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Air Pollution

The Ontario Medical Association recently warned that air pollution results in the preventable deaths of 1800 Ontario residents alone. Studies have shown that these deaths are a result of exposure to ground level ozone, aerosols and industry produced particulates. Further studies showed that 24% of emergency visits to hospitals in southern Ontario are attributable to air pollution, and the problem is getting worse every year. Not only does that mean people are getting sicker and even dying, but the increase health care costs could be as high as $1.2 billion annually by the year 2015. Now while most of the really sick people are people who have significant respiratory problems, there are many who have minor problems who are also greatly affected by this pollution.

Just when we are free to exercise in the great outdoors after our normally long cold winter, we are plagued with the effects of air pollution. Pollution is greatest in the summer because ground level ozone is created when chemicals such as car emissions or paint thinners combine with sunlight and water vapour(both more common in the summer) What does this mean to those that exercise in the outdoors exposed to this smog. People who have a condition such as asthma are most prone to problems. Often people with mild asthma will only have problems on these days and otherwise healthy people may have distress on a particularly bad day. Exercise speeds the rate of breathing increasing the amounts of pollutants absorbed in the system.

Chronic exposure to pollution can lead to long term problems such as cancer not in line smoking. Besides the health effects, air pollution can lead to a decreased performance. Cough, shortness of breath or chest tightness may occur. Asthma almost certainly will be aggravated by these pollutants. The following are suggestions to avoid the bad effects of this ever worsening pollution.

1/Listen to the smog report on the radio. It can guide you as to how bad the pollution is and guide your exercise accordingly. There are some days that you should simply avoid outdoor exercise altogether.

2/ Exercise early in the morning or late in the day(not even in the early evening when levels remain high). The prime time to avoid smog is in the morning.

3/Exercise in open areas where there is good air circulation.

4/ Exercise away from heavy traffic areas.

5/ Avoid low lying shaded areas, which although are cooler often harbor more pollutants.

6/ Avoid first and second hand smoke immediately before and after exercise

7/ Special groups should be extra careful to avoid pollution. They are: Children who are vulnerable because of their smaller airways. Pregnant woman History of Asthma or other cardiopulmonary disease The elderly 8/ Lobby the government and industry to control the ever increasing problem we have to deal with. Anyone who has or treats children will realize the great increase in the amount of asthma today as compared to even 20 years ago. A rule of thumb is to consider exercising indoors if the PSI is over 100. So go out and enjoy the great outdoors but beware of the unseen danger of pollution.


Olympic Best

The Olympics start this week and we are going to be treated to see the finest athletes in the world compete for Olympic glory. Athletes dream of Olympic gold and spend their lives training for this opportunity. The chance only arrives every four years which makes this the granddaddy of sporting events. As we watch this event we are treated to a wide variety of sports with many different body types. At the end of the day and all those gold medals who in fact is the best athlete at the Olympics and shouldn't this person derive special status at being the best athlete in the world. Is it the 100 meter sprinter, the rower, the marathoner, the soccer player, the decathelete, or any of the other sporting events that require their own special skill set. Every sport utilizes different skills and strengths. Most sports involve an overlap of energy systems while others are much more specific.

A soccer player utilizes several different energy systems and agility skills as well as fitting into a team event while at the other extreme a weight lifter utilizes pure strength and is all alone. The highest profile event of the Olympics is the 100 metre sprint. These thoroughbreds are classified as the fastest humans on earth. The utilize mostly stored energy in the muscle and have the ability to have the brain connect to all their muscles fibres in their legs to propel them as fast as possible for 9-11 seconds. Are they a better athlete than the power weight lifter who lift 3 times their body weight over their head. They again use only stored energy in the muscles and have the ability for their brain to command all the muscles needed to fire at the same time to lift the incredible amount that they do. Remember ""Pocket Hercules"" from Turkey in the last Olympics who was that small man who eclipsed all records. The recent issue in the New Yorker called rowing the most grueling sport in the Olympics.

Many people think that the rowers like the cross country skiers in the winter are the best all round athletes. They have a very high ability to use oxygen to make energy. Unlike most sports the rowers use all of their body and many muscle groups to help propel their boats to victory. Depending on the event the rowers use a combination of stored energy in their bodies and aerobic energy which is energy that is made by the body as the muscle demands. At the other extreme the marathoner has to endure a very rigorous training program sometimes running in excess of 100 miles a week. They then have to run 26 miles in the extreme high heat and humidity of Atlanta. The run at a pace that very few of us could even run one mile at. The use almost totally the aerobic system and rely on the body to make energy as needed as they go. Maybe a team sport player like Pele who uses their great athletic ability and is able to fit that to a sport that requires team work is the beast all round athlete.

In my mind the best athlete in the Olympics is the winner of the men's decathlon and the woman's heptathlon. These are mature athletes that have spent their life devoted to mastering many disciplines and can excel at sports that require very different skills. From sprints to longer distance races to pole vault to feats of strength and all in a two day span. They are the masters of using all the bodies energy sources and mental strength. So as you watch Donovan Bailey, Silken Laumann, Peter Fonseca, Michael Smith and all the other fine Canadian and other Olympians you can decide for yourself who you pick to be the best athlete in the world.


Marathon Heat

This weekend is the Marathon at the Olympics. As far as I am concerned this is the event that typifies the Olympics. When I think of the ancient Greeks I envision the4 marathon. This event which the athletes will train in excess of 100 miles a week(often up to 150) and can only race twice a year. Everything must be going in their favor on race day. They will complete 26.2 miles at a pace of under five minutes per mile. This year these athletes will have an added huge obstacle as the heat in Atlanta may be the biggest problem of all. These athletes may have to endure a hot humid heat of up to 36 degrees. Not only will affect how fast they run, but this can be extremely dangerous to their health. The following are the problems that these athletes or any of us that exercise in the heat may be exposed to. HEAT RASH This is often referred to as prickly heat. Probably all of us have experienced this before.. There is usually a skin rash consisting of dry red skin.

This is not serious or life threatening and the only way to avoid this sensation if you are prone to this is by avoiding the heat. HEAT CRAMPS These are a little more disabling. Heat cramps are very painful. They most often occur in the calf muscle, but can occur all over the body. In the worst case scenario, an individual will have continuos migrating cramps. This usually occurs after a long distance event. It will start with a cramp in one muscle and as soon as the one cramp is relieved another muscle will start to cramp. This rare situation is quite painful and sometimes hard to treat. The cause of the cramps is loss of fluid and electrolytes. This is from a combination of excessive sweating with not enough intake of fluids. The muscles in the body require a steady flow of electrolytes to contract and relax. If their is low fluid in the body their is less blood flow to the muscles which in turn supplies less electrolytes to the muscles.

This changes the electrical sensitivity around the muscle causing it to contract involuntarily and stay contracted. Once you have a cramp the best way to relieve it is by stretching the muscle group involved. If the cramp is not relieved then massage or ice application will usually work. The most important factor is to replenish the fluids and electrolytes that you have lost. That is with water and electrolyte drinks. After endurance events when the cramps are more severe and can not be resolved, we sometimes require intravenous fluids and even drug therapy to stop the cramps. After the cramp is resolved, their is really no reason that the person can not continue to exercise as long as the muscle is not to painful. The problem is that until you correct the fluid imbalance, the cramps are likely to come back. HEAT SYNCOPE It is not uncommon to feint or pass out in the heat let alone while exercising in the heat. This is due again to the loss of fluids in the body.

In the upright position the blood pools in the lower extremity and their is decreased blood flow to the brain. This will cause you to pass out. The treatment is to lay down with your feet elevated. The next important thing is to cool down and replenish your fluids. HEAT EXHAUSTION We are now getting into the more serious kinds of heat problems. At this point the body temperature is raised. You will become very fatigued and may not even be able to continue. The heart rate is raised and you may even cease to sweat as your fluids are so low. The early signs are decreased performance, increased breathing rate, mental confusion, blurry vision or hallucinations. decreased sweating, and collapse. This is very serious and must be treated. It can be fatal in the elderly, those with heart disease, or those that attempt to continue to exercise. HEAT STROKE As heat exhaustion becomes more serious it can lead to heat stroke which can be fatal even if treated.

Their have been several deaths in marathoners during a hot race. This requires medical attention immediately. At the Toronto Marathon I treat several runners each year with this serious heat disorder. Luckily with our excellent medical team, no one has had serious trouble. The beast way to treat heat disorders is to prevent them. Here are a few tips.

1/FLUIDS This is the most important. You should drink on a regular basis to prevent chronic dehydration. Before exercise drink a glass of water or electrolyte drink and a further glass every15 minutes of exercise. Remember that their is a significant decrease in performance if you are even 4% dehydration. This occurs long before your thirst mechanism kicks in. If you have waited to drink until you are thirsty you have waited too long for both a safety and performance point of view.

2/TIME Avoid exercising during the heat of the day. Early morning is the best or in the evening.

3/DRESS Dress appropriately for the heat. Newer fabrics will help to keep you cool. Do not attempt to overdress to sweat more to lose weight in the heat.

4/DIET If you are prone to cramping, you should increase your intake of potassium and magnesium in your diet.

5/ACCLIMATE It takes your body at least two weeks to adapt to the heat. Do not attempt to push yourself in the heat without having time to adapt.

6/COMMON SENSE Listen to your body. Pay attention to the warning signs listed above. If it is very hot do not push yourself, even if it is a race you have been training for. Better to finish alive then not at all. Save your big performance for a day when the weather is cooperating. Remember as I stated early in the article all of these problems can be prevented. So, as you watch those marathoners compete just imagine yourself walking in that heat let alone competing in that grueling heat.


Pre Season Physicals

The summer must be coming to an end. I spent this week preparing for the physicals for the Maple Leafs who report to camp next Saturday. We perform a per season physical on all players. The players who pass and it is a rare case that a player will not pass their physical will start the arduous training camp in the hopes of making the team and being part of a successful season. Not only does hockey start in the fall , but there are many other sports that start as the summer holidays end. All these athletes should have some evaluation before participating. While most of the kids will be healthy and have no problems there are a select few that have problems that should be dealt with. This is one of the roles of the pre-participation examination. Very few of our young athletes will have a physical before starting to play sports.

It is my feeling that all children should have a sport specific physical examination by a medical doctor before starting certain sports or on a yearly basis depending on the sport and level of training and competition. This may be for a 10 year old gymnast or a high school football player. The physical is best done at an appropriate time for the sport. This is when the sport is starting for the year. The fall is the most common time for many sports. This can be done on a team basis or on an individual basis. The following are the objectives of the pre-participation examination.

1. Determine the general health of the athlete.

2. Look for problems that may limit participation. This may be a medical problem such as a heart defect or a structural problem such as very loose joints in a gymnast.

3. Uncover conditions that may predispose the athlete to injury.

4. Bring the athlete to an optimal level of performance.

5. Evaluate the size and level of maturation

6. Introduce the athlete to a sport medicine physician. The physician will then know the body of the individual athlete and be able to compare the body in a ""healthy"" state as to when it might be injured. The athlete will then have a relationship with a physician with whom he/she can seek future help from.

7. Allow the athlete to ask questions about health and fitness. I have completed hundreds of pre-participation examinations. I am always amazed of the things that we uncover. There have been very few athletes that should not be competing at all, but there are always athletes that require medical or physical help before they can participate. The athlete when they have the examination starts by filling out a questionnaire of their past health and injury profile. Family history is also important especially in regards to sudden death. There are certain cardiac problems which can cause sudden death in a young athlete which are genetic.

There are other symptoms of heart problems which may have occurred to the child. This has to be closely investigated before the athlete can play. Previous surgical and/or medical problems are reviewed and their present status is reviewed. There are certain activities that should not be done with certain medical problems. All medication the athlete may or will be taking is assessed. All previous injuries are reviewed to determine the extent of the injury and how they were treated. This will also help in the physical examination where extra time must be spent on previous injured areas. Any brace or taping requirements are also reviewed. Other important information gathered in the history is allergies, vaccinations, and drug and alcohol use which may affect performance or have other health consequences during the season.

The next step is the actual physical examination. A full general physical should be performed. Special attention should be on the heart and musculoskeletal system. The major cause of sudden death is from cardiac problems. Now while not all of these can be determined by a good history and physical, some of these can and should be referred for further testing if there is any indication that there might be a problem. A thorough examination of all joints and muscles should be done. Any previous injury is assessed to ensure proper healing and to make sure the injury has been fully rehabilitated to full strength and flexibility before the athlete can continue. Certain problems are sport specific and those areas should be assessed for any predisposing problems which might lead to the common injuries in that sport.

All other systems are examined. There may be other relevant findings that may preclude or effect the athletes involvement in the sport. The athlete may have to be referred to other specialists if there are problems discovered in the examination. After completion of the examination the doctor will meet with the athlete. All results are discussed with the athlete and a plan is made to deal with any problems. A follow up appointment is made to make sure the problem is dealt with appropriately. This is as important as the physical itself. Any rehabilitation or conditioning required is arranged for the athlete.

If there is a more serious problem where the athlete's participation is in question a meeting should be arranged with the athlete, coach, and parent. A game plan is then made to decide the future of the athlete. In summary, the pre-participation examination although not proven to be cost effective is an excellent method to help athletes especially those involved in contact or strenuous sports. It is the law in certain parts of the United States that athletes must have an pre-participation examination before being allowed on the field. Serious problems that may even lead to death may be discovered. The athlete is assessed to make sure they are performing at their optimal level with the least risk of injury.


Allergies

Allergies are generally bad in the spring, summer, and fall seasons. This year has been particularly bad with the longer hotter summer. While sports and outdoor activities do not necessarily cause allergies they certain can not only affect the performance, but can be aggravated by the outdoor activities. Allergic reactions can be serious and even life threatening in reacting to a bee or wasp sting in individuals who are susceptible, but general allergies run into more of the nuisance category. For those of you who do suffer from allergies they know how bad they are and how bad they can make you feel. Problems with breathing, headache and fatigue are the two major complaints that would affect performance.

This certainly can affect mood concentration and motivation. For someone who is poorly controlled it may be bad enough to avoid exercise. Treatment is done to allow the individual to enjoy the activity that they want to do. People have different allergies and it is often the people who tend to be allergic in nature have allergies to several things. Hay fever is likely to be exacerbated in outdoor exercise when they are exposed to the pollens of typically ragweed or grass. If the allergen is mold then exercising in a dark moist environment such as the woods would be the most troublesome. On the other hand a person who is allergic to algae would have a problem swimming in a lake or a river. Definite allergies are often hard to diagnose.

It is usually based on the symptoms and the season in which they occur. Tree pollen are most common in the early spring. Grass problems are worse in May through July, and the dreaded ragweed season starts sometime in August. Indoor allergens such as dust, mites and animals can be a real problem especially if you are not staying in your own home where you have more control of your environment. If there is a problem identifying the allergen, than an allergist is consulted and skin tests are performed to help determine the most aggravating allergens. As in any disease the most important thing is prevention. Once you identify the major allergens that affect you than you can try to avoid places where there is a high concentration of these allergens.

Everyone has to decide the risk reward ratio of changing their activities. It would be difficult for a keen golfer with an allergy to grass to avoid the golf course. The key thing is to limit your exposure as much as possible depending how bad you are. A runner may have to modify the time of day when they run or even run indoors when they are in a particularly bad season. The time of day can also be important. The concentrations of many pollens such as ragweed are usually highest in the morning, decreasing in the middle of the day and increasing again in the afternoon Certain routes a cyclist or runner usually takes may be worse than others. It is wise to keep a journal of your exercise and your symptoms.

There are now many good anti-histamines that you can use to decrease the symptoms of these allergies. While the traditional medications can be sedating to some people there are now many new antihistamines that are non sedating. It is best to try a few to see which ones work best for you. If you are in an event where you might be drug tested, check with your physician to ensure that particular medication is not a banned substance. In resistant cases an allergist will prescribe a series of immunotherapy (allergy shots). The key is that with the proper approach the majority of people with allergies will continue to enjoy and perform at their chosen sport and activity.


Headaches

Headaches are one of the most common ailments that human's complain about. It is one of the most common reasons for a person to seek help from their family physician, but it is not one of the things that you would think would affect sport performance. The fact of the matter is that it really is quite common to have a headache that can affect your ability to perform and enjoy your sport. In last seasons hockey playofffs Mark Rechi was said to be suffering from migraines and we all can remember the famous Denver Bronco's running back who could not play for the first half due to a migraine as well. Headaches related to exertion were reported as early as 2000 years ago by Hippocrates. The two most likely cause of headache in an athlete is a tension headache or a migraine headache.

Headaches can be stimulated by trauma and by the increase blood flow of the arteries into the brain. Determining the exact cause of the headache will help determine the treatment. Exertional headaches are usually from a short high level exertion such as weight lifting or wrestling. The headache is usually moderately severe for seconds to a few minutes and then settles down to a low grade headache for several hours. The headache is recurrent with exertion of a similar nature but the person is otherwise normal. The cause of these headaches is from a sudden rise in blood pressure. These headaches can also occur with sexual activity. Effort induced headaches are the most common type of sport headache. It occurs with endurance events. They are more evident in hot weather.

These are migraine type headaches where the athlete will often have some visual dysfunction preceding the onset of the pain. The pain can last for hours. The athlete may have a family or personal history of migraine headaches. The most talked about headaches are trauma induced. There are al least six different types of trauma induced headache. These range from chronic muscle contraction headache to trauma induced migraine to superficial pain at the trauma site. The most prevalent type of trauma induced pain is now from the post concussion syndrome where pain may persist for months after a blow to the head which may not even have been that hard. Injuries to the cervical spine will often lead to a tension type headache running up the back of the head to the front when severe.

It is crucial to realize that any headache if persistent or severe enough can be indicative of a more serious problem in the head such as a tumor, a burst blood vessel, or an infectious process. Other headaches unique to a specific sport can occur.Goggle headaches in swimmers and scuba diver. Divers headaches are thought to occur from carbon dioxide accumulation from skip breathing. Ice cream headaches occur when the temples and face are exposed to very cold weather. Headaches when exercising at altitude especially the first few days are more common than not. Headaches are not usually a serious problem in sport participation but it must be checked out to ensure there is not a more serious problem that exists. When your physician determines the cause of your headache than appropriate steps can be taken to eliminate the pain and enhance your enjoyment and performance.


Prevention Of Injuries In Football

The spring is the time when a lot of contact sports begin. While hockey is the main sport in Canada, other sports such as football are also popular and due to the nature of the contact pose the athlete to risk of injury. As a Sport Medicine physician it is my interest to prevent as many injuries as possible. The Michigan Governer's Council on Physical Fitness, Health and Sports has made the following recommendations. While these are made for football the same principles apply to any contact sport.

1/ Age and Maturation: Children under 6 should not play football. Tackle football should not be played for children under 10. Youth teams should be matched for size and skill level.

 2/ Pre-participation physical: Every athlete should receive a pre participation physical to detect conditions which playing may be life threatening or disabling. The athlete should be checked for any muskuloskeletal conditions that would predispose to injury. The examination should be ideally done at least six weeks before the season to allow time for correction or rehabilitation of injuries.

3/ Knowledge and skill development: Before playing games each child should have mastered a basic set of information and skills. Basic skills in relation to injury should be emphasized such as spearing with the head or hitting from behind.

4/ Conditioning: Year round conditioning programs involving exercise and appropriate nutrition are essential to the athlete's safety. A more intensive program specific to football should be initiated in the six weeks preceding the season especially for the older players over 12. It has now been shown that appropriate conditioning programs can prevent injuries.

5/ Equipment: Equipment should be in good shape and appropriate for the size and level of competition. Helmets are crucial and must be approved by CSA or a similar standard company.

6/Facilities: Playing fields should be well-lighted and free of holes, broken glass and other hazardous debris. All fields should be well maintained. Goal posts should be well padded.

7/Coaches Responsibilities: The coach has the overall responsibility for the safety of the players, including teaching safety principles to them, overseeing proper selection, fitting and maintenance of equipment, seeing that they are properly conditioned, requiring proper warm up, teaching appropriate techniques, avoiding unsafe environment conditions, and preventing players from competing beyond their fatigue level. The coach should have a full mastery of the rules.

8Officials: Officials should promote the safety of the athletes by having a thorough mastery of the rules and enforcing the rules strictly.

9/Parents: Parents of players should be well informed about injury prevention and the proper and safe technique utilized in the game. They should ensure that the coach and training staff are aware of any injury or medical problem.

10/Athletes: The athlete themselves must comply with all of the above principles.

11/ Emergency: An emergency action plan must be in place and all the appropriate people must be aware of how to proceed in the event of an emergency.

12/ Weather: Extreme weather conditions threaten the health of the athletes, coaches, and spectators. A plan must be in place to deal with the extremes of lightning, severe storms and tornadoes, extreme heat or cold.

13/Warm-up: Players should stretch before and after training or competing. There should be a minimum of 15 minutes warm up before any game or practice and a cool-down period after. There should also warm up for 5 minutes after any prolonged break in activity.

14/Re-Injuries: All athletes must be fully rehabilitated from an injury before they can go back to play. An athlete must be cleared by a physician before return.

15/Communicable Diseases: Equipment should be sanitized before it is shared. All athletic staff should follow universal precautions to protect themselves from exposure to blood borne diseases.

16/Transportation: Vehicles used for transporting players should be carefully maintained, inspected for safety and driven by appropriately licensed drivers.


Infectious Disease

Fun and competition are the main reason we participate in sporting activity. We enjoy the activity and reap the health benefits that have been proven to correlate with regular physical activity. The last thing we want in a sporting activity is to be at risk for developing illness and disease, but the risk is definitely there. There are three main ways to obtain a disease from another opponent. The first is with exchange of body fluids. The second is with air borne infections that are sneezed or breathed in into the air and the last is with skin to skin contact with an exposed contagious lesion. The most talked about blood transmitted disease is HIV. There is good reason for this. It is now the number one cause of death in Africa. It is the fifth most common cause of death in the world and there are 16,000 new cases of HIV infection acquired every day.

Fortunately the risk of transmission sport is extremely low. In fact there has only been one case of HIV transmission sport. This involved a bloody fight between two soccer players in Italy. Even in this case it was not proven that the player actually contracted the virus in the game in question. Nonetheless it is the sports where there is potential to be exposed to blood such as hockey and boxing where there is even a risk as small as it may be. The NFL has conservatively estimated the risk at one in 85 million game contacts. It is thought that there is probably no chance that the virus can be transmitted through sweat or saliva. The other blood born virus that we worry a lot about is Hepatitis B. This can cause significant illness and even death. It is a lot more contagious than HIV and such more of a worry for those involved in sport where there is a potential to be exposed to blood.

There are over one million carriers in North America. While it is a lot more transmissible than HIV there is only one confirmed event where it was transmitted. This was in high school aged sumo wrestler in Japan. Despite the evidence that these blood born diseased have not been a factor in sport we can not be cavalier in our attitude. It behooves to follow strict procedure and precautions when blood is involved. Teammates have a risk of developing illness when sharing water bottles and with close exposure on the bench and locker room. There have been case reported of several members of teams developing meningitis. The more common illness we worry about is cold and flus. With the close exposure to each other and with the shared water bottle it is easy to transmit these viruses. While generally not life threatening it will affect the teams and individuals performance.

It is easier to prevent these problems as there is virtually no treatment for these illness. It can be devastating for a team to have several illness at that same time. The best way to prevent these illness is to practice proper hygiene. Personal water bottles is a must. Regular washing of hands will reduce the risk of transmission especially in individuals who have more contact with the athletes. Athletes who are sick should avoid contact with other team members and at the very least ensure that they have a good supply of tissues to sneeze and cough into which is the primary means which the virus is put into the air and can infect other people. Athletes who are involve in high level sports or whose main season is in the fall and winter should consider a flu vaccine. Athletes whose skin is exposed to other athletes must be careful when they have a skin lesion such as herpes which is quite contagious. These athletes must not compete until there is complete resolution of that lesion. There is a potential health risk of the above events but with the proper precautions we can limit our risk significantly where we can enjoy our sporting life and reap the health benefits that we are out to achieve.


Return To Play

Almost before an athlete wants to know what the injury is, they want to know when they can get back to playing. The nature of the injury is of secondary importance. They will let me decide what I can do to expedite their return but the timing of when they can return is of paramount importance. Whether you are a regular casual runner or an Olympic athlete it is crucial to know when you can get back to do your activity.

Once the injury is diagnosed a game plan is set out to heal the injury and timelines are approximated as best as possible with the present status of the injury. The goal is to return the athlete to their activity as soon and as safe as possible. The goals of the treatment plan is to eliminate the pain, regain full function of the injured area and maintain athletic conditioning. Once those are obtained then they can go on to determine the persons ability to return to sport. The following are the main factors we consider.

1/Pain: Pain is diminished as the injury heals. The pain or discomfort should be at a level that does not inhibit the persons ability to do their sport. Pain is a message from your body to you telling you that there is something wrong. While there is often s fine line between discomfort and pain only you can answer how much pain you are in. Pain may be an indication that you are making the injury worse and may in fact lead to other injuries if it changes the way you do your sport.

2/Range of Motion: The range of motion of your joint that you have injured or affected by your injury must be sufficient to allow you to do your sport fully without any restrictions.

3/Strength and Flexibility: You must have regained almost all of your strength to be able to compete and prevent injury. We often quote 90% of strength and this can be accurately measured on special computerized equipment.

4/ Equipment: Protective equipment and or shoes must be appropriate and in good condition.

5/Bracing: Often special braces or supports must be worn to protect the injured area.

6/ Sport specific ability: Regaining full strength and flexibility is only one part of regaining the ability to play your sport. It is important that you train the complex movements required in your sport. Athletes playing team sports must slowly start to practice with their own team and slowly increase the level of practice before they return to the high level of full competition. Psychological factors: We can not underestimate the power of mental preparation.

Athletes must have a realistic attitude when returning to their sport.They first must understand the nature of the injury and how it might affect their return. They have to know what style they can return to and be realistic of what they should avoid. They must have the confidence to feel that they are ready to return and at the same time not to be too cavalier.They still must have a healthy respect for their own body.

Maturity: The maturity of the athlete must be assessed to ensure that the athlete will continue to monitor the status of their injury and to report any problems. Biology: Above all else we must ensure that the biology of healing is complete.Even if we pass all the above criteria it is crucial the we have given biology the amount of time necessary to heal the trauma to the body. The above is a guideline to allow us to get back playing quickly and of course with a minimal risk of re-injury. Athletes always want to get back immediately but if they do not follow the above guidelines it is a recipe for disaster.


Throwing Faster And Harder

Where does the power come from in the batters swing? This is a question that has recently been answered. This gives us the clues to creating more power. Most people come to see me with the pretense of having an injury, but what they really come to see me for is a problem that is preventing them from doing the sport as well as they want to do it. Therefore people want me to help them get back to doing their sport as well as the same level prior to their problem. What I really want to do is to get them back to doing their activity better than prior to their injury. That is when I enjoy my job the most.Often an injury is an excuse to bring an athlete in so that we can work on their body to make them a better athlete. Most athletes and coaches do not know the exact science as to what will make an athlete perform better. They may know a lot about technique and motivation, but it is the sport scientists who have the best idea of what can make the athlete run faster,throw harder and jump higher.

An great example just came out of the performance laboratory of the Kerlan Jobe clinic in Los Angeles. This clinic provides medical care to most of the professional sport teams in Los Angeles. The question they asked is what provides the source of power in a baseball swing. Most people will look at the large pythons of Mark McGuire and say the arms and shoulders. Researchers did not find this to be true. They found that the majority of power came through the hips and then transferred through the trunk and to the arms. The batter which starts their swing any higher up than the lower extremities will not be as powerful as one that starts in the hips. In the study the batting technique of several professional baseball players and focussed of the pattern of muscle activity in 12 muscles. Surface electrodes measured the muscle contractions on the trunk, upper and lower extremity muscles, including triceps, posterior deltoid, middle serratus, and gluteus maximus.

Their swings were filmed using high speed motion picture photography. While many experts believed that super strong forearm muscles delivers the punch, this study showed that is in fact the hips that create the power of the swing. While strength training can not ignore the forearms, arms, and shoulders, it is crucial that the athlete work on the strength and power of the hips and trunk if they truly want to develop power. The training has to train the coordination of the movements from the hips to the trunk and into the arms. The beauty of this knowledge allows me to take this baseball player who may have shoulder pain and take him to a new level . The origin of the pain may in fact be from improper technique. The treatment is initially based on reducing the inflammation and pain. That part is easy and can be accomplished by anyone. The expertise comes into play when we can then take that athlete and put them on a program to not only prevent the injury and pain from returning but to improve their performance.

Our goal is to always make someone a better athlete. Our focus then moves to improving the strength in the parts of the body that this athlete has probably never focussed on. Once we develop the strength in these body parts we start to work on complex movements to sequence the muscles specific to the activity that this particular athlete is participating in. In the example here of the origin of the power of the batting swing can be extrapolated to other activities including the slapshot in hockey or a golf swing. Almost every movement in sport has a series of complex movements that are crucial for optimal performance and injury prevention. Athletes must be aware of these facts to optimize performance. It is important that when you seek help for your injuries that the providers have the philosophy to treat your injury completely and have the mandate to make you the best that you can be.



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