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Nutrition and Performance: How our Sports Medicine Doctors optimize Diets for Athletes

Nutrition and Performance: How our Sports Medicine Doctors optimize Diets for Athletes

Aug 4, 2024

Photo by Nicolas Hoizey on Unsplash

The world of sports is not just about raw talent and rigorous training; it also hinges on the foundation of optimal nutrition. The dietary choices of athletes play a critical role in determining their performance, recovery, and overall well-being. While athletes often follow disciplined training routines, it is the guidance of Sports Medicine doctors who fine-tune diets, which helps athletes unlock their full potential.

The Role of Nutrition in Athletic Performance

Nutrition forms the cornerstone of athletic performance. An athlete’s diet fuels their body, affecting their energy levels, strength, and endurance. Carbohydrates are essential for providing quick energy, making them vital for athletes engaged in high-intensity sports. On the other hand, proteins aid in muscle repair and growth, while fats act as long-lasting energy provisions during endurance activities.

Moreover, vitamins and minerals are indispensable for various physiological processes, such as metabolism, oxygen transport, and nerve function. Athletes can maximize their performance potential by optimizing their nutrient intake to achieve peak results in their respective sports.

Inadequate nutrition and athletic injuries

High-intensity sports training for athletes demands high functional joint mobility, and a solid musculoskeletal system, making it essential to ensure physical fitness levels and optimal nutrition. Athletes often overexert their bodies and ignore optimal nutrient intake, which can result in athletic injuries that include:

  • Sprains and Strains are injuries to ligaments (sprains) or muscles/tendons (strains) due to overstretching or tearing.
  • Muscle Cramps are painful contractions of muscles caused by dehydration, overuse, or electrolyte imbalances.
  • Tendinitis is an inflammation of a tendon, often caused by repetitive movements or overuse.
  • Stress Fractures are small cracks in bones due to repetitive impact or over training.
  • Concussions are head injuries resulting from a blow to the head, common in contact sports.
  • Shin Splintsis the pain along the shinbone caused by overuse or improper footwear.
  • Knee Injuries include anterior cruciate ligament (ACL) tears, meniscus tears, and patellofemoral pain syndrome.
  • Ankle Sprains are ligament injuries in the ankle, often from twisting or rolling the foot.
  • Groin Strains are strains or tears in the muscles of the inner thigh.
  • Shoulder Injuries  include rotator cuff tears and shoulder impingement and are common in sports involving overhead movements.

Sports Medicine Doctors: The Architects of Athletic Nutrition

Sports Medicine Doctors at specialised clinics such as Opus Biological play a crucial role in athletic success. Their expertise in athletic nutrition, exercise physiology, and injury prevention helps them take a personalized approach, ensuring they meet each athlete’s unique nutritional requirements.

Assessment and Tailoring Dietary Plans

Crafting an athlete’s optimal diet begins with a comprehensive assessment. Sports medicine doctors consider the athlete’s sport, training intensity, body composition, medical history, and specific goals. They may conduct blood tests and other investigations to evaluate nutrient levels and identify any deficiencies that could hinder performance. With this information, the sports medicine doctor develops a tailored dietary plan that addresses the athlete’s needs. These plans encompass appropriate caloric intake, macronutrient ratios, and micronutrient-rich food sources. The goal is to provide the body with the proper nutrients at the right time, optimizing performance and promoting recovery.

Impact of Specific Nutrients on Athletic Performance

Nutrients play vital roles in supporting various physiological processes directly influencing an athlete’s abilities and performance. Here are some key nutrients and their effects on athletic performance:
  • Carbohydrates: As the primary energy source for athletes, carbohydrates are critical for maintaining high-intensity performance and replenishing glycogen stores after intense workouts. Sports medicine doctors work with athletes to determine the optimal carbohydrate intake to sustain energy levels during training and competitions.
  • Proteins: Protein is essential for muscle repair and growth, making it crucial for athletes to support their physical demands. Sports medicine doctors help athletes determine the right amount of protein to include in their diet, considering factors such as training intensity and any injuries requiring additional tissue repair.
  • Fats: While often underrated, fats play a vital role in endurance sports. They serve as an energy reserve, especially during long-distance activities. Sports medicine doctors ensure athletes consume healthy fats to maintain sustained energy and support overall health.
  • Hydration: Proper hydration is paramount for athletes to perform at their best. Sports medicine doctors guide athletes on fluid intake, considering factors like climate, intensity, and duration of activity to prevent dehydration and maintain optimal performance.

Recovery and Injury Prevention

Adequate nutrition is crucial for top-notch athletic performance, post-exercise recovery, and injury prevention. Sports medicine doctors focus on the following aspects:
  • Muscle Recovery: Nutrients such as protein, carbohydrates, and antioxidants aid in muscle repair and reduce inflammation. Sports medicine doctors emphasize post-training meals that facilitate the body’s recovery process.
  • Injury Management: Nutritional support is essential during injury rehabilitation. Sports medicine doctors ensure athletes receive proper nutrition to promote tissue healing and boost their immunity.
  • Bone Health: Calcium and vitamin D are vital for maintaining strong bones, reducing the risk of stress fractures and other bone-related injuries. Sports medicine doctors ensure that athletes’ diets include adequate nutrition.

Conclusion

Nutrition is the bedrock on which athletic performance is built. Sports medicine doctors are pivotal in optimizing athletes’ diets, considering their needs, performance goals, and health conditions. By tailoring dietary plans and emphasizing the importance of specific nutrients, sports medicine doctors can unlock an athlete’s full potential, enhance their performance, aid in recovery, and reduce the risk of injuries. At Opus Biological, we understand your sports nutrition needs. Our sports medicine doctors optimize your nutrient intake, enhance recovery, and boost endurance. Additionally, we provide personalized dietary plans and supplements catering to individualized training regimens, ensuring you receive the right nutrients at the right time. With our support, athletes can maximize their potential, improve overall athletic performance, and maintain their competitive edge in the world of sports.
Sometimes – less means more

Sometimes – less means more

Jul 23, 2024

Unfortunately, sometimes we come face to face with patients who have a rather long road ahead of them when it comes to returning to their pre-injury status. An ACL or Achilles reconstruction for example. This means a longer period for them to be vigilant, compliant and motivated with their session attendance, exercise and management techniques in and away from face-to-face sessions. I for one know that if I was placed in this scenario, I would find it tough to keep the same level of determination to adhere to my programme from beginning to end. So, can we use a little something to aid this lengthy process for our patients which will not negatively impact their progress? In my opinion, yes. Deloading.

Bell et. al (2023) (1) define ‘Deloading’ as a period of reduced training stress designed to mitigate physiological and psychological fatigue, promote recovery, and enhance preparedness for subsequent training.

In the realm of sports rehabilitation, the concept of deload periods has gained significant traction as an approach to managing and enhancing recovery from injuries. Deload periods, often implemented within a structured rehabilitation program, involve a planned reduction in exercise intensity and or volume. This technique is particularly beneficial in long-term recovery processes, offering numerous physiological and psychological benefits that can expedite healing and improve overall outcomes

The primary physiological benefit of deload periods is the mitigation of overtraining and excessive fatigue (Rogerson et.al 2024) (5). During a prolonged rehabilitation process, continuous high-intensity training can lead to increased stress on the injured tissues, potentially exacerbating the injury or slowing down the healing process. By incorporating deload periods, the body is afforded the necessary time to recover and adapt to the rehabilitation exercises without being overwhelmed by continuous strain.

Deload periods can also play a crucial role in preventing the risk of re-injury. As targeted structures are gradually strengthened during rehabilitation, they require adequate rest to fully recover and adapt to the increased loads. Without sufficient recovery, these structures remain vulnerable to further damage. As per Mosewich, Kent and Kowalski (2013) (4) deloading helps ensure that the healing tissues are not subjected to undue stress, thus reducing the likelihood of setbacks.

Additionally, deload periods facilitate metabolic recovery. Intense exercise sessions can deplete glycogen stores, disrupt hormonal balances, and lead to an accumulation of metabolic byproducts. A period of reduced training intensity allows for the replenishment of glycogen stores, normalization of hormone levels, and clearance of metabolic waste, thereby optimizing the body’s readiness for subsequent training phases (Ivy 2004) (3).

Beyond the physiological advantages, deload periods offer substantial psychological benefits that are vital for a successful rehabilitation journey. Long-term injury recovery can be mentally taxing, often leading to feelings of frustration, anxiety, or even burnout. Scheduled deload periods provide individuals with a break, helping to alleviate mental fatigue and maintain motivation throughout the rehabilitation process. It is a well-known fact that within elite sport it is common for a player to be advised to go away to somewhere warm to put their feet up for 7-10 days at a certain stage of their recovery. This gets the player away from the current rehabilitation setting, enabling them to switch off mentally and relax.

The psychological relief afforded by deload periods also promotes adherence to the rehabilitation program (Bell et. al 2022) (2). Consistently high levels of training intensity can lead to a sense of dread or reluctance towards rehabilitation sessions. By incorporating periodic reductions in training demands, individuals are more likely to remain engaged and committed to their recovery plan, ultimately leading to better long-term outcomes

The implementation of deload periods within a rehabilitation program should be tailored to the individual’s specific injury, recovery progress, and overall training load. Generally, deload periods are scheduled every 6-8 weeks, but this can vary based on the intensity and frequency of the rehabilitation exercises. Monitoring the patient’s feedback, progress, and any signs of overtraining or fatigue can help in deciding the optimum time for this process also.  During a deload week, exercise intensity and volume are typically reduced by 50-70%, allowing the body ample time to recover without completely halting progress.

So, I think based on the above, it is safe to say that as therapists we should very much consider the implementation of the deload principle into the rehabilitation plans of those patients who have a longer and slightly more mentally and physically testing battle ahead. It is a big part of our role to support our patient’s and to keep them on the right track. Sometimes that may mean periodically seeing them and doing less to achieve more down the line.

Reference List

 

  • Bell, L., Ben William Strafford, Coleman, M., Patroklos Androulakis-Korakakis and Nolan, D. (2023). Integrating Deloading into Strength and Physique Sports Training Programmes: An International Delphi Consensus Approach. Sports Medicine – Open, 9(1). doi:https://doi.org/10.1186/s40798-023-00633-0.
  • Bell, L., Nolan, D., Immonen, V., Helms, E., Dallamore, J., Wolf, M. and Androulakis Korakakis, P. (2022). ‘You can’t shoot another bullet until you’ve reloaded the gun’: Coaches’ perceptions, practices and experiences of deloading in strength and physique sports. Frontiers in Sports and Active Living, [online] 4. doi:https://doi.org/10.3389/fspor.2022.1073223.
  • Ivy JL. Regulation of muscle glycogen repletion, muscle protein synthesis and repair following exercise. J Sports Sci Med. 2004 Sep 1;3(3):131-8. PMID: 24482590; PMCID: PMC3905295.
  • Amber D. Mosewich , Peter R.E. Crocker & Kent C. Kowalski (2013): Managinginjury and other setbacks in sport: experiences of (and resources for) high-performance women athletes, Qualitative Research in Sport, Exercise and Health, DOI:10.1080/2159676X.2013.766810
  • Rogerson, D., Nolan, D., Korakakis, P.A. et al. Deloading Practices in Strength and Physique Sports: A Cross-sectional Survey. Sports Med – Open 10, 26 (2024). https://doi.org/10.1186/s40798-024-00691-y

Sometimes – less means more

Recovering from Delayed Onset Muscle Soreness

Jun 26, 2024

Delayed onset muscle soreness (DOMS) is defined as ‘ultrastructural damage of muscle cells due to unfamiliar sporting activities or eccentric exercise, which leads to further protein degradation, apoptosis and local inflammatory response’ (Hotfiel et. al 2018) The micro tears caused by eccentric movements can impact performance by reducing joint range of motion and alter muscle recruitment patterns. This can increase risk of a soft tissue injury but treatment strategies for DOMS remain uncertain. Common treatment strategies include anti-inflammatories, massage and cryotherapy. Seidel et. al investigated the optimum treatment for DOMS and found non-steroidal anti-inflammatory drugs did reduce the pain but delayed the recovery.  Other interventions were examined (nutritional and physical) and found that there was a reduction in inflammation but no treatment aided muscle regeneration. (Seidel et. al, 2012)

Massage can be an effective tool to aid recovery from DOMS, however most research states the type and timing of the massage is important.  Hilbert et. al found that there was a reduction in muscle soreness 48 hours post exercise when massage is administered 2 hours after exercise, (Hilbert et. al, 2003). However, Visconti et. al found massage to be an effective tool to reduce DOMS during the onset of symptoms (Visconti et. al, 2015).

Cryotherapy has conflicting research on the effectiveness to alleviate DOMS. For example, Eston and Peters studied the use of cold-water immersion for recovery. They found 2-3 days post exercise, participants who used cold water immersion had increased joint range and reduced creatine kinase activity compared to the control group. However, both groups presented with muscle tenderness, swelling and reduced isometric strength 3 days following exercise. Howaston and Van Someren investigated the impact of ice massage therapy on DOMs, however discovered it is not an effective treatment due to only noticing creatine kinase reduction at 72 hours (Bishop et. al, 2008).

Evidence suggests adapting your exercise programme is the most efficient method to alleviate DOMS however the analgesic effect has been shown to be temporary (Zainuddin et. al, 2011). Cheung et. al suggests when exercising on a daily basis, one should reduce intensity and duration of exercise 1-2 days following DOMS. Training body parts that are less affected by DOMS and progressively overloading eccentric exercises over a 1 to 2 week period are efficient methods to manage DOMS (Cheung et. al 2003).

Reference List

Bishop, P.A., Jones, E. and Woods, A.K. (2008). Recovery From Training: A Brief Review. Journal of Strength and Conditioning Research, [online] 22(3), pp.1015–1024. doi:https://doi.org/10.1519/jsc.0b013e31816eb518.

Cheung, K., Hume, P.A. and Maxwell, L. (2012). Delayed Onset Muscle Soreness. Sports Medicine, [online] 33(2), pp.145–164. doi:https://doi.org/10.2165/00007256-200333020-00005.

Hilbert, J.E., Sforzo, G.A. and Swensen, T. (2003). The effects of massage on delayed onset muscle soreness. British Journal of Sports Medicine, [online] 37(1), pp.72–75. doi:https://doi.org/10.1136/bjsm.37.1.72.

Hotfiel, T., Freiwald, J., Hoppe, M., Lutter, C., Forst, R., Grim, C., Bloch, W., Hüttel, M. and Heiss, R. (2018). Advances in Delayed-Onset Muscle Soreness (DOMS): Part I: Pathogenesis and Diagnostics. Sportverletzung · Sportschaden, 32(04), pp.243–250. doi:https://doi.org/10.1055/a-0753-1884.

Seidel, E., Rother, M., Hartmann, J., Rother, I., Schaaf, T., Winzer, M., Fischer, A. and Regenspurger, K. (2012). Eccentric Exercise and Delayed Onset of Muscle Soreness (DOMS) – an Overview. Physikalische Medizin, Rehabilitation Medizin, Kurortmedizin, 22(02), pp.57–63. doi:https://doi.org/10.1055/s-0032-1304576.

Visconti, L., Capra, G., Carta, G., Forni, C. and Janin, D. (2015). Effect of massage on DOMS in ultramarathon runners: A pilot study. Journal of Bodywork and Movement Therapies, [online] 19(3), pp.458–463. doi:https://doi.org/10.1016/j.jbmt.2014.11.008.

Zainuddin, Z., Sacco, P., Newton, M. and Nosaka, K. (2006). Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Applied Physiology, Nutrition, and Metabolism, 31(2), pp.126–134. doi:https://doi.org/10.1139/h05-010.

Sometimes – less means more

Take a dip!

Jun 18, 2024

Hydrotherapy, or aquatic based therapy, is a treatment method I have personally used with patients ever since first becoming an MSK physiotherapist. From my first ever exposure to the method in my early NHS, Junior Physiotherapist role, to using a pool with elite athletes competing in a number of different sports in my more recent career, I very rarely find that the patient doesn’t leave the session with some form of positive gain.

Hydrotherapy is defined as the external or internal use of water in any of its forms (water, ice, steam) for health promotion or treatment of various diseases with various temperatures, pressure, duration, and site (Mooventhan and Nivethitha, 2014) (4). Like many good things, it has been used for 1000s of years to assist in the management of health conditions whether that be to aid movement or relieve pain. Today, we very much utilise the benefits of water to treat a variety of health conditions ranging from cardiovascular, to rheumatological, neurological and musculoskeletal injuries.

So what are the benefits of hydrotherapy? Well, to break it into pointers, these are the reasons as to why we can find benefit from hydrotherapy:

  1. Pain Relief 
  • Immersion in warm water can help reduce pain and inflammation in muscles and joints. The heat increases blood flow, which can ease discomfort and accelerate the healing process. The pressure exerted by water also helps to reduce swelling and improve circulation
  1. Muscle Relaxation and Recovery
  • Warm water helps to relax tense muscles, reducing spasms and stiffness. It can also enhance muscle recovery after intense physical activity by promoting blood flow and reducing lactic acid buildup.
  1. Improved Circulation
  • Warm water immersion helps dilate blood vessels, improving circulation throughout the body. This can aid in delivering oxygen and nutrients to tissues and removing waste products.
  1. Stress Reduction and Mental Health
  • The soothing properties of water can help reduce stress and anxiety. The buoyancy and warmth create a relaxing environment that can promote mental calmness. This can have a direct positive correlation to improving a person’s ability to sleep due to the relaxed state they enter.
  1. Mobility
  • The buoyancy of water reduces the load on joints, making it easier to move and perform exercises. Water provides a low-impact environment for exercise, reducing the risk of injury. This makes hydrotherapy an excellent option for rehabilitation after surgery or injury.

It is easy to see how we can utilise hydrotherapy to benefit a variety of patients based on the benefits mentioned. Carere and Ore (2016) carried out a review which concluded that hydrotherapy has a positive effect on pain, quality of life, condition-related disability and functional exercise capacity. In fact, the perceived benefit of well-being was actually superior to land-based exercise protocols in cases where water temperature was within a thermoneutral range (33.5–35.5 °C). (2)

Cikes et al. (2021) (3) looked specifically at the use of hydrotherapy as an alternative to dry land therapy for rotator cuff repair patients. Through their study they found that the use of pool-based rehabilitation was as effective as dry land rehabilitation at the 1 and 2 year follow up points but that Pool based rehab was in fact MORE effective than dry land exercise at the 3 month follow up point. This therefore suggests that the use of water in the early to mid stages of this particular recovery is beneficial.

Then, away from rehabilitation, the pool can also be a useful tool in the role of optimizing recovery for athletes between heavier training sessions or competition. As such, the pool can be used as a recovery tool to support low load conditioning and accelerated recovery between training sessions or match play. This is particularly relevant following intense training days on the field and/ or in the gym, which are designed to load the athlete to develop their tolerance to increased training demands. (Buckthorpe et al 2019) (1)

So, whether it be for: rehabilitation from surgery or an acute injury, pain management for a longer-term condition or as a tool in optimizing active recovery, hydrotherapy is another great string to our bow as physiotherapists and can be of great benefit to a large chunk of our patient population.

Reference List

 

  • Buckthorpe, M., Pirotti, E. and Villa, F.D. (2019). BENEFITS AND USE OF AQUATIC THERAPY DURING REHABILITATION AFTER ACL RECONSTRUCTION -A CLINICAL COMMENTARY. International Journal of Sports Physical Therapy, [online] 14(6), pp.978–993. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878863/.
  • Carere, A. and Orr, R. (2016). The impact of hydrotherapy on a patient’s perceived well-being: a critical review of the literature. Physical Therapy Reviews, 21(2), pp.91–101. doi:https://doi.org/10.1080/10833196.2016.1228510.
  • Cikes, A., Kadri, F. and Lädermann, A., 2021. Evaluation of Three Different Rehabilitation Protocols After Rotator Cuff Repair, and the Effectiveness of Water/Pool Therapy. A Randomized Control Study. Journal of Shoulder and Elbow Surgery, 30(7), p.e421.
  • Mooventhan, A. and Nivethitha, L. (2014). Scientific evidence-based Effects of Hydrotherapy on Various Systems of the Body. North American Journal of Medical Sciences, [online] 6(5), p.199. doi:https://doi.org/10.4103/1947-2714.132935.

Sometimes – less means more

The Posterior Oblique Sling

May 29, 2024

The posterior oblique sling (POS) comprises the latissimus dorsi and contralateral gluteus maximus which is connected through thoracolumbar fascia, erector spinae, multifidus and bicep femoris. This activation pattern provides stability of the lumbopelvic region by transferring force through the trunk. For insistence, erectus spinae generates force whereas the multifidus creates stability. The posterior oblique sling is thought aid recovery from lower back pain (LBP) and is often a fundamental part of rehabilitation despite minimal research on the topic (Kang and Hwang, 2019). However, most recent research suggests patients with LBP have abnormal motor recruitment in the lumbopelvic region (Kim et. al, 2014); therefore, activating the POS may offer spinal mobility, stability and prevent LBP (Kang and Hwang, 2019).

Prone hip extension (PHE) is a useful measure to assess and activate the POS. In healthy individuals, one should be able to maintain neutral lumbar and pelvic position during PHE, however patients with LBP have been found to have altered lumbar and pelvic movement. This in turn can cause lumbopelvic dysfunction, spinal instability and postural disturbance (Kim et. al, 2014). For example, Kang and Hwang found patients with LBP often have delayed onset of gluteus maximus and earlier onset of bicep femoris (Kang and Hwang, 2019).  When the gluteus maximus does not activate, there is a loss of pelvis control which can cause the contralateral latissimus dorsi to become dominant. Therefore, to aid lumbopelvic control, practitioners can manipulate the PHE to focus on the less dominant muscle (Kim et. al, 2014).

Lee et. al altered the PHE technique to assess the impact this has on POS. The PHE was compared to abdominal drawing in maneuverer prone hip extension (ADIM PHE). The ADIM PHE had increased contralateral latissimus dorsi and ipsilateral gluteus maximus compared to hip extension, whereas PHE had increased ipsilateral erector spinae and ipsilateral bicep femoris ((Lee et. al, 2020). Lee et. al also compared PHE to PHE with hip abduction and knee flexion. They discovered the contralateral latissimus dorsi, ipsilateral erector spinae and gluteus maximus electromyography was higher with phone hip extension with hip abduction and knee flexion than PHE (Lee et. al, 2019). Therefore, depending on the clinical presentation of the patient, practitioners can isolate specific muscle groups within the POS. PHE with hip internal rotation and shoulder internal rotation and shoulder extension with 1lb dumbbell was found to be the optimal PHE variation for POS activation to aid recovery with LBP (Kang and Hwang, 2019).

This research highlights the importance of using PHE as an assessment and treatment tool to identify weakness within the POS and then adapting the PHE to support recovery from LBP.

Reference List

Kang, D. and Hwang, Y.-I. (2019). Comparison of Muscle Activities of the Posterior Oblique Sling Muscles among Three Prone Hip Extension Exercises with and without Contraction of the Latissimus dorsi. Journal of The Korean Society of Physical Medicine, 14(3), pp.39–45. doi:https://doi.org/10.13066/kspm.2019.14.3.39.

Kim, J.-W., Kang, M.-H. and Oh, J.-S. (2013). Patients With Low Back Pain Demonstrate Increased Activity of the Posterior Oblique Sling Muscle During Prone Hip Extension. PM&R, 6(5), pp.400–405. doi:https://doi.org/10.1016/j.pmrj.2013.12.006.

Lee, J.-K., Hwang, J.-H., Kim, C.-M., Lee, J.K. and Park, J.-W. (2019). Influence of muscle activation of posterior oblique sling from changes in activation of gluteus maximus from exercise of prone hip extension of normal adult male and female. Journal of Physical Therapy Science, 31(2), pp.166–169. doi:https://doi.org/10.1589/jpts.31.166.

Lee, J.-K., Lee, J.-H., Kim, K.-S. and Lee, J.-H. (2020). Effect of abdominal drawing-in maneuver with prone hip extension on muscle activation of posterior oblique sling in normal adults. Journal of Physical Therapy Science, 32(6), pp.401–404. doi:https://doi.org/10.1589/jpts.32.401.