Saturday, 27 May 2017

Dental Health and Performance

When I run workshops for young athletes encouraging them to take care of their general health and wellbeing, I advise them to look after their teeth and to visit a dentist regularly. Right on que, a hand will go up (often one of a parent), and I can predict what the next question will be. “What have teeth to do with performance?”

Yes Eliz, what have teeth to do with performance?

Well let me start with an extreme case. Alan Campbell…. British rower….training for 2008 Beijing Olympics…abscessed lower-left wisdom tooth… disaster! The infection from the abscess spread to his shoulder, back and later his right knee. The knee required surgery two months before the games and required Campbell to miss six weeks on-water training, in the run-up to what was meant to be the biggest race of his life. 

Campbell finished fifth in the single-sculls final in what may, forever, have been a case of ‘what could have been’. Thankfully, this story has a happy ending. Campbell won bronze in London four years later. And learned an important life lesson in the process: our teeth can not only ruin our sleep, they can trample all over our dreams.

Campbell’s case is not an isolated one. Empirical (controlled scientific studies done by the scientists) and anecdotal evidence (observations of those in the know, this case people like dentists) suggests that athletes have poor dental health. Their finely honed bodies, often epitomising the very picture of health, often cover up a mouth full of bad teeth.

Causes


There are a number of proposed reasons why high-performance athletes have bad teeth, though little research has been done specifically on the causes of poor dental health in athletes.

Direct impact or trauma is a major cause of dental morbidity in sportspeople. Impact sports such as hockey, basketball and rugby have a high incidence of broken teeth, and worse. 

This is the obvious stuff. But there is substantial poor dental health even in those who participate in sports which involve no person-to-person impact.



The high volumes of carbohydrates required to meet energy demands can have a negative effect on teeth, particularly when a large portion of those carbohydrates come in the form of sugary, acidic sports drinks, gels and energy bars.

Physiological changes which occur during exercise may also play a role. These include decreased salivary flow and drying of the mouth (saliva is needed to regenerate tooth enamel) and exercise-induced immune suppression.

Grinding of teeth when lifting weights, or generally at night from stress, may also wear down teeth.
And then there’s the practical things like not making oral health a priority. Frequent travel may lead to busy high-performance athletes missing their regular check-ups, or pushing them down the to-do list. 

And then there’s the expense of keeping your teeth in check. Athletes struggling to make ends meet may simple not be able to afford regular check-ups or the cost of any follow-up maintenance work required.

The role of eating disorders, particularly bulimia, which is not uncommon in sport, cannot be overstated. Stomach acid, which will come in contact with teeth during vomiting, has a catastrophic effect on teeth, and can erode away dental enamel in a relatively short time period.

Something else to bear in mind is that individuals generally have the most trouble with their teeth, especially problem wisdom teeth, from the early twenties to their mid-thirties, the age bracket in which the vast majority of high performing athletes fall.

Effects

Dental health has a direct effect on general wellbeing and quality of life. The effect on sports performances can be both direct and indirect. 

Pain - from sensitivity, cavities and abscesses -  is the most obvious consequence of poor dental health. This can lead to sleepless nights, effecting performance and training, and indirectly leading to an increased risk of injury. Pain and dental discomfort can affect eating, and can have psychological impact on performance.

Tooth and gum infections can lead to systemic inflammatory response – a condition which is closely related to sepsis – and which isn’t good for either your general health or your sporting performance. 
A mouth full of bad teeth can also make an individual self-conscious which doesn’t do much for confidence.

Recommendations

Brush and floss regularly
Have regular dental check-ups. Use the off season to get any work required done.
If you participate in an impact sport, always wear a custom made mouth guard in potential impact situations (games and contact training)
If you find yourself grinding your teeth at night, seek help, both in reducing the stress that is causing the grinding, but also in protecting your teeth. You may need to wear a mouth guard at night.
And keep smiling!

Some further reading:

Oral health and elite sport performance A Consensus Statement, Needleman et al, 2015.

Friday, 3 March 2017

Book Review: Retired - What Happens to Footballers when the Game's up

'Almost half of professional footballers face the threat of bankruptcy within five years of their retirement. A third will be divorced less than a year after hanging up their boots... many end up addicted, depressed, living with debilitating illnesses, behind bars or even worse.' So writes Alen Gernon in his thought-provoking book about life after football.

I bought this book because of my interest in the difficulties sportspeople face when they retire rather than my interest in football. While I can accept that footballers are a little bit more three-dimensional than the common perception of over-paid, attention-seeking tugs, I didn't expect to be almost feeling sorry for them by the time I'd finished the 256-page, easy to read publication.

The initial chapters each covered one of the main, often inter-related, tragedies facing retired footballers - the crippling after effects of physical and mental injury, divorce, bankruptcy, mental health issues, run-ins with the law - and while the issues are not unique to football, it is the sheer frequency that they occur which startles.

These chapters didn't really contain anything new for me - though to be fair I have already read extensively on the area of retirement and mental health issues in sport - and they were occasionally repetitive. However, the book really came to life in the latter chapters. The stories of players who retired early, by choice, from the game - those of Shane Supple, Espen Baardsen and David Bentley - really hammer home how toxic the football environment can be for some, and how, despite increased support, preparing players for life in the 'real world' is not always an expected function of the sport.

As always it's those that we don't hear about that have the most interesting stories to tell, and Gernon should be commended for collating and putting context to those less well known stories.


This book is definitely worth a read for those who would like to understand football and footballers a little deeper as well as those who work with transitional footballers of all ages. It is a gentle reminder of the responsibilities we have for the welfare, as well as the sporting performance, of those who we support.


Sunday, 2 October 2016

WADA Prohibited List 2017

WADA, the world anti-doping body, has published it's updated prohibited list for 2017, which will come into effect on January 1st. It is available to view here.


They have also, helpfully, produced a document which summaries the changes to the list. That document can be viewed here.

Athletes should remember that they are responsible for whatever substances are found in their bodies, and should stay abreast of changes to the Prohibited List. Any medications that you are taking should be checked on the relevant database (Global DRO if you live/purchased your medication in the UK; Eirpharm if you live/purchased your medication in the Republic of Ireland) on a regular basis as medications that you are taking may change in status.

Those of you who follow the doping news (or sports news in general) will remember the furore earlier this year when a number of top sporting stars failed tests for meldonium, a substance which was added to the 2016 banned list. Some, including Maria Sharapova, claimed that they didn't know the substance was banned, in Sharapova's case because she only knew the substance it only by its trade name Mildronate; others claimed they had stopped taking it before January 1, but that it hadn't cleared the system. Sharapova is currently serving a two year ban, as it was her responsibility to ensure that the drug she was taking wasn't banned.

Sharapova got off lightly - the standard ban for a first time doping offence is four years!

Wednesday, 3 August 2016

Personal development concepts: a bias for action

I was first introduced to the concept of 'a bias for action' when reading the excellent The Skilled Helper, by Gerard Egan (no relation), six years ago. The book was one of the main texts for a course in career counselling that I was studying for at the time, but which I never managed to complete (the course that is; I still have aspirations of finishing the book), and, somewhat ironically, the phrase 'a bias for action' resonated with me. It is one of the main values which I constantly endeavour to bring to my consultations with athletes.

'A bias for action' is a term often used in the business world. In that sphere it refers to the "propensity to act or decide without customary analysis or sufficient information, to 'just do it' and contemplate later" (ref: thebusinessdictionary.com). In the business world, it is rarely the most effective way of doing things and is typified by people attempting to simply look busy, feel productive, or to be seen to be making a difference.

The term has a slightly different meaning in the helping context, though in certain contexts, there is a value to doing things for the sake of doing something, not over analysing and just trying things out. 

In essence, those with a bias for action are doers rather than bystanders. They set and pursue life goals, they take responsibility for their actions and they persist against obstacles. According to Egan, bias for action is one of the key values that drive the helping relationship. "The doer is more likely to move beyond problem management to opportunity development" (Egan 2007, p61).

The overall goal of the 'helping' practitioner - in this case the personal development/lifestyle support practitioners - is to help the client (athlete) become more effective in managing problems and developing opportunities. This involves helping them "become more effective 'agents' in the helping process and in their daily lives - doers rather than mere reactors, preventers rather than fixers, initiators rather than followers" (Egan, 2007, p61).

The practitioner should adopt a bias for action themselves, as well as help the athlete become doers and active agents for themselves. During consultations, practitioners with a bias for action will question what more they can do to increase the chances of the athlete taking action and solving their own problems in an intelligent and prudent way. Relationship building is a fundamental part of the 'helping' process but it shouldn't get in the way of solving problems and developing opportunities. Councelling and coaching are often seen as simply listening to the client, and yes, listening is an important component, since, afterall, we can't actually advise the client or take action on their behalf. But we can facilitate them to take action.

Egan goes on to talk about non-discretionary and discretionary change. Non-discretionary change is something that is mandated to us; something that we have to change in order to achieve a certain outcome. In the high performance sport context, a governing body might tell an athlete that unless they start attending their strength and conditioning sessions, they will be removed from funding. If they want to remain on funding, they must make the change.

Discretionary change, on the other hand, is something that we choose to do simply to improve our situation. Human nature means that if we don't have to change, we generally don't. We generally think that others should change first and that we will only change if we absolutely have to. This is the reality that we as helpers need to be aware of. Having a bias for action will help promote discretionary change.

Take, for example, an athlete who expresses concern over how their coach-athlete relationship has developed. They might feel that they are not having enough input into their development. The relationship which worked well when they were a junior athlete is no longer optimal. Often, however, the athlete in this situation isn't motivated enough to have a conversation with the coach about how they fell, and how they can work together to change the situation. Before long, the athlete's performances start to drop, they blame the coach, trust is lost, and something which could have been fixed with a conversation and some basic discretionary change, requires drastic intervention. The athlete will often end up changing coaches or moving training groups. Helpers with a bias for action would encourage action when concern was first expressed.

In many cases, simply taking action can help an individual to feel better about themselves. Take and injured athlete for example. In most cases, athletes who take control of the situation will fare much better psychologically (and probably physically) than those that don't. Whether it is just making an appointment with the physiotherapist, doing rehab exercises, or hitting the cross-training, each action that an athlete takes is a step closer to getting better. Deciding, after weighing up all the options, to use the injury as an opportunity for a prolonged rest is, in itself, action.

And not all action has to take place in the consultation itself. In fact, most of it will occur between sessions. There are normally 4 to 8 weeks between my consultations with athletes. In order to promote action, at the end of a session I will ask them to summarise how they now feel about the situation that we have discussed, and ask them what actions they are going to take before the next session. Depending on the situation, I may follow up via email. At the start of the following session I will ask the athlete what actions they have taken following our previous session.

If you would like to learn more about bias for action and other aspects of Egan's Skilled Helper Model, purchase the book via the link below.


Wednesday, 27 July 2016

The Olympic Creed: Living it out in your sporting lives

Amid a backdrop of corruption allegations, selection controversies and doping scandals, the latest edition of 'the greatest show on earth' is fast approaching. When Pierre de Coubertin set up the modern Olympic Games 120 years ago, he could hardly have imagined, firstly, how big the Games would become and, secondly, just how far removed the modern day ethos of the Olympics would appear to be from that he originally envisaged.

The Olympic creed come's from de Coubertin's words spoken at a reception in 1908, words which had been inspired by those of Ethelbert Talbot, Bishop of Pennsylvania.
"The most important thing in the Olympic Games is not to win but to take part, just as the most important thing in life is not the triumph but the struggle. The essential thing is not to have conquered but to have fought well",
No matter how commercialised the games have become, or how much the desire to win at all costs removes us from de Coubertin's original vision, it is important to regularly remind ourselves of the creed on which the modern Olympic Games were built, and to ask ourselves whether or not we're doing everything we can to live out that creed in our everyday sporting lives, whether we be a weekend warrior or an Olympic medallist, because, at the end of the day, it doesn't matter whether or not everyone else is living out the Olympic spirit, if, when we reach our 'Olympic' moment, we get that warm fuzzy feeling inside knowing that we have both struggled and fought well, and done so with honour and integrity.

Irish Olympian Ciarรกn O'Lionaird said it best when he posted the following on his Facebook page earlier this week:


And remembering that the struggle is more important than the triumph doesn't mean that we have to give up on victory, or reduce or sporting goals in any way. Going about achieving success in a way that is true to the Oath may even make us more successful.

Here are some ideas on how we can apply the true Olympic spirit (not the win at all costs one), to our everyday sporting lives. Please feel free to add any further suggestions that you might have as comments below.

1. Don't forget to enjoy the moment, whether that's at a national championship or an Olympic Games. You've earned your place on the start line. This is what you do. Take a moment to take it all in.
2. Whether you win or loose, shake the hands of your fellow competitors. Without them there is no battle to win.
3. Be gracious in defeat, and humble in victory, but don't let that stop you feeling the emotions your win or defeat has created.
4. Play by the rules, and by the spirit of the game.
5. Set goals with are both stretching and realistic. Challenge yourself. Strive towards your goals.
6. Thank your coaches.
7. Encourage others.

Monday, 18 July 2016

Burnout in young athletes: Are we doing everything we can?

As a teenager and young adult the end of season break from athletics was always an important part of my training year. Two weeks of complete rest normally coincided with the first few weeks of settling back into school or university, and was followed by a further two weeks of mild and varied exercise. I always looked forward to this phase of the year, but, after a week or two I was keen to get back into training. By the end of the four weeks I was ready, both physically and mentally, to get stuck into the hard winter miles again.

Even now I take a break at the end of the season, though various enforced breaks mean that the end of season isn't always a predictable period in September, sometimes falling much earlier, and some years a lot less needed than others. However, whether I feel like I need an off-season or not, this break in training is necessary, if just to mark the start of the next 12 month cycle, reflect on what went well or not so well in the previous 12, and set new goals for the season ahead. A finishing point for one season gives you a starting point for the next.

I have no doubt in my mind but that the annual break helped me remain mainly injury free over the years, and has allowed me to have a 'career' that has spanned 24 years, and counting. The value of the off-season is well supported by scientific and anecdotal evidence and is a fundamental component of any sound training programme.

It is therefor disappointing when I hear of 12 and 13 year old athletes who take no annual break from sport, or even have a day a week free from some form of physical activity. Yes, that's prepubescent boys and girls partaking in sport seven days a week, 52 weeks of the year, for as many years as their bodies (and minds) will put up with it. That, in my book, is child abuse.

Don't get me wrong, it's great to hear of young people participating in sport, trying multiple different sports, and not being afraid to partake in competition. But that shouldn't be at the expense of the fundamental principles of training. If an elite Kenyan athlete - who doesn't have school or university, or even making a living to worry about - can spend 4-6 weeks away from sport each year, then surely growing boys and girls can.

The great thing about athletics is that there are always things to train for. But that is also its downfall. I remember as a child how packed the annual calendar was, particularly since I competed in multi-events and cross country in addition to a range of events on the track and field programme both indoors and out. There was a competition on the programme almost every weekend, and even more once I became eligible to compete in junior competitions as well. When I was finally good enough to reach the national Community Games finals, the season end was extended to early September, with county cross country championships - races that I had to do to be eligible to compete in regional and national competitions - usually being held just 4 or 5 weeks later. The season was almost endless. Thankfully my coach was wise enough to know that the break was essential, no matter what the calendar said, and my ego was robust enough to take a sever beating when racing county championships more or less straight off a break.

Other sports are similar. Seasons have been extended to prevent athletes wandering off to other sports and not coming back. That's not to say that athletes don't do multiple sports - they just try to do 3 or 4 sports with overlapping seasons on top of each other, and with no consideration for the overall loading that their body is taking. But the physical components of sport, particularly in young individuals, are transferable. Training can, absolutely, be altered to take into account what an individual is doing in training elsewhere. If they are developing speed and endurance in another sport, then they just need to concentrate on the skills and technical aspects of that sport. This fear of loosing athletes to other sports or not having complete control over their participation in your sport is having undesired effects. Not only are they not coming back, not making the transition from talented juvenile to junior and senior competition, not being the next star athlete, they are being lost from sport altogether. The 'must-find-and-keep-the-next-superstar' attitude has to change because too many young athletes, each with the potential to be a useful sportsperson, are being resigned to the scrapheap long before they have the opportunity to fulfil their potential.

And that is not fair play.

Wednesday, 13 July 2016

Anyone can be an Olympian; but that doesn't mean it's easy

This week has been a big week in the lives of track and field athletes across the world. This is the week in which most national governing bodies are announcing and nominating their teams for one of the central sports on the Olympic programme. It is, in short, the week in which dreams are made and hearts are broken.

This morning I gave a small talk to some of the athletes attending the week's Wexford Athletics Summer Camp. Twenty-three years in the sport has thought me that if just one of those young athletes makes the Olympic, they'll have beaten the odds. In fact, if even two or three of them compete in athletics as an adult, that'll be a small miracle. Over the years I've seen hundreds of young athletes, many far more talented than me, give up on the sport because they can't handle been beaten, because they want to concentrate on their studies, because they want to get a job or spend more time socialising, because they get injured, because they go through a bad patch, because they think that success doesn't happen to people like them and because they think that if they are not good enough for the Olympics then the sport has nothing to offer them. Some simply fall out of love with the sport, move on, or do other things with their lives. And that is perfectly fine. There are things that I did as a child that I no longer do, there are things that I realised that I wasn't very good at, and there are things that no longer interest me. 

But, the Irish team named on Tuesday disproves all the myths about where successful athletes come from or what they do with their lives. It proves that you don't have to give up on your academic goals to follow your sporting ones - Paul Pollock and Sara Treacy are both doctors; Mark English is working towards that goal; Ciara Evarard has studied physiotherapy; Michelle Finn will go straight into a block of teaching practice when she gets back from Rio. It proves that you can absolutely work full time and still be a top athlete - Kevin Seaward is a fulltime PE teacher, Breege Connolly works full time in software testing, and Lizzie Lee, a fulltime employee at Apple, recently said that she wouldn't have it any other way (yes, that's half our marathon runners with proper jobs!). It proves that it's not always the best juvenile athletes that make it big time - many of the team will not have been standout juveniles - only a few years ago Michelle was deemed not good enough to be sent to a European Cross Country Championships, now she's going to the Olympics. Indeed, Breege and Lizzie didn't even start to run until their late twenties. It shows that injuries can be overcome - before winning European bronze on Sunday, Ciara McGeehan, one of the true former junior standouts to make the team, had not worn an Irish vest for five years because of injury. 

But most of all, it proves that ordinary people, like you and me, can make it to the Olympics. 

And those of us that don't, can have a darn good time trying, and achieving our own 'Olympic' goals.

The closest I'm likely to get to an Olympics

Wednesday, 15 June 2016

Mood cards and understanding our emotions

Recognising and understanding our emotions and knowing how to deal with them is an important skill for managing our lives both on and off the sporting field. Whether it's managing pre-competition nerves, dealing with anger on the pitch or learning how anxieties and fears about our personal lives are holding us back, moods and emotions constantly need to be managed. 

That's not to say that we should bottle up anger, fear, anxiety and other emotions which are perceived to be negative, and constantly exude happiness, excitement, love and hope. Quite the opposite is true. Expressing our emotions, both positive and negative, can help us to better cope with life, but recognising the emotions that drain our energy, the thoughts that we associate with certain emotions, and the situations that initiate or prolong negative emotions can help us deal with them. Sometimes emotions just need to be acknowledged.

Take the mood of depression*, for example. Feeling depressed is rarely a positive experience. Sometimes we feel depressed for no real reason. Sometimes it's something we feel when we're bored or have reached a crossroads in our lives. Sometimes it's something we experience in the lul period after a big event or time of extreme excitement or on a Monday morning after a particularly big weekend. Sometimes it's one of the many feelings we experience when we get sudden or unwanted news, experience an injury or go through a breakup. Depressed moods can also be associated with female hormone fluctuations (periods, in other words) and low iron levels. 

When we are feeling depressed, we may find ourselves crying unexpectedly, we may have a more negative outlook on life that usual, our lust for life may have temporarily disappeared, or we may find that we simply do not feel anything. In some situations we simply have to go through the emotions (or lack of), cry the tears and feel sorry for ourselves, for a while. But recognising and acknowledging the mood can help us to deal with it quickly. Acknowledge what is making you feel depressed. Ask yourself what you can do to change your situation. Think of a time when you were in a happier mood and what your outlook on life was then. Acknowledge the emotion, take time to deal with it, talk it through with someone or write down your feelings, and, when you're ready, move on. (If your depressed mood lasts longer than expected or becomes uncontrollable, make sure that you seek appropriate help.)

While I generally avoid labels and categorising things, I have found the naming and recognition of moods and emotions particularly useful, both personally and for some of the athletes I work with. A few months back, when looking for mood scales on the internet, I came across this particularly useful tool - a set of mood cards which each have a mood or emotion on them, a face representing that emotion and a phrase associated with the emotion. On the reverse of each card is a series of questions and an affirmation relating to that emotion. They are a great tool for personal exploration, group work, and one-on-one therapy sessions. They are probably the most useful and versatile I currently have in my toolbox.


*Depression can refer to both a mood or emotion and a mental illness. Unfortunately, because of the lingering taboos associated with the mental illness, we shy away from describing our emotions and feelings as being depressed. We don't want to be labelled as having depression or not being able to cope, but truth is that most people experience a depressed mood on a relatively regular basis. That doesn't mean that they have a mental illness. However, failing to deal with a lingering or severely depressed mood may predispose or lead to depression. 

Wednesday, 4 May 2016

Time management tips for student-athletes

Exam season is now upon us. Many student-athletes will be busy trying to balance the time demands of revision, the stress of exams, and the physical and mental challenges of training. Check out our Time Management Tips factsheet for some ideas on how to get the most out of your time.

Best of luck in the exams, and remember, no matter how you do, life still holds numerous wonderful possibilities that you can't even imagine right now.

Saturday, 12 March 2016

Sharapova, Meldonium, and our anti-doping responsibilities

In light of the recent doping revelations concerning Sharapova and meldonium, there’s no better time to remind athletes and their support staff of some key anti-doping rules and responsibilities in the fight for #cleansport.

Athletes are subject to ‘strict liability’ when it comes to the presence of banned substances in their samples. The athlete, and the athlete alone is responsible for what is found in their bodies. Take responsibility for what you take, and take all the necessary measures to ensure that you are not taking a banned substance.

Just because it’s not yet illegal doesn’t mean that it’s not immoral. We'll cover this point more in future blogs, but probably sums it up quite well (this in relation to Sharapova and Meldonium):

Just because it’s not on the banned list now doesn’t mean that it won’t be in the future.

Just because it’s available without prescription doesn’t mean that it doesn’t contain banned substances.

Supplements can inadvertently contain banned substances. They are not subject to the same strict production controls as drugs and medications.

The anti-doping code, including the list of banned substances and methods, changes every 12 months. Changes come into effect on 1st January, but the updated list is generally available from September the previous year. Regularly check all the medication you take.

If you are taking medications or supplements, be sure to list them on your doping control form if/when you are tested.

If you need a medication for known medical condition, ensure that you have followed the correct TUE procedures for the level you are competing at/the medication you are taking.

All the resources and information that you need are available at:
GlobalDro: Database on which you can check whether your medication in permitted or prohibited (for products purchased in Canada, UK, USA or Japan) 
Eirpharm: Similar database to the above, for products purchased in the Republic of Ireland.
UKAD, Sport Ireland, or the national body which oversees antidoping in the country where you are.
WADA, the world anti-doping agency

Friday, 1 January 2016

30 ways to reinvigorate your life: Our 2016 challenge to you

This challenge is an adaptation of a task I recently saw somewhere on Twitter. There are 30 suggestions of different things you can do to make the world a more interesting place - some of which will benefit others; all of which will add new meaning and purpose to your life.

Making others feel good; doing something different; gaining knowledge - these are all ways of giving our life a little boost. All the little boosts added together can mean the difference between living a meaningful, happy life, and just getting by.

Hell, even cleaning the fridge can have major therapeutic benefits.

Try to achieve one of these tasks each week until the whole grid is complete.

Why not print off the sheet, cut out each square, place them in a hat, and pull one out each week?

Go on, give yourself those regular little boosts; you deserve it!
Pdf version of task sheet can be found here

Thursday, 24 December 2015

Recovery snacks: ideas to boost your recovery

Recovery snacks are very important and can make the difference between you reaping the benefits of training and not. And so, our Christmas gift you is a special one-page factsheet with lots of  recovery snack suggestions.


Did you know that failing to consume some form of food or snack within 15-20 minutes of finishing training can severely delay recovery, prevent you from adapting and benefiting from the session, and can make you more susceptible to colds and infections?

The recovery snack should contain:
1. Carbohydrates to replace muscle and liver glycogen stores and to suppress cortisol secretion - This is one time when quick release carbohydrates (ie simple sugars) are ok, and often encouraged.
2. Protein to assist with muscle repair (and after a weights session to promote muscle growth).
3. Fluids to rehydrate (and perhaps some sale or electrolytes after prolonged training in the heat).
4. Vitamins, minerals etc to support the immune system (esp Vitamins C & E, Zinc, Glutamine & Probiotics).


Lots more information, and suggestions can be found on the Recovery Foods factsheet.

Wednesday, 16 December 2015

Pre-competition nerves: can they be harnessed?

A common concern among athletes of all levels is pre-competition nerves and how to deal with them. No matter how long we've been competing for, or what level we compete at, nerves appear to hold us back.

I, like many athletes, suffer from pre-race nerves. Sometimes they completely hinder my performance, making what should have been a big performance appear more like a laboured recovery jog. Other times they are something in the background that simply makes me need the toilet a little more frequently than normal. Ok, a lot more frequently.

But the one thing that I've found that helps is embracing the nerves; recognising them for what they are, and welcoming them onboard rather than fighting them. They don't like the friendly welcome so much, and often waddle off into hiding in response.

Some otherwise talented sportspeople never fully learn to manage their pre-competition nerves, and performance anxiety can make competition day so unbearable that they quit their sport.

It doesn't have to be like this. Any good sports psychologist will be able to give you techniques to manage your nerves in a positive way.

Athletes of all levels experience pre-competition nerves, but once the gun goes the adrenaline has other outlets.

What are per-competition nerves?
Nerves manifest themselves and affect each individual in a different way. Also known as competition anxiety, pre-meet jitters (or, in the worst cases, choking), pre-competition nerves are a collection of physical and mental responses to increased adrenalin secretion. Adrenalin is required to get us up for a big performance. This 'fight or flight' hormone/neurotransmitter increases our heart rate, muscle strength, blood pressure and sugar metabolism in preparation for strenuous activity and in response to strong emotions such as fear or anger or a perceived threat. Adrenalin secretion is necessary for a good performance, but too much adrenalin or arousal (as 'getting up' for the performance is often called), can result in a number of unwanted side effects.

These unwanted symptoms include 'butterflies' in the stomach, nausea, vomiting, poor concentration, lack of spatial awareness, negative thinking/thoughts, tight muscles, sweaty palms, cotton mouth, feelings of apprehension, desire to urinate, diarrhoea, feeling of fatigue, flushed skin, forgetting details, increased respiratory rate, irritability, heart palpitations, hyperventilation, visual distortion, voice distortion, yawning and vomiting.

Many of these symptoms, particularly the ones that can be described as somatic (or related to the sympathetic nervous system e.g. increased heart rate, sweaty palms, urge to urinate), disappear once the race, game or contest starts; as soon as we have the opportunity to put the adrenaline to other uses. Their presence can be taken as a sign of physiological readiness to compete. They should have no negative effect on performance, so long as we can actually make it to the start line.

However the cognitive state anxiety symptoms - the poor concentration, feelings of apprehension, tiredness, etc. - fluctuate throughout the contest as the probability of success/failure changes. These symptoms, if not controlled, can have a harmful effect on performance. This is when our mind is feeding us negative thoughts which we start to believe.

Nerves are often at their worst when the perceived demand is not balanced by the athlete's perception of their ability to respond effectively to the 'threat'. If you want to do really well in a big competition (perceived demand), but feel inadequately prepared (ability to respond), the nervous response is potentially high. (Conversely if it is a very small competition that you can easily win, your arousal may be insufficient; this arousal malarkey is a fine balancing act).

Managing nerves
Strategies to manage and overcome nerves fall into three main categories. Firstly, relaxation techniques can reduce the level of arousal, and get you into the arousal zone in which you can perform at your best. Secondly, nerves often cause us to think negatively, or talk ourselves out of a certain situation. There are a number of strategies we can implement to redirect these negative thoughts. Finally, you need to learn to embrace the nerves.

If you suffer badly from nerves and anxiety, don't be afraid to enlist the help of a professional. Sports psychologists will be able to provide with strategies and techniques to relax, refocus and respond to nerves.

1) Relaxation Techniques
Examples of relaxation techniques that can reduce nerves, physiological arousal, anxiety and muscular tension include hypnosis, meditation, progressive relaxation and autogenic training. These techniques can be learned and practised in the training environment well in advance of important competitions. The more they are practised, the more effective they will be in competition situations. Techniques like progressive relaxation can be combined with mental imagery techniques to enhance confidence as well as relaxation. Even simple relaxation techniques such as deep breathing will reduce the somatic symptoms of pre-competition nerves.

2) Redirect Thoughts
Having things to distract your mind in the lead up to a competition can be beneficial. Constantly thinking about competition day, wondering how we're going to preform and worrying about every tiny niggle or sneeze, can lead us to over thinking things and imagining barriers to great performances that don't even exist. We also risk becoming over-aroused, or aroused too soon. If you find that you over-think things in the lead up to a competition, find ways to take your mind off it. Plan to go to the cinema with friends the night before, avoid being around other nervous people on the morning of a competition, don't get to the competition venue too early (without risking being late), find things that relax you and which you can do in the build up to a competition.

The negative thoughts that go along with pre-competition anxiety will also need to be redirected out of your mind. Process cues - words that describe the feeling or image of the perfect performance of technique and which you can say to yourself when you recognise the negative thoughts raising their heads - can be helpful. Again these should be prepared and practised in the training.

3) Embracing the Nerves
The third step to overcoming nerves is to simply face them head on. Acknowledging that you're nervous is a good first step. Recognise that nerves is a sign of physical readiness, and embrace them. Verbalise your fears or your symptoms. Over time you can identify the symptoms that you experience, and you can prepare those around you for them, particularly if you get irritable. Tell others (particularly parents, coaches, team mates) what you do and don't like them to say when you're nervous or give them cues which they can repeat when you're nervous.

A few years ago, I arrived at a team hotel the night before a World Championship event and one of the girls, who I knew reasonably well at the time, kept telling me that she had a headache. I asked her if it was nerves, and she said that she thought so. Just raising the issue seemed to lift a huge weight from her shoulders. Her mood seemed to change almost instantly. The next day she went out and had one of the best races of her life. This is just one example of how recognising or acknowledging the symptoms of nerves can help.

Dealing with pre-competition nerves - upcoming workshop
If you would like to learn more about some of these techniques and how to control pre-competition nerves, please come along to our workshop in Adamstown (Co Wexford) on Monday 4th January 2016 (1pm-3pm). Further details to follow. Email eegan41@gmail.com if you would like to attend.

Some useful reading:

Monday, 31 August 2015

Performance Workshops

Next month we'll be running a couple of workshops at the Ferrycarrig Hotel in Co Wexford, one aimed at athletes of all levels who are looking to improve performance, and the other targeted at coaches of high performance athletes, particularly those who coach performance athletes within a mixed ability group.

Thinking like a high performance athlete: a seminar for aspiring sports people 7:30-9:30pm, Oct 15; €10/€5 (includes free entry into draw for useful resources)

This seminar will explore some of the lifestyle and sports science practices used by high performance athletes, and explore ways in which you can integrate them into your training and competition. Topics to be covered will include, but are not limited to:
  • Planning for performance – Goal setting, time management and decision making to improve performance
  • Looking after your health – An introduction to the Female Athlete Triad, eating disorders, mental health issues, burnout, anaemia, immune function and dental health
  • High performance sleep and recovery
  • Building your support network
  • Anti-doping issues – Anti-doping issues which athletes of all levels should be aware of will be outlined.
Competitive athletes aged 15 or older, of all abilities who would like to improve their performance are welcome to attend. The workshop is open to athletes from team and individual sports. Coaches and parents are also welcome to attend.

Supporting the high performance athlete: a special forum for coaches 6:30-9:30pm, Oct 19; €25

Do you coach high performance athletes as part of a mixed ability group? Are you unsure of how to support their special needs? Would you like the opportunity to meet and learn from other coaches in similar situations?

This session will provide coaches of high performance athletes with the opportunity to discuss challenges they face, to share experience and knowledge and to discuss best practice. Topics covered include:
  • An introduction to the special health concerns of the high performance athlete: mental health issues, eating disorders, the female athlete triad, anti-doping issues, burnout, injury, etc.
  • Building a support network and working within an interdisciplinary team.
  • Real life concerns: long term athlete development; athletes moving on; burnout and dropout; integrating high performance athletes into a mixed-ability group; managing packed competition schedules.
  • Lifestyle support: how the coach can help.  Will look at lifestyle balance, goal setting, time management, planning, managing transitions, decision making, dual careers, retirement and exam stress.
This session is aimed at the coaches of high performance athletes, particularly those who support high performance athletes as part of a mixed ability group. Experienced and inexperienced coaches are welcome.

We would appreciate if you reserve your place in advance via email. Payment on the night.

About the facilitators
Elizabeth Egan has more than 10 years’ experience working with high performance athletes from a range of individual and team sports. She specializes in lifestyle and personal development support for development and student-athletes, and has worked on two successful sport scholarship programmes in the UK. She has published an altitude training travel guide (Notes from Higher Grounds) and her PhD looked at the causes and consequences of menstrual dysfunction in female athletes.

Jenny Higgins is a 2014 Sport and Exercise Science graduate from University of Limerick. She has completed several research internships in the area of physical activity and diet including research in hydration, post-exercise recovery, body composition and the influence of exercise on metabolism & health. She is now pursuing a PhD looking at the interaction of diet and training on bone health in athletes.

Ciara Wilson holds a degree in PE & Biology from DCU, where she was a sports scholarship recipient, and has spent the last 2 years teaching. She is the Schools Participation Officer for the charity Cycle Against Suicide, and has an interest in a wide variety of sports. Ciara has just started a PhD at DCU.

All three have competed at a national level, have coaching experience and are passionate about supporting talented athletes in their pursuit of excellence.

Further information and news relating to these workshops will be posted here and on Facebook.

Tuesday, 4 August 2015

Transferable skills

Athletes who have been training full time their whole adult life often find it difficult to find a job once they retire. Without relevant experience in the working world, they may rely on transferable skills to give them a boost. Too often, however, we see CVs with skills listed as: ‘passion, teamwork, hardworking, works off own initiative’, or something along those lines. Show me somebody that couldn’t list those as skills!

When applying for graduate entry jobs, or roles that you don’t have specific work-based experience for, you need to think about your ‘super strengths’ or unique selling points. Think about qualities and skills that you have which will separate you from applicants and think about clear examples of where you’ve demonstrated these skills or qualities.

Useful frameworks to build examples around are ‘Challenge, Strength, Result’ or ‘Problem, Action, Result’. What problem or challenge were you faced with? What action did you take, and what was the result of your actions?

Some transferable skills that you might possess as an athlete include the following:

Self improvement
Many athletes, particularly those who have been striving for perfection for a number of years, are committed to personal development and self-improvement. Those looking for marginal gains are often self-critical (in a positive way), willing to accept feedback, aware of blind spots and dedicated to making improvements in all aspects of their performance. These skills and qualities can be useful in a variety of roles.

Problem solving and working with others to overcome a challenge
We don’t always think of the sporting field as a problem-solving environment, but think about the decisions that you and your team have to make on a regular basis in a high pressured environment. Overcoming an injury and putting together a rehabilitation plan may demonstrate problem solving skills, as may addressing defensive issues as a team, or adapting tactics following a last minute injury to a key player.  Putting forward suggestions, listening to others suggestions, devising a plan, reflecting on common goals, and following direction are just some of the important aspects of the problem solving process.

Communication skills
Being able to communicate with a variety of individuals in a variety of positions, is often something that employers look for. Think about all the people that you communicate with on a regular basis and how you communicate with them. Athletes often develop mature relationships with adults and people in authority from an early age. The coach-athlete relationship is one often reflects employer-employee relationships. The way in which athletes communicate with funders or sponsors, national governing bodies, appeals committees, and the media tends to be similar to the communication styles required in worked-based situations. Managing relationships with teammates is similar to managing relationships with colleagues. Any experience you have mentoring young athletes or less experienced teammates, coaching or officiating, or making guest speaker appearances will further demonstrate an ability to communicate with a diverse range of people. Make a map of who you communicate with on a regular basis, the roles that those people fill, and the ways in which you communicate with them.

Resilience
Few athletes reach the top of their sport without demonstrating resilience and an ability to repeatedly overcome setback. Think about how appealing your ability to refocus, reassess goals and adapt your methods following setbacks, and your ability to continue to work towards your ultimate aim, no matter what life throws at you, would be to a potential employer.

Commitment to excellence
The ability to demonstrating a commitment to excellence is likely to be appreciated by many employers. Those who demonstrate a commitment to excellence in their sport are likely to commit to excellence in other aspects of their lives. Wanting to be the best you can be, taking ownership of you life in order to achieve excellence, and being able to build a support team around yourself who also want to excel are abilities which are desirable in most work settings.

These are just some examples of skills that you may have developed as an athlete which may appeal to potential employers. Think about the things that you do in your sporting life, and how the skills and qualities required to be a top athlete can be applied to the workplace. Remember to think outside of the box and to avoid vague terms such as passion, teamwork and hardworking, unless you have very specific examples which separate you from the 99% of other applicants who will also list these skills on their application form.

Thursday, 23 April 2015

Milk.... The Perfect Recovery Drink?

Athletes of all abilities are looking for marginal gains, for the added extras that will improve their performance. When exploring marginal gains, diet is one of the first areas to look at. And athletes who are spending lots of time training, travelling and competing need to ensure they have a diet that is meeting their nutritional demands. They often turn to supplements as a quick fix to filling any nutritional gaps. Trying to fill these gaps with a natural source will not only be a cheaper approach, but may also be a healthier one, and some natural foods may also provide nutritional benefits beyond those intended.

Milk is one of these foods and may well be a suitable alternative to many sports drinks on the market. In terms of recovery products, there is none better than milk!

What is milk made up of?

Milk is a nutrient dense food containing lactose, proteins, fats, minerals, vitamins and water. Lactose, the major carbohydrate present, is essentially only found in milk. Milk contains a number of specific proteins, but the most common is casein, which compared to other proteins is very digestible in the intestine. Like eggs, milk also provides all nine essential amino acids. Calcium and phosphorous are the major minerals found in milk, and there are relatively small amounts of most other minerals required by the body, including zinc, magnesium, iron and copper. In addition, compared to other beverages, milk contains relatively large quantities of the electrolytes sodium, chloride and potassium. Milk contains varying quantities of many vitamins, including the fat soluble vitamins A, D, E, and K, found primarily in the milk fat.

Milk and performance

Due to issues relating to ease of consumption, the speed of release and the palatability of milk, it is less popular as a sports drink immediately before and during exercise and commercial sports drinks often become the preferred choice. But it's as a recovery drink that milk really comes into its own, and elite athletes often consume bottles of flavoured milk or milkshakes immediately after training or competition.

Post Recovery Nutrition

Many athletes will be familiar with the ‘golden window’, the period 30-60 mins immediately following exercise, during which nutrition can aid recovery. Refuelling correctly during this period is vital to those who may be training or competing more than once a day.

Recovery includes a number of processes, and milk can play a role in all of these:

1. Refuelling the muscle and liver glycogen stores (carbohydrate):
Athletes should aim for around 1g carbohydrate per kg of body weight to help refuel after exercise. Around 600ml of milk will provide 50g of carbohydrate, approximately the same amount as around 500-700ml of a sports drink (depending on the brand).

2. Replacing the fluids and electrolytes lost in sweat:
Athletes should aim to replace around 150% of their sweat lost during the 4-6 hours after training or competition. They should also replace the electrolytes lost in sweat, to ensure that fluids taken on board aren't just excreted in the urine. As well as being 87% water, milk is also a source of sodium, potassium and magnesium, all important electrolytes. Some but not all sports drinks contain electrolytes.

3. Manufacturing new muscle protein, red blood cells and other cellular components as part of the repair and adaptation process:
Early intake after exercise (within the first hour) of essential amino acids from good quality protein foods helps to promote protein rebuilding. Though research into the optimal type (e.g. casein versus whey), timing and amount of protein needed to maximise the desired adaptation from the training stimulus continues, most agree that both resistance and endurance athletes will benefit from consuming 15-25g of high quality protein in the first hour after exercise. Adding a source of carbohydrate to this post exercise snack will further enhance the training adaptation by reducing the degree of muscle protein breakdown. Around 300ml of milk contains 10g of naturally occurring protein and amino acids.

4. Allowing the immune system to handle the damage:
Ensuring adequate carbohydrate stores before exercise and consuming carbohydrate during and/or after a prolonged or high intensity workout has been shown to reduce the disturbance to immune system markers. The carbohydrate reduces the stress hormone to exercise, thus minimising its effect on the immune system, as well as also supplying glucose to fuel the activity of many of the immune system white cells. Milk provides a good source of protein and carbohydrates as well as a number of key vitamins and minerals to enhance the immune system and support overall health.

Milk can play a role in all the key recovery processes, is a naturally occurring product, supplies a number of key nutrients, and is cheaper than many sports drinks and recovery supplements. It could well be the best sports drink available!


Tuesday, 24 March 2015

Why is depression so common in sport?

PDF version of this piece to download

Think of your sporting hero. Chances are you're thinking of somebody that you see as a real winner. Somebody with seemingly superhuman qualities. Somebody who can overcome the most challenging of obstacles. Somebody who personifies physical and mental strength. Somebody who is invincible.

Mental illness is probably not something that you associate with your sporting heroes.  Yet, a surprising number of world class athletes suffer from depression, anxiety, addiction, eating disorders and other mental illnesses. On an almost weekly basis we hear of another high level athlete suffering from depression, and many more continue to suffer in silence.  Kelly Holmes has admitted to self-harm during an illustrious career which saw her become a double Olympic Champion. Ian Thorpe, a five-time Olympic swimming champion, was admitted to rehab for depression in 2014. Boxers Ricky Hatton, Frank Bruno and Mike Tyson, jockeys Frankie Dettori and Mark Enright, and footballers Paul Gascoigne, Neil Lennon, Stan Collymore and Clarke Carlisle are among the many well-known sports stars to have admitted to periods of depression. In a previous blog post we have looked at the life, and death, of Robert Enke, the former German goalkeeper who took his own life in 2009. Just last week, Olympic medallist and former badminton player Gail Emms became the latest sportsperson to speak about suffering depression after retirement.

So why are athletes, people that we see as invincible superhumans, so susceptible to mental illness? Do the perceived superhuman qualities in themselves play a part?

Kelly Holmes, one of the many high profile sports start to have suffered from depression during her career
By Russell Garner derivative work: MachoCarioca (Kelly_Holmes_at_Athens_2004.jpg) [CC BY-SA 2.0], via Wikimedia Commons

Mental illness in cricket

England cricketer Marcus Trescothick returned home from the 2006-07 Ashes in Australia due to a 'recurrence of a stress-related illness'.  Despite several attempts, Trescothick never returned to play for England, and announced his retirement from the international game in 2008, seemingly unable to cope with the stress of touring.  In his autobiography, Coming Back to Me, released later that year, Trescothick revealed that he had suffered from anxiety attacks since he was 10.

Cricketers appear to be at particularly at risk.  As is well known, mental health issues are higher in men than in women, and so, in a male dominated sport, it's no coincidence that depression is common. But it would appear that there's more to it than that.  Writing in the wake of the Trescothick case, Geoffrey Boycott blames the congested international test calendar, and states that 'the burden of playing non-stop cricket is taking its toll'.  This may be a slightly simplistic view.  An online article by Antionette Muller (2013), looked at why cricketers, more than other sports people, are at risk.  She concluded that the long periods of time spent away from home, the pressure of top-level, high-profile sport, and the game itself were contributing factors.

Cricketers can spend as much as half the year on tour, and a disproportionate amount of that time, particularly during test matches, is spent waiting to bat, or to bowl.  Skill is important, but luck also plays a major factor, and after waiting for hours to have their chance in the spotlight, a highly-skilled batter can often be left reflecting on why they are walking off the field without even hitting a ball. Knowing that their public perception and perhaps their place on the team are dependent on their latest performance, it's little wonder that cricketers are at risk of developing a distorted perception of their own self worth.  And the long periods of inactivity in hotel rooms and media analysis which follows provides the perfect conditions for such distorted perceptions to fester, distort further and ingrain themselves in the individual's psyche.

A batter's performance can last anything from a single ball, to a prolonged innings stretching over the course of two days, with a completely unpredictable outcome to each ball bowled in their direction. In few other sports is the duration of the performance so unpredictable. In many sports, the better you perform, the shorter the race or match.  In cricket, the complete opposite is true.

In cricket, more so than in other sports, there is a lot of time to contemplate failure, but not an awful lot of time to celebrate success.

In his book Silence of the heart: cricket suicides (2001), David Frith poses a further, important question:
'... does cricket more than any other game, actually attract the susceptible by virtue of its wicked, teasing uncertainties, its long-drawn-out routine, its compulsive, all-consuming commitment? Or conversely, by its sometimes cruel and frustrating pattern, does it gradually transform unwary cricket-loving boys into brooding, insecure and ultimately self-destructive men when the best days are past?'
This is one of the points that former New Zealand cricketer Iain O'Brien touches on in the excellent video which follows. O'Brien also speaks about his own depression and the social anxiety that he experienced as a player. He felt at home on the park, but it was in the dressing room that O'Brien was least comfortable, and he spend much of his career trying to fit in with the other personalities on the team.



Cricket governing bodies are starting to recognise the mental health issues within their sport, and steps are being taken to help prevent depression.  More needs to be done, but recognising the problem and being willing to implement change are important first steps.

The stresses and strains of cricket appear to contribute to the high rates of depression and anxiety among it's players
Photo credit: Matthew Bowden www.digitallyrefreshing.com, via Wikimedia Commons

Mental illness in football

Football, too, appears to have an above average incidence of mental illness. Research carried out by the international footballers association, FIFAPro, reported that just over a quarter of 149 current players and 39% of 104 former footballers experienced anxiety and/or depression (Gouttebarge, 2015).  While there may have been a response bias (the response rate was 29%), these are pretty stark results. Recent life events and low social support were among the factors significantly associated with mental health problems in this study.

In reports associated with this study (Telegraph Sport and agencies, 2014), former New Zealand captain Chris Jackson, linked his disappointment at not making it into European football with his depression and substance abuse. Jackson says:
'I had and still have a lot of anxiety regarding performance. The pressure bottled up for years particularly when I captained different teams and had to be the face of the team when going through tough times.'
The wellbeing section of the Professional Footballer's Association website deals predominantly with depression and mental wellbeing.  It has four important subsections, each looking at a section of the footballer's life and the predominant associated feeling or emotion: Change & Anxiety, Contracts & Stress, Performance & Panic and Retirement & Anger.  This grouping highlights the main risk areas for players.  It also recognises the role of emotions in mental illness.

In a male dominated environment, machoism and a pressure to confirm no doubt play a part, and there would be, at least until recently, a stigma associated with mental health, which, no doubt would prevent players from seeking help. Players are typically involved in football-focused surroundings from a very early age and few top players earn qualifications outside of their sport. This increases the likelihood of identity and retirement related issues discussed later.  Players at the top level, more so than in other sports, live out their lives is the media spotlight.  Constantly moving clubs can also have an effect.

Football is a sport where your worth as a players is dependent on how much you earn, or how much you are sold for. Consequently, time lost through injury, a lack of form, or a run of bad luck can adversely affect your perceived value as a player, and if internalised, your self worth.
'I'd just suffered a severe knee injury and had convinced myself that without football people would see me for what I really was, which was nothing. I sat on a bench in that park, washed the pills down with a can of beer, and waited for it to happen.' (Carlisle, 2013)
These are the words of Clarke Carlisle, speaking about his suicide attempt aged just 21, in a BBC website piece promoting his 2013 BBC Three documentary Football's Suicide Secret.  Carlisle was found in time and had his stomach pumped, though depression and alcoholism dogged his career and he made further attempts to take his life.  While Carlisle will always suffer from the illness, he is now actively involved in increasing awareness of the disease and ensuring that others in his position are supported.

In an interview following the launch of the Mental Health Charter for Sport and Recreation last week (Liew, 2015), Carlisle pointed to another important factor within football that may explain high mental illness rates - the unnatural social environment in which footballers often find themselves:
'I was in the sport for 17 years, and I could count on two hands the number of genuine life friends I've made. That's just a by-product of the industry. You're there for a month, a year, if you're lucky three years. In training there are five centre-halves, and I'm fighting against at least three of them to get in the side. Then you're sold the next day, and all of that team are now opponents. It's a very complex dynamic, and it's incredibly hard to make genuine life friends in that situation.' (Liew, 2015)
High disposable incomes can lead to gambling and substance abuse, and may in turn may lead to depression.  Not having interests or work outside of football may increase the likelihood of psychosocial problems such as these, particularly when a player is injured or not getting game time.

Mental illness in other sports

Rugby league is among the other sports which recently recognised that it has a mental health problem.  Many of the factors associated with depression in football may also play a part here. Constant pressure to perform and media spotlight, along with issues surrounding injury and lack of form, are likely to play a large part.

Boxing, particularly at a professional level, also seems to have a major problem.  In addition to Hatton, Bruno and Tyson - who all have had mental health issues - there have been a number of suicides in the sport.  Jonny Tapia, a five times world champion, and Lewis Pinto, a promising young super middleweight fighter, both ended their own lives in May 2012.  Irish 2008 Olympic bronze medallist Darren Sutherland's death in 2009, not long after turning professional, is presumed to have been by suicide.  He too had suffered from depression.

Along with all the aforementioned issues, repeated brain injury, making weight, inconsistent income, a long time between fights and the bravado and intense rivalries surrounding fights, could all contribute to the high rate of suicide and depression in boxing. Another important factor is the extreme self believe that goes alongside fighting. This focus on the positives, and complete dismissal of vulnerabilities, weaknesses and fears, and its effect on mental health will be discussed in more detail later, but is probably most evident in a sport where the aim of your opponent is to literally knock you out.

Highlighting these sports and some of the factors within them may help us gain a better understanding of mental illnesses, the unique pressures that sportspeople face, and what can be done to prevent depression.  But it should not detract from the fact that no sport is immune to depression and mental illness.  Gaelic footballers and hurlers, who do not have the money, lack of distraction and changing team issues evident in football, are also at risk.

Identity and purpose

Depression is highly associated with identity issues, low self-esteem, and a low sense of self-worth. While it is unknown whether low self-esteem and low self-worth cause depression, or are as a result of it, there is considerable evidence to suggest that identity issues in athletes can lead to depression.

Athletic identity, the degree to which an individual feels that his or her identity is built around his or her role as an athlete, is a major factor in determining the degree of depression felt by an injured athlete.  Athletic identity is also a major cause of post retirement depression in sportspeople. When the thing that a person feels defines them and gives them purpose is taken away, their self-esteem and purpose diminishes.

Temperament and personality traits

Various personality traits common in successful athletes have been associated with mental illness, though much more research is required to ascertain whether susceptible personalities are attracted to sport, or sport 'creates' susceptible personality characteristics. As was suggested in relation to cricket, individuals with certain traits may be attracted to certain activities, and these traits may predispose them to depression and anxiety. A form of natural selection may exist, meaning that the most successful athletes are those who are most susceptible to depression.

Perfectionism has been associated with various forms of maladjustment, particularly in sports (Hewitt, 1990). Flett and Hewitt (2005) have identified and described what they call the perfectionism paradox - the way in which certain sports require athletes to achieve perfect performance outcomes, though being 'cognitively preoccupied with the attainment of perfection often undermines performance and fosters a sense of dissatisfaction with performance'. In addition to maladjustment, this obsession with perfectionism can actually hinder sporting performance.

Research by the Black Dog Institute indicates that those with certain temperament and personality styles are at a greater risk of developing depression. Among the susceptible personality and temperament styles are self-focused and perfectionistic personalities, both of which may be high among sports people.

Obsessive compulsive disorder (OCD) is just one of the mental disorders for which former footballer Paul Gascoigne has received treatment. He has also suffered from bipolar disorder, alcoholism and eating disorders. Obsessive-compulsive disorder (OCD) is highly linked with depression, and some aspects of high performance sport may contribute to the development of OCD  (Aldhous, 2009). Those susceptible to OCD may, of course, be attracted to certain skilled sports sports to begin with, and there is little, if any evidence to link OCD in such cases with depression.

Retirement

Examples of sportspeople who have struggled with the 'loss' that comes with retirement are plentiful. Indeed, research by the Professional Players Federation, published in 2013, found that 16% of 1200 ex-footballers, rugby union and rugby league players, jockeys and cricketers surveyed experienced depression or feelings of despair in the 12 months post retirement.

In 2014, Rubgy League star and former Great Britain player Sean Long admitted to attempting suicide, having struggled to cope since being forced to give up the game, due to injury, in 2011.
'I didn't finish playing on my terms really. It was the injuries...I didn't know at the time but I've had depression and suffered from anxiety over two-and-a-half years.'
Those who are forced to retire because of injury or deselection generally have greater difficulty in adjusting to life after sport than those who retire on their own terms.  Forced retirement is often followed by a period of grieving, as the individual attempts to come to terms with their loss.

But even those who retire on their own terms can struggle, as athletes lose their perceived purpose in life, the structure and routine which they have lived around for so many years and, for some, their livelihood. Others simply miss the endorphin kick that comes with exercise. Endorphins are, of course, a natural antidepressant.

Athletic identity, the degree to which an individual feels that his or her identity is built around his or her role as an athlete, is also a major factor in determining the degree of depression felt by an athlete post retirement. Planning for retirement is an important determinant for successfully transitioning from the life of an athlete to the life of an ex-athlete, and finding meaning and purpose in the world outside of sport is crucial.

Gail Emms recently spoke about suffering from depression after retiring, and stated that it was only when she had her first child that she found a new meaning to her life. Hers is just one of thousands of stories

Retirement and the associated problems will be dealt with in more detail in a forthcoming post.

Post Olympic blues

The aftermath of an Olympic Games, FIFA World Cup, or other major sporting can be a major breathing ground for depression and addiction. Post Olympic Depression Syndrome (or Post Olympic Stress Disorder, as it is sometimes known) is a well-known phenomenon, and not just something that is experienced by the fans! Even (or more accurately, especially) athletes that have been successful suffer from the condition. Only a small proportion of the world's population will ever win an Olympic gold medal, and no medal comes with an instruction manual on how to deal to the emotions that go along with it.

After a major sporting event as big as the Olympics, athletes struggle to adjust to normal life and find their place in the world.  For many athletes, the completion of a Games coincides with retirement or an unplanned for future, with some having put off retirement decisions until after the Olympics. Identity and retirement issues have been dealt with earlier, so only get a passing mention here.

Other causes of Post Olympic Depression Syndrome relate to coming down from a massive high, dealing with becoming famous, a sudden lack of routine, achievement of extrinsic goals or dealing with failure on the world's greatest stage, and simply readjusting to life in the real world.

An overwhealming majority (77%) of surveyed South African participants at the 2000 Olympic Games  reported subjective feelings of post-Olympic depression (Portgieter, 2001). Of these, 27% reported 'extreme' depression after the Games.

The Olympics provide a platform for successful athletes, particularly in minority sports, to gain media attention. Athletes previously unknown to the outside world find themselves in a strange and unfamiliar place; one which some may find particularly stressful. While some gain the recognition that they have craved for so long, many struggle to come to terms with their new found fame and the social and media demands that go along with success.


Bradley Wiggins is just one of the numerous athletes to have suffered depression and addiction after the Olympics. In his 2008 autobiography Wiggins revealed how, having little else to do with his time, he found himself waiting outside his local pub at 11am each day, for a period of 8 or 9 months following the 2004 Olympic Games. 'I wasn't just drinking for England during this period, I wasn't quite at the races mentally either. For a while my life threatened to spiral out of control.' He had won 3 medals, including his first gold in Athens.

For Wiggins, it was not the fame, but the lack of fame, which was most difficult to deal with. He expected things to change after the Olympics. He thought that sponsorship and endorsements would come flooding in and things to be a little easier financially. They didn't. In a 2008 interview (McRae, 2008), Wiggins says:
"You end up trying to give the perception you've got a bit of money. 'Yeah, it's great, lots of offers rolling in ...' The reality was quite different. I woke up every Monday morning and we were still overdrawn and I'd think, 'God, I don't feel like riding my bike again.' There was a bitterness that nothing had changed after all the hard work but it went deeper than that. I'm not saying I was clinically depressed but there were definite bouts of depression - and lots of drinking."
Those who are extrinsically driven and motivated purely by winning are more likely to suffer from post Olympic depression than those who are motivated by the process.

Those who were successful and achieved their goals may suffer from something known as post achievement depression, similar to the feeling many get following the completion of a PhD thesis or other project in which they have been engrossed for a prolonged period of time.  Post-Olympic blues and post achievement depression are similar in some ways to post-natal depression, post wedding blues, and other emotional come-downs following a 'high'.

Injury

The link between injury and depression can operate on at least three different levels, namely the emotional stress and boredom as a direct result of the injury and subsequent loss of training, the link between any prolonged or chronic pain and depression, and depression as a result of opioid painkillers.

Injury, a constant worry and major interruption to the attainment of their goals, and indeed their livelihood, plays a major role in lives of many athletes.  In most athletes, depression is a short-term response to an injury, and is seen as a normal emotional response to severe injury. In extreme cases, recurrent injury can constitute stress, one of the factors which can lead to major depressive episodes. Boredom, if training is not possible, can also exacerbate the depressed mood.

Athletic identity, the degree to which an individual feels that his or her identity is built around his or her role as an athlete, is a major factor in determining the degree of depression felt by an injured athlete. Like retirement, athletes who see injury as a threat to their core identity are more likely to experience depressed mood during an injury. While this response is depression the emotion, rather than depression the illness, it's likely that prolonged, repeated and severe injury could result in long-term depression.

Though not all injuries involve pain, it is important to note that chronic pain can often go hand in hand with depression.  Both physical and emotional pain are registered in the same part of the brain, which essentially treats depression in the same way as physical pain. Physical pain therefore often causes depression, and depression can worsen the physical pain.  Some antidepressants can actually help relieve the physical as well as the mental pain

Opioid painkillers, often prescribed for chronic pain, have been linked with depression (Scherrer et al., 2014), anxiety, hallucinations and suicidal tendencies.  Their abuse to enhance performance is dealt with the doping section below.

Doping?

While it may be unethical and practically impossible to prove a link between doping in sport and depression, there is at least a theoretical and anecdotal basis for such an association.  Some drugs, including steroids, have been associated with mental disorders, and may result in depression in those who abuse them.

The use and discontinuation of anabolic steroids in particular have been associated with depression (Pope & Katz, 1994) and other mood disturbances and mental disorders such as paranoia, mania, hypomania, steroid dependence and schizophrenia.  Cortiosteroids, a group of steroids often prescribed for injury and other medical conditions and abused by cyclists and other athletes to enhance performance, have also been linked with mood disturbances and depression in a large proportion of users (Patten, 2000).

EPO, the performance enhancing drug of choice for endurance performancers overstepping the doping rules, appears to actually treat depression. However, anecdotal accounts report that cyclists associate depression with the use and discontinuation of EPO.  Amphetamines, beta blockers and cannabinoids, drugs abused to varying degrees in various sports, may also lead to depression.

Opioids, a group of drugs with both pain killing (analgesic) and narcotic properties that includes codeine and Tramadol, among others, appear to be abused in cycling (Benson, 2013), and are taken by riders simply to get them through a race.  This group of substances, though not currently on the WADA banned list, are highly addictive, and can cause a number of nasty side effects, including anxiety, depression, suicidal thoughts and hallucinations. Withdrawal can also cause serious side effects, including insomnia, depression and anxiety.

In her excellent article outlining the high incidence of depression in cycling, Suze Clemitson (2014) proposes that there is a possible link between the prevalence of doping and the seemingly high incidence of mental health issues and suicides in the sport. In the article Clemitson quotes cyclist and whistleblower Jesus Manzona, who says:
'The drugs lead you to other addictions. The anti-depressants almost automatically accompany other doping treatments. I took up to eight pills of prozac a day when I was racing...Prozac cuts the appetite, keeps you in another world, a world where you're not afraid of what you're doing.  You're no longer afraid to inject yourself with all the crap. It takes you to a world where you don't ask any more questions, especially you don't ask your doctor questions either or your sporting director. Then there are periods where you must stop doping you feel like superman. Then one day all of the sudden it stops and you become dramatically depressed.'
When you put it like that...!

A cycle of shame and guilt, a constant fear of being caught, a redirection of one's moral compass as a result of choosing to dope, and dealing with the sense of loss if caught, are just some of the other factors which may result in depression.

While there are many possible causes behind the high rates of depression, suicide and unexplained deaths in cycling, the sport we most associate with doping, there is at least a theoretical link between doping and mental illness.

Concussion and other medical issues

We often think of depression as a purely psychological issue.  But physiological factors may contribute to depression and anxiety. Overtraining, iron-deficiency anaemia and thyroid problems - which can be common in athletes - and a number of other underlying medical conditions may also contribute to a depressed mood or result in similar symptoms.

Among the many symptoms of iron-deficiency anaemia are depression and anxiety, which may result in OCD-type obsessions and compulsions, as well as many of the symptoms of depression itself, including insomnia, irritability and poor appetite. While these depressive symptoms appear to be reversed with treatment, they may lead to full blown depression in those who are already at risk.

Many of the signs and symptoms of overtraining syndrome and depression overlap, making it difficult to establish if overtraining and burnout can cause depression, if depressed mood is simply a reversible symptom of overtraining, or if overtraining syndrome is, in fact, a form of depression experienced by athletes. In addition to sharing many physical and emotional signs and symptoms, biochemical responses, including immune, endocrine, and neourtransmitter patterns, are remarkable similar in the two conditions. The cycle of poor performance and inadequate recovery which result in overtraining could, in theory, independently also lead to depression.

A history of recurrent concussion and head trauma appears to be linked with an increased likelihood of being diagnosed with clinical depression in retired America Football players (Guskiewicz, 2007). Other sportspeople who experience recurrent concussions may also be at risk.

Performance psychology and a focus on winning

Sports psychology is all about winning at all costs, ignoring all weaknesses and negative thoughts, and 'believing' that you can do it.  An unrealistic mental environment in which you believe that you are better than anybody else is often created. There is no room for weakness or vulnerability on the playing field.

While this may be the optimum approach from a performance perspective, it is far removed from everything that psychiatry has thought us. Failing to acknowledge and work through our tiny everyday concerns, worries and weaknesses can lead to major psychological issues in the long term, and in an environment where the focus is always placed on the positive, unbreakable and invincible can remove the opportunity for sportspeople to learn everyday coping skills.

This is not to say that some sports psychologists don't take a holistic approach, or that they fail to deal with everyday concerns and worries, but more that performance psychology in its purest sense can fail to take into account such issues.

Stress

Stress, or a series of stressful events, can trigger depression and anxiety. Performance in itself, particularly under constant media scrutiny, can be seen as a form of stress. While good and bad days are an accepted part of the life of a development athlete, there is little room for an off day for those in the media spotlight. This pressure to perform week in, week out for the duration of an ever extending season can place a lot of stress on a sportsperson, and the fear of a bad performance, while not likely to be the sole cause of depression, may contribute to depression in those that are particularly susceptible.

Defeats, disappointments and failures are accepted steps along the path to the top. Individuals often learn more from their mistakes than they do their successes, and shouldn't be afraid to take risks and to make mistakes along the way. Issues may arise when athletes are suddenly shot into the media spotlight and suddenly feel that they can no longer make mistakes, are not used to having their performance analysed in such a public way, or go through a particularly bad dip in performance.

Trying to maintain a place on a team, making up for previous misfortune or underperformance, or simply trying to reward somebody's belief in you can be additional sources of stress.

Other factors associated with professional sport

Professional sport does much to disempower participants. Those who participate in a very structured and protected environment from a young age (e.g. footballers who join a club academy) rarely have to make major decisions for themselves, and don't go through the same life learning as their peers. The life skills that a typical 18 year old is learning is far removed from those of an 18 year old academy player, and while the typical 18 year old can set out on their voyage of discovery in a pretty anonymous fashion, the professional sportsperson is growing up in the media spotlight. Modern sports support structures often try to make life easy for the sportsperson and reduce the 'stress' in their lives. In doing so, they often reduce the opportunities for athletes to grow and learn, and to deal with manageable amounts of stress.

Professional sportspeople often spend large amounts of time away from home.  Cricketers, for example, often spend months at a time on tour, away from family, and lack certainty and routine. While life on the road may be an ideal life for some, it is not for everyone, and can be particularly difficult for those with young children. Despite being around their team mates, many can feel isolated and lonely. Spending large amounts of time in the presence of those who may be fighting for your place on the team can also be difficult.

Being a fulltime athlete has many advantages. But it also has downsides. Large amounts of downtime can result in boredom, overanalysis of performance and results, or a reduction in self worth, all of which may contribute to the development of depression. Boredom or having time on their hands, together with access to large amounts of cash, may, in turn, lead to problem drinking and substance abuse.

The sports supporter

We always talk about the sports participant, but is there a risk for sports supporters? Participants are, at least most of the time, in control of their own destiny. Once they get out on the pitch or track, they are doing what they can to win, but the supporter can do nothing to control their destiny. They have no arena in which to dissipate the pressure. If superstition is an issue for the player, then what potential does it have to upset the onlooker?

And then there's the off season! Where does the sports fan get their kicks from during the off season? Or do they, like the player, benefit from taking time away from the sport, recuperating from the season's exertions, bringing some sense of balance to their lives, and preparing for the inevitable highs and lows of the season ahead?

It appears that experiencing the blues after a sports related defeat is a common experience among sports fans. Sometimes, after watching their team losing an important game fans can go through a form of grieving. Indeed, some radio phone-in shows after weekend football fixtures sound more like counselling sessions than they do sports programmes. Prolonged post-mortems in modern sport can add to the grief felt by fans, and extend the depressed feelings beyond their natural life (Woods, 2014).

On the flip side, some research suggests that those who have a close affiliation with a sports team have fewer bouts of depression and alienation than those uninterested in sport (Branscombe & Wann, 1991).

And of course, spectators as well as participants can experience post-Olympic blues.

The final paradox

Exercise is a known cure for depression and other forms of mental illness. It is often a prescribed treatment for such illnesses. Chemicals known as endorphins, a form of natural anti-depressant, are released during exercise. Regular exercise can help relieve stress, and provide an opportunity to unwind after a difficult or stressful day. Sports participation can also give individuals a sense of routine and a purpose in life. It can increase self-esteem and feelings of self-worth. And most of all, it can empower.

This seems to contradict everything that has gone before. I guess, like everything in life, a sense of balance is needed. Sport has the power to enrich the lives of those who participate in it, but it also has the power to destroy them. Knowing the risks, spotting the warning signs and recognising that individual growth is more important than winning at all costs, are good first steps in the fight against mental illness in sport.

Conclusion

There are lots of unknowns, and much more research is needed in the area. The question, however, is not whether or not sportspeople are more susceptible to mental illness that the general population. Many top level professional sports are dominated by males in their twenties and early thirties – the group in which mental illness and suicide are at their highest – and so, a high level of mental illness should not be unexpected. Depression, in many cases, is preventable, and the real questions that we should ask is why sport - something that should empower, increase self-esteem, promote self-worth, and allow talented individuals achieve their goals - can, in certain circumstances, take all that away? Why, when exercise is often prescribed as a treatment for depression, does it lead to depression in some, and what can be done to ensure that sports can have positive outcomes for participants at all levels? And finally, and most importantly, are there still barriers stopping those suffering mental illness from seeking help?

No one factor leads to depression, and the information discussed here include hypothetical aspects of sport that may lead to mental illness. We hope that this article will help raise awareness of some of the issues faced by high performance sportspeople, and lead to more open discussion on the topic. Please share your thoughts by commenting below.

Useful reading

    

References