Staying hydrated is one of the most important things to consider during exercise. Proper fluid intake is essential for maximal performance and safety. The more intense the activity, the more important it is to drink not only enough fluids but the “right kind” of fluids.  Common causes of dehydration are excessive sweating, failure to replace lost fluids lost during exercise, exercising in dry/hot weather and inadequate fluid intake. Finding the right amount of fluids to drink depends upon a variety of factors including the length and intensity of exercise. Two simple methods one can use to determine adequate hydration levels during activity are to check urine output and the color. Generally speaking, a large amount of light-colored urine means that you are hydrated; small amounts of dark-colored urine can mean that you are dehydrated. The other way for telling if you are adequately hydrated is weighing yourself before and after exercise. It is unlikely that weight loss during the work out will be from more than water weight loss. Long term weight loss happens over time and the number will not dramatically change after working out. You should try to drink enough to replace the weight loss so that you are making sure you are rehydrating properly

To find the correct balance of fluids for exercise, the American College Of Sports Medicine suggests that “individuals should develop customized fluid replacement programs that prevent excessive (greater than 2 percent body weight reductions from baseline body weight) dehydration. The routine measurement of pre and post-exercise body weights is useful for determining sweat rates and customized fluid replacement programs.” According to the Institute of Medicine, the need for carbohydrate and electrolytes replacement during exercise depends on exercise intensity, duration, weather and differences in sweat rates. They write, “Fluid replacement beverages might contain ~20–30 meqILj1 sodium (chloride as the anion), ~2–5 meqILj1 potassium and ~5–10% carbohydrate.” Sodium and potassium are to help replace sweat electrolyte losses, and sodium also helps to stimulate thirst. Carbohydrate provides energy for exercise over 60-90 minutes. This can also be provided through energy gels, bars, and other foods.

What about sports drinks? Sports drinks can be helpful to some athletes and can be detrimental to others by upsetting the gastrointestinal system during exercise. Sports drinks can be beneficial if used more after activity as a refueling than used during activity as a “quick” fluid replacement. It is said that sports drinks can be good for athletes exercising at a higher intensity activity (60 min or more). Fluids supplying 60 to 100 calories per 8 ounces helps to supply the needed calories required for continuous performance.

Recommendations for pre-exercise hydration is mostly related to intensity of the activity being performed. Two to three hours before exercise, drink about 15-20 fl. oz. and drink 8-10 oz. 10-15 min before exercise. A good hydration goal during exercise  is 8-10 oz. every 10-15 min. If exercising longer than an hour and a half, try to drink a sports drinks every 15-30 min to rehydrate and replenish some of the calories and electrolytes being lost during longer exercises. Post exercise, weigh yourself and drink 20-24 oz. of water for every pound lost. It is ok to consume sports drinks after exercise to replenish glycogen stores but should be done within two hours after exercise for greatest effect.

General Guide:

http://www.webmd.com/fitness-exercise/features/drink-up-sports-fitness

Contrasting views on hydration:

http://sportsmedicine.about.com/od/hydrationandfluid/a/060704.htm

http://sportsmedicine.about.com/cs/hydration/a/022504.htm

Link from Gatorade Sports Science Institute on Gatorade and water and the benefits.

http://www.gssiweb.com/tackleheat/pdf/vswater.pdf

One of the most common knee injuries facing active people are traumas to the meniscus, which is often collectively called “torn cartilage”. The meniscus is a piece of cartilage that helps to support and absorb impact to the bones of the patella-femoral joint and it serves to help provide a near friction-less surface that allows uninhibited  motion to occur at the knee.

The location of the injury and the type of tear to the meniscus plays the largest role in the return to activity, both with surgical and non surgical cases.  Most tears that occur on the outer edge of the meniscus have a relatively sufficient blood supply and may heal on their own. However the further the tear is from the outside blood vessels, the less probably that it will heal on its own.  Depending on the type of tear (visual examples of the types of tears can be found here) people can have  varying degrees of pain. The pain may be present with all activity or only with certain movements. The general rule is that if it is affecting your quality of life and has not resolved on its own in a reasonable amount of time, surgery may be your best option.

Typically with surgery, small holes are made on the outside of the knee to allow small scopes and instruments to pass into the joint from the outside. The doctor will visualize the meniscus and make their judgment from there. Sometimes the best plan is to debride (remove) the part that is torn. Sometimes sutures (stitches) are placed in the meniscus, sewing it back together.  And in the most significant cases, holes are drilled through the meniscus and into the bone, bringing new blood to the area to help it heal itself. While most meniscus surgeries are rather painless and allow you to return to full activity in just a few weeks, procedures requiring drilling can take longer to heal and cause more pain after the surgery.

The initial rehab goals after surgery are to decrease pain and inflammation and to increase range of motion. This is a balance, because increasing your range of motion too soon will cause an increase in pain and inflammation. Your certified athletic trainer or physical therapist will use evidence based practice when rehabilitating you post injury and will progress you through several benchmarks before allowing you to return to full activity. Once cleared by your surgeon, you will be allowed to return to all activities that you enjoyed prior to surgery with no restrictions as long as you’re are functionally able. Most people do great with this surgery and will have many more years of activity ahead of them!

Websites of interest:

http://orthoinfo.aaos.org/topic.cfm?topic=a00358

http://meniscustears.net/

http://www.medicinenet.com/torn_meniscus/article.htm

Really good article discussing the use of energy drinks from the USA Today. It gives great information about the amount of caffeine in various beverages and the risks/rewards of taking them. HIGHLY recommend taking a few minutes to read and educate yourselves.

http://www.usatoday.com/sports/story/2011-12-01/young-athletes-and-energy-drinks-a-bad-mix/51556148/1

Medial Tibial Stress Syndrome (MTSS) is often referred to as shin splints which is a catch all term for  pain in the distal one half to one third of the shin, localized along the inside(medial) border of the tibia.  MTSS is an overuse syndrome that is often the result of repetitive running or jumping.  In fact it is accounted for 10 to 15 percent of all running injuries, and up to 60 percent of all conditions that cause pain in athlete’s legs.  Not everyone who likes to run or jump is at risk for this injury.  There are certain risk factors that make one more prone to developing MTSS.  The risk factors that are more controllable include: weakness of lower leg muscles, shoes that provide little support or cushioning, inadequate calcium intake, increased muscular strength of the plantar flexors, and training errors such as training on hard, uneven, or inclined surfaces and overtraining.  Risk factors that are a little less controllable but still manageable include: malalignment problems such as a varus foot, tight heel cord, hypermobile pronated foot, or a forefoot supination, and previous injury to the structures involved.

Some studies indicate that the rate of pronation and the timing of pronation are more significant risk factors than pronation alone. If pronation is excessive or occurs too quickly or at the wrong time then greater tensile loads will be placed on the muscle-tendon units that assist in controlling this complex tri-planar movement.   Pronation occurs in order to get the forefoot in contact with the ground for push off.  Sprinters may present with similar symptoms but with a different cause, that being overuse of the plantar flexors secondary to being on their toes during their event.  Anatomic evidence suggests that the soleus and the flexor digitorum longus are the two muscles involved, posterior tibialis has been ruled out because it does not have any medial tibial attachments.

There are several suggested treatments and prevention plans available, however they do not work for everyone and none of them are guaranteed. Treatment plans include: increase strength (especially eccentric) in soleus muscle, control overpronation by use of orthotics and exercises, promote adequate shock absorption via insoles, new shoes, maintenance of proper foot biomechanics, and work with coaches to commit at least one day per week for a pool work out or some other type of non-weight bearing cardio exercise to allow tibial unloading and for proper bone remodeling response.  Shoes for a pronated runner should not exceed 500 miles, and should be specifically designed to prevent the arch in the foot from falling too much and/or too quickly. Ideally athletes should not return to full play until there is minimal to no pain upon palpation, all causes of excessive pronation have been addressed with an orthotic and proper shoe wear, there is sufficient gastrocnemius-soleus musculature flexibility, and when the athlete has completed the gradual running progression and a sport-specific functional progression without an increase in symptoms. MTSS can lead to a tibial stress fracture if symptoms continue to worsen without treatment.  As with all injuries, it is important to communicate effectively with your athletic trainer and team physician about the severity and timing of symptoms.

Suggested exercises for pronation correction:

Lying on Back

1. Curl the toes downward, and hold while pulling the foot upward and inward
2. With legs straight and together, try to touch the soles of the feet together

Sitting on Chair

1. With left knee crossed over right, move left foot in a half-circle downward, inward, and upward, and then relax.  (do not turn the foot outward.) Repeat with the right foot
2. With the knees apart, place the soles of the fee together and hold while bringing the knees together
3. Place a towel on the floor.  With the feet parallel and approximately 6 inches apart, grip the towel with the toes, and pull inward (in adduction) with both feet, bunching the towel between the feet
4. With a small ball (~1 ¼ to 1 ½ inches in diameter) cut in half and placed under anterior arch of the foot, grip the toes downward over the ball

Standing

1. With the feet straight ahead or slightly out-toeing, roll weight to the outer borders of the feet by pulling upward under the arches.

Walking

1. Walk along a straight line on the floor, pointing the toes straight ahead and transferring weight from the heel along the outer border of the foot to the toes.

Kendall, F. P., McCreary, E. K., Povance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles, testing and function with posture and pain. (5 ed., p. 446). Baltimore: Lippincott williams & Wilkins.

Prentice, W. E. (2004). rehabilitation techniques for sports medicine and athletic training. (4 ed., pp. 597-598). New York: McGraw-Hill.

Craig, D. I. (2008). Medial tibial stress syndrome: Evidence-based prevention. 43(3), 316-318.

Beck, B. R., & Osternig, L. R. (1994). Medial tibial stress syndrome. the location of muscles in the leg in relation to symptoms. 76, 1057-1061.

Low temperatures alone can pose some problems, but when such temperatures are further accentuated by wind, the chill factor becomes critical.  Take a runner who is traveling at a pace of 10 mph directly into a wind of 5 mph, this results in a chill factor equal to a 15 mph headwind.

Very important to the runner is the issue of dampness or wetness.  Air itself can be relatively comfortable at 50 degrees, but water at 50 degrees is intolerable.  With a cold temperature, wind, and wetness added to the formula a runner is at a much higher risk for hypothermia.

A very common condition for runners who take on the cold conditions is frost nip.  This condition normally involves the ears, nose, cheeks, chin, fingers, and toes.  The before mentioned conditions predispose the runner to this condition.  At first the affected area will present as very firm and cold painless area that may peel or blister over the next 24 hours.  Sustained pressure with the hand (not rubbing) and blowing hot breath on the area is a quick and easy initial treatment.

There are a few considerations to take before heading out into the cold for a run.  First and foremost any runner needs to be dressed properly.  Many different brands such as Nike, Adidas, and Underarmour have developed fabrics that are both waterproof and windproof but still allow the passage of heat and sweat evaporation.  If breathing the cold winter air seems distressful a ski mask can be used to somewhat warm the air.

Just with running in a hot environment, proper hydration still applies to the runner in a cold environment.  When dehydration occurs blood volume decreases which means less fluid is available for warming the tissues.

With this guidelines, we hope all of you runners out there may finally make this the year that you follow through with your New Year’s resolution, and if not just remember there is always next year….unless the Mayans are right.

Prentice, William E. Arnheim’s Principle of athletic training. 13. New York: McGraw-Hill, 2009. 184-186. Print.

Hawley, Kristen. “Cold Weather Running Tips.” Fitsugar. n.d. n. page. Web. 5 Jan. 2012. <http://www.fitsugar.com/Cold-Weather-Running-Tips-12643714>.

The best way to prevent the spread of MRSA as well as many other bacteria and viruses is to practice good hygiene. Proper hand washing with soap and water alone greatly decreases the spread of communicable disease.  15-20 seconds rubbing vigorously with hand soap and water is all it takes to get rid of most bugs.

You would be surprised at how many surfaces we touch daily that can harbor the bacteria. And once contaminated with the bacteria, some surfaces can host them nicely for months!

Here are some unnerving facts about how long MRSA can survive at room temperature on common surfaces around our everyday environment:

• Stainless Steel – 3 days
• Mop – 8 weeks
• Cotton Towels – 9 weeks
• Linens/Blankets – 6 months
• Common Dust – 7 months
• Healthy Skin – INDEFINITELY

That’s right; some people can be natural carriers of Staph. About 7% of those who work in hospitals/health care facilities are carriers of the bacteria, and about 2% of the normal population.  What this means is that these individuals can carry the bacteria on their skin without becoming infected themselves, but they are more susceptible to having active infections in open cuts or scraps on the skin, or if their immune system is otherwise compromised.

What are the signs and symptoms?

As mentioned earlier a MRSA infection can be very deceiving. The first signs and symptoms start to appear between 4 and 10 days after contact. The initial appearance usually looks like a raised bump, with a white center and very red perimeter. It can range in size and can mimic the look of a pimple or boil. MRSA infections spread extremely fast however, and an infected person may have extreme pain and swelling in the area infected very quickly. As time goes by, the bacteria emaciate the flesh as it spreads out from the initial area of infection. As it spreads the individual will be in immense pain, and will have systemic symptoms such as fever, chills, nausea, and shortness of breath, chest pain, and general ill feeling.  Not only does MRSA attack the skin, but it can also infect bone, heart, lung, and blood. These infections can progress from the first signs and symptoms to death in just a few days if left untreated.

How can YOU prevent MRSA infections?

Staph and MRSA infections have become increasingly more prevalent in the athletic community. Here are some guidelines to help keep you MRSA free and in the game!

• Clean Hands thoroughly with soap and water or alcohol based hand sanitizer both before and after practice
• Immediately Shower after practice and/or exercise and use a clean towel Every Time.
• Keep all wounds clean and covered until they are completely healed, especially during competition or practice
• Keep all equipment and uniforms clean and in good condition. If washing towels and gear, do so in HOT (140 degrees Fahrenheit) water, and be sure that these items are completely dried in a dryer. (High heat helps to sanitize clothing).
• Never share equipment, towels, razors, or soap as this can spread bacteria.
• Always report any suspicious skin rash/lesions to your Athletic Trainer, Physician, or other Health Care Professionals for proper evaluation. Early detection is KEY.

*Reported by the LA County Jail – inmate died three days after first symptoms of MRSA appeared.

For further helpful information on MRSA and ways to prevent it, click on the following links:

http://bacteria.emedtv.com/mrsa/mrsa-(methicillin-resistant-staphylococcus-aureus)-infection-p3.html

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004520/

http://www.nata.org/health-issues/MRSA

https://plus.google.com/u/0/112037599088185278095/posts?hl=en

How long has it been since your injury?

There are three phases to the healing process, for the sake of this blog we will focus on the first two stages which are the inflammatory and the proliferative stages.  The first stage on average lasts from 48-72 hours after the initial injury.  During this stage of the healing process always use ice.  An acute injury, one that has a sudden onset, such as a sprained ankle requires ice within the first 48-72 hours.  Immediately after an injury occurs the body responds by flooding the injured area with an increased flow of blood with inflammatory agents in it, this process is what causes swelling.  With the application of ice vasoconstriction occurs.  Vasoconstriction is the narrowing of the blood vessels and by doing so the inflammatory agents can no longer flood the area as quickly and cause swelling.

Beginning shortly before the inflammatory phase ends is the proliferative phase.  Regeneration of new tissue begins during this stage which lasts four to six weeks.  During this phase heat may be used prior to exercise to increase blood flow to the area.  Ice should still be used after exercise however to continue the regeneration of tissue.

For what reason are you using ice or heat?

As said before, ice should be used immediately after an injury to reduce swelling.  Ice also acts as an analgesic, or pain reliever.  Unlike heat, ice should not be used directly before exercise for this can set yourself up for further injury.  Application of ice should only occur after exercise to ease pain and swelling from said exercise.

During the proliferative phase of the healing process heat may be used prior to exercise.  The purpose and goal of heat application in this scenario is to increase blood flow, increase elasticity of the tissue, and pain relief.  The same guidelines apply to chronic injuries, or those that have been occurring for an extended amount of time.  For injuries that appear to be aching or muscles that seem to be tight, heat prior to exercise may loosen the tissue or relieve the aching.  A guideline that I live by is that jumping on a stationary bike for a few minutes works just as well or better than a heat pack.

So Miss Perry, to simply answer your question previously asked, there are different times and reasons for using either ice or heat.  The safe bet if you are unsure as which modality to use is to take the safe route and use ice.  Remember, although heat may feel nice, do the sure thing and use ice.

References:

http://sportsmedicine.about.com/cs/rehab/a/​heatorcold.htm

http://orthopedics.about.com/cs/sportsmedicine/a/iceorheat.htm

http://thesportsfamilyclub.com/ice-vs-heat-whats-best

The official National Athletic Trainers Association website .

The website for the American College of Sportsmedicine.

Collegiate Sports Medicine Foundation. Great resource for articles and education related to sports medicine.