Tips from the Training Room

Have a great spring without any injuries!

February 2011: Delayed Onset Muscle Soreness (DOMS)

When you have pushed yourself hard in the gym, performed some intense exercises, or had a long bike ride/run, you may feel extremely sore and your legs or shoulder may feel heavy after 24 - 48 hours. Some people call this condition the �athletic hangover�. This is commonly referred to as delayed onset muscle soreness (DOMS). Although common sense would suggest complete rest to recover, research suggests otherwise!

DOMS is a familiar experience for elite or novice athletes. Symptoms can range from muscle tenderness to severe debilitating pain. Theories suggest lactic acid, muscle spasm, and muscle damage as some of the reasons for DOMS. There are many therapeutic interventions aimed at alleviating DOMS. These include standard physical therapy modalities such as cryotherapy, electric stimulation, massage, and stretching. We have experienced that the best way to alleviate pain during DOMS is to perform modified exercises.

Next time you feel you have DOMS, use the steam room or a good warm shower; follow up using the foam roller with one minute on each body part; ride the stationary bike with very low resistance; or use a low resistance on the elliptical then stretch or do yoga. After this protocol, we are usually able to get our players back on the court for practice. Repeat the same exercise protocol after the workout.

To avoid DOMS, follow the 10% rule: do not increase exercise intensity, frequency, or duration more than 10-15% a week. After an intense workout, be sure to cool down: Ride slow on a stationary bike, do some easy jogging/walking or slow lap swimming, ice or use the foam roll, and get a soft tissue massage.

December 2010: Push-Up

Push-ups are a popular method to assess shoulder, arm and trunk muscular endurance. It is an easy exercise to perform, progress, and to determine your current level of strength compared to the general population. Pushups are a very safe, low risk and functional exercise to strengthen the upper body and improve muscle performance. They can also be performed as a spine stabilization exercise that can be made more challenging as the exercise becomes easy. For example, you could start by doing a modified wall push up while standing. Then, eventually you could progress to a high end challenge like an one arm Plyometric push up. Army physical fitness tests and The American College of Sports Medicine (ACSM) uses push-up as a test to measure upper body strength and muscular endurance.

The ACSM guidelines for the push-up test are as follows:

1. With males, start in the standard �down� position. Hands should be pointing forward and under the shoulder, back straight, head up, and using the toes as the pivoting point. With females, use the modified �knee push-up� position, with hands shoulder width apart, back straight, legs together, lower legs in contact with the mat, ankles plantar flexed and head up.

2. You must raise the body by straightening the arms and then return to the starting position, touching the chin to the mat. The stomach should not touch the mat at any time.

3. Both men and women�s backs must be straight at all times and the push up must be to a straight-arm position.

4. Count the maximum number of push-ups performed in good form without rest. Test is stopped when you cannot maintain good form on two consecutive reps.

Here are the age-adjusted standards based on guidelines published by the (ACSM):

Ratings for Men (Full Pushups), based on Age

Ratings for Women (Modified Pushups), based on Age

Part VIII: Certification in Advanced Sports Rehabilitation: My adventures in Australia

Peter B. O'Sullivan, PT, PhD from Curtin University School of Physiotherapy was our lecturer today. He has published over 87 papers in international peer review journals and has presented the findings of his research at more than 50 National and International conferences. It was really fascinating to listen and learn from �the� Peter O�Sullivan. His methodology of back evaluation is very simple yet the most effective way to evaluate patients. Everything he did and he presented was evidence-based. His philosophy is treating the behavior patterns and fixing the movement patterns.

Then I got an opportunity to sit in a treatment/practice session with the female cricket team in Western Australia, the Western Fury. Shani Blay is the head team Physiotherapist for the Fury. Shani and head coach Steven Philippe were so wonderful to have me over to their practice. It was a pleasure to meet Shani and talk to her about her travels with the team and share tricks of the trade. Although the Fury is a professional cricket team, these ladies truly play for the love of the sport! Even though some of these same players play of the Austrian national team, Fury professional athletes are not paid! All of them have full-time jobs and practice in the afternoons. It was so wonderful to see these young ladies give all they got despite just having finished a full day�s work at a job.

Part VII: Certification in Advanced Sports Rehabilitation: My adventures in Australia

For the past two days, I was blown away by Ms. Lynn Watson's knowledge and the presentation skills on the shoulder. She is the most knowledgeable person on shoulders that I have met. She has been the shoulder consultant to the Australian Cricket team since 1984. Ms. Watson is both a manipulative physiotherapist and a sports physiotherapist specialist. For over 20 years, she has specialized in shoulders diagnosis, treatment, and rehabilitation. I learned some great new shoulder evaluation techniques that I could add to my tool belt to treat my players and patients.

Then, I visited David Philpot, the head Team Physiotherapist for the Perth Wildcats. They are the 2010 Champions of the Australian Basketball League. I spent the morning observing David treating his players and Coach Rob Beveridge�s practice. They were extremely gracious hosts and all the players and the staff were really friendly and nice. It was a great experience to see how the best basketball team worked in Australia.

Part VI: Certification in Advanced Sports Rehabilitation: My adventures in Australia

On Friday, our presenter was Dr. Margaret Potter. She is a physiotherapy with a PhD in sport psychology - a very unique background. It was very interesting listening to her talk about the role of sport psychology in enhancing performance & optimizing rehabilitation. I learned about the SMARTER concept and how to apply it to achieving a goal - Specific, Measurable, Achievable, Realistic, Time based, Evaluate, and Record.

Saturday morning, I had a wonderful opportunity to visit with Perth Glory soccer team = DC United soccer team. I spent the morning observing the head physiotherapist, Chris Hutchinson, and his assistant physiotherapist, Sarah Cunningham. They were wonderful to invite me to a soccer practice and give me an insider's look into their work practices. It was very interesting to talk to Chris and Sarah about their concepts for injury prevention, injury management and return to play. I was very impressed by the work Chris and the strength and conditioning Coach Warren Andrews did monitoring their athletes daily on their volume of training and management/detection of overloading. Then, I was treated to the Perth Glory against Sydney FC soccer match Sunday afternoon! What a great way to spend a weekend in Perth!

Part V: Certification in Advanced Sports Rehabilitation: My adventures in Australia

We had 3 fantastic days of tendinopathy pathology and management talk by Craig Purdam. His knowledge on tendinopathy is incredible! He has written an article in the December 2009 edition of Sports Medicine Journal titled "Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy." I highly recommend this article if you are interested in reading and learning about all the current concepts of tendinopathy. He presented the same information that he presented at the 2010 International Scientific Tendinopathy Symposium. In a nut shell, he teaches you to look for Kinetic Chain Dysfunctions as a cause of tendinopathy. The work load should be gradually increased only when the tendinopathy is diminished and the dysfunction is corrected.

Then, I went to visit Robert Collings, the sports physiotherapist for the Retravision Warriors cricket team. This is the professional cricket team for Western Australia. Being born and raised in a country that considers cricket a national past time, I was elated and excited about the opportunity. It was great to pick Robert's brain on the different treatment methods and discuss tricks of the trade he uses on his athletes to get them healthy. As a bonus, I got an opportunity to walk on the same field that the Sri Lankan cricket team will be playing in Australia next Sunday! It�s hard to explain but imagine Sri Lanka doesn�t have an organized professional team like in the NBA, NFL, or NHL, what Sri Lanka has is a cricket team! So, the national cricket team is our country's pride! Walking on that field was a memory that I would cherish and remember forever.

October 2010 Part IV: Certification in Advanced Sports Rehabilitation: My adventures in Australia

For the next few days, our lecturer is the head physiotherapist for the Western Australian Institute of Sport (WAIS) - this is the American version of the Olympic training center. We were introduced to tendinopathy, pathology and management. It�s amazing how all of WAIS's concepts are evidence-based medicine. They use the best available evidence gained from scientific methods to treat their athletes. This shows in the playing field, they are the world rugby champions, they have great cricketers and they were 6th overall in total medal count in the 2008 Olympics

October 2010 Part III: Certification in Advanced Sports Rehabilitation: My adventures in Australia

Another wonderful day of learning from Ms. Jenny McConnell. It�s great to learn about the �fresh off the press� new evidence-based treatments and research findings. Learning from Ms. McConnel is like getting it straight from the horse's mouth. Today, I also visited Chris Perkin, the Specialist Sports Physiotherapist for the West Coast Eagles Football Club. I had a great time discussing treatment techniques and learning about his school of thought on treatments. I learned lots of fun techniques he does with the Australian football players.

October 2010 Part II: Certification in Advanced Sports Rehabilitation: My adventures in Australia

The next 3 days of our class are going to be taught by Ms. Jenny McConnell. She is a pioneer in physical therapy and the most famous physical therapist in the world! Just as James Naismith is to basketball, Ms. McConnell is for knee taping and patellofemoral pain! I have never really been interested in taking a picture with a professional athlete but I truly wanted a picture with Ms. MConnell! Her knowledge is amazing and everything she preaches and teaches is backed by evidence based literature and her experience. She is the type of person I would love to sit down with and pick her brain. I am very excited about spending 2 more days with her. Since our class size is limited to 12 people, we have unlimited access to interact and learn from the so called �knee taping and patellofemoral pain guru� herself!

October 2010 Part I: Certification in Advanced Sports Rehabilitation: My adventures in Australia

I got a wonderful opportunity to travel to Australia this month to study for a Certification in Advanced Sports Rehabilitation. The faculty for the seminar includes pioneers and leaders in the physiotherapy world such as Jenny McConnell, Peter O�Sullivan and Kim Robinson! Today was my first day in class. I have 14 classmates from all over the world - Australia, India, New Zealand, Ireland, England, Indonesia, etc. They are all leaders in their profession - Osteopath, Physicians or the leading physiotherapist for the Indian women�s cricket team to name a few titles. I am trying to taking it all in. For the next four weeks I have the opportunity to visit and observe the leading physiotherapist for the Western Australian Cricket Association, Perth Glory basketball team, and the Perth Wildcats. It will a great opportunity to see and experience how the rest of the world treats their athletes. Today�s lecture was presented by the Sports Physiotherapist of the West Coast Eagles Australia football team. Even though I just arrived in Australia yesterday after more than 24 hours of flying, surprisingly, I don't feel tired at all! I am so excited about the class and about what they are teaching; I can't even think of feeling tired. Each week I will keep you posted on what new things and exercises I have learned in Australia.

Until then good day mate!

September 2010: Barefoot

Lately, many people having been asking me what I think about running barefoot.

Growing up, we ran barefoot all the time from the gravel roads to the paved hot asphalt. Now, as a clinician, I have a different perspective: all of us are might not be mechanically built to run barefoot. However, I believe that it is still possible to gradually progress from walking barefoot to barefoot running given the fact that millions of people around the world and our ancestors walk and run barefoot everyday and are not predisposed to foot, ankle, knee, hip, and back pain. An article in the Journal of Applied Biomechanics (2010) featured a study of people wearing shoes versus going barefoot. This study concluded that there were no significant differences between the two groups in mechanical changes in the foot that would lead to injuries. So, you may be a person who is mechanically able to run barefoot or you may need to wear more supportive shoes because of bodyweight or hyperpornoate feet.

Before you start running barefoot, please consult your physician and please be careful of hazardous and sharp objects on the ground

August 2010: Swimming as Exercise!

Hello to all Mystics fans! My name is Melissa, the athletic training intern for the 2010 season and I am a senior at Shawnee State University in Southern Ohio majoring in athletic training. Since the start of training camp in the preseason I have been working with Navin Hettiarachchi, the head athletic trainer, to prevent as many injuries as possible because the best type of injury is a prevented injury! Along with prevention of injury we strive to keep our athletes healthy several aspects. One of these is exercise, both cardio and weight lifting, to maintain body composition and improve on areas that need improving or �tuning up�. If the athlete is conditioned well in all areas of the body, the risk for injury becomes less because fatigue does not set in as quickly. While weights, treadmill, and elliptical are great tools, swimming can provide a lot of different variables in one exercise because of the resistance of the water. Swimming is not just a great summer activity it doubles as a great exercise activity too.

When most people think of swimming they think of going to the pool with their kids or friends for leisure activity. If this is the case for you, know that you can also do a pool workout there too. Swimming can be incorporated into a workout schedule so the body does not become accustomed to the same workout day in and day out. Not only is it different, but you might find you actually enjoy this type of exercise. Swimming can be used as a form of cross training to maintain the general condition already established. For athletes incorporating cross training into the workout schedule can also minimize overuse injuries.

By doing a pool workout a person can burn up to 4 times more calories. The water also provides resistance to movements while taking stress off the joints. In addition to swimming laps, here are just

a few exercises from every day health. Any exercise can be done in the pool; you just have to be creative as to how it is performed.

Try to do each of these exercises for 5 sets of 10 repetitions � do what you can in the beginning, and work up to it!

July 2010: Exericise In All Directions!

I see people at the gym everyday training only in one planer motion. There are three types of planer motions. Sagittal plane is where you have front and back motion. A Sagittal plane is an imaginary vertical line that divides your body as left and right from the top of your head to the feet. It is true that we do most of our daily actives like walking, sit-ups, knee extension in Sagittal plane. However, we perform many daily activities in multiple planer motion such as putting on a jacket, dance, or cleaning a counter top. Therefore, we should strength and condition our bodies to be able to carry out multi planer movements.

The other two planer movements consist of frontal plane (where you have an imaginary line dividing your body into front and back) movements such as jumping jacks. Transverse plane is (where you have an imaginary line dividing the body into halves) is generally rotational movements.

Research has shown that injuries such as Anterior cruciate ligament injury very rarely occur when a person is doing a one plane motion activity. I recommend you adopt exercises in all planer motion to help prevent injury and improve performance. Here are some examples of exercises you can perform to ensure all your planers are exercised:

Sagittal plane exercises:

- Inverted hamstring

- Pushups or lat pull-down

Transverse plane exercises:

- Reverse flys

- Medicine ball wall throw

Frontal plane exercises:

- Lateral lunges

- Shoulder press

So, next time you workout, try your best to be creative with your workouts and have movement variations. Have fun!

May 2010: Ankle Sprains: It�s Not the Shoe!

Can a shoe prevent ankle sprains or cause ankle sprains? Yes, it can prevent ankle sprains and cause ankle sprains as well. These days shoe designers design shoes with specific goals such as providing stability, injury prevention and energy efficiency. Shoes with a deep heel cup and a stable wide rear foot base help to reduce ankle sprain. Shoes without these features and poor mid foot support are most likely to cause foot and ankle injuries.

You can prevent ankle sprains by having good hip, knee and ankle mobility, stability and strength. If one of the three main components is missing, you are predisposing yourself to injuries, it does not matter how good the shoe is!

Lateral ankle sprains are one of the most common injuries in basketball. According to an article published in the Journal of Rehabilitation, the primary reason for ankle sprains is neuromuscular fatigue. I am a firm believer of this reasoning as well. Fatigue in the foot/ankle muscles cause decreased activation and muscle firing patterns. This leads to ankle sprains when running and jumping. Unfortunately, athletes very rarely proactively work on their balance or ankle strength training unless they get injured.

I believe in injury prevention programs that consist of single leg balance and single leg strength training as part of a daily exercise routine. For basketball players, the feet and ankles are like wheels on a car. It does not matter how powerful the engine is if the wheel alignment is off, the car wouldn�t perform to its potential. So, make sure you are taking care of the wheels of your body -the foot and ankle.

March 2010: "On the go" Breakfast

It stuns me everyday how some of my patients and athletes find no time to eat the most important meal of the day. Without breakfast, you are already starting your day with only half a tank of gas. You will have a tendency to become mentally and/or physically tired and irritable because you have not had a good nutritional breakfast to kick start your day. It's a daily habit - we all run out of the house and we don�t make time to sit down and have a proper meal. Skipping breakfast makes you crave more junk food during the day to minimize food cravings or hunger. The lack of nutrients will make the body look for energy by breaking down muscle not the fat.

When you do have breakfast, the key is to have food with high nutritional value. Breakfast food should not consist of �dead� calories and sugar such as Pop-Tarts, pastries or donuts. Your breakfast should have Carbohydrates to provide energy, Protein to make energy last and Fiber to make you feel full longer. Here�s a sample list of nutritionally rich breakfast food that you could eat on the run:

The other alternative is to prepare your breakfast the night before, so all you have to do is grab and go in the morning!

If you want to be more productive and energized throughout the day, eat a healthy breakfast. You could eat these "On the go" breakfast meals while you are walking to the metro, walking to the car or waiting for the bus. No matter what and how you do it, always remember to eat a healthy breakfast to start your day off right!

February 2010: Shoveling Snow

I just got in from shoveling snow...I didn't realize how rigorous and demanding it is on the total body!

I never thought about how strenuous shoveling is on the heart and the body. Regardless of age, we must all take preventive care when shoveling snow.

So, before you head out of the house to shovel snow, you should prepare yourself as if you are about to take part in an athletic event. First, make sure you know your limitations. If you're a first time runner, we don't recommend running 26 miles on the first day. It is the same with shoveling snow. Know your limitation and your physical ability. Pushing yourself too much could lead to injuries.

My Five Basic Tips:
1. Warm your body up by walking or jogging around the house for a few minutes and then stretch your upper and lower body. You are more likely to strain your muscles when the body is not warmed up.
2. Wear warm clothes with gloves and a hat. Dress in layers.
3. Take a break every 15-20 minutes to go inside and warm up. Hydrate, preferably with water and/or a drink with electrolytes.
4. Proper technique of shoveling is very important! Continual postural dysfunction, poor habitual mechanics or gait patterns cause most injuries. You have to take care of your spine. Always maintain the natural curve of the spine. Do not twist to throw the snow. Step in the direction that you're throwing the snow. Trauma and stress to the spine is more debilitating than snow in your driveway. Be safe and be patient!
5. It is OK to stop if you are feeling fatigued and tired. If you are experiencing dizziness, fainting, sweating, nausea, shortness of breath and you have a history of heart problems, seek medical help immediately.

December 2009: My favorite exercise equipment

The holiday season is upon us and the New Year is approaching! It�s the time where you are trying to find time to get a workout in or trying to start up a new workout routine. I want to introduce you to one of my personal favorite exercise equipment, the TRX Suspension Trainer.

TRX Suspension Trainer is used by top pro-athletes like Reggie Bush, Carmelo Anthony Heather Mitts and Drew Brees just to name a few. Even NBA, NFL, NHL teams are now using what I believe to be the most versatile piece of workout equipment ever!

The TRX weighs less than three pounds. It can easily be stored in a nylon mesh pouch and carried in a backpack or briefcase. So for you travelers, no more excuses of not having a hotel gym! The TRX sets up in less than a minute and can be attached to a door or a post. Depending on your mood, you can decide if you want to workout indoors or outdoors; you simply take the TRX anywhere and workout any time. This exercise system uses your own bodyweight to do the exercises so you don�t have to worry about having additional heavy weights or expensive equipment. It allows you to adjust the degree of difficulty, regardless of your fitness level, age or fitness goals. Best of all, it costs a fraction of the cost of a home gym or a gym membership.

The main reason that I use the TRX myself and with my patients is the functional movement patterns that challenge the capabilities of the users. For example, if you ask a person to bench press 100 lbs, that person might not be able to do so. That person may not have the strength or joint stability throughout the full range of motion to perform the exercise. The great thing about the TRX is that if the exercise is difficult, you can modify the exercise�s progression/regression making the transition easy.

The TRX Suspension Trainer is the fastest and most efficient way to incorporate functional core and strength training into your routine. You can immediately begin to benefit from a functional workout at home as it uses absolute muscle activation and a realistic movement pattern to build strength, core stability, muscle flexibility and overall endurance. It is also an amazing piece of equipment to correct your body imbalances and improve flexibility and mobility because it is able to get the users to perform movement-specific multiplanear exercises. In sports or in our daily life, our bodies don�t just move in a single plane. TRX employs frontal, sagittal and transverse multiplanar movements which improve muscular balance resulting in efficient power transfers and injury prevention. Another reason that I like the TRX is the unilateral functional training. With injury prevention, it�s very important to have strength, power, stability and balance in single leg strength. TRX makes targeting single leg strength very efficient and functional.

You can use this equipment to perform hundreds of strength-training and flexibility exercises that target every muscle group. All this could be done in the comfort of your home, at the office, in your dorm, outside � anywhere! This is one of the few strength and conditioning equipments that has no age or strength bias. I have used the TRX with young athletes to 85 year old adults. If you are looking for a gift to treat yourself or your loved ones, TRX is my recommendation. Go to http://www.fitnessanywhere.com for more information.

November 2009: Pilates is for Athletes

What dancers have been doing since 1926, the NFL, NBA, MLB and other professional athletes are now beginning to discover: Pilates. Pilates is a form of exercises which focuses on core strengthening and flexibility to improve overall conditioning and physical health. Top-tier athletes across the country are now using this method of strengthening including the New Jersey Nets, Cincinnati Bengals and San Francisco 49ers.

Pilates was developed by Joseph Pilates in the early part of the 20th century as a system of exercises that emphasizes strength, flexibility, breathing and body awareness. Many of the movement patterns can be done on a mat using gravity as resistance; however, there are pieces of equipment including the spring-based Reformer and spring-based Cadillac that can enhance the overall benefit of Pilates. Pilates exercises strengthen the core, stretch tight muscles and improve posture which may allow an athlete to run, jump and sprint with greater efficiency. This can improve the overall condition of an athlete as well as permit a higher level of performance.

Athletes are gravitating toward Pilates because of the functional similarity between the Pilates movements and the movements necessary on the court and on the field. After years of the �no-pain, no-gain� thought process, professional athletes are happy to shift to a kinder, gentler and more holistic approach to fitness and exercise.

Pilates integrate the trunk, pelvis and shoulder girdle to improve stability. It emphasizes breathing to help with control, corrects spinal alignment to allow fluid movement, and improves concentration by using the mind and body connection. This enables the athlete to access each individual part of the body to improve sport specific movements and overall physical well-being. One can also minimize the risk of injury and decrease unwanted spinal pressures through Pilates because of its controlled ways of movement and relatively safe and low impact nature. With the Mystics, we use the Pilates Reformer after an injury as a bridge between therapy and sport specific movements.

In conclusion, Pilates is a great way to improve strength, condition, and fitness while also improving posture, coordination and control. By combining mind and body theories, Pilates provides a way of exercise appropriate for all walks of life.

I want to thank Margaux Wallace for contributing to this article and being our Pilates Certified Physical Therapist consultant at Sports Therapy and Rehabilitation clinic in Washington DC.

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:

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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