Sports Medicine

5 HYDRATION MYTHS BUSTED

1. Caffeine Dehydrates You

Let’s start these myths off on a positive note: Your morning cup of coffee can boost your hydration levels. While experts have long believed that caffeine, like that contained in coffee, acts as a diuretic to dehydrate the body, recent research published in PLOS ONE found that in people who drink up to four cups of caffeinated Joe per day, coffee is just as hydrating as H2O.

It's important to remember that hydration levels tend to be lowest in the morning, since you spend all night sleeping, not drinking. So if what you want first thing in the morning is a cup (or two) of coffee, go for it, says registered dietitian and board-certified sports dietitian Georgie Fear, author of “Lean Habits for Lifelong Weight Loss.”

2. You Need to Drink Eight Glasses of Water Per Day

There are multiple reasons why this well-meaning guideline falls short of guaranteeing good hydration. For starters, every person’s hydration needs are unique. Age and sex are two big factors: The National Academies of Sciences, Engineering, and Medicine recommends that while men and women ages 19 to 30 consume 15.6 cups and 11.4 cups of water per day, respectively, toddlers need as little as 4 cups per day. Climate, exercise as well as pregnancy and lactation all move the needle, too.

Here’s how popular functional waters, which promise benefits beyond hydration, stack up.

But this next part is also important: All of that water doesn’t have to come in beverage form. According to the National Academies, roughly 20 percent of the average adult’s water consumption actually comes from food. “If you eat more of a plant-based diet, it could contribute even more,” says registered dietitian Betsy Opyt, creator of Betsy’s Best. She notes that fruits and veggies such as watermelon, cucumbers, celery and star fruit are more than 90 percent water.

3. As Long as You Aren’t Thirsty, You’re Well-Hydrated

Think of thirst like sunburns – it doesn’t pop up until it’s too late. “People are typically dehydrated by about 2 to 3 percent of their body weight, which is enough to impact physical and mental performance, before thirst kicks in,” explains registered dietitian and board-certified sports dietitian Marie Spano. Plus, the body’s biological thirst mechanisms tend to become even more faulty with age, so it’s especially important for older adults not to count on thirst as a hydration gauge.

While many experts like to use the guide, “as long as your urine is pale yellow or clear, you’re well hydrated,” it’s important to remember that everything from medications and supplements to the foods you eat can influence your urine color, Spano notes. Her bathroom rule: If you need to pee once every few hours, you’re likely well-hydrated.

4. The More Water You Can Drink in a Day, the Better

“If you really push the fluids, you can dilute the concentrations of electrolytes in your blood." “Hyponatremia, or low blood levels of sodium, is a dangerous condition, even life-threatening. Some unfortunate deaths have occurred as a result of drinking a gallon of water as part of a contest, or among marathoners who drank too much water without taking in any electrolytes.”

While, fortunately, these tragedies are uncommon, the National Academies similarly notes that acute water toxicity can occur by drinking excessively more fluid than your body can excrete in a given timeframe – about 3 to 4 cups per hour.

5. Sports Drinks Are Always Superior to Water

Sports drinks are great for their electrolytes (think: calcium, magnesium, potassium, sodium, phosphate and chloride), helping to prevent issues such as fatigue, nausea, headache, impaired muscle function as well as severe hyponatremia – all of which are possible when you’re sweating out electrolytes and drinking plain ’ol water. Meanwhile, they also contain simple sugars and calories that are meant to keep the body primed with energy when you’re in the middle of a long endurance workout.

However, a quick jog around the block doesn’t qualify. “Unless you’re exercising for more than 90 minutes or in extremely hot and humid conditions, water will do,” says Fear, noting that downing sports drinks when you really don’t need them is why many people who take up running gain, rather than lose, weight.

3 REASONS TO SEE A PHYSICAL THERAPIST EVEN IF YOU'RE NOT HURT

1. You want to boost your ‘athletic’ performance.

We are all athletes. Whether you aspire to play sports in college or just like shooting hoops on weekends, you’re an athlete in my book. Maybe gardening is your thing. If you don't think those dance classes you go to involve athletic ability, just consider how much more clumsy you felt when you first enrolled. Yes, we are all athletes. 

But is your body getting what it needs to move most effectively? Is everything that should be moving moving well? Are the parts that should be nice and stable actually holding things together?

SPJs have the power to keep you running at top speed, no matter what your favorite activities are. They just have to watch you move to see the unseen. It's common to see an SPJ quickly identify a seemingly unrelated part of the body that winds up having a huge impact on your athletic ability – whatever that means to you. SPJs know where to push and pull and allow your body to do the rest. 

2. You don’t want to get injured. 

What if you don't hurt or only hurt "a little?” While it's not always necessary to seek care for the bumps and bruises that come from normal activity, it’s useful to become educated and get answers when small pains begin to stack up and change the way you move normally. 

Our bodies already have a few superpowers. For example, they’re immensely resilient and have an impressive capacity to heal. More often than not, fear of re-injury and compensating for a previous injury by, say, changing your gait slightly, actually leads to more persistent pain. SPJs are great to have around in these cases because they know exactly when and where to apply stress to the body to speed up healing, as well how to help people best understand how to heal themselves

3. You want to save money and time. 

Surgery can be expensive, timely and require a frustrating amount of recovery time. But what if I told you that mounting evidence shows that, in some cases, an SPJ’s management is as effective as many surgical treatments for hip, back, shoulder and knee pain? Believe it. Not only can SPJs save people from some unnecessary surgeries, but good SPJs can also be more cost-effective than the many expensive diagnostic tools typically used to "take a look" at those painful areas. Even if surgery is the best option, a well-trained SPJ can guide you along the healing process and get you back to your favorite activities in no time.

ATHLETIC PUBALGIA

What is it?
Athletic pubalgia is defined as pain in the groin area of an athlete. It has been given many names in the past, such as sportsman hernia and hockey groin. It often happens in sports that require running, twisting, or kicking including soccer, hockey, rugby, and football. Many conditions can cause athletic pubalgia, including tendon strains, nerve injuries, joint problems, and true hernias.

Symptoms
The pain is in the groin region, can occasionally radiate up into the stomach or down into the thigh, and is frequently increased with running, kicking, twisting, sit ups, coughing, or sneezing.

Sports Medicine Evaluation
There may be tenderness when the doctor pushes on the painful area, and it may hurt when the hip is twisted. X-rays may show abnormalities in the hip or pubic joint. An MRI or ultrasound may show soft tissue abnormalities such as a muscle or tendon injury. A dynamic ultrasound, which involves looking at the area while the athlete moves or "bears down" can help identify hernias or weaknesses in the muscles or tendons.

Treatment
Initial treatment usually includes avoiding painful activities and specific strength and flexibility exercises. Ice, heat, and occasionally anti-inflammatory medications may improve symptoms. Occasionally, tendon injuries require injections to help the area heal, and hernias and certain hip joint and nerve problems may require surgery.

Injury Prevention
Because there is no single specific known cause of athletic pubalgia, prevention can be difficult. However, strengthening the hip adductors and abductors is important. In addition, core strengthening and not playing through pain is important.

Return to Play
Athletes who require rehabilitation must have adequate hip range of motion, good strength, and be functional in their sport before returning to practice or competition. This may take up to 12 weeks. Athletes who undergo surgery are typically able to return to sports but this can take 4 weeks to 6 months.

References
Caudill P, et al. Sports hernias: a systematic literature review. Br J Sports Med. 2008; 42(12):954-64.
Litwin DE, et al. Athletic pubalgia (sports hernia). Clin Sports Med. 2011; 30(2):417-34.

CHEERLEADING INJURY PREVENTION

Legend has it that cheerleading started with a University of Minnesota student standing up in the stands and leading his fellow students in "cheering" for their team during a football game. Cheerleading has morphed drastically since then. Today, it's considered an athletic activity that incorporates elements of dance and gymnastics along with stunts and pyramid formations. In 2002, an estimated 3.5 million people in the United States participated as cheerleaders, from six-year-olds to adults who cheerlead for professional athletic teams. While cheerleading is meant to support an athletic team, its intense competitions at the high school and collegiate levels have created a whole new dynamic, including increased risk for injury.

WHAT TYPES OF INJURIES ARE MOST COMMON IN CHEERLEADING?


The U.S. Consumer Product Safety Commission (CPSC) estimates that cheerleading led to 16,000 emergency room visits in 2002 (the latest year for data). While not as frequent as injuries in other sports, cheerleading injuries tend to be more severe, making up more than half of the catastrophic injuries in female athletes. Cheerleading injuries affect all areas of the body — most commonly the wrists, shoulders, ankles, head, and neck.
 

HOW CAN INJURIES BE PREVENTED?

Stunt Restrictions

In an attempt to curb the amount of catastrophic injuries in cheerleading, restrictions have been placed on stunts. They range from height restrictions in human pyramids, to the thrower-flyer ratio, to the number of spotters that must be present for each person lifted above shoulder level.

For example, the limit for pyramids is two body lengths for the high school level and 2.5 body lengths for the college level, with the base cheerleader in direct contact with the performing surface. Base supporters must remain stationary and the suspended person is not allowed to be inverted or rotate on dismount.

Basket toss stunts in which a cheerleader is thrown into the air (sometimes as high as 20 feet) are only allowed to have four throwers. The person being tossed (flyer) is not allowed to drop the head below a horizontal plane with the torso. One of the throwers must remain behind the flyer at all times during the toss.

Mats should be used during practice sessions and as much as possible during competitions. Cheerleaders should not attempt a stunt if they are tired, injured, or ill, as this may disrupt their focus and cause the stunt to be performed in an unsafe manner.
 

Training

The importance of a qualified coach is also critical. Coaching certification is encouraged. Precautions should always be taken during inclement weather for all stunts. Also, a stunt should not be attempted without proper training, and not until the cheerleader is confident and comfortable with performing the stunt.  Supervision should be provided at all times during stunt routines.

As with any sport, proper conditioning and training are important to minimize injury, including:

  • Resistance exercises to gain strength in the lower back, stomach, and shoulders
  • Regular stretching, yoga, or pilates instruction to improve flexibility
  • Speaking with a sports medicine professional or athletic trainer if you have any concerns about injuries or cheerleading injury prevention strategies
  • Returning to play only when clearance is granted by a healthcare professional
     

HOW ARE CHEERLEADING INJURIES TREATED?


One of the most common injuries cheerleaders suffer is an ankle or wrist sprain or strain. For treatment of a sprain or strain, remember RICE:

  •  Rest the injured site for at least 24 hours
  •  Ice the injury at least every hour for 10-20 minutes during the initial four hours after injury. Icing then can be done 10-20 minutes four times a day for two days
  •  Compress the injured site with a snug, elastic bandage for 48 hours
  •  Elevate the injured limb for at least 24 hours Immediate medical attention is required for any cheerleader with a suspected head or neck injury.
     

REFERENCES AND ADDITIONAL RESOURCES


Campbell, John D, and Barry P. Boden. Cheerleading Injuries. Sports Medicine Update. September/October 2008.

Boden BP, R Tacchetti, FO Mueller. Catastrophic cheerleading injuries. Am Journal of Sports Med. 31:881-888, 2003.

Shields BJ, GA Smith. Cheerleading related injuries to children 5 to 18 years of age: United States, 1990- 2002. Pediatrics. 117:122-129, 2006.

The following expert consultants contributed to the tip sheet:
John D Campbell, MD
Barry P. Boden, MD

THE DIFFERENCE BETWEEN ACL AND MENISCUS TEARS THAT TELLS ALL

Fall sports have a tendency to have the highest number of ACL and meniscus tears on average compared to any other sports seasons. Between football, soccer, volleyball, cross country, and off-season basketball, physical therapy clinics are swarming with ACL and meniscus tears.

Both, ACL and meniscus, will likely result in a decreased range of motion, excessive swelling, and pain on occurrence; although some people state that they had no pain at the time of the initial tear - simply just heard a "pop". 

The huge difference will be visible at around 24 hours after the tear. Aside from the initial pain, most ambulation impairments (troubles walking) on flat ground are going to be from self-preservation for an ACL tear.  In other words, if you're limping more than 24-48 hours following an ACL tear, it's likely as a result from your being cautious, as opposed to your actual injury causing pain. Many ACL tears we see only have problems ascending stairs, jogging, or walking downhill but can walk up hills and on flat roads without an increase in pain. A meniscus tear, on the other hand, will cause fairly severe pain even just standing on it.

The reason they have this huge symptomatic difference is due to each of their respective anatomical locations. While the ACL is a ligament connecting the backside of the femur (thigh bone) to the front of the tibia (shin bone) helps to support the knee joint by protecting the femur from moving too far forward during deceleration (stopping quickly, ascending stairs, lateral movements), the menisci (2 per knee) sit on the tibia and are used as a form of biological padding to protect the tibia from colliding with the femur.  When a meniscus is torn, putting pressure on it in many forms can cause severe pain, as there is not only a torn tissue, but also there is no longer much support between those two bones when standing, walking, and even sitting, or bending the knees while laying down, depending on where the tear is located. 

This excess in pain is likely going to cause an increase in swelling for a longer period of time than that of an ACL. The process of inflammation takes 7 days to complete, but increases in pain is correlated with increases in bloodflow, with is correlated with increases in inflammation. Essentially, it's a repetitive cycle that typically results in higher levels of swelling for longer periods of time following an initial injury. 

More questions? Come see us at Champion Performance and Physical Therapy at 7510 State Line Road, Suite A in Prairie Village!

RUNNING IN THE RAIN

Since Kansas City is one good rain short of drowning, we figured there's no better time than now to post a few tips as far as being smart when running in the rain.

Many avid runners don't find running in harsher weather conditions to be intimidating, and casual walkers, joggers, and runners are more likely to head outside in the rain when the weather warms back up in the spring and summer. Don't get me wrong - a few of us are all about it, too. We just want to make sure we can help you to stay safe and prevent situations or injuries the rain will increase when you hit the road, outdoors.

1. Wear Your Neon!

On the rainier days, neon is especially important for drivers on the road to see you. Visibility is almost as low as when it's dark outside, but car brakes have a higher flaw ratio when conditions are anything less than perfect.  Bright colors will just help to ensure drivers see you in time to make adjustments and accommodations to runners and bikers.

2. Compression Is Best

If you're not wearing running leggings, wear compression shorts underneath your running shorts.  Not only do they help to maintain body temperature, but they're also great to help wet thighs avoid chafing. 

3. Seal Your Electronics ---

Use workout gear with sealed, zipper pockets, to keep your phone or ipod directly out of the rain. However, since most zipper pockets may not completely keep the water out, you can always put your phone in a plastic bag or plastic wrap, or even find yourself a waterproof case. They're more expensive than a typical case, but I'm sure you'll get more use out of it than just running in the rain (dropping phones in the bathroom, in lakes/pools, etc.)

4. CHECK YOUR SHOES!!!

Take a look at the bottom of the running shoes you're planning to wear. If you've had them for a long time, or they've acquired milage from running on treadmills from over the winter, the tread may be worn down to the point that they no longer have any useful amount of traction. This isn't typically a big problem when it's dry outside, but it does add a significant increased risk of injury in the rain. Use some shoes that have more tread on them to avoid slips, falls, or other injuries.

5. Adapt Your Workout

Firstly, don't plan on beating your personal best when it's raining. Harsh weather conditions can considerably decrease your speed - even if you don't realize it. More importantly, increase your stride rate. If you're one to run with longer strides or you have longer legs, try your best to shorten your stride to decrease your time on a slippery surface. 

6. DO. NOT. RUN. WHEN. IT'S. STORMY.

Rain is one thing, storms are completely different. Water is an electric conductor, and the risk of dangers to your health increase when lightning is near. Make sure to check radar to ensure it's only rain coming in your direction, not hail or lightning. 

MEET THE PHYSICIANS: THE UNIVERSITY OF KANSAS

The University of Kansas
Sports Medicine and Performance Center

10730 Nall Avenue, Suite 200
Overland Park, Kansas 66211

Please note all information listed below is the most current information on the physicians' clinic websites. Any incorrect information is not the responsibility of Champion Performance and Physical Therapy, but we'd like to get the information corrected immediately. Please contact us with any changes at 913-291-2290. We do not accept submissions of change to any information listed below without a valid NPI number. 

Randall Goldstein, DO

Focus lies within sports medicine, both operative and non-operative, specifically pediatric and gymnastics. Dr. Goldstein is one of the most highly renown pediatric, sports medicine physicians in the Kansas City Metro. He also practices at The University of Kansas Hospital Training Complex for Sports Medicine as a team physician for the Kansas City Chiefs and Royals. 

Vincent Key, MD

Focus lies within sports medicine, specifically for adults.  While he is classified as a general orthopaedic surgeon, Dr. Key specializes in arthroscopic procedures involving the shoulders and knees. He also practices at the Renner Road location, as well as The University of Kansas Hospital Training Complex for Sports Medicine.

Scott Mullen, MD

Focus lies within sports medicine, as well as general orthopaedic, arthroscopic surgery of the shoulder, knee, and hip. Dr. Mullen also has a sports medicine focus in gymnastics, along with his colleague, Dr. Goldstein.  According to our patients, his arthroscopic reconstructions have made him one of the best in the city!

Stephen Munns, MD

Focus lies within sports medicine, and although he is board certified as a general orthopaedic surgeon, most often performs both, arthroscopic and reconstructive procedures of the shoulder and knee.  His daughter was a student at our clinic this past Spring of 2016!

Joshua Nelson, MD

Focus lies within general orthopaedic surgery and sports medicine, both arthroscopic and reconstructive. While he performs multiple procedures on both the shoulder and knee, he also performs procedures on the general upper extremity (including the elbow.) While many of Dr. Nelson's patients are adults, he does perform pediatric orthopaedic procedures. He also practices both, at Arrowhead Stadium and The University of Kansas Physicians Medical Office Building on Rainbow Road at the main hospital campus. 

Joseph Noland, MD

Focus lies within sports medicine non-operative care, with specialities in musculoskeletal pain, adolescent medical disorders, and preventative medicine. Dr. Noland practices primarily at the Renner Road location, both as a specialist and primary care, family physician. 

J. Paul Schroeppel, MD

Focus lies within general orthopaedic, sports medicine surgeries, with specialties in both the upper and lower extremity, pediatric and adult procedures.  His common surgical procedures include arthroscopic and reconstructive methods on the shoulder, elbow, hip, and knee. Dr. Schroeppel also practices out at Arrowhead Stadium, at The University of Kansas Hospital Training Complex. 

David Smith, MD

Focus lies within sports medicine, non-operative, orthopaedic care.  Dr. Smith is a family practitioner, with emphases in concussions in athletes, as well as health, wellness, and preventative medicine.  Dr. Smith also practices out at Arrowhead Stadium at the Training Complex.  

Lucas Thompson, MD

Focus lies within medical and non-operative orthopaedic sports medicine. Dr. Thompson conducts stress testing and impact concussion testing with athletes.  His only practice location is at The University of Kansas Hospital Training Complex at Arrowhead Stadium. 

Bruce Toby, MD

Focus lies within the upper extremity, specifically microsurgeries. Microsurgery is a surgical subspecialty requiring a microscope. Dr. Toby's procedures include operations ranging from the general orthopaedic upper extremity (hand and elbow), to microvascular, to peripheral nerve surgical procedures. He currently only practices at The University of Kansas Physicians Medical Office on the main hospital campus. 

For more information, please visit http://sportsmedicine.kumed.com/our-providers

A newer blog segment titled MEET THE PHYSICIANS provides general focus information of some of the best, and most outstanding orthopedic clinics in the Kansas City metro area, respectively. From these clinics, a number of their most prominent surgeons refer to us here at CHAMPION Performance and Physical Therapy. 

THROWING INJURIES

As with many orthopedic injuries, repetitive motion like throwing can create an excessive stress on shoulder and elbow tendons and ligaments. Repeated stress can also tear the ligament and tendon away from the bone and can even pull off tiny bone fragments. In the case of children, normal bone growth can be affected if this condition is left untreated.  As children are starting to play sports competitively much younger and continue to play at a high level throughout their entire career, injury recognition is key to preventing further damage that could potentially lead to career-ending problems. 

Symptoms of Injury

The symptoms of a throwing injury can include shoulder pain or elbow pain, a reduced range of motion and, with the elbow, the tendency for the joint to lock.  Tendonitis or frayed tendons are most commonly caused by, surprisingly enough, a lack of functional strength in certain muscles. 

These athletes have been conditioned to throw using a certain technique throughout the majority of their lives.  The muscles necessary to recreate that technique time and time again are very strong, but the surrounding muscles may not be activated nearly as much as they should be. Muscles insert via a tendon to bone, and will usually cross bony prominences, or bumps on the bones, to get to their insertion point.  For a strong, healthy muscle, tendons have enough slack to reach their insertion point without obstacles, but remain taut enough to keep the tendinous portion from rubbing on the bony prominences they cross. 

When the muscles are not activated regularly (strengthened properly), these muscles will get pulled in whichever direction the strong, frequently-utilized muscles are willing the bones.  For example: if pectoral muscles in the chest are tight and the scapular stabilizers between the shoulder blades aren't fired enough, their weakness will allow the tightness of the pectorals to round the shoulders forward.  This will lead to poor posture, and potentially cervical issues. 

When these weak muscles get pulled in a different direction due to lack of strength, their tendons rub constantly over the bony prominences - and this is worsened by repetitive motion, such as throwing. This will fray the tendinous portion of the weak muscles over time, until eventually there is too much inflammation, causing fairly debilitating pain, or until the tendon tears. 

Treatment Options

The most common treatments include resting and icing the affected area to reduce inflammation. As difficult as it is to pull players out of games and practice at such a high level, it's vital that any injury be treated as soon as possible to prevent further damage.

NSAIDs such as ibuprofen may be helpful to ease pain and inflammation, and physical therapy may be recommended by an orthopedic specialist. Physical therapy will strengthen the muscles around the damage to relieve them from the strain of bony prominences. This can relieve pain, but will likely not repair damages in the tendons. In some cases, surgery may be necessary to repair rotator cuff tendons in the shoulder or ligaments on the inside of the elbow to restore proper function and throwing mechanics and reduce pain.  Surgery is a more common solution for older athletes - high school and up, and most likely due to chronic symptoms and extensive damage over time as compared to a single incident. 

Common Throwing-related Conditions

Click below for further information.