Training Tips

Dr. Eagar is a dual credentialed provider with degrees in sports medicine, chiropractic medicine, and exercise science. Dr. Eagar owns Active Advantage, a private sports medicine practice with an emphasis on rehabilitation and chronic injury management. He enjoys answering questions and can be reached at [email protected]. For more general information you can visit his website http://www.activeadvantagechiro.com.

Hydration and Electrolyte Replacement – Why & How?

When we talk about hydration we should really divide it into two categories. First, is simply good old H20. You need water to function. Failure to consume enough water can elevate blood pressure, contribute to increased risk of heat illness (including both heat exhaustion and heat stroke), and decrease muscle function. If you break down the biochemistry you’ll see that water is a key component to basically every process in your body. So make sure you drink enough water. A good rule of thumb is one half cup per 20 minutes of exercise.

The second category of hydration is electrolyte replacement. For this I recommend becoming aware of what I call the Big 3: sodium, potassium, and calcium. These three are heavily involved in the normal function of muscles and nerves in the body. This includes skeletal muscle as well as heart muscle. Unfortunately, normal electrolyte levels can require a delicate balance to function well. In all three cases the electrolyte in question can have negative effects when the levels are too high or too low.

For sodium, not getting enough is not usually the problem. Even if you consciously eat a low sodium diet you probably still get plenty of it. However, there is a condition called hyponatremia that most commonly affects endurance athletes. Despite having adequate sodium in the diet, consuming large quantities of water without any electrolytes can dilute the concentration of sodium in the blood. This is a serious medical emergency and the consequences may be severe. The purpose here is not to scare you, but to make you more aware of the need to replace those electrolytes as you go. This is why I recommend using a sports drink (or sports gel and water) containing electrolytes while you are doing any vigorous endurance exercise, especially if the conditions are hot and humid.

Potassium is almost an opposite of sodium. Where most diets have more than adequate sodium, they often lack potassium. There are two ways to combat this. You can take a supplement or you can improve your diet. The concern with taking a supplement is that it may not be absorbed as well and it may be too much. Unlike sodium where too little is dangerous, having too much potassium can lead to a condition called hyperkalemia, which can also have severe consequences. So I recommend getting your potassium from food sources. Many people think of bananas as a great source for potassium, but better still are sweet potatoes and dark, leafy greens. Here’s a link to other great food sources of potassium http://www.health.gov/dietaryguidelines/dga2005/document/html/appendixb.htm.

Calcium is probably the least severe of the group since the body is very effective at regulating the concentration in the blood. However, one of the ways this is done is by pulling calcium from bones when it becomes scarce. This is one of the reasons female endurance athletes are more susceptible to conditions such as osteoporosis. Dairy remains one the best sources for calcium, but can be accompanied by less healthy nutrients, especially if you think ice cream is the best way to get calcium. In addition, many people choose to eliminate dairy due to personal choice or food allergies. You can eat foods fortified with calcium (soy milk, some juices) or spinach and some other leafy greens. The above link has tables for both typical dairy sources of calcium as well as non-dairy sources.

So what’s the bottom line for all this? First, when hydrating during long exercise bouts, choose a sport drink (or gel and water) that contains sodium and potassium to reduce the risk of severe side effects. Second, get enough calcium as part of your daily diet to prevent bone loss. If you eat right and keep exercising you’ve put yourself in the best possible position to have a long healthy life.

Cool down, Recovery, and Flexibility

I’m sure that for many people when they cross the finish line all they want to do is collapse.  I can certainly understand that desire.  Sometimes it’s exhausting just watching you race!  Try to resist the temptation to stop immediately.  A good cool down and recovery can make all the difference for how your body avoids injury and continues to improve performance.

When completing an endurance event (or any exercise lasting longer than 15 minutes) it’s important to have a proper cool down routine.  A cool down involves continued activity at an easy pace for about 5-10 minutes.  Some people like a light jog, while others prefer to walk.  Where available a low resistance, slow-paced stationary bike is a great option.  You can also hop in a pool and do some lazy laps.  This allows for proper transition of your heart and muscles from a highly active state to a resting state.  The bottom line is to keep moving until heart rate and breathing have mostly normalized.

The other big aspect of recovery is to get fuel into the body.  This should include fluids (with electrolytes) and calories.  For more about electrolyte replacement see my tip about hydration.  Calories may seem like a no brainer, but there is actually an ideal way to do it.  The first part is timing.  You should eat within a few minutes of completing exercise.  During the first thirty minutes post exercise you have a significantly increased muscle protein synthesis, meaning your muscles are trying to recover and giving them the fuel to recover will improve that recovery.  After thirty minutes you still experience an elevated muscle protein synthesis, but it is not as great and is gone within about sixty minutes of exercise completion.

The second part of calorie replacement is what kind of calories.  Some people think that if you are rebuilding muscle then protein should be important.  Almost the opposite is true.  Excessive protein intake can decrease recovery effectiveness.  What your body has really lost is carbohydrate calories.  It needs to replace glucose and glycogen stores in order to rebuild muscle.  Try to consume about 100g of carbohydrates (roughly equivalent to a peanut butter and jelly sandwich) within those first thirty minutes post exercise.  You don’t want to make yourself sick by eating too much too fast, but those 100g are a good goal.  After that you should eat a good healthy diet the rest of the day and don’t starve your body.

The final step in cool down and recovery is flexibility.  Much of the research relating to flexibility training is about pre-exercise stretching and shows little to no effect, with the exception of dynamic flexibility (a topic for another time).  However, a recent study shows potential for decreased injury with static stretching (see the abstract here).  Flexibility is something I consider to be part of overall health.  Poor flexibility may contribute to back pain, shoulder pain, risk of muscle strains, and generally decreased body function.  Stretching won’t stop delayed onset muscle soreness (DOMS), but it may improve your overall well-being and help you avoid chronic injuries.

The best time to stretch is after you have been using your muscles.  Any muscle used should be stretched.  There are lots of muscles involved in running and they all should get some attention.  Include hamstrings, quadriceps, calves (both gastrocnemius and soleus muscles), iliotibial (IT) band, gluteals, piriformis, and psoas.  Sounds like a lot?  You can do all this in less than ten minutes even if you hold each stretch for 30 seconds.

If you include these aspects into your recovery routine you’ll stay healthier through a long season and hopefully enjoy it even more.

Chronic Injuries and Sports Massage

For many athletes, the injuries that have the greatest long-term impact are chronic injuries or injuries that occur over time with no obvious incident.  Chronic injuries include things like patellar tendonitis (aka Runner’s or Jumper’s knee), Achilles tendonitis, “shin splints”, shoulder impingement, IT Band syndrome, and bursitis to name a few.

With the exception of bursitis, all of these injuries share one common element.  That element is scar tissue as a result of microtrauma.  Microtrauma can occur from repeated overuse as seen in activities like distance running, swimming, jumping, biking, weight lifting, throwing, or any other activity performed numerous times in succession.  It can also be the result of a single injury such as an acute sprain, strain, or bruise that fails to completely resolve and is exacerbated by continued activity.

Once microtrauma has occurred the body begins the cycle of inflammation and repair.  Inflammation on it’s own is not a bad thing.  It is the body’s way of removing damaged tissues and preparing the site for healing.  Inflammation can cause problems when poorly controlled or when the healing is incomplete.  One of the results of this is the development of excessive or bulky scar tissue.  As the body heals it lays down rudimentary scar tissue without concern for future use.  This scar tissue should eventually be removed and replaced by more refined scar tissue and eventually fully repaired tissue.

It is important that old bulky scar tissue be broken down and removed by the body in order to break the chronic injury cycle.  Anti-inflammatory medications can help break the cycle of bad inflammation and pain, but do not actively address the formation of scar tissue in chronic injuries.  Sports massage, or deep tissue massage, is an intense therapy used to assist the body in breaking down scar tissue so that it can ultimately be removed through the normal cycle of inflammation and repair.

In addition, the use of sports massage can help to re-align collagen fibers as healing occurs.  This re-alignment is important to establish future strength in healthy tissues.  Based on Wolff’s law (and the expanded idea of Specific Adaptation to Imposed Demands), which says that tissues will adapt to the stresses placed upon them, increasing tissue stress during healing (carefully!) will result in a better overall recovery.

The other significant benefit of sports massage is that it decreases the overall muscle hardness.  Muscle hardness might best be described as abnormally high tension within the muscle.  This increased tension predisposes the muscle and tendon to injury.  Post exercise stretching can help reduce this, but once chronic injuries have begun sports massage may be necessary to decrease muscle hardness to the point where stretching can maintain normal muscle flexibility.

Is sports massage something every athlete needs or should have regularly?   Not necessarily.  Some people never experience these types of chronic injuries and many injuries never become chronic because they resolve on their own.  However, if you are experiencing on-going symptoms that fail to resolve, sports massage (along with rehabilitative exercise) may help speed your recovery and may help prevent a re-injury in the future.

So what’s the bottom line for all this?  First, when hydrating during long exercise bouts, choose a sport drink (or gel and water) that contains sodium and potassium to reduce the risk of severe side effects.  Second, get enough calcium as part of your daily diet to prevent bone loss.  If you eat right and keep exercising you’ve put yourself in the best possible position to have a long healthy life.

Plantar Fasciitis

You wake up first thing in the morning and you step onto the floor. Immediately you feel pain on the bottom of your foot close to the heel. You carefully step your way through your morning routine until the pain begins to fade. Later, you head out for a run. As you begin your run the pain in your foot returns, but you hobble along until it again fades. You repeat this routine for days or even weeks, but eventually the pain does not fade.

If this sounds familiar then it is likely you have experienced or are experiencing plantar fasciitis (perhaps better termed plantar fasciosis, meaning deterioration of the plantar fascia). Simply put, this is irritation to the connective tissue that crosses the long arch of your foot. When you stop walking and running (especially when sleeping) the tissue begins to tighten. Those first steps before the tissue stretches back out are the most painful.

Why do some people get this condition and not others? Lack of support for the arch of the foot is the simple answer. In the body muscles and ligaments support joints. Muscles should be our primary means of support, but when those muscles fail in their job ligaments are the back-up plan.

The foot and lower leg are filled with muscles that support the arches of your feet. The plantar fascia is a band of tissue, like a ligament, that crosses the whole bottom of the foot from back to front. Its primary job is to assist these muscles in holding up the arch of the foot.

If the small muscles on the bottom of the foot and the longer ones from the lower leg are not strong enough then this may cause too much stress on the plantar fascia and cause pain with regular use. Some individuals may also have unusually high or low foot arches that cause increased stress and result in the same problem.

Ice/anti-inflammatories, stretching, and deep tissue massage can help plantar fasciitis. In order for the condition to be resolved, however, the support for the arch of the foot must be improved. Strengthening muscles can often be a simple solution, but in more severe cases a special shoe or an orthotic may be necessary to provide ample support.

If you are experiencing on-going symptoms of foot pain, don’t wait to get it resolved. The longer you experience the pain, the worse the injury will become. It’s always easier to fix an injury when it’s a small one.