In the training room, Mystics Athletic Trainer Navin Hettiarachchi shares a few tips on vital pre-exercise habits.
Check in regularly for new tips.

September 2009: Hydration: Water vs. Sports Drinks

Hey there Mystics Fans! My name is Leah and I am the athletic training intern this season. Since the pre-season I have been working with the head athletic trainer, Navin Hettiarachchi, to prevent injuries and to make sure our athletes stay healthy. In the event that a player is injured, we are there to take care of her and get her back on the court as quickly as possible. There are many ways to prevent injuries and keep athletes healthy. One of the simplest ways to avoid injury or to prevent the need to stop exercising is to stay hydrated. Especially during the summer, when heat and humidity levels are high, it is imperative to drink fluids before, during and after physical activity – especially if you are outdoors.

As important as it is to consume fluids during physical activity it is just as crucial to “pre-hydrate.” According to the National Athletic Trainer’s Association (NATA) Position Statement on Fluid Replacement for Athletes, it is important to drink “17-20 fluid oz of water or a sports drink 2 to 3 hours before exercise and another 7-10 fl oz of water or a sports drink 10 to 20 minutes before exercising” (http://www.nata.org/statements/position/fluidreplacement.pdf). Bob Murray Ph.D with the Gatorade Sports Science Institute says that “An athlete who fails to replace body fluids lost as sweat, typically experiences many adverse functional changes, including a higher exercise heart rate, a higher plasma osmolality, a lower blood flow to the skin, and a higher core temperature. As dehydration becomes greater, so does the negative impact on performance.” (gssiweb.com). To prevent harmful side effects of dehydration exercisers should try to drink every 7-10 oz every 10-20 minutes during exercise. After your workout, be sure to re-hydrate within 2 hours, especially if you plan on exercising again shortly after.

The NATA recommends drinking “water or a sports drink,” but is one a better choice than the other? Many people opt for water because of the calories and high sugar levels that tend to come with sports drinks. However, if you are planning on doing intense physical exercise, sports drinks may be better option to drink before activity. This is because the carbohydrates levels are too high to be metabolized efficiently during exercise. Murray adds that although plain water is “a good thirst quencher, [it] is a poor rehydrator…. Water shuts off thirst before an athlete can properly hydrate…. Ingesting water can alleviate thirst when hydration status is not even close to normal” (Ibid). Dennis Passe, PhD from the Department of Kinesiology Sensory Testing Laboratory adds that “If the beverage is chilled and flavored, drinking can be more than doubled when compared to plain unchilled water.” (gssiweb.com).

The NATA does caution against consuming certain substances such as fructose, caffeine, alcohol and carbonated beverages. Whether your drink of choice is a sports drinks or water, it is important to enjoy one before, during and after your workouts. Depending on the type of exercise and amount of liquid consumed, both water and sports drinks have their benefits, so drink up!

April 2009: Not just a trainer…We are Certified Athletic Trainers!

You've probably seen me or other certified athletic trainers rush to help one of your favorite injured athletes during a basketball game or any other sporting event. As the certified athletic trainer for the Mystics, I am responsible for all the athletes’ health care including helping our athletes prevent injuries and treating the injured athletes to ensure a fast recovery. Athletic Trainers help prevent and treat injuries for people who are physically active, not just professional athletes. Also, certified athletic trainers work in diverse settings such as the military, hospitals, NASCAR and corporate health clubs and programs to name a few.

The term "Athletic Trainer/Certified Athletic Trainer (ATC)" is very often used interchangeably with a "Trainer/Personal Trainer", an individual who has chosen to work for a gym or health club. However, there is a significant difference between the two professions.

Athletic Training is defined by National Athletic Trainers' Association as "Athletic training is practiced by athletic trainers, health care professionals who collaborate with physicians to optimize activity and participation of patients and clients. Athletic training encompasses the prevention, diagnosis, and intervention of emergency, acute, and chronic medical conditions involving impairment, functional limitations, and disabilities." (Approved by NATA Board of Directors in October, 2007)

Here are some noteworthy differences between the two professions:

Athletic Trainer/Certified Athletic Trainer	Trainer/Personal Trainer
MUST have a bachelor’s or master’s degree from an accredited college or university in order to practice athletic training. Athletic trainers’ bachelor’s degrees are in pre-medical sciences, kinesiology, exercise physiology, biology, exercise science or physical education.	May or may not have higher education in health sciences.
MUST pass a comprehensive national board of certification exam before earning the ATC credential.	May or may not be required to obtain Certification. May become certified by any one of numerous organizations that set varying education and practice requirements.
Once certified, MUST meet ongoing continuing education requirements in order to remain certified.	May or may not participate in continuing education.
Specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses (acute and chronic).	Prescribe, monitor and change an individual’s specific exercise program in a fitness or sports setting. Work with clients to achieve fitness goals. Help educate the public about the importance of physical activity.
Work in schools, colleges, professional sports, clinics, hospitals, corporations, industry, military, performing arts centers, etc.	Work in health clubs, wellness centers and various other locations where fitness activities take place.

An athletic trainer's job responsibilities begin with injury prevention. This responsibility includes educating athletes and patients about what they should do to avoid putting themselves at risk for injuries. Certified athletic trainers also may advise people about the proper use of equipment and may apply protective devices, such as tape, bandages, and braces.

When someone is injured during a sporting event, athletic trainers are often among the first healthcare providers to arrive at the scene. Therefore, they must be able to recognize, evaluate, and assess injuries and provide immediate care, when needed. Athletic trainers are also involved in treating, rehabilitating injuries and performance improvement. They collaborate with physicians and other healthcare workers by discussing treatment, rehabilitation programs, injury-preventive practices and guidelines for other health related issues to provide a comprehensive treatment procedure for the injured patient.

Athletic trainers practice under state statutes recognizing them as health care professionals similar to physical therapists, occupational therapists and other health care professionals.

Regardless of whether we are working in a clinical, athletic, academic, or research setting, we wake up every morning excited and passionate because we get to help people with their well-being and make a difference every day. It could be helping a professional athlete to get back in the field, an injured weekend warrior to run a marathon or a patient to return to his/her favorite recreational activity after a total hip or spine surgery.

Have you heard of the saying "Choose a job you love, and you will never have to work a day in your life"? That is how I feel about my job as a certified athletic trainer. I love what I do and I feel that I have the best job in the world helping people everyday!

Information for this article was adopted from nata.org and the Occupational Outlook Quarterly Journal, Spring 2005.

For more information about Certified Athletic Trainers, contact:

National Athletic Trainers' Association
2952 Stemmons Freeway
Suite 200
Dallas, Texas 75247
(214) 637-6282
www.nata.org

March 2009: Sit-Ups...Are They Worth the Pain and Effort?

In my personal opinion and based on research, evidence show that sit-ups are an expensive exercise. Let me first define the exercise that is called “sit-ups” or “crunches”. The Merriam-Webster Online Dictionary defines a sit-up as: a conditioning exercise performed from a supine position by raising the torso to a sitting position and returning to the original position without using the arms or lifting the feet.

What do we get out of doing sit-ups/crunches? During a sit-up the intervertebral disc is compressed anteriorly causing the anterior annular fibres to bulge and double the intradiscal pressure.

Yes, stronger abdominals are a part of the core and are necessary to prevent back injuries. However, I feel that sit-ups are more unsafe than beneficial because it’s not a functional exercise or sport specific exercise. Sit-ups promote poor postural behavior and unnecessary loading to the spine.

Can we do some other exercise with that time to benefit more?

Our muscles are constantly flexed while we are sitting down at a computer at work. So do we really need to do more flexion exercises? According to literature, the number one reason for disc herniation is repeated lumbar flexion (sit-up motion). St-ups could also cause side-effects or contribute to degenerative changes of the lumbar disk.

As you do sit-ups, you fatigue your rectus abdominis muscle (front of the stomach) and start using your hip flexors (illopsoas muscle group) to come up on a sit-up. This high activation on the hip flexor muscle causes these muscles to tighten and result in a poor pelvic position which can lead to imbalance and stress to the back and pelvis.

The common thinking, especially among people who want to lose weight, is that doing sit-ups will result in a flat mid section or a six-pack. That is not the case! Lie horizontally and place a book or magazine on your bellybutton. This is the adipose (fat) layer of your stomach. In order to see you bellybutton you have to take out the book. Similarly, you have to take that adipose layer out of your body somehow to see your six-pack. You do not lose your adipose layer from doing crunches; you lose it by burning the fat off.

A recurring error I see in athletes playing sports such as golf or basketball is the over flexion of their stomach/spine and not using their hips to hinge. Therefore, if an athlete is constantly performing sit-ups/flexion exercises they are prone to over flexion while playing the sport.

Electromyographic studies show there is no single exercise that best recruits all of the abdominal muscles simultaneously. Try a more sports specific exercise such as a plank. The plank or bridging is a great exercise that stabilizes the trunk, while activating the abdominal obliques and rectus abdominis in a safe manner without stressing the spine.

George Sibel, the Physical therapist of the Cleveland Cavaliers says that he prefers to train athletes’ abdominals in standing positions with functional movement exercises. He recommends an exercise such as the Med ball wall throws which replicates the demand that these individuals will place upon their core during a particular athletic event.

As with any exercise that you do, before you do you sit-ups, think about what you are trying to achieve with this exercise. Is it s a functional movement?

Ask your healthcare provider for more suggestions for more advanced and safer exercises that you could perform. Good luck!

February 2009: A Technique I Use to Decrease Pain and Improve Function

I use a technique called the Graston Technique® to detect and treat areas of “scar tissue” or adhesions in muscles, tendons and ligaments that can lead to pain and dysfunction.

In the healing process our body attempts to repair muscles, tendons and ligaments with “scar tissue”, much like the scar that forms on the skin when you have scraped or banged your knee. As you can imagine, that scar tissue is not as strong and flexible as normal, healthy, undamaged tissue. Over time we can have a build up of this fibrous scar tissue, particularly in the muscles, tendons and ligaments that get a lot of use. This can lead to pain and dysfunction because this replacement tissue lacks the strength and flexibility of healthy tissue (in some areas it may even mat down and entrap a nerve).

This Graston Technique® allows me to better detect and treat these areas in the basketball players because it uses a stainless steel instrument that glides along a player’s muscle, tendons or ligaments and acts like a “scar tissue” stethoscope. I use it for IT band syndrome, joint sprain, lower back pain, muscle strain, painful scar, plantar fasciitis, post fracture pain and tendonitis in athletes. When knots or bands of scar tissue are encountered, I use the instrument to “break up” this restriction or adhesion. Then I get athletes to do stretching exercises to promote re-alignment of the fibers so that they behave more like normal, healthy tissue. This technique also increases the amount of improvement in a given amount of time. Unfortunately, an unaided hand is hard pressed to detect and break up as much scar tissue as the stainless steel instruments can.

When the Graston Technique® is coupled with the necessary strengthening and stretching exercises, it helps athletes get better quicker and more completely. It is a Technique that I use often for great results. For more in-depth information on Graston Technique visit GrastonTechnique.com.

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