Condition - Summer sports inuries - keeping clients injury-free
During the summer months approaching, you’ll find many clients launching themselves into a new sport or outdoor activity. From serious sporting events to a casual game of tennis or golf - even vigorous gardening - this can lead to an increased number of injuries. Here’s how to help your clients keep fit and healthy…
Given the nature of the British seasons, by the time of summer is upon us, many people are anxious to start improving their fitness. Often, they have done little in the way of exercise through the colder months, which is unfortunate because, apart from the health and fitness implications, an unaccustomed spate of exercise can easily instigate injury. Injuries that result from activity can generally be divided into impact or over-use injuries. The latter is common in the keen athlete, through overtraining.
This is the most common cause of injury in team sports and combat/fighting sports, although it can also occur during individual sports; from falling off a bike or a horse to twisting an ankle while running. It can involve the straining (tearing) of muscles, fracture of bones and injury to joints. The common impact injuries include(1):
Hamstring strain: Often seen when somebody suddenly sprints for a ball. The hamstrings may not be conditioned or warm enough to deal with such a change of pace.
Fracture of tibia (shin bone): A poorly-timed sliding tackle in football or a wayward hockey stick may be responsible for such an injury.
Anterior cruciate ligament (ACL) sprain: One of the ligaments that hold the femur and tibia bone ends in the knee. Sharp twisting of the knee, such as rapidly rotating to make a pass in netball while your feet stay grounded on a sticky floor, can cause this injury.
These types of injuries do not appear overnight. They build up over time, due to an imbalance in muscular strength and flexibility in relation to the amount of load put on the involved tissues. Over-use injuries most often involve muscles and the tendons connected to them, although a prior impact injury, muscular imbalance or systemic inflammation may put pressure on certain joint structures. Additionally, severe training loads with poor recovery might lead to stress fractures in the feet of runners.
Here are some common over-use injuries(2):
Achilles tendonitis: Repeated running or step aerobics can irritate this tendon. It is often due to a weak or inflexible calf-achilles unit, relative to the amount of exercise carried out on it.
Tennis elbow: Repeated hitting of a tennis or squash ball, or even working with a computer mouse on a daily basis, can irritate the tendons that run over the lateral epicondyle (outer edge of the protruding bone of the elbow), causing local swelling.
Slipped disc: In the lower back, this can be due to degeneration of the connective tissue, which holds the disc together. This allows fluid to seep out of the disc and put pressure on the spinal cord, often resulting in sciatic pain through the buttocks and down the leg.
Helping clients with injuries
There are several nutritional approaches for dealing with an injury. Perry(3) developed an excellent model for nutrition in injury rehab. She categorised the injury as (a) acute (12 to 72 hours), (b) sub-acute (four to six weeks) and (c) chronic (on-going), and devised nutritional strategies to rehabilitate them. Impact injuries will be acute and over-use injuries are generally sub-acute and chronic.
A concept with which nutrition practitioners are very comfortable is inflammation(4). Inflammation is an essential part of the injury process: Tissue breakdown is required prior to building up to new levels of tissue strength. Training deliberately causes microtrauma to tissues, which will then (via inflammation) be rebuilt to stronger and more adapted levels. In fact, if you want to improve in fitness, you need to constantly challenge your tissues through training. However, inflammation can be excessive during injury, leading to delayed recovery, so it is important to understand how to modulate an inflammatory response, without completely blocking it.
There is much debate at present into the appropriate anti-inflammatory and antioxidant strategies during exercise training and injury recovery(5). For example, a traditional practice after an injury is to immediately use an ice-pack and/or use anti-inflammatory drugs to reduce swelling. However, perhaps the body knows best and relies upon this inflammatory response to clear dead tissue and support recovery. As such, the ice may, in fact, slow the natural response and, potentially, recovery. The same argument has been noted within nutrition: Vitamin C supplementation has been associated with a reduction in delayed onset muscle soreness (DOMS) after eccentric exercise(6), but with prolonged DOMS in another investigation(7). An interesting theory proposed by these investigators was that a certain amount of oxidative stress is required for rapid tissue repair after exercise and that excess antioxidant use may inhibit the process. This study was looking at muscle soreness after exercise and not actually injury, so further research is required to explore this question further. Similar observations, though, have been made in the field of amino acid research(8). Branched chain amino acids are recognised as important for improving training progress; some degree of protein degradation has been suggested as being important to improve remodeling and repair of muscle tissue.
Some practitioners use antioxidant and anti-inflammatory nutrients and herbs to aid injury recovery. Perhaps excessive levels of these could slow down the tissue adaptation process but, until further information arises in the literature, modulation (not blockage) of the inflammatory and oxidative processes would appear appropriate. During an injury (e.g. muscle strain), nutrient and oxygen delivery to the area is impaired(9). The area is affected by a build-up of inflammatory debris and extracellular fluid, while transport of oxygen, electrolytes, glucose, protein and antioxidants into the injured region can be impaired.
Nutritional interventions that are whole-body in nature can aid transport of nutrients to the site of injury. Recommendations made by Kohlstadt and colleagues(10) include the following:
Whey protein, which contains the amino acids required for synthesis of the antioxidant glutathione, plus the collagen building blocks e.g. proline, lysine and glycine(11).
Vitamin C, which is required for collagen formation and its repletion, has been associated with improved clinical response to healing musculoskeletal strains(12).
Fruit and vegetables, in addition to containing antioxidants, are also considered alkalising. Muscle strain is a localised region of metabolic acidosis.
Zinc serves as a co-factor for over 300 enzymes, including carbonic anhydrase (removed CO2 from cells) and lactate dehydrogenase (conversion of lactate to pyruvate).
Iron is required for tissue oxygenation.
Additionally, these products are thought to be helpful in injury rehabilitation:
Proteolysis enzymes have been used in the acute injury setting, to inhibit the synthesis of pro-inflammatoryprostaglandins and to clear inflammatory debris from the injury site(13).
Fish oil supplementation is thought to attenuate pain and inflammation(14), plus it is appropriate to include omega 6 seed oils, for modulation of the inflammatory response(15).
Glucosamine provides proteoglycans, which are important for the viscoelastic properties of connective tissues. 2,000mg has been shown to significantly reduce joint pain and improve function in as little as eight weeks(16).
Herbs such as boswellia, ginger, garlic, rosemary and turmeric have been shown to modulate the inflammatory cascade(17).
Mark, suffered a calf injury during a weekly five-aside football match with friends. He had jumped into the air for a header and landed awkwardly on somebody else’s foot. He immediately felt a ‘popping’ sensation in the back of his leg, having torn his gastrocnemius muscle. In addition to stopping his running for about four weeks and slowly working through a progressive exercise rehabilitation programme with him, he was recommended these dietary inputs:
A reduction in foods shown to increase inflammation in the body, such as the saturated and processed fats and refined carbohydrates found in his daily, ‘snacky’ diet.
An increase in anti-inflammatory foods, such as fresh fruit and vegetables, nuts, seeds, fish and their oils.
‘Little and often’ consumption of food with appropriate protein: carbohydrate ratio for blood sugar balance noted to influence inflammation.
Supplements – a comprehensive multi-nutrient with sufficient antioxidant support, short-term proteolytics enzymes, a herbal anti-inflammatory blend and a hydrolysed collagen product.
Although Mark didn’t stick particularly well to the dietary suggestions (as expected), he did take his supplements and followed the strict exercise regime. In the course of about six weeks, he was back to half games of football, which he slowly extended to full matches over the following month.
Other suggestions for clients could involve improving alkaline balance in the body with foods and supplements, increased use of anti-inflammatory herbs and spices in meals and snacks, green juices, protein powders, increasing omega 3 intake with fish oil supplements, as well as through diet, and inclusion of fruits such as pineapple and papaya for their natural digestive protein enzyme support. In addition, looking for deficiencies in the diet or limited digestion and absorption is important for supporting clients, to ensure sufficient supply of nutrients needed for recovery and repair. Deficiencies can be screened for by laboratory tests, if necessary, although experienced practitioners can often pick up signs and guide clients with appropriate dietary and supplementary approaches.
Ian Craig and Christine Bailey run sports nutrition courses, open to practitioners and athletes, and a competitive athlete MSc module at CNELM, Wokingham. For further information, contact Christine Bailey on email@example.com. Alternatively, Ian Craig can be contacted on firstname.lastname@example.org.
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2.Peterson L & Renstrom P. Sports Injuries: Their prevention and treatment. 1983, Martin Dunitz Ltd. London.
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10.Kohlstadt et al. Muscle Strain. Chap 19. Scientific Evidence for Musculoskeletal, Bariatric, and Sports Nutrition. Edited by I Kohlstadt. 2006. Taylor and Francis Group.
11.Bralley & Lord. Laboratory Evaluations in Molecular Medicine. Nutrients, Toxicants and Cell Regulators. 2000. IAMM.
12.Bryer S & Goldfarb A. Effect of High Dose Vitamin C Supplementation on Muscle Soreness, Damage, Function, and Oxidative Stress to Eccentric Exercise. International Journal of Sport Nutrition and Exercise Metabolism, 2006, 16:270–280.
13.Rathegeber WF, The use of proteolytic enzymes (chymoral) in sporting injuries. South African Medical Journal 1971, 45(7):181–83.
14.Institute for Functional Medicine, Nutritional Management of Inflammatory Disorders. 1988, Metagenics.
15.Vasquez V. Integrative Rheumatology: Integrative, Botanical and Nutritional Treatments for Inflammatory/Autoimmune Disorders. 2006, Nutri Link Seminar – Royal Society of Medicine, London.
16.Braham et al. The effect of glucosamine supplementation on people experiencing regular knee pain. British Journal of Sports Medicine 2003, 37:45–49.
17.Institute for Functional Medicine, Nutritional Management of Inflammatory Disorders. 1988, Metagenics.