Memorial Herman

Tips from the Trainers

Calcium

Ask any athlete why calcium is important and they will likely tell you "because it helps build strong bones." While this is true, calcium is involved in many other important processes as well. Approximately 99% of calcium in the body can be found in the bone and teeth. This calcium not only acts as a major part of the skeletal structure providing strength, but also as a reserve for when calcium is needed elsewhere. As calcium levels in the blood decrease, the body is able to increase its absorption from food while also pulling calcium from bone reserves at a greater rate. The remaining one percent of calcium which is found in blood and fluids assists in the clotting of blood, muscle contractions, and in the breakdown of carbohydrate stores when energy is needed. Additionally, some evidence has linked the intake of calcium containing foods to lower blood pressure as well as healthier body weight.

Genetics, exercise and calcium intake each play a significant role in the density of bones. Peak bone density is achieved during the teenage and young adult years. The greater the density of bone, the less likely an athlete is to have a bone fracture or later in life, osteoporosis. For this reason, it is especially important that teens and young adults consistently consume enough calcium. When calcium intake is consistently below the recommended amount, calcium reserves in the bone will be depleted in order to maintain normal blood levels, resulting in increased risk of fractures.

Calcium can be found in a variety of foods. Dairy products such as milk, yogurt and cheese are all exceptional sources of calcium. As little as four servings of dairy by itself are enough to meet the calcium needs of a teen athlete. Calcium requirements can also be met without the consumption of dairy. Calcium fortified drinks such as soy, almond, or rice milk can be consumed as well as fortified juices, each providing similar levels of calcium compared to cow’s milk. Broccoli, kale, and collard greens among many other green veggies provide significant levels of calcium. High oxalate containing vegetables such as spinach are not a recommended source for calcium due to the decreased absorption of calcium. Calcium can also be found in many nuts and tofu which has been processed with calcium. In addition to these examples, fish such as sardines that contain edible bones can be consumed as a quality source of calcium.

Calcium Needs:

  • Males and Females Age 9-18: 1,300mg
  • Males and Females Age 18+: 1,000mg
  • Females Age 50+ : 1,200mg

High Calcium Meal Ideas:

1 cup yogurt with 1 oz. of almonds and ¼ cup chopped fruit (~450mg calcium)

Salad: 1 cup of kale of with ½ cup of broccoli, ¼ cup chopped carrots, 1 oz. walnuts with sprinkle of dried cranberries (~150mg calcium)

Stir fry: 1 cup cooked rice with ½ cup broccoli, ½ cup tofu made with calcium sulfate, 1/2 cup pineapple, with ½ cup of additional vegetables of choice. Add low sodium soy sauce and minced garlic to taste.(~400mg calcium)

Two slices of whole grain toast with 2 tbsp. of almond butter with 8 oz. glass of calcium fortified soy milk. (~450mg calcium)

Tournament Eating

Tournaments are challenging for any athlete. Just as many athletes have a standard warm up before games, athletes should also have a nutrition game plan planned in advance. It is important for athletes to try out which foods work for them before, during, and after exercise so when the time comes for games, they are confident their nutrition plan works for them. When preparing for tournaments away from home, know which restaurants and groceries are near the fields or hotel, and bring any food or drink you typically feel most comfortable with. If you are forced to eat out, research in advance, as many chain restaurants will list nutrient content online.

Tournament eating consists of pre-exercise, during exercise, and recovery fueling. Find which routine works best for you so come game time you can be at peak performance.

Pre-Exercise Fueling

There are really two pre-exercise fueling windows. The first is the night before; the second is the morning of an event.

Night Before a Competition

The night before an event you want to eat foods that are high in carbohydrate, have some protein, and some fat, but not too much fat. If it is an out of town event, research restaurants before you go so you will know where you are eating. If the restaurant has a long line when you arrive, get it “to go” and eat it in your hotel room.

An example of an appropriate night before competition meal would be spaghetti with meat sauce or meatballs and 1 – 2 breadsticks. The meatballs should be about the size of a deck of cards (about 3 – 4 oz). Cream-based sauces like Alfredo sauce is not recommended because it is too high in fat.

Morning Eating

Most athletes want their stomach empty before starting their competition. This means eating breakfast 3 – 4 hours before their event. This meal should be high in carbohydrate with some protein and fat. The carbohydrate provides energy while the protein and fat will help them stay fuller longer. If you are traveling, find out what food is provided for breakfast where you are staying. If the food is not what has been eaten at home either take the food with you or go grocery shopping when you arrive to stock up.

Some examples of a morning meal include:

  • Bagel with peanut butter
  • Oatmeal with peanut butter or oatmeal and a hardboiled egg

Between the first meal and the competition, the athlete should be drinking water to stay hydrated. Drinking 8 oz of sports drink about 30 minutes before the competition (if the athlete will be playing at the start of the game) can top off the athlete’s tanks with fuel.

During Exercise Fueling

Athletes should eat or drink primarily carbohydrates during their competitions. The amount of carbohydrate ranges between 30-60 grams depending on the length of the competition and how long the athlete is playing. Liquid sources are usually easiest to tolerate, but solids can work, too. Low fat and low fiber fuels are preferred because fat and fiber slow absorption of the fuel. Small amounts of protein can help with satiety. Below is additional information about fueling during exercise:

  • Carbohydrates: During games, try to consume between 30-60 grams carbs every hour. This can be in the form of sports drinks or can include gels, or solid foods. Liquids are typically easier to consume. The athlete can have commercial sports drinks or if you want to make your own sports drink, search “homemade sports drink” for recipes. Gels and juices are highly concentrated and should be diluted with water.
  • Cool fluids: Cooler drinks are absorbed quicker and are often more appealing than warmer fluids.
  • Stay Hydrated for Easier Refueling: When dehydrated, fluids and foods stay in stomach longer due to delayed gastric emptying. Stay hydrated!
  • Fluids, how much: Drink about 4-8 oz every 15-20 minutes. Plan ahead how players can consistently get fluids. Ideas include having bottles around the field and having drinks available during timeout and play stoppage. Some studies have shown that having a personal bottle for each player increases the drinking of fluids.
  • Protein: Protein is not necessary during games though it can be consumed and may help with satiety. 3-5 grams per hour can be appropriate. There are some powdered sports drink mixes out there that have protein.
  • Sodium: For heavy sweaters, during hot temperatures, or for athletes who are susceptible to cramping sodium containing sports drinks are ideal. Commercial sports drinks contain sodium.

Examples:

  • Gatorade: 20-36 oz will provide ~30-60 grams carbs. If the athlete is only drinking 20 oz, they may need to drink additional water to stay hydrated.
  • Powerade: 20-36 oz will provide ~30-60 grams of carbs. If the athlete is only drinking 20 oz, they may need to drink additional water to stay hydrated.
  • Gu: 1 packet at the start of the game with 12 – 16 oz of water, followed by ½ or 1 Gu 30-45 minutes later with 6 – 16 oz of water (providing a total of ~35-50 grams carbs).

Between Events

The athlete can have something to eat or drink between events. What they have depends on how much time there is between events. If it is an hour or two or less, then it is usually better to stick with liquids because they will clear the stomach faster. Sports drink can be a good solution because of the carbohydrates. If the time between events is two to three hours or longer, having something solid may be an option. A turkey sandwich and piece of fruit could work.

Before trying between game foods, we recommend trying it during practice. Eat the food after a practice and see how the athlete feels two to four hours later. If the athlete feels sluggish or has a full stomach, try another food the next time.

Post Exercise

  • Refueling: For exercise within 24 hours, or with multiple games or training sessions within one day, repletion of glycogen stores, carbohydrate stores in the muscles, immediately following exercise is imperative. Repletion is greatest when carbohydrates are consumed 30 – 60 minutes immediately after exercise and then having a meal within 2 - 4 hours.
  • How Many Carbs? Immediately following the game, aim for 0.45– 0.7 gram per pound of carbohydrates. Low fat and low fiber foods and drinks are preferred. Liquids and solids work equally well, though many athletes prefer liquids immediately following exercise.
  • More Refueling: One to two hours after the game, aim for an additional 0.45 – 0.7 gram per pound of carbohydrates. This may typically be a mixture of solid foods, though carbohydrate containing sports drinks may be included as well.
  • Protein: Consuming small amounts of protein immediately following exercise can improve muscle tissue repair and enhance recovery. 10-20 grams of protein is adequate for recovery, greater than 25 grams is not necessary and will likely be converted to fat or glucose.
  • Fiber & Fat: Continue to avoid high fiber and high fat foods throughout the day of games as fiber and fat will only slow absorption.
  • Hydration: Rehydrate! Thirst is not an indicator of fluid losses, by the time thirst sets in, you are already behind! Drink on schedule rather than thirst. Monitor weight loss post event and post training to give yourself an idea of how much fluid loss is occurring. One pound of fluid loss is equivalent to 16 oz. Best practice is to try to consume 20-24 oz for every pound lost.
  • Monitor Urination: Urine should be clear or pale lemonade color. Darker urine is a sign of dehydration. Between games, continue to hydrate until urination is appropriate color.

Examples (1-2 hours post game, 2 hours prior to next match): For the same 155 pound male. Additional 70-100 grams carbs plus 10-20 grams protein is appropriate.

  • 6 inch Subway Sandwich with 3 oz of meat, no cheese such as 6 inch Oven Roasted Chicken Breast + 1 cup of fruit or 20 oz Gatorade = ~75 grams carbs, 25 grams protein
  • 1 cup of rice with 3 oz chicken + 1 large banana = ~75 grams carbs, 20 grams protein

****Note - 1 Cup dairy, ½ cup fruit, ½ cup grains, usually = ~ 15 grams carbs. 1 cup of dairy, or 1 oz of meat, usually = ~ 7-8 grams protein.

Examples (Immediately Following Exercise): For a 155 pound male, likely needs between 70-100 grams carbs post match and may consume between 10-20 grams protein.

  • Chocolate Milk (or other flavored milks): 16 oz + ½ cup of fruit = ~ 71 grams carbs, 16 grams protein. 12 oz plus 1 cup fruit or large banana = ~ 72 grams carbs, 12 grams protein.
  • Gatorade Recover: 1 Carton plus 1 cup or large piece of fruit = ~75 grams carbs, 20 grams protein
  • Dannon Light and Fit Strawberry Yogurt: 1 cup + 16 oz orange juice = ~ 73 grams carbs, 7 grams protein
  • Plain Bagel with 2 Tbsp. Jelly = ~80 grams carbs, 10 grams protein.

Pre-Exercise Fueling

There are really two pre-exercise fueling windows. The first is the night before; the second is the morning of the game or the final meal prior to the start of the match.

Goals

When we start a game or tournament, we want to have our full energy available so we can play our best. Carbohydrates are our body’s preferred fuel source. Fortunately, our body is able to store the carbohydrates we consume in our muscle and liver in what is known as glycogen, or the storage form of carbohydrates. While our body is only able to store away so much glycogen, we use it for energy throughout the day and especially when playing sports. Because of this, it is important to make sure we provide our bodies with plenty of carbohydrates before exercise so we have plenty of energy available to use. While fat and fiber are an important part of our diet, eating too much of it before a game slows down digestion which may cause food to still be digesting at game time. This can be problematic because stomach discomfort can occur, and the energy we want from the food may not be available yet. Moderate amounts of protein can help us feel full longer and is an important part of our diet, but excess protein prior to games is unnecessary and can also feel heavy. Focus on eating plenty of easily digestible carbohydrates with moderate amounts of fiber, fat, and protein when preparing for games.

Night Before a Competition

The night before a game you want to eat foods that are high in carbohydrate, have some protein, and some fat, but not too much fat. If it is an out of town event, research restaurants before you go so you will know where you are eating. If the restaurant has a long line when you arrive, get it “to go” and eat it in your hotel room.

An example of an appropriate night before competition meal would be spaghetti with meat sauce or meatballs and 1 – 2 breadsticks. Only about 2-4oz lean meat is needed. Cream-based sauces like Alfredo sauce is not recommended because it is too high in fat.

Morning Eating

Most athletes want their stomach empty before starting their competition. This means eating breakfast 2 – 4 hours before their event. This meal should be high in carbohydrate with some protein and fat. The carbohydrate provides energy while the protein and fat will help them stay fuller longer. Athletes can aim for roughly 0.9 gram of carbohydrates per pound of body weight when eating 2 hours or more prior to game time. If eating 3 – 4 hours prior to the match, athletes can eat as much as 1.3g of carbs per pound of body weight. This means a 150 pound athlete may eat approximately 130-200g of carbohydrates prior to the game.

Some examples of a morning meal for the above example include:

  • Bagel with peanut butter and jelly, banana, 20oz sports drink
  • Oatmeal with honey and raisins, 1 large fruit, and a hardboiled egg

Between the first meal and the competition, the athlete should be drinking water to stay hydrated. Drinking 8 oz. of sports drink about 30 minutes before the competition (if the athlete will be playing at the start of the game) can top off the athlete’s tanks with fuel.

Afternoon Eating

The same rules discussed above apply to pregame meals for afternoon or evening games. Some examples of potential meals are:

  • Sub sandwich with turkey, veggies, honey mustard, fruit and water
  • Boiled Rice, veggies, fruit, flavored yogurt

Basketball Finger Injuries

Although finger injuries can occur in many sports, they are particularly prevalent in basketball due to the skills required of an athlete to dribble, shoot, pass, defend and rebound. Finger injuries are the third most common injury in basketball among adults 25 to 40 years old and the second most common injury in basketball among children ages 7 to 17.

If not properly diagnosed and treated, a finger injury can result in decreased range of motion and function of the involved finger. Recognizing and treating these injuries in a timely manner is necessary to avoid prolonged and permanent damage. Two finger injuries commonly seen in basketball players are extensor tendon injuries (mallet finger) and flexor tendon injuries (jersey finger). Each is unique in how it occurs and how it can be effectively managed.

Mallet Finger

  • Mechanism of Injury: A mallet finger is a rupture or stretching of the extensor tendon at the last joint of the finger. It commonly occurs due to a blunt force trauma to the tip of the finger that forces the straightened finger to bend, such as a basketball “jamming” a player’s finger. Figure 1
  • Diagnosis: An athlete with this injury will likely present with a finger bent at the last joint – the distal interphalangeal (DIP) joint – and will be unable to fully straighten the finger at that joint.
  • Acute Management: Initially, a splint is used to maintain the DIP joint in full extension, or completely straight (Picture 2). Extension splints are worn 24 hours a day for at least six to eight weeks to allow proper healing of the tendon. If the finger is allowed to bend at all in that time, the healing tendon is considered compromised, the treatment time reset, and the six-week protocol is begun again. Figure 2
  • Rehabilitation: After the extensor tendon is properly healed, night splinting is used for an additional two to three weeks and light range-of-motion exercises should be initiated with no more than 20 to 25 degrees of bending allowed in the first week to prevent overstretching the tendon. The amount of bending can then be increased by 10 degrees every week until full active range of motion is attained. Gripping and pinching exercises may also be initiated and performed weekly to regain any dexterity that may have been lost.

Jersey Finger

  • Mechanism of Injury: A jersey finger is a rupture of the flexor tendon at the last joint of the finger (Picture 3). It commonly occurs due to a powerful extension of the joint while the athlete is forcefully flexing it in the other direction. This injury can occur when a player’s finger gets caught in an opponent’s jersey. Figure 3
  • Diagnosis: An athlete with this injury will likely present with mild pain and swelling and a finger that is straight at the last joint – the DIP joint – and will be unable to fully bend or flex at that joint (Picture 4). Figure 4
  • Acute Management: An athlete who is unable to flex or fully bend at the DIP joint must be referred to an orthopedist. A radiograph is mandatory as an avulsion, or tearing of bone away by the tendon, is common and will have an effect on treatment and prognosis. Unlike extensor tendon injuries (mallet finger), flexor tendon injuries (jersey finger) must be repaired surgically.
  • Rehabilitation: After surgical reattachment of the flexor tendon is accomplished, a complex rehabilitation program consisting of dynamic splinting and therapist-supervised tendon gliding exercises is initiated and full recovery can take 10 to 12 weeks.

Jaime Aparicio and Kevin Maloney are currently sport physical therapy residents at Memorial Hermann-Texas Medical Center and can be contacted at Jaime.Aparicio@memorialhermann.org and Kevin.Maloney@memorialhermann.org.

Tips for Reducing Risk of an Ankle Sprain in Basketball

What is an Ankle Sprain?

Sprained Ankle DiagramAnkle sprains are one of the most common musculoskeletal injuries, affecting athletes and non-athletes alike. An ankle sprain refers to an injury to one or more of the ligaments of the ankle. Under normal circumstances, these ligaments support the bones and stretch like rubber bands to accommodate motion, but then return to their normal resting state. When forces act on the ankle that stretch the ligaments beyond their normal range, a sprain or tear may result. The most common injury occurs when the foot is rolled underneath the ankle., otherwise known as an inversion ankle sprain. This affects the ligaments on the lateral side of the ankle, namely the ATFL (anterior talofibular ligament). Indoor court sports, such as basketball, have the highest incidence of ankle sprains. They may occur after jumping up and landing on another player’s foot, twisting the ankle while changing directions on the court or even stepping onto an uneven surface.

Treatment of an Acute Ankle Sprain

If there is suspicion that an athlete has sustained an ankle sprain, timely intervention is imperative.

Common Signs and Symptoms

  • Twisting sensation
  • Sudden pain
  • Audible sound/pop
  • Swelling in foot and ankle
  • Discoloration or bruising (12 to 24 hours after injury)

If an ankle sprain is suspected, the best course of action is to apply the PRICE principles. Protection, resting, icing, compression and elevation can lead to a quicker reduction in pain and swelling.

Some sprains will be significant enough that the athlete cannot put weight on the foot and crutches may be required for the first several hours following injury. Depending on the severity of the injury, you may need to call your doctor and seek medical care.

Self-Treatment

While symptoms of pain and swelling can resolve fairly quickly, more than 70 percent of people who sprain their ankles continue to have problems and up to 80 percent will sprain the ankle again in their lifetime. This suggests that additional care may be necessary to resolve dysfunction in the ankle after a sprain and to prevent injury in the future. After the initial protective phase, it is important to restore normal range of motion, flexibility and strength of the muscles around the ankle. Home programs such as drawing the ABCs with the ankle, using elastic bands to strengthen the surrounding muscles and working on restoring balance are a few of the exercises utilized after a sprain.

However, a research report published by the Journal of Orthopaedic & Sports Physical Therapy compared the outcomes of a home program with a more involved treatment program that includes early physical therapy and a supervised exercise program. Those who participated in the supervised program, including hands-on techniques, had significantly decreased pain and improved ability to return to their sport compared to those who participated in the home program alone.

Appropriate Shoe Wear

As popularity of youth sports continues to grow and the number of select basketball leagues expands, athletes are looking for ways to gain an advantage on the competition. Not too long ago, there was a common belief among coaches and athletes that high tops were superior to low tops in the prevention of ankle sprains. In 1993, researchers at The University of Oklahoma conducted a study comparing high- and low-top basketball shoes and the rate of ankle sprains. The study concluded that there was no correlation between shoe type and injury rate. Fast forward 21 years to 2014, researchers at Shanghai University of Sport and The University of Tennessee found that high-top shoes do not decrease the amount of ankle motion as compared to low-top shoes.

The take-home message of these two studies is that the type of shoe top – high or low – does not affect the risk of sustaining an ankle sprain. The best advice is to find a shoe that fits well and feels comfortable.

To Brace or Not to Brace?

While ankle braces add to the flair of an athlete’s appearance, the question remains, do ankle braces actually work? The answer appears to be a resounding, “Yes.” A large study at the University of Wisconsin found that lace-up braces reduce the rate of acute ankle sprains compared to unbraced athletes. The cost of the braces used in this study is around $35 each. A price tag of $70 for two braces may sound steep, but when you compare the “cost” of playing time missed and the monetary and time costs for treatment (ER, X-rays, etc.), $70 is quite a deal.

Andrew Nasr and Caitlyn Lang are currently orthopedic physical therapy residents at Memorial Hermann-Texas Medical Center and can be contacted at Andrew.Nasr@memorialhermann.org and Caitlyn.Lang@memorialhermann.org