo who had moderate to severe arthritis in their knees. There were no increased adverse effects although some people complain about some abdominal distress. Another study done right here in Toronto had similar results with about half of the people feeling better on glucosmaine alone. There are also several European studies to collaborate the results. The interesting thing is that there is some thought that this combination of glucosamine, chondroitin and adding manganese ascorbate may in fact affect the disease process itself.

There is some evidence that it will stimulate cartilage production. It is the cartilage that lines the bones in the joint that gets damaged to lead to the arthritis. It would be fantastic if this combination would not only slow the progression of the disease process but even reverse some of the arthritis in the joint. At present there is NO evidence to show that this is true. Unfortunately, there are very little guidelines and government regulations for the advertisers of herbal supplements. Companies and stores are claiming that these supplements will rebuild their half destructed joints which simply is not going to happen. I have many patients which are being given glucosamine for any muskuloskeletal compliant or injury for which there is absolutely no basis for their use. The consumer has to be aware of the knowledge or lack of knowledge of the sales person in the health food store. They are still sales people trying to make a sale.

There are also many different manufacturers of theses supplements who have far less stringent controls from the government than the very controlled pharmaceutical industry. I can tell you from my personal experience that it has helped many patients of mine while others thought it was a waste of money. I would recommend a trial of glucosomine and chondroitin in and only in patients who are suffering from an osteoarthritic or wear and tear arthritic joint and not for any other problem or pain. I takes about six weeks to feel the effectiveness. If it is helping I would recommend maintaining its use but there is certainly not enough evidence to condone its use in the guise that it is going to actually cure your problem. Stay tuned for future developments.


 

Injury Comeback

I recently heard a report on the recovery from a serious injury sustained by Doug Weight. The reporter was compaining vigoursly about the lack of output from this one time star of the Edmonton Oilers. The reporters went on to say that even though Doug Weight underwent reconstructive knee sugery he should be close to his niumbers from last year. The fact that he under went a major physical and emotional change to his body in this very season should have no bearing on his ability to play in the last half of the season especially as the tempo of the game increases towards the play off run. I felt terrible for doug Weight who is one of the premier prototype players in the NHL and I felt anger at the reporters for being so harsh on a player after going throug a major cahnge in his life and a major obstacle to overcome in his major knee sugery. From day one Doug Weight was under the microscope of the public eye.

The replay of his injury was first shown repeatedly on all the sport news chanels. His actual sugery was broadcast in the intermission of Hockey Night in Canada. His rehabilitation was followed in the written press as well as shown on HNIC. He then came back to play very quickly after the surgery. We tell most of our athletes who have major knee surgery that they will be 9-12 months before returning to full contact sport. The professional athlete can often beat the time lines by the amount of time they spend each day in rehabilitation. None the less they are constantly pushing the limits. Usually it works out fine but occasionally it does not as Jerry Rice proved a couple of years ago. Often the injury has healed well, but there are many other factors that affect an athletes ability to play at their previous pre injury level. The first decision is to decide when the athlete is actually ready to play at all. This is a decision that involves many people.

The doctor looking after the athlete has to be sure that the injury has actually healed. Whether it is a fracture, a ligament sprain, a head injury or some other illness the physician must be sure that it is safe for the athlete to continue to play. The physician and the therapist must also ensure that not only has the actual injury healed but the athlete has regained most of his strength and conditioning to compete at the previous level. At the same time the athlete has to retrain the game skills. Especially at the highest level, the athlete has to compete at a very high speed. If an athlete takes a period of time off, let alone recovering from an injury it takes time for the mind and the body to react to those very fast game situations. The coach and training staff play an important role in evaluating if an athlete is ready to compete in a full game situation.

Often, even once an athlete has been given medical clearance to play the coach may hold the athlete out until they feel they are ready to compete at their pre existing levels. The ultimate decision of when to play rests with the athlete themselves. They know their body best and can determine if they feel ready to compete. The athlete will often consult family members, agents or other medical personal before they will make their actual decision. It often takes a coordinated conference involving several people to make the final decision. Finally the athlete is ready to play. Unfortunately there is one major intangible. The athlete may have undergone a major injury or illness requiring surgery or a significant time off from the game.It is not easy to just jump back. There is a large component of anxiety in the athlete. Athletes need to play at the highest level to maintain and hone their skills. They lose a lot of these skills and confidence when not playing.

It is very difficult to come back in the middle of the season like Doug Weight has done this year. All the players have been improving their skills and game conditioning all year that he has missed out on. He is probably nervous about his knee especially since he came back from a major operation so soon. It only takes a small amount of speed and skill to turn a superstar into an average player. While I am sure that he has come back at the appropriate time, it is totally unfair to think that he will perform the first few months the same as prior to his injury. It is my experience that it takes the better part of one full year to come back to an athletes preinjury status after a major injury requiring a significant time off. Doug Weight will come back to his super star status but let us allow the proper time to come back. He needs the playing time and confidence that all athletes need to regain his large skill set. He has made a valiant effort to work so hard to come back so soon but let us not forget that he is still in the final recovery stage.


 

Keeping Primed For The Playoffs
Although the teams play all year, the real intensity of hockey begins with the playoffs. Teams play almost every other night unless they are good and luckey enough to finnish a round before their next opponent is ready. Not only are the players playing that more often, the intensity at which they have to play is almost much higher. This is particularly so for the star players who will see their playing time increased let alone the extra intensity of battling opponents at this increased level. The other intangible is overtime. Often the games go longer and this means even more attrition to the body. What this all means is the the athletes have to keep themselves well fueled and hydrated to maintain their abilities. It is not uncommon for a player to lose 7-10 pounds in a game. This is a lot of fluid. An athletes performance becomes affected at less than 4% dehydration. It is crucial to maintain their fluid balance. The athletes play very close attention to their fluids during the game.

For events that last more than 45-60 minutes it has been proven that an athletes performance can be enhanced by the appropriate simple carbohydrate. This is most easily obtained by one of the many sport drinks on the market today. They are all fairly similar in the amount and type of carbohydrate. It really comes down to personal preference of flavor. The other way to easily obtain the right type of carbohydrate without affecting your stomach is to use one of the carbohydrate gels or bars. These must be taken with fluids. Immediately after the game, the most important thing is to replenish the rest of the fluids that were lost in the game. It is impossible to totally maintain all your fluids. For some athletes who become severely dehydrated we will use intravenous fluids to rapidly restore the athletes fluid balance. The next important thing is to restore the athletes energy sources as rapidly as possible as they have to play again in less than 40 hours.

We know that the best time to replenish the energy sources is within a few hours after exercise. It is very hard to eat when dehydrated as this suppresses an athletes appetite. There are now special drinks that have a high concentration of carbohydrate that are excellent for this exact purpose. The players all drink these soon after the game. The players then eat a meal of mostly carbohydrate as soon as their appetite returns after the game. A full plate of pasta is in the dressing room after the game so the players can replenish their energy stores after the game. This along with their fluids is the best way to make sure they are primed for the next game. The other component of the diet that is important for energy is protein. Athletes often focus too much on carbohydrates during these intense periods of competition or training. It is important to replenish your protein as well so your body does not break down and either lose strength or become injured. Days in between games and intense training sessions is the best time to eat more protein to maintain your balance. It is also important to maintain the fluids in the off days as well. There are so many things to consider when you are trying to be your best, but modern science has determined ways that can definitely improve your opportunities to perform at your optimal level. The above principles will go along way to help you achieve your goals and dreams.


 

 

Psychology Of Healing

I am a Sport Medicine Physician. My job entails seeing people all day with various ailments. While most of these are self limiting some injuries are more dramatic and can be quit devastating to the athlete. While I have to rarely diagnose life threatening problems such as cancer which are masquerading as sport injuries, most of the psychological problems I deal with are athletes that have serious enough injuries which may limit their participation or may even be career limiting. The easy part of my job is making a diagnosis of the injury. The diagnosis is made and a plan of action is given to the patient whether it be medication, therapy, bracing, or surgery. Once a serious diagnosis made I always look at the patient to see their reaction. The reaction to hearing they have a serious injury can range from total denial to psychological shock. If the athlete reacts immediately, it is important to deal with it immediately. I spend extra time explaining the injury and the implications of the injury.

Often the patient is in complete denial and needs time to digest the information. Either way I always arrange to see the patient again within a couple of weeks to discuss the injury. This gives the athlete time to think about the injury. Often they will talk to other athletes who have had the same injury. When I see them again in a couple of weeks they are much better prepared to understand the nature of the injury make an informed decision of how they will deal withe the injury. This is when the healing process really starts. A lot is talked about but little is understood of the powers of the mind in healing the human body. It is very hard to quantify these powers but there is no doubt that how an athlete deals with the injury, will play a significant role in how they recover and return to their sport.

The first important thing is to ensure the athlete understands fully the implications of the injury. I explain fully the nature of the injury and how it might impact future performance. It is important for the athlete to understand their recovery time period so they can adjust to the time they will be off and the amount of work it will take to get back to the level they are accustomed to. The mental state is quite different if they will be off a couple of weeks or a year. The other important factor the athlete has to deal with is upcoming competitions. This may range from an athlete preparing for the Olympic games to an executive training for the Boston Marathon. A two week injury precludes participation in an important event may be just as devastating to a person as a more serious longer recovery injury to another person. It is important to consider that mental and physical preparation the athlete has put into their training .

Once the injury has occurred it is important to get the athlete actively involve in their recovery. The more they feel they are a part of the process the easier it will be for them to deal with the injury, I find it the best to have the athlete involved with other athletes who are in different phases of recovery. Often when the injury is fresh one can not see the potential for recovery, but if they are with other athletes progressing along they will be encouraged that they too will soon be at that level of recovery. It is important that the athlete is associating with doctors and therapists that are experts in sports injuries. They understand the nature of the injury and can relate better to the recovering athlete. The athlete knows that they are in an environment that is doing their utmost to get them back to their sport an soon as possible.

I try as much as possible to keep the athlete involved with their team. Spending time with their team whether it be attending games, team meetings or meals makes the athlete still feel part of the team and that they are not alone in their recovery. This will encourage the athlete to work harder to get back to their sport. If they cannot do their sport it is important they use their energy for other things. This may involve cross training to maintain fitness or other activities to occupy their mind and body to help you feel good about yourself. A lot of psychologists use visualization to help the injury heal. The athlete must focus on a positive image of that particular body part healing. Use those great powers that made you perform to help you heal the injury and get back to your sport. I hope that none of us ever get injured, but if you do it is important to set realistic positive goals to get back to playing as soon as possible. Use the injury in a positive sense to go back to your sport invigorated and ready to reach a even a higher level at which you were performing before your injury.


 


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