Ankle Sprains – 101
With football underway and basketball beginning, one of the more common injuries a student athlete or weekend warrior will encounter is an ankle sprain. This can be a major setback and if left untreated may become a chronic issue. With proper diagnosis and treatment you can speed recovery and return to competition.
The definition of a sprain is an injury that stretches a ligament (tissue that connects one bone to another). Ankle sprains most often occur during high impact or cutting activities but can also occur with a simple slip on an uneven surface or ice. They can range from a mild (Grade 1 sprain) to a more severe (Grade 3 sprain) which could involve tearing of a ligament.
Approximately 80% of ankle sprains involve an injury to the ligaments on the outside of the ankle. This happens when the foot is rolled to the inside relative to the lower leg. When these ligaments sprain, pain and swelling often times limit your range of motion, strength, and ability to balance.
The most accepted way to initially treat an ankle sprain is to follow the acronym R.I.C.E.
Rest – involves decreasing activity on the injured ankle. This can mean using crutches to completely avoid use or to continue walking but avoid running.
Ice – within the 72 hours after an injury we recommend icing the ankle for 20 minutes at a time. By placing ice on the ankle this helps to reduce blood flow to the area and decrease swelling. Ice also helps to numb the ankle which reduces pain.
Compression – apply an ACE wrap in a circular fashion beginning near the toes and ending on the shin to help compress or move the swelling toward your heart.
Elevation – prop the injured ankle on pillows to elevate the entire leg above heart level. This uses gravity to also help move swelling toward your heart.
Once the initial pain and swelling decrease, proper rehabilitation exercises begin. It’s important to keep the ankle mobile with range of motion exercises that involve moving the ankle in all planes. Strength can be restored with resistance band exercises and by performing activities on your feet: squats, lunges, step ups, etc. Balance exercises are key for full recovery, standing on one leg, standing on uneven surfaces, or balancing while trying to catch a ball. Next, returning to running and then cutting/agility drills. The use of ankle tape can help protect the ankle and reduce the severity of reinjury but may not completely prevent a sprain.
If you unfortunately sustain an ankle injury it is best to be evaluated by an athletic trainer, physical therapist, or orthopedic physician. They will help individualize a plan of action to help you rehabilitate and return to activity while minimizing complications. Feel free to contact us at UnityPoint Health – Des Moines Physical Therapy or Athletic Training Services.
Brett Beltrame, PT, ATC ||special8226|| UnityPoint Health – Des Moines ||special8226|| Outpatient Therapy West ||special8226|| 6001 Westown Parkway Suite 205 ||special8226|| West Des Moines, IA 50266 ||special8226|| (515)224-5225
Anterior Cruciate Ligament (ACL) Injuries
By: Courtney Wohlwend, ATC/LAT Unity Point Health Des Moines – Athletic Training Services
The Anterior cruciate ligament (ACL) is one of the four major ligaments in the knee. The ACL crosses in the middle of the knee, connects your femur (thigh bone) to your tibia (shin bone), and helps provide stability in the knee. Most ACL injuries occur during sport or fitness activities. The most common mechanism of injury is sudden stopping, pivoting, cutting, and landing.
When an ACL injury occurs, many times the athlete will complain about hearing a pop, they will have severe pain, the knee will swell, and/or they will complain about the knee “giving away” or feeling unstable. If you suspect an ACL injury, it is important to see an allied healthcare professional immediately. Many schools offer a Certified Athletic Trainer, and the athlete should see this healthcare professional. The Certified Athletic Trainer will determine if the athlete will need a referral to a physician or orthopedic surgeon. If an ACL tear is suspected, the physician will likely order an MRI to confirm diagnosis. Depending on the severity of the ACL injury, treatment may include surgery to replace the torn ligament, followed by rehabilitation to help regain strength and stability.
Women are significantly more likely to have an ACL tear than are men participating in the same sports. Women tend to have a strength imbalance, with their quadriceps being stronger than their hamstrings. The hamstrings help prevent the tibia from moving too far forward during activities, which aids in the function of the ACL. In addition, when landing from a jump, some women land in a position that increases stress on their ACL (their knee goes inward). Other possibilities for why women are more likely to tear their ACL’s than men include hormonal differences and the makeup of the notch where the ACL attaches.
How can you prevent an ACL injury? Research suggests that ACL injuries can be reduced by more than 50% by using a preventative training program. Prevention programs typically are a combination of plyometrics, agility, balance, strength, and flexibility.
The Female Athlete Triad
Laura Lawler, Senior Dietetics and Exercise Science Student, Iowa State University
The female athlete triad is a combination of disordered eating, amenorrhea and osteoporosis resulting from intense athletic training.
The athlete triad typically begins with disordered eating, which the National Eating Disorder Information Center defines as irregular, chaotic eating patterns from eating disorders to compulsive eating to habitual dieting (1). Many athletes turn to dieting to lose weight exposing them to factors of eating disorders. Athletes have added pressure to perform at high standards, acquire unrealistic weight and/or body fat goals, and achieve perfection. Perfection is a state of being, it cannot be "set", it can be interpreted, judged, etc. by coaches, family, peers or the athlete herself. Some sports pose a higher risk for developing eating disorders, especially those which perceive thinness provides the greatest performance; for example running, gymnastics, and dance. To attain peak performance, it is easy for female athletes to become preoccupied with food, caloric intake and body weight, which can lead to a distorted body image and disordered eating to set the female athlete triad into motion. (2)
Over decades, women have gained major ground in societal hierarchy. Yet, with all of these advances, feminism still holds a connotation of a slender body frame. Holding such an image can depress many individuals own body image. For many women, body image is the main triggering factor to developing an eating disorder. Body image is comprised of perception, attitude and behavior toward one's own body. When the attitude toward the body contrasts with an individual's personal view, body distortion develops because the mind does not see reality. A preoccupation with one's own body image can become pathologic, a compulsion, and simple food restrictions can develop into a wide spectrum of restrictions of foods, caloric intake or enjoyable daily activities.
Restricting behavior is a warning sign for eating disorder development. There are two types of factors involved in the development of eating disorders; predisposing and precipitating factors. Predisposing factors, which enhance the onset on eating disorders, are conflicts within families, a cultural ideology of thinness and/or obsession with perfection. Precipitating or contributing factors to eating disorders are chronic dieting, being a victim of bullying based on weight or the death of a loved one. The most commonly diagnosed eating disorders are Anorexia nervosa, Bulimia nervosa, Binge eating and Eating disorders not otherwise specified. Anorexia nervosa is categorized when there is severe weight loss from self-starvation and/or persistent behavior that interferes with weight gain. Within Anorexia nervosa, athletes can be diagnosed with Anorexia athletica; excessive fears of becoming obese, restrict calories, have severe weight loss and gastrointestinal dysfunction. Also, the athlete must show at least one of the following: body image disturbance, compulsive exercising, binge eating, purging, delayed puberty or menstrual dysfunction (although, amenorrhea is no longer a requirement for diagnosis). 4 Warning signs include amenorrhea, muscle loss, dry hair and skin, bradycardia, and minimal subcutaneous fat.
Bulimia nervosa, also, is composed of a drive for thinness and distorted body image but, the individual's body weight is usually normal or above normal because of the binge eating followed by a method of purging (vomiting, laxatives, diuretics, fasting, excessive exercise) at least once weekly. Warning signs of bulimia include erosion of tooth enamel, calluses on the back of the hand, preoccupation with quantities of food and/or calories, and eating alone.
Binge eating is when an individual has recurring bouts of significant caloric intake in a short amount of time than most people would under similar circumstances because of a lack of self-control. Many have a feeling of guilt, embarrassment of disgust, which can cause distress. Binge eating disorder is diagnosed when the average of binges is at least once a week over the last 3 months. (4)
In a Norwegian study, 20% of elite female athletes met the criteria for having an eating disorder, compared to 9% of female athletes who were not considered "elite."1 Although, most female athletes do not meet the strict criteria for these disorders, athletes often have many of the characteristics, putting them into classification of Eating Disorders not otherwise specified (EDNOS). (2,3) This classification of eating disorders is usually disordered eating through excessive exercise and inadequate caloric intake in excess or deficiency.
An athlete who has an eating disorder needs to be treated for complete recovery. Eating disorders should be treated nutritionally, psychologically and behaviorally. An undiagnosed eating disorder can decrease an athletes performance level, which can add more pressure, worsening the disordered eating habits. If eating disorders are not treated, complications can occur such as improper functioning of the cardiovascular, hormonal and gastrointestinal systems, imbalance in fluids and electrolytes, the onset of depression and even death. (2)
An imbalance in hormonal secretion can affect the menstrual cycle causing amenorrhea. The menstrual cycle is dependent on hormone levels in response to gonadotropins released from the hypothalamus in the brain. A normal menstrual cycle lasts 23-35 days, but any alteration in the hormonal secretion of gonadotropins will affect the menstrual cycle because these hormones regulate normal growth, sexual development and reproductive function. There are two types of amenorrhea: primary and secondary. Primary amenorrhea is when a female athlete has not started menarche (first menstrual cycle) after the age of 16. Secondary amenorrhea is the absence of a period for at least three to six consecutive months. Athletes have a higher incidence rate of amenorrhea because of the many factors that impact the menstrual cycle: weight, body composition, fat distribution, eating behavior and exercise. (2)
It has been proven that athletes with as low as four percent body fat can still have a regular menstrual cycle, but it is not uncommon for athletes to stop having regular menstrual cycles during their competitive season and return to a normal cycle during the off-season. When there is a lack of caloric intake, amenorrhea can occur because the gonadotropin, luteinizing hormone, a hormone that affects menstrual regulation, is not signaled. Luteinizing hormone depends on the energy available within the body. Since there is a lack of caloric intake, amenorrhea is the body's way of conserving energy. Amenorrhea has been related to decreased bone density, reproductive dysfunction, decreased estrogen levels and risk for cardiovascular disease. A decreased bone density can lead to stress fractures and early development of osteoporosis. Amenorrhea is completely reversible by decreasing the amount and intensity of training and/or increasing caloric intake if calories are deficient. (2)
When amenorrhea occurs, the body is deficient in the production of estrogen, the hormone that regulates bone density leading to osteoporosis. During the adolescent years and up until the age of 18, most women reach 95% of their peak bone mass. Once peak bone mass is reached, women lose about 1% of bone mass per year until menopause. Athletes who develop amenorrhea have more bone mass loss than those who have regular menstrual cycles. The exact rate of bone mass loss varies because of other factors such as age of menarche, timing and duration of amenorrhea and caloric intake. Osteoporosis is when an individual's bone mineral density is greater than 2.5 standard deviations below the mean of a normal young female, according to the World Health Organization. Many athletes participate in weight-bearing exercises, which does increase bone density. For example, speed skaters, gymnasts and soccer players have higher bone mass densities because of the high weight bearing loads and quick, spontaneous movements. Although, most athletes participate in weight-bearing exercises, these exercises may not be enough to offset the effects of the high intensity training. Therefore, athletes who are amenorrheic or are prone to low levels of iron should have their bone mass density monitored regularly through pre-physical exams. (2)
Beginning with disordered eating, leading to amenorrhea and osteoporosis, the female athlete triad can be prevented through education of the athlete, coaches, parents and teammates. Theoretically, any female can fall into the triad but it typically appears in female athletes because of societal pressures to be thin in order to achieve athletic perfection. It is important to take care of oneself emotionally, physically and spiritually which will improve body image and boost self-esteem. By suppressing disordered eating, the body's regular functioning of hormones allows for menstruation to completely cycle and reduces the rate of osteoporosis. If you or you know someone who falls into the female athlete triad, seek help as the long-term consequences of the condition are life threatening.
For questions, contact: Carrie J. Leiran, MS, RD, LD, The Nutrition Centre at UnityPoint Health - Des Moines, 515.241.8686, Carrie.Leiran@unitypoint.org
1 Bear, M. National Eating Disorder Information Center. Web. 20 Jun 2013. <http://www.nedic.ca/index.shtml>
2 Lebrun, Constance M M.D., M.P.E., C.C.F.P. and Rumball, Jane S. B.Sc., "The Female Athlete Triad." Sports Medicine and Arthroscopy Review. (2002) 10.1: 23-32.
3 Hobart, Julie A. M.D., and Smucker, Douglas R. M.D., M.P.H. "The Female Athlete Triad." American Family Physician. (2000) Jun 1;61(11): 3357-3364. < http://www.aafp.org/afp/2000/0601/p3357.html>
4 Grohol, John M. PSY.D.. "DSM-5 Changes: Feeding and Eating Disorders." PsychCenteral. (2013) May 28. <http://pro.psychcentral.com/2013/dsm-5-changes-feeding-eating-disorders/004412.html>
Heat Illness - What is it and how do we prevent it?
Chris Wiedmann, ATC
UnityPoint Health - Des Moines Athletic Training Services
Hyperthermia, or Heat Illness, is a condition in which the body temperature is elevated. This can affect performance, and in some instances, pose a very serious health risk.
Each year, exertional heat stroke results in thousands of emergency room visit, hospitalizations, and lost time from practice and play nationwide.
Football may get a majority of the attention, but every sport is susceptible. Any sport with a high air temperature and humidity can become dangerous. Even a gymnasium without air conditioning can become very hot and humid, putting those athletes at risk. The better prepared the student athlete is before heading into his or her sport, the less likely they will be to suffer from these symptoms.
While proper hydration will not necessarily prevent exertional heat illness, it will decrease the risk.
Dehydration occurs when a person loses more fluid than he or she drinks. When this mismatch occurs, it becomes more difficult for the body to function properly, leading to early fatigue and an increased risk for heat illness.
Being properly hydrated is one of the easiest ways for athletes to ensure optimal performance and lower the risk of heat illness. Dehydration can impair athletic performance and make it more difficult for the body to cope with exercise in a hot and/or humid environment. Because students differ in body size, sweating rates and training regimens, it is difficult to recommend a "one-size-fits-all" hydration approach.
Here are some signs/symptoms of dehydration:
- Muscle cramps
- Dry lips and mouth
- Dark colored urine (should be clear or light yellow)
Here are some early signs/symptoms of heat injury to watch for:
- Deterioration in performance with signs of struggling, moving more slowly, and/or bending over with hands on knees
- Pale or bright-red flushing of the skin
If these signs/symptoms of heat injury occur:
- Remove the athlete from play and immediately move him or her to a shaded or air-conditioned area.
- Remove excess clothing and equipment.
- Have the athlete lie comfortably.
- If the athlete is not nauseated or vomiting and is able to drink, give cold water or a sports drink. If the athlete is unable to drink, the Emergency Medical System should be activated.
- If a rapid improvement is not seen with the interventions as above, activate the Emergency Medical System for transport to an emergency facility.
- The athlete should not return to physical activity until given clearance by an appropriate health care provider.
The goal of any practice is to challenge the athlete, which often results in him or her being fatigued. However, there are things to look for that may indicate more severe distress than just being exhausted. Recognize the more serious signs of exertional heatstroke.
Watch for these serious signs:
- Severe fatigue
- Obvious behavioral changes and/or other central nervous system problems such as confusion, loss of consciousness or seizures
If you see these signs, the activity must immediately stop and initiate rapid full body cooling while the Emergency Medical System is being activated.
For an athlete with exertional heat stroke, immediate medical treatment and rapid cooling can prevent serious illness or death. The first choice of immediate treatment is submerging the athlete in an ice-water filled tub. If an ice-water filled tub is unavailable, cold wet towels rotated frequently, and ice bags placed on the groin and armpits should be used for cooling.
The majority of heat-related injuries occur during the first few days of practice, from doing too much, too fast. Many high school athletes have a Superman complex and believe they can't, or won't get hurt. For this reason, it may be challenging to convince students that proper hydration is an important component of staying healthy. An easy way to determine sweat loss is to record the difference in body weight before and after exercise. It doesn't take much dehydration to affect performance. Losing even as little as 1 ||special189|| -2% of body weight can take a toll on performance by causing fatigue and affecting physical and mental skills. Students should drink 16-24 oz. of fluid for every pound lost during exercise to achieve normal fluid levels within 6 hours of stopping activity. Fluid should always be readily available for students before, during and after all workouts, practices and competitions. For most athletes, the ideal replacement fluid is water. It's quickly absorbed, well-tolerated, an excellent thirst quencher and cost effective. While water is always an excellent choice for hydration, a properly formulated sports drink can provide some additional benefits. Most sports drinks contain a 6 to 8% carbohydrate solution and a mixture of electrolytes. The carbohydrate and electrolyte concentrations are formulated to allow maximal absorption by the gastrointestinal tract.
What's in a Sports Drink?
- Sodium: Sodium is the most critical electrolyte lost in sweat and plays an essential role in maintaining fluid balance. Once in the bloodstream, sodium helps maintain blood volume. That translates into a lower heart rate and greater blood flow to muscles and skin, which is important in helping sustain performance.
- Carbohydrates: Carbohydrates are the body's first choice for fuel, and consuming them during exercise helps fuel working muscles. Different types of carbohydrates found in Sports Drinks stimulate fast absorption by the gastrointestinal tract.
- Flavor: In many cases, the primary advantage of sports drinks may be that the flavor will be more likely to encourage greater consumption. Thirst is the body's defense against dehydration, and the combination of flavor and electrolytes encourage students to drink.
What not to drink
- Energy drinks are not the same as sports drinks. They are popular, but they are not designed to re-hydrate athletes during activity and should not be used in such circumstances. There is no regulatory control over energy drinks, thus their content and purity cannot be ensured.
- Fruit juices with greater than 8% carbohydrate content can result in a bloated feeling and abdominal cramping.
- Carbonated beverages and soda may cause an upset stomach or a bloated feeling.
An athlete will often show early signs and/or symptoms of developing exertional heat-related distress. If these signs and symptoms are promptly recognized and the athlete is immediately and appropriately treated, serious problems can be averted and the athlete can often recover, and return to activity when signs and symptoms have fully resolved.
The goal of hydration is to maintain normal hydration status, avoiding both dehydration and over-hydration. This is accomplished by drinking gradually and periodically before, during and after exercise. Water should be readily available at all times and access to water should never be restricted. Students can follow their hydration status by weighing in before and after workouts.
Recognize early signs of distress and developing exertional heat illness, and promptly adjust activity and treat accordingly. First aid should never be delayed.
MOUTHGUARDS: WHAT'S PROTECTING YOUR SMILE?
Melanie Mason, MS, ATC, LAT, CSCS; Scott Fleagle, ATC, LAT
UnityPoint Health - Des Moines Athletic Training Services
As football season quickly approaches, one area of protection that athletes often don't think about is their mouth and teeth. Mouthguards come in a variety of types, styles, and colors. Unfortunately, athletes usually pick the mouth guard that looks the "coolest". In this article, we will discuss the reason for using mouth guards, the different types of mouth guards, and the strengths of each type.
Mouthguards provide a cushion that prevents the teeth from being forced against each other in a violent way. They also provide protection from blows by objects and/or other athletes. Guards help prevent injuries to both the teeth, and the surrounding soft tissues of the mouth. They are required in football, but can also be helpful in other contact sports.
Type 1: Stock mouth guards
These mouthguards are the least expensive type. They are meant to be used right out of the package, with no alterations. Stock mouth guards do provide some protection, but not a lot because they aren't fit to each athlete's teeth.
Type 2: Boil and bite mouthguards
Boil and bites are heated in boiling water to soften the material, then placed into the athlete's mouth to form around the upper teeth. The boil and bite guard is inexpensive, convenient, and easy to mold, and provides better protection than stock mouthguards.
Type 3: Custom mouth guards
Custom mouthguards are the most expensive type, but also provide the most comfort and protection. A dentist creates an exact mold of the athlete's teeth. This mold is then used to create a mouth guard that fits perfectly over the athlete's teeth.
When using any type of mouthguard, always make sure that it hasn't been "chewed down" or cut off. Wear the guards as they are intended to be worn, and follow all instructions for wear and care.