Sports Nutrition – The Ins and Outs

While many focus on the strength training and exercising as a means for becoming fit, the nutritional piece is equally, if not more, important. 

Here are a few tips on sports nutrition for athletes and people interested in fueling a healthy and active lifestyle:

Fats: Athletes should get 20-35% of their total calories from fats. Apart from being a good source of energy, fats are needed for the absorption of several vitamins essential to body. Good fats can be obtained from almonds, peanut butter, avocados, and olive oil.

Protein: Considered one of the essential building blocks of life, protein is necessary for repair and rebuilding muscle tissue. The daily requirement of protein ranges between 1.2 and 1.8 grams per kg per day. If you wish concentrate on strength training, try to remain within the high end of this range.

Carbohydrates: Your body efficiently converts carbohydrates into energy. Athletes should consume 1 to 4 grams/kg of bodyweight of carbohydrates about 1-4 hours before a game. Endurance athletes may require a higher amount (7 to 10 g/kg/day) of carbohydrates. Try to consume slow-burning carbs such as whole grains or sweet potatoes rather than processed foods.

During activity: If the game or physical activity lasts longer than an hour, you should focus on replenishing electrolytes and glucose. This can be done during short breaks from the game. Sports drinks that contain carbohydrates, electrolytes, and fluids are a good idea for endurance athletes.

Hydration: The importance of staying well hydrated cannot be overstressed. Try to consume 16 ounces of water 2 hours before a game and drink some water every 15-20 minutes while playing to prevent dehydration.

A balanced diet will fuel your endeavors, no matter what they are.  Whether you’re trying to run a 5K or just feeling better from day to day, nutrition

Questions to ask your physical therapist on your first visit #Seattle

Physical therapists are experts in body rehabilitation and movement. They help improve or restore mobility and reduce painful symptoms through different types of active treatment. Physical therapy may be recommended after undergoing surgery to help you return to activities of daily living.

During your first visit to the physical therapist you may be asked a lot of questions, so a personalized physical therapy rehabilitation plan can be created that will best suit your condition. You too must ask questions to ensure your health goals are achieved through the physical therapy program and so that you fully understand the course of treatment that you will undergo.

Here are some key questions to ask your physical therapist:

Does your physical therapist have any specialized experience in treating your condition?

If you have a musculoskeletal problem, a physical therapist with advanced certification or specialized training in Orthopedics would the ideal choice to design your plan of care. This way you can be sure that the treatment plan will be designed with relevant experience and knowledge.

Will you be seeing the same physical therapist during all your therapy sessions?

Seeing the same provider for all your sessions will help build a rapport and improve communication between you and your physical therapist. You will be better able to give accurate feedback regarding how you feel the therapy is helping you.

If you will be seeing more than one therapist, make sure you ask to meet all of your providers at your initial visit.  Often times, physical therapists will also work with a physical Therapy Assistant to achieve the recommended number of sessions while still being schedule-conscious.

What specific type of physical therapy will be provided for your condition?

Physical therapists employ a number of different types of therapies to regain your motion and lack of pain.  These can consist of manual therapy, ice & heat therapy, ultrasound, electrical stimulation, strength training, aquatic therapy, sports-specific conditioning and functional therapy.  Your physical therapist will design a treatment plan that could include many of these, but they are all to assist with your recovery.

What level of discomfort or pain can be expected during each physical therapy session?

There may be some amount of discomfort or pain during your physical therapy session. However, pain that worsens with each therapy session may be an indication that adjustments must be made to the physical therapy program. Be sure to give your physical therapist precise feedback regarding the intensity, duration, and frequency of your pain.

By closely following the instructions of your physical therapist regarding how to perform your exercises, doing them regularly at home as recommended, and not missing any scheduled sessions; you may be able to keep the number physical therapy sessions to the bare minimum and maximize treatment outcomes.

Cooler Weather is Approaching – Tips to Stay Active all Winter in #Seattle

With cooler weather on the horizon, many people who suffer from joint pain, especially those with existing joint or muscle injuries, are beginning to dread the months to come.  Some may even begin limiting activities outdoors in order to avoid the cold-induced pain.   However, this limiting of physical activity due to colder weather can lead to much worse consequences like weight gain, worsening joint pain, and seasonal affective disorder.

 To stay active during the cooler months, follow these tips!

Wear clothes in layers

Exercise clothing during cooler months should consist of three essential layers. First, wear a thin layer of synthetic material like polypropylene that wicks sweat from the skin. Avoid other fabrics like cotton as it prevents sweat from evaporating. Next, wear a second layer of wool for insulation. Finally, a third layer of waterproof, breathable garment should be employed to keep you dry and warm.

Protect your extremities

When your body senses cooler temperatures, blood flow is directed more to the core of the body to keep your vital organs functioning.  However, this leads to less blood flow to your hands and feet causing for them to get much colder.  Wear woolen head scarves, headbands, hand gloves and socks to protect your ears, head, fingers and feet and keep them insulated. Heat also keeps joint pain under control. When you go for cycling or other winter sports use a helmet to prevent injuries due to falls. Wear goggles or dark glasses to protect your eyes against ice glare and snow.

Choose the right activities

If you don’t prefer to be outdoors in the colder months, there are still plenty of options to stay active.  You can do something as simple as walking around a mall or shopping center or take a class in yoga or group fitness.   This way you can stay active and remain flexible through the winter months.

Swim indoors

You can enroll for indoor swimming classes at your local gym or even just join a gym with lap pools. . Swimming is a great exercise and particularly beneficial for people with arthritis pain. In addition to burning excess calories, swimming engages your joints and increases your range of motion which is helpful if you suffer from joint pain.

Don't let cold weather be your excuse, get moving and fight off those winter blues!

Early Rotator Cuff Shoulder Repairs Lead to Promising Results #Health #rotatorcuff #Seattle

Rotator cuff tears are a very common condition, causing pain and reduced movement of the shoulder. While these injuries may not demonstrate symptoms at first, gradual degeneration may cause shoulder pain and other symptoms to develop within a few years

 "Repairs of isolated supraspinatus tears maintained considerable improvement in clinical and radiographic outcomes at 10 years," according to the report by a French orthopedic surgery research group. The lead author was Philippe Collin, MD, of CHP Saint Gregoire Vivalto Sante. The study provides new evidence that early surgery for supraspinatus tears can improve long-term outcomes by preventing later rotator cuff muscle degeneration.

 The researchers, in a French multi-site clinical setting, identified 511 patients at 15 hospitals who underwent complete rotator cuff tear surgery.  These same patients were had a clinical longitudinal research follow-up ten years later, where 288 patients returned for follow-up evaluation, including MRI scans in 210 patients.

 The results of these patients saw substantial improvement of quality of life as well as general range of motion and use of the affected shoulder. The average Constant score -- a standard assessment accounting for shoulder motion, strength, daily activities, and pain -- improved from about 52 (out of a possible 100) before surgery to 78 at ten years' follow-up. The MRI scans showed similar results with a marked improvement in the quality of the tendon strength.

 Journal Reference

 Philippe Collin, Jean-François Kempf, Daniel Mole[Combining Acute Accent], Nicolas Meyer, Charles Agout, Mo Saffarini, Arnaud Godene [Combining Grave Accent] che. Ten-Year Multicenter Clinical and MRI Evaluation of Isolated Supraspinatus Repairs. The Journal of Bone and Joint Surgery, 2017; 99 (16): 1355 DOI: 10.2106/JBJS.16.01267

Recovery After Shoulder Surgery #ASES #AAOS #Seattle #Health

The group of muscles and tendons that surround, stabilize and allow movement at the shoulder joint are the rotator cuff muscles. Because of this, any surgical procedure on the shoulder will likely have some involvement with your rotator cuff muscles.   No matter the reason for your shoulder surgery, here are some general tips to help maximize your recovery.

 Support your Rotator Cuff

It is important to insure that the muscles that have recently been operated on are supported and allowed to heal with minimal strain.  Wearing a sling or some sort of standing support will allow for this throughout the day and sleeping with a pillow to support the affected side at night will help.   

 Develop your Rotator Cuff

The rotator cuff muscles will take time to heal.  Initially you should avoid putting any strain at all on your shoulder.  After some time however, it’s important to stick to the physical therapists recommended exercises to slowly and gradually re-build the muscles. 

 Manage your Shoulder Pain

Of course pain will be more significant immediately after the operation as compared to a few weeks out.  To manage this, you can rely on prescription or over-the-counter medications as well as inflammation management practices like cold compresses.   In addition, wearing your sling should help reduce shoulder pain and reduce the likelihood of unnecessary strain or damage to the muscles and tendons during the recovery period.

 Gradually get back to normal

Consult with your physical therapist or physician as to when you can begin to resume normal activities with your post-operative shoulder. For example, from about 6 weeks you usually will be able to start using your shoulder for gentle tasks such as washing and dressing while at 12 weeks you will be thinking about using your arm for other moderate activities, such as swimming.

Eat Well for Good Joint Health #Seattle #Health #Fitness

Since bones are living tissues that are constantly working to regenerate and produce new tissue material, the food that we ingest and how remain physically active is vitally important to the maximized production of healthy bone and tissue.

Below are some foods that help boost healthy bone and tissue:

Soy-Based Foods: Foods like tofu and edamame are low in fat and high in protein and fiber. They have anti-inflammatory properties that may relieve joint pain and help with bone and tissue regeneration.

Extra Virgin Olive Oil:  Extra virgin olive oil has been associated with increased levels of bone formation and regeneration. In its pure form, olive oil has a lot of anti-inflammatory and antioxidant properties.

Fish: Fatty fish such as tuna, salmon, herring, and mackerel are rich in omega-3 fatty acids. About 3-4 ounces twice a week will benefit those with rheumatoid arthritis.

Dairy Products: Low-fat milk products such as cheese and yogurt are packed with calcium and vitamin D,  which increases bone strength.

Sweet Potatoes:  a rich source of potassium and magnesium which can aid in boosting bone health.

Grapefruit: This fruit is high in vitamin C, an important vitamin that helps prevent bone loss.

Broccoli: Besides containing a high amount of vitamins C and K, broccoli also contains the compound sulforaphane, which helps slow down the progression of osteoarthritis.

Eating a diet full of these foods will aid in maximizing your bone and tissue regeneration, allowing for you to experience better range of motion and likely better quality of life.

What is “Golfer’s Elbow”? #Health #Seattle

Hitting the links on a beautiful day can be a relaxing and enjoyable experience.  However, many people experience what is called media epicondylitis or Golfer’s Elbow when playing a round.   Symptoms include tenderness and occasional sharp pains on the inside of the elbow, caused by inflammation or tiny tears in tendons near the elbow. The pain centers on the bony bump on the inside of the elbow and may radiate into the forearm.

Many professional players, including Tiger Woods, have battled golfer’s elbow severe enough to warrant withdrawal from major tournaments in the past.. Woods first experienced issues with his elbow at the U.S. Open in 2013 when he was hitting out of the rough, a stroke that is typically achieved with more force than others. That pain, along with tenderness, swelling and weakness on the inside of the elbow indicates a probable golfer’s elbow.

This condition is usually triggered by overuse of the muscles in the forearm that allow you to grip, rotate your arm, and flex your wrist. Repetitive flexing, gripping, or swinging (something that is of course very common in the game of golf) can cause inflammation or tiny tears in the tendons.  A similar condition, tennis elbow, is much more common and affects the lateral epicondyle, though the pain profiles of each of these are very similar.

When it comes to seeking treatment there is no benefit to early medical intervention. Playing through any discomfort is usually fine if the pain is tolerable and rest does not typically help elbow tendinitis.   Golfers should know, however, that it is not uncommon for low-grade symptoms to persist for many months before the condition resolves.

If you find that these symptoms are persisting for an extended period of time, it’s recommended that you visit your physician as there may be something that can be addressed medically happening. 

Is this exercise bad for my shoulder? #Fitness #Health #Seattle

The deltoid

Shoulder injuries are very common with sports and exercise.    2 out of 3 people will experience a shoulder injury or problem at some point in their lives.  Deltoid exercises are very common with many who lift weights, however, the anterior deltoid normally gets most of the attention.  The deltoid actually consists of 3 main heads: the anterior, middle, and posterior.  Imbalance in the 3 heads of the deltoid can lead to injuries.  A study conducted by the University of Wisconsin LaCrosse evaluated proper deltoid exercises to see which were most effective.

To determine which exercises are most beneficial for activating shoulder muscles, researchers compiled a list of the 10 exercises most often performed by both recreational lifters and athletes and most commonly prescribed by trainers.

• Barbell upright row

• Battling ropes

• Bent-arm lateral raise, great for the medial deltoids

• Cable diagonal raises

• Dips

• Dumbbell front raise

• Dumbbell shoulder press, tops in training for the anterior deltoids

• Push-ups

• Seated rear lateral raise, excellent for the posterior deltoids

• 45-degree incline row, excellent for the medial and posterior deltoids

Following the testing these exercises on 16 athletes, researchers compiled and evaluated the data.  The conclusions were:

• For targeting the anterior deltoid, the dumbbell shoulder press elicited significantly higher muscle activation than any other exercise tested.

• For the medial deltoid, two exercises came out on top: the 45-degree incline row and the bent-arm lateral raise.

• For the posterior deltoid, researchers found that the seated rear lateral raise and the 45-degree incline row both provided the greatest muscle activation for the back of the shoulder. 

My Take

For the most high yield workout, you are best served starting with weakest rear deltoid with either the 45-degree incline row or the seated rear lateral raise followed by the dumbbell shoulder press to target the front of the shoulders.

Exercise is very important both physically and mentally, but always needs to be done the right way.  I hope that this info will add to your workouts.

Do non-surgical factors affect recovery after a rotator cuff repair? #AAOS #Health #Seattle

A recent paper - A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors set out to answer this question. 

Many shoulder surgeons like myself have noticed that patients can have a wide range of outcomes after the same rotator cuff repair surgery.  This paper gives further evidence that many psychosocial factors can affect the result of surgery and need to be addressed to maximize a patient's outcome.  Patients with preoperative narcotic use, higher preoperative pain scores, and lower scores on the WORC (rotator cuff questionnaire) index and emotion sections.

I am immensely interested in studying how we can use different technologies and treatments to best address the psychosocial factors that we all have our shoulder and elbow patients.  Check out more about my research in this field here.

If you have a rotator cuff tear and are considering rotator cuff surgery, please ask your shoulder surgeon if there is anything that you can do before surgery to improve your outcome.