Tuesday, 29 April 2014

Injury prevention and treatment: lessons learned from 21 years of track and field

As part of my preparation for a workshop on injury prevention last week, I made a list of all the injuries that I’ve had over last 21 years – the length of time that I have been competing in athletics – and one thing stood out to me: I’ve been very, very lucky.  Well I like to think that I have made a bit of my own luck, as I will discuss later, but the list is notably short for a distance runner.

Injuries, take note: the page is already full!

The purpose of listing all my injuries is to highlight injury patterns, causes, and treatment, and to ask myself what I would have done differently.  While the sample size of one wouldn’t pass scientific significance levels, the duration of the sampling gives a useful snapshot into injury.  Before I go on to discuss injury prevention in general, I wanted to highlight a few of my ‘findings’.

I hope that I’m not tempting fate here, but I have never had a stress fracture.  I never trained on the road as a teenager, did so sparingly in my twenties, and now, further into my thirties than I’d like to admit, I still train off-road on a regular basis.  I feel that avoiding the roads until my body was mature enough to handle them, has had a large impact, if you pardon the pun, on my low injury rate.  Regular periods, eating a healthy diet, and having a slight addiction to cheese as a child and a teenager, has meant that my skeleton is in the best possible shape that it can be. 

However, I feel that the biggest factor in not getting injured in the early days was the four week end-of-season break that was enforced on us.  Four weeks of not running was like hell, but it meant that my body got an annual holiday, and I was always rearing to go at the start of the season.  There was some pride to be swallowed in the early season cross country races for which I would not have done as much training as my closest rivals, but these breaks (and occasions of pride swallowing) definitely never did me any harm.

Visual representation of some of the many causes of injury

Unfortunately, the biggest factor in diagnosing and treating injuries is often a lack of knowledge and I definitely didn’t do everything perfectly. These are some of the lessons I've learned along the way:

Lesson 1 - Different tissues respond differently.  Stress fractures and other bone injuries get sorer as a run goes on, while the pain associated with muscle or tendon injuries abates as the body warms up.  Some injuries clear up after a few days, but some need a very gradual return to training, sometimes starting with just a two or three minute run.  When I had shin pain in 2010, I rested for 4 or 5 days, as I had previously done for shin splints.  Bone, with a poorer blood supply than muscle, takes longer to heal and return from bone or tendon injury should be particularly gradual.  Then I'd come back training, feel good, and end up doing 40 or 50 minutes.  Then I'd wonder why I was in agony again the next day.  As I later found out, I had tendinitis  and needed to start with a 5 minute run, and increase very gradually.

Lesson 2 - Listen to the advice that you are given, and don’t be afraid to ask questions.  In 2012 I was bitten by a dog.  There was nothing that I could have done to prevent that injury.  But when the doctor prescribed antibiotics, I decided not to take them (I figured that if I wasn't on antibiotics I'd be back running in 2 or 3 days).  My leg ended up getting infected, and I missed two weeks of training.  As it turns out, the antibiotics weren't a precaution against possible infection, they were a necessity against inevitable infection.

Lesson 3 - Don't underestimate the value of rest.  Soft tissue breaks down during training, and needs time to rebuild and repair.  End of season breaks, easier weeks between meso cycles, and rest days every week or two, will help prevent injury, and allow you time to respond to training   There are no short cuts to success, and a rest day here and there can actually help prevent time out with injury.

Lesson 4 - Cross training isn't always the answer.  Non-weight bearing exercise can be a great way to maintain fitness when injured.  But it doesn't always work.  When I had the aforementioned tendonitis in my shin, I tried aquajogging to maintain some level of cardiovascular fitness, but it actually made the tendonitis worst.  Similarly, I tried cycling last year when I had a niggle in my foot, only to realise that it was my pedals that caused the niggle to begin with.  If an injury is caused by low body weight and over training (e.g. a stress fracture), think about what your body is telling you.  Cross training like mad may heal the injury, but it won't heal the underlying cause.

As time goes on, I'm better able to distinguish between discomfort and an injury, but it's taken me two decades of regular running to get to that stage.  Find a physiotherapist that you trust, and get niggles and pain sorted out before it becomes a major problem.  If in doubt, rest.

In future posts, we'll look into lifestyle factors relating to sports injuries, and deal with how to cope with injuries and other setbacks.

Building core strength and stability is one way of reducing the risk of injury.  To learn more about muscles, stability and injury prevention, get yourself a copy of this great book: 

Tuesday, 22 April 2014

It is said sport stars die twice, the first time at retirement

The announcement last week that Michael Phelps, the greatest swimmer of all time, was coming out of retirement and aiming to compete in the 2016 Olympics timed quite well with me finishing the autobiography This is Me,  Ian Thorpe’s journey out of retirement in his quest to qualify for the London Olympics, sadly unable to fulfil his dreams. 

I’ve heard the phrase that athletes come out of retirement an average of 1.6 times. I have probably contributed considerably to that statistic, retiring from swimming in 2006, retiring from pentathlon in 2010, retiring again from swimming in 2012 only to take up triathlon. Although I have never competed at the intense international level of Michael Phelps or Ian Thorpe, perhaps there are some similarities in the reasons why athletes come out of retirement whether they are amateur or professional. 

Other top names who have made a return to international sport after making the decision to end their career include Michael Schumacher, Ricky Hatton, Andrew Flintoff and James Cracknell.  So why do so many athletes struggle with retirement and make a return to sport?

Loss of identity - Athletes identify themselves by what they do - take that away and it’s like a major piece of them missing.

Sugar Ray Leonard said that his inability to separate the boxer from the man became all consuming, forcing him to the depths of depression and leading him to make repeated comebacks.

Biological Factors - Athletes who have retired fail to experience the endorphin highs since they no longer complete. They used to have regular doses of serotonin and suddenly that has stopped.  Athletes such as James Cracknell who don’t make a comeback in their former sport, chase adrenalin highs in other sports.

Tunnel Vision - An athlete’s regimented life leaves an athlete at loss with retirement bringing a void where the comfort of training routine once was.  

So how can athletes manage this transition?

There are two main differences between those who successfully manage their retirement and those who don’t. The reason why an athlete retires is important; if they are forced to retire through injury or de-selection the negativity can lead to a period of denial, isolation, anger and depression. The focus is a loss of way of life and not the beginning of a new one, a ‘grieving process’. The Professional Players Federation have found that 16% of the 1200 ex-footballers, rugby union and league players, jockeys and crickets interviewed experienced depression or feelings of despair.  

Those athletes who are better prepared and have plans in place of their retirement with a strong support group have a better acceptance for their decision and therefore manage the transition much more successfully. So how can athletes do this?
  • Reduce the athlete’s exclusive identification with their sporting role and get involved in other areas of interest outside of their sporting career.
  • Discover other interests or careers beyond their sporting career and begin to prepare for their retirement. Coaches should be encouraged to support their athletes skills outside of their sport
  • Begin to take control of their daily routine
  • Develop a strong support network of family and friends who can help support you through your retirement.
This is Me is a good example of some of the challenges athletes face in coming out of retirement. Ian Thorpe retired from swimming at the age of 24 after reaching his goals and achieving more than he could have dreamed of in the sport. The media was cited as being one of the main reasons why he quit the sport with the athlete fed up of the paparazzi that surrounded him. However, he loved the sport and ending his career created a void in his life. He missed the training, the competition and ‘swimming’ itself and  four years later, at the age of 28, he decided to return to the sport and attempt to make the London Olympics. 

The book goes on to describe the motivation for his return, how he managed his comeback and the setbacks and challenges he had to face along the way; the media, doping conspiracies and speculations against his sexuality and even though feedback from performances in training indicated he was on track, his performances in the Australian Olympic Trials were unable to secure him a placed at the 2012 Olympic Games. 

If he had made the decision earlier, given himself more than 18 months to prepare, would he have made the team?

Wednesday, 16 April 2014

Post Marathon Recovery

As the dust settles on the Virgin London Marathon which took place on Sunday, thousands of runners will be taking a well-earned rest after the months of long and hard training needed to met their goal and complete the challenging 26.2 mile distance.

During their training period, many runners will have experienced at least one occasion where they were unable to train due to a cold or flu like symptoms. Like many other endurance athletes, some will have suffered from repeated bouts of infections which caused a real disruption to their training routine and ultimately their performance. Suppressed immunity is common during and following periods of hard training, and athletes often pick up an illness shortly after a marathon or major race. In addition to allowing the mind and muscloskeletal systems to recuperate, the recovery period should aim to boost the immune system.

There are many theories as to why immune defence is weakened following strenuous endurance activity. Athletes with a high training load (more than 11h moderate intensity training per week), experience more than twice as many upper respiratory tract infections compared with those on low-moderate training volumes. So how can athletes help maintain their immune system and prevent the training disturbances caused by bouts of illnesses?

Here are a few starting points:
  • Stay hydrated and try to rehydrate effectively as soon as possible post training or competition. This will help maintain saliva production and sustain the release of saliva proteins know to have important antimicrobial properties.
  • Ensure sufficient rest - don’t return back to exercise too quickly and maintain light exercise until fully recovered.
  • Ensure that you get adequate sleep (at least 7 hours per night) in order to help your body to recover and repair any damage that has occurred.
  • Keep away from people suffering with cold or flu where possible, or reduce physical contact.
  • Maintain good hygiene e.g. washing hands regularly.
  • Promote recovery as much as you can - try to consume a good quality carbohydrate snack within 30mins post exercise. This may mean athletes need to be prepared by packing light snacks to have after training. Sometimes waiting until you get home is too late and can often lead to poor food choices.
  • Forward plan to ensure that you have access to foods appropriate to meeting nutrition goals for training. Plan and prepare meals so that when you go grocery shopping you can ensure that your cupboard is full of things you need for healthy meals.
  • Choose a wide variety of foods within your diet - each food has a different range of nutrients; the wider the choice and range of your foods, the more different nutrients you will consume.
  • Include cereal rich foods such as wholemeal, multi-grain or seeded breads, brown rice or pasta. Athletes who are training for endurance activities need to maintain a high carbohydrate diet to support their energy needs and help their body to recover efficiently.
  • Eat a wide variety of fruits and vegetables throughout the day - the more colour the better.

Tuesday, 15 April 2014

Dear Asafa, ...

Last week it was announced that Jamaican sprinter and former world record holder Asafa Powell, was banned from competition for 18 months after testing positive for Oxiforan, a banned substance.  Powell claimed that the source of the substance was a nutritional supplement, which was given to him by his trainer, and which did not list Oxiforan as an ingredient.

Powel, his lawyer, and his agent, claim that he is innocent.  In this public letter to Asafa, I point out how he isn’t innocent, irrespective of whether or not he intended to cheat.

Dear Mr Powell,

While I may have been the first to cheer you on at a major championship, and hope that you might finally fulfil the potential that your fast times indicated, I have now lost all admiration for you as both an athlete and a person.  You have clearly broken the rules, so, in the words of Kim Collins, ‘man up’ and accept your punishment. 

As a lesson to you for the future (no doubt you’ll be like all the other cheats and won’t go away), and for other athletes who want to take the ‘I didn’t mean to cheat’ route, I just wanted to point out a few things that you should already have known.
  1. Strict Liability – An athlete, and only an athlete is responsible for what is found in his or her body.  If you’re going through airport security and a gun is found in your bag, blaming someone else isn’t going to do you much good.  Similarly, you should be vigilant about what is going into your body, and don’t go blaming coaches, trainers, parents, agents, doctors, dogs or baby sitters when a banned substance is found in your body.
  2. Nutrition supplements aren’t regulated, and the ingredient list should be taken with a pinch of salt.  The nandrolone scandal, now almost 20 years old, should have been a lesson to athletes that they can’t trust nutrition supplement producers.  We get that you don’t work in a supplement factory (I’m don’t know of any top level athlete that does), but surely you’ve heard other athletes blame positive tests on supplements they were taking?
  3. If a supplement claims to be ‘mind-bending’, as Epiphany D1 does, it’s probably not something you should be taking.  Having said that, if the supplement is called Epiphany D1, it’s probably not something you take to make up for not eating your greens.  Other things which the supplement claims to do include enhancing focus, attentiveness, short term and long term memory and vision, speeding up auditory and spatial thought processing, and optimising motor coordination.  On reading these benefits, would the word ‘stimulant’ not immediately pop into your head?  Think again about what the supplement claims to do – surely this is performance enhancement that if not illegal, is immoral.
  4. You benefited from a banned substance – there’s no denying that.  You should have to serve some punishment one those grounds alone.
  5. Nutritional supplements are generally a waste of money, and if not, they probably contain banned substances that they don’t list.  Try eating a balanced diet, and stop trying to get an unfair advantage.
  6. Next time you’re tested, try listing all the supplements and medications you’re taking on the doping form.  If there’s too many to remember, consider point 5 again.
  7. Jamaican charm may get you a long way with the ladies, but it won’t get you out of sticky doping situations, nor will pretending to be stupid.
For me, only one question remains: was 18 months long enough?

That is all.

Elizabeth Egan
(for drug free sport)

p.s. This advice is free.  No need to thank me.  Similar advice is available on the WADA website.

Wednesday, 9 April 2014

Branched Chain Amino Acids

When you type Branch Chain Amino Acids (BCAA) into a search engine, immediately a number of different brands of supplements pop up suggesting their benefits, mainly to the weight training athletes with their immediate claims being that they:

·         Maintain lean tissue
·         Preserve stores of glycogen
·         Prevent tissue breakdown during training

What are BCAA?
Amino Acids are known as the building blocks for skeletal muscles, enzymes, hormones and other proteins which are necessary for the optimum functioning of the body. Of these amino acids there are both essential and non-essential, with essential amino acids being those which must be ingested by the body through the diet. There are eight known amino acids which can be found in dairy, poultry, eggs, beef and pork, and soy protein for a vegetarian source. The essential amino acids valine, leucine and isoleucine are known as BCAA’s and are thought to be metabolized differently to other amino acids by being taken up by the skeletal muscle rather than the liver to contribute to the energy production, this means they can be quickly depleted.

There are many thoughts as to how BCAA’s within the diet or supplementation can help towards athletic performance the main theory is through Central Fatigue.

Central Fatigue Theory- Prolonged exercise lowers BCAA plasma concentration through oxidation of the amino acids with an increase in plasma free fatty acid concentration from fat oxidation. This creates a cascade effect which ultimately leads to an increase in free tryptophan levels in the brain which can be converted into serotonin. Serotonin can have a negative effect on mood and therefore compromise athletic performance through the feeling of fatigue.

There are two theories in which this can happen:
  • During the latter stages of prolonged exercise when there is low blood sugar- this stimulates the body to find glucose from non-carbohydrate sources and BCAA are broken down and used as a fuel source. This creates a reduction BCAA/Tryptophan ratio leaving a higher level of tryptophan to enter the brain and convert to serotonin.
  • FFA’s are broken down in higher amounts as glycogen depletion and fat oxidation increases. This creates more competition between Tryptophan and FFA’s to free albumin site and can therefore increase the amount of free tryptophan to cross the blood-brain barrier which can be converted to serotonin.

Other benefits include:

Immune Response- May improve serum glutamine levels leading to a lesser incidence of illness following exercise.
Overtraining- During a period of overtraining glutamine stores can be depleted faster than the body can replenish them and therefore over trained athletes typically suffer from low glutamine levels and BCAA could as above help to improve serum glutamine levels. 

It is thought that by supplementing BCAA in the diet, there will be a higher level of BCAA in the blood during prolonged exercise and decrease the amount of serotonin being produced and resulting in less central fatigue.

But does it really work?
The research is still conflicting on the issue of BCAA and the increase aerobic performances however BCAA’s are as mentioned earlier are essential amino acids and should be consumed within the diet. Although there will be a number of supplements claiming to increase BCAA and athletic performance as with all nutrients, the best sources are those that are natural and choosing a wide variety of food types will ensure a good intake of BCAA's as well as  a wide variety of other nutrients as well. 

The best sources will be protein rich foods, and are normally consumed in sufficient quantities in the regular diet and include, lean red meat, poultry, eggs, dairy including milk, cottage cheese and yoghurts. Non-meat sources include soy protein, brown rice, beans, nuts and lentils.

Tuesday, 8 April 2014

Nutrition: Essential Amino Acids

Protein, made up of amino acids, is essential for growth and repair of all human tissues.  Not all amino acids are equal, however!  Well that's not completely true, but in the first of a series of posts about proteins and amino acids, I explain why some amino acids are more essential in the diet than others. Tomorrow Rachael will look at Branched Chain Amino Acids, a subgroup of essential amino acids.

What are proteins, peptides and amino acids?
Proteins are organic compounds that form a vital component of every living cell.  Proteins protect and provide structure to the body in the form of skin, cartilage, tendons, muscles, callus and hair; regulate catalyze and protect body chemistry in the form of enzymes, antibodies, hormones and globulins, and enable the transport of oxygen and other chemicals in the form of haemoglobin, myoglobin and lipoproteins. Consuming protein regularly is necessary for growth and repair of body cells and tissues, general health, and regulation of homeostasis.  Excess protein is used as a source of energy, or is converted to urea and excreted from the body.

Amino acids are the compounds from which peptides, and proteins are constructed.  Each amino acid consists of amine and carboxylic acid groups, along with a specific side-chain which determines which defines the amino acid.  Amino acids contain nitrogen, oxygen, carbon and hydrogen, though some amino acids contain other elements in their side-chains.  A proteins properties is determined by the amino acids that it contains, and the sequence of amino acids within its structure.  Amino acids are crucial in both their role as protein building blocks, and as intermediates in metabolism.  

What are essential amino acids?
Of the 22 biologically available amino acids, nine must be consumed in the diet.  This does not mean that they are more important human tissues than the other 11, but unlike the non-essential amino acids, they cannot be made from other amino acids, or produced from other substances within the body.  Argining, for example, is crucial in the formation of bone, among other things, but is not essential as it can be produced from citrulline Leucine, important in muscle synthesis, and isoleucine, important in both muscle and haemoglobin synthesis and blood sugar regulation, on the other hand are essential amino acids and must be consumed in the diet.

Where can I find essential amino acids?
As a rule, animal proteins are better sources of essential amino acids than vegetable proteins, though soy is a notably useful plant source of essential amino acids. Eggs and milk are the particularly good, and both contain all nine essential amino acids, along with a number of non-essential and semi-essential ones. Vegetarians and those who can't consume diary products or eggs should ensure that they obtain protein from a variety of sources, including soy.

Eggs are an excellent source of essential amino acids

Combining certain vegetable proteins can ensure that essential amino acids needs are met.  Indigenous staples in a number of developing countries cleverly achieve this in the absence of animal foods.  Examples include Mexican corn and beans, Cajun red beans and rice, and Japanese soybeans and rice. 

The following are the essential amino acids and some of their top food sources*:
Histidine - eggs, soy protein, sesame, peanuts, parmesan
Isoleucine - eggs, soy protein, parmesan, pork, whitefish
Leucine - eggs, soy protein, sesame seeds, parmesan, whitefish
Lysine - eggs, soy protein, parmesan, whitefish
Methionine - eggs, soy protein, sesame seeds, whitefish
Cysteine - eggs, soy protein, sesame seeds, peanuts, mustard seeds 
Phenylalanine - eggs, soy protein, sesame seeds, peanuts, whitefish
Tyrosine - eggs, soy protein, sesame seeds, parmesan
Threonine - eggs, soy protein, sesame seeds, whitefish
Tryptophan - eggs, soy protein, sesame seeds, chia seeds
Valine - eggs, soy protein, sesame seeds, parmesan, beef

*Note the these are the top food based on available protein per 100 grammes, but eating 100 g of sesame seeds or parmesan cheese is a lot more difficult than drinking 100 ml of milk.

How often should protein be consumed?
The body is constantly growing and repairing it tissues, and has a constant demand for amino acids.  Small amounts of protein should be consumed with each meal (this doesn't need to be a steak or chicken breast). The best way to ensure that your essential amino acid needs are always being meet, is to ensure that you eat an egg or drink a glass of milk daily, or that you consume protein from a variety of sources.  Different foods will have different minerals and vitamins, so eating foods from a variety of sources has additional benefits.

Key points
  • Eggs or milk should form part of your diet
  • Protein should be consumed from a variety of sources

Useful references and resources