Fueling Your Workout
Alison Tedrow, Senior Dietetics Student, Iowa State University
Have you ever heard someone say they like to workout on an empty stomach because then they burn more fat? This is one of the most detrimental workout myths out there. The reality is, working out on an empty stomach breaks down muscle instead of building it and will most likely lead to not having the energy to complete a good workout. This is because the body's preferred source of energy is carbohydrates. When a workout is completed in a fasted state the body will use whatever carbohydrates are left, then protein from muscle degradation, and finally fat. Food is fuel, and just like a car can't run without gas, the body cannot run without food. Therefore, proper nutrition can make the difference between a good workout and a sluggish workout. The keys to successfully fueling a workout are meal or snack composition and timing.
What is eaten immediately before a workout, if anything, is an important item to consider because this is what the body will primarily rely on to get through the workout. It is generally considered best to provide a good source of simple carbohydrates and protein. Why? Because carbohydrates are the body's preferred source of energy and simple carbs will be absorbed quickly. However, during a long workout (2 or more hours) consuming a combination of complex and simple carbs would be best so that the complex carbs can fuel the later part of the workout, due to slower absorption. Protein will promote quick muscle recovery and help to minimize damage. Research has shown that supplements that combine carbohydrates and protein reduce muscle damage and soreness because of the response created by both the myoglobin and the creatine kinase in muscle (1). Supplying a pre-workout meal with carbs and protein can be as simple as making toast with peanut butter, mixing Greek yogurt with berries, grabbing a handful of raisins and almonds, or blending a protein shake. Precisely how much one should eat is going to vary by the intensity, frequency, and duration of the workouts. In addition to eating before a workout it is also important to remember to properly hydrate with plenty of water.
Timing of a pre-workout snack or meal is just as vital as what is eaten. The exact best time to eat before a workout is going to vary from person to person so make sure to experiment a little, but generally between thirty and ninety minutes before a workout is going to be best. Eating too close to a workout will cause the stomach to compete with the working muscles for blood to help digest the food, which can cause stomach cramping and nausea. Eating too far ahead can cause the body to run out of fuel before the workout is complete, causing the body to feel tired and fatigued. Not only does correct timing fuel the workout it also can increase lean body mass and increase muscle strength gains during resistance training (2). Now what about those morning workouts? Those can be tricky, but the best option is to eat some combination of simple carbs and protein immediately after waking up so that by the time the workout has begun the body has had adequate time to process the food. If this does not seem like enough time, a bed time snack the night before could also fuel the workout (3).
While both what is eaten and when it is eaten are important, the trick is putting those together. Meal or snack and timing should vary by how close it is to the workout. For example, if a workout is planned for 4 in the afternoon, consuming a substantial lunch 3 to 4 hours beforehand and then a snack approximately 1 hour before should provide sufficient fuel. A substantial lunch would allow the metabolism to continue supporting the body through the day and should include all of the macronutrients: carbohydrates, protein, and fat. An example of a food containing all of the macronutrients could be a turkey and cheese sandwich with mayo. The pre-workout snack should be modeled as discussed above including simple carbohydrates and protein to provide the fuel needed for the workout. However, if time did not permit for lunch until closer to the workout consuming a lighter lunch may end up being the best option. Adjusting your meals and snacks can be easily achieved as long as proximity to the workout and meal or snack composition is considered.
No matter what your exercise plans may be, make sure to also plan your pre-workout nutrition. With good meal or snack composition and timing you will be providing yourself ample energy to have a successful workout. Just remember, if you can't fuel it you can't move it!
For questions, contact:
Carrie J. Leiran, MS, RD, LD
The Nutrition Centres at UnityPoint Health - Des Moines-Des Moines
515-241-8686
leirancj@ihs.org
Works Cited
Baty, J. et al. The effect of a carbohydrate and protein supplement on resistance exercise performance, hormonal response, and muscle damage. Journal of strength and conditioning research/national strength and conditioning association , 21:321-329, 2007. (1)
Clarke, N. Sports Nutrition Guidebook. Champaign: Human Kinetics, 2008. (3)
Cribb, P. J. and Hayes, A. Effects of Supplement Timing and Resistance Exercise on Skeletal Muscle Hypertrophy. Med Sci Sports Exercise , 38:1918-1925, 2006. (2)
Wellmark||special174|| Blue Cross||special174|| and Blue Shield||special174|| has named Iowa Methodist, Iowa Lutheran and Methodist West as a Blue Distinction Centers Plus (+). The Blue Distinction Centers for Specialty Care||special174|| program is a national designation awarded by Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality specialty care - and has recently expanded to include more robust quality measures focused on improved patient health and safety as well as new cost-efficiency measures.
- Iowa Methodist was recognized Blue Distinction Center Plus (+) for Spine Surgery.
- Iowa Lutheran was recognized as Blue Distinction Center Plus (+) for Knee and Hip Replacement.
- Methodist West was recognized as Blue Distinction Center Plus (+) for Spine Surgery along with Knee and Hip Replacement.
"The Blue Distinction Center designation places a high value on research and evidence-based health outcomes," said Timothy Gutshall, M.D., Wellmark Vice President and Chief Medical Officer. "It also celebrates and affirms the excellence and commitment of the physicians and staff of these health systems in combining state-of-the-art surgery with state-of-the-art care."
Since 2006, consumers, medical providers and employers have relied on the Blue Distinction program to identify hospitals delivering quality care in Bariatric Surgery, Cardiac Care, Complex and Rare Cancers, Knee and Hip Replacements, Spine Surgery, and Transplants. The selection criteria used to evaluate facilities were developed with input from the medical community, and include general quality and safety metrics plus program specific metrics. Iowa Health - Des Moines is proud to have met the rigorous selection criteria set by the Blue Distinction Centers for Specialty Care programs.
"These designations are a tribute to the dedicated teams of physicians, nurses, orthopaedists and therapists who have helped develop our hospitals' comprehensive programs in hip, knee and spine surgeries, " said Eric Crowell, Iowa Health - Des Moines President and CEO. "Their clinical expertise in orthopaedics care has resulted in better overall results for our patients."
Research confirms that the newly designated Blue Distinction Centers and Blue Distinction Centers+ demonstrate better quality and improved outcomes for patients, with lower rates of complications and readmissions than their peers. Blue Distinction Centers+ are also more than 20 percent more cost-efficient. The program provides consumers with tools to help them make better informed healthcare decisions, and these results enable employers, working with their local Blue Plan, to tailor benefits to meet their individual quality objectives.
About Blue Distinction||special174|| Centers
Blue Distinction||special174|| Centers met overall quality measures for patient safety and outcomes, developed with input from the medical community. Blue Distinction||special174|| Centers+ also met cost measures that address consumers' need for affordable healthcare. Individual outcomes may vary. National criteria is displayed on www.bcbs.com. A Local Blue Plan may require additional criteria for facilities located in its own service area. To find out which services and providers (including hospital based physicians) are covered under your policy, or to learn about Local Blue Plan Criteria, contact your Local Blue Plan; and contact your provider before making an appointment to verify its current Network and Blue Distinction Centers status. Each hospital's Cost Index is calculated separately, based on data from its Local Blue Plan. Hospitals in portions of CA, ID, NY, PA, and WA may lie in areas served by two Local Blue Plans, resulting in two Cost Index figures; and their own Local Blue Plans decide whether all hospitals in these areas must meet Blue Distinction Centers+ national criteria for one or both Cost Index figures. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for damages, losses, or non-covered charges resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers. To find out more, contact your Local Blue Plan.
OVERHEAD PITCHING MECHANICS: THE KEY TO
INJURY PREVENTION
Caleb Freeze, ATC, LAT
Pitching is a smooth continuous motion that happens over a brief period of time. During this time all segments of the body are used, starting with the legs during wind-up and ending with the hand and shoulder during release and deceleration.
Proper pitching mechanics is key to preventing injury in baseball pitchers. Understanding the four phases of the baseball pitch will be cornerstone of starting pitching program for young baseball players. These four phases are the wind-up, cocking, acceleration, and deceleration or follow-through.
Phase I. Wind-up
The wind-up phase of pitching allows the pitcher to develop a rhythm and balance. It is the least demanding phase of the pitching motion. In the wind-up phase the opposite leg is lifted significantly and the trunk is rotated toward the pitching hand side, creating potential energy for the pitch.
Phase II. Cocking
The cocking phase prepares the arm for acceleration by placing it into an extreme stretch. The cocking phase begins with the transfer of the ball into the throwing hand, and ends with the planting of the opposite leg into the ground. During the cocking phase the pelvis and trunk are rotated towards home plate and the shoulder and elbow are maximally stretched creating great potential force for the pitch. This stretching of the shoulder puts maximum stress on the front of the shoulder joint.
Phase III. Acceleration
The acceleration phase begins with maximum shoulder rotation and ends with the ball leaving the hand. During the acceleration phase the shoulder provides support for the "whipping" of the elbow and arm. Movement of the shoulder during acceleration is primarily internal rotation. The elbow moves from a flexed position of an extended position. The baseball is accelerated from 0mph to as much as 100mph during this phase and it is all done in a very short time.
Phase IV. Follow-Through
The follow-through phase is from the point the ball is released to the completion of the forward motion when the support leg contacts the ground to stop the forward body motion. It is during this phase the maximum stress is placed on the rear portion of the shoulder and injury can occur to this area. The deceleration forces are nearly two times as great as the acceleration forces on the shoulder.
The throwing motion is a progression of the larger body segments of the legs progressing to the smaller body segments of the arm and hand. Therefore while training, all muscle groups of the legs, torso, and upper body, including shoulder, bicep, triceps and forearm, should be emphasized for maximum performance.
Injury Prevention for Overhead Throwing Athletes
Amy Carnahan, PT, DPT, OCS
Spring is in the air, and it is time to play ball. Some year round athletes are anxious to get outdoors, while others are dusting off their gloves and warming up their shoulders. As competitive athletics start at a younger and younger age, players continue to feel overwhelming stress to increase the frequency and intensity of their play. This means increased pitch counts, more games played, and ultimately less rest. Adolescent athletes are unique in that they demonstrate increased joint laxity, open growth plates, and under developed motor skills. This means susceptibility to injury. As an athlete prepares for the throwing season, specific attention should be taken to develop conditioning programs to prevent injury.
Leg and core strength: In order to transfer energy from the body to the shoulder to the ball, good core control is needed. For young athletes, this does not necessarily mean hitting the weight room. An effective way to train is for an athlete to utilize his own body weight. Exercises like planks, push-ups, sit-ups, squats, lunges, and pulls ups are great ways to encourage core stability.
A healthy throwing shoulder will demonstrate advanced dynamic control coupled with increased shoulder ROM. The control muscles of the shoulder are much smaller and weaker than other major muscle of the body. Therefore fatigue occurs quicker. High speed controlled movements, such as pitching, require a lot of energy from multiple body systems.
Strengthening: Specificity of training is important. For young athletes, developing a basic strength program is key. However as the athlete matures, conditioning should be tailored to the throwing motion. A specific program for throwing athletes is beyond the scope of this article; however, consult with a trained medical professional, such as a physical therapist or athletic trainer for ideas for your athlete.
Warm up: Throwing involves the entire body, as should the warm up. A proper warm up should include legs, core, shoulders, wrists, and hands. A good warm up will start with a light jog to loosen up the legs. Dynamic stretches, stretching while you are moving, are best. Dynamic exercises can include arm circles, trunk rotation, pitching motion simulation, walking lunges, high knees, walking toe touches, and arm chops. Static stretches, 'stretch and hold for 30 seconds,' are best done when the shoulder is warm. Throwers should concentrate on stretching the posterior capsule (reaching across the body) and shoulder internal rotators ('sleepers stretch').
Toss: After an athlete is warm, throwing should begin. Throwing should never 'warm up' an athlete. Toss should start slow and short and progress to faster speeds at longer distances.
Proper Biomechanical training/coaching: Proper pitching and mechanical assessment should be completed as early as possible in development.
Watch pitch counts: (From the Little League Baseball||special174|| Pitch Count Regulation Guideline for Parents, Coaches, and League Officials).
|
Age (Years)
|
Number of pitches per day
|
|
7-8
|
50
|
|
9-10
|
75
|
|
11-12
|
85
|
|
13-16
|
95
|
|
17-18
|
105
|
|
Age (Years)
|
Pitch count
|
Days of Rest
|
|
16 and under
|
61 or more
|
3
|
|
|
41 to 60
|
2
|
|
|
21 to 40
|
1
|
|
17 to 18
|
76 or more
|
2
|
|
|
51 to 75
|
2
|
|
|
26 to 50
|
1
|
|
|
1 to 25
|
0
|
Listen to the experts in regards to specific pitches. The breaking ball should not be thrown before the onset of puberty. Research is shown to support both sides of this argument. Some studies indicate that pure overuse is the cause of young shoulder and elbow injuries, not the curve ball. While other studies indicate increased risk of injury when an athlete starts throwing a breaking ball before puberty. Nonetheless, in 2012, the American Academy of Pediatrics Policy Statement on Baseball and Softball recommends that the curve ball not be introduced until after the age of 14 and the slider until after the age of 16.
Pushing through muscular fatigue, poor form, and pain usually results in injury. That is why watching pitch counts, proper strength and conditioning programs, and throwing mechanics are so important. Young athletes need to listen to their bodies, and parents and coaches need to continue to listen to their athletes to ensure a healthy and safe spring season.
If you have any questions or need assistance in evaluating or rehabilitating an injury, feel free to contact an UnityPoint Health - Des Moines Des Moines Physical Therapist or Athletic Trainer.
Amy Carnahan, PT, DPT, OCS
Waukee Physical Therapy
50 E Hickman RD
Waukee, IA 50263
(515) 216-2999
Managing Muscle Strains in the Athlete
Dan Sweet, PT
Physical Therapist
UnityPoint Health - Des Moines Des Moines Outpatient Therapy West
If you are an athlete, parent of an athlete or a coach you probably have been challenged by muscle aches, pains, and strains common with all recreational and competitive sports. Determining the severity of the injury is sometimes difficult because the athlete doesn't want to be pulled from participation. However, it is often the most important factor to insure the safety of the athlete. The one common goal should always be to return the athlete to competition in the safest and most efficient manner.
There are many components to consider when evaluating an injury to determine the severity and/or ability to return to play. Initially you should consider the history and/or mechanism of the injury. Did the injury gradually build up, or did it occur on one specific moment in training? Injuries that can be isolated to one specific event generally indicate a more severe or complex injury. Gradual symptom onset typically indicates overuse type injuries, or injury due to training errors. If a collision occurred there is a greater probability for a variety forces and torques involved therefore more risk for injury. Is there any acute swelling? Significant, acute swelling is a sign that the body itself has recognized that an injury has occurred and it has started the inflammatory/healing response. Are they able to maintain full, fluent movement of the joint without pain or hesitation? Are they able to walk or run without hesitation or a limp? If an athlete is hesitant with movement of their body at game speed, they will be at a disadvantage when facing an opponent leaving them susceptible to re-injury, or a more significant injury. After considering the above factors, if you feel the athlete sustained a significant injury, you should seek medical attention through the school's athletic trainer, or physician's office.
After evaluating the injury, the focus turns to injury management. The initial goal is to reduce pain and swelling as well as maintain full, pain free range of motion of the affected joint and surrounding joints. Rest, ice, elevation and a compressive wrap may help with any swelling that may have occurred. Simple movements of the joint can be done in addition to gentle stretching to restore joint mobility. Promote weight bearing if this can be done without hesitation, instability or pain. Light to medium level cardio activities such as stationary bike, elliptical or water exercise can be done to promote early mobilization without directly stressing the affected area.
As the injury heals the athlete will become more comfortable with movements and use of the affected area. At this point you can continue to advance the intensity of cardio activities, progress stretching, and begin to incorporate "pre-game" warm up type activities or sport specific strength and conditioning. The athlete should continue to be monitored for any signs of hesitation with these activities and not be allowed to advance to more strenuous activity or contact if hesitation is observed. Throwing athletes should be evaluated with short toss before being progressed to long toss. Running/agility athletes should be evaluated with straight forward/backward movement before incorporating any cutting drills/activities. Jumping mechanics should be evaluated for body control before combining with running and more complex activities.
The recovery time frame from the initial injury to return to competition can vary from a few days to several weeks or months. It's dependent upon the severity of the injury and most importantly varies from athlete to athlete. It is important to allow adequate time for tissue healing, as well as a full return of strength and agility. Following a stepwise approach to any muscle strain will allow for a safe and efficient return to sport, and will contribute to greater longevity of the athletes career.
If you have any questions or need assistance in evaluating an injury or rehabilitating an injury feel free to contact an UnityPoint Health - Des Moines Des Moines Physical Therapist or Athletic Trainer.
Dan Sweet, PT
Physical Therapist
UnityPoint Health - Des Moines Des Moines Outpatient Therapy West
6001 Westown Parkway Suite 205
West Des Moines, IA 50266
(515)224-5225