Wednesday, April 20, 2016

Tips for Spring Training

I know I owe everyone some really good blog articles on fun sports and medical topics, BUT I realized that I haven't found the time to write something for you since January, so this means a quick blog to get us started and then hopefully some more research-based things coming up soon. All of my research writing time has gone into actual research and not blogs lately, go figure!

Tips for Spring Training -

1. Embrace the Awesome
having a blurry fun time and ready
for spring swimming!!!!
This spring weather makes everyone go park and exercise crazy. One of my new favorite catch phrases is #embracetheawesome. (I thought I made it up and was so excited, but when I wrote the hashtag, I realized a bunch of other people have already used it. Oh well.) At any rate, still Embrace The Awesome. This spring and sunny weather has you gliding on air and ready to spend every last bit of daylight out enjoying the essence of spring...then go with it! Use that boost to get yourself back to being active again, pump up your bike tires, dust of your running shoes, grab your tennis racket, make it happen!

2. Stay hydrated
This goes without saying, but you may forget how much hydration you need to bring with you for workouts or how to replenish afterward. With warmer weather, there is more sweating, more salt loss, and hydration and rehydration become even more important. A good rule of thumb is that your pee should be clear prior to your workout (concentrated urine that looks darker is a sign of dehydraton). More than an hour of strenuous exercise in the heat means an electrolyte replacement drink after, and  you should have a protein and carbohydrate meal/snack within 30 minutes of endurance training if possible, to maintain muscle mass and properly replenish glycogen stores.

3. Don't Forget the Sunscreen
Athletes are the biggest culprits of not using sunscreen. You think you have a base tan, you think you want a base tan, you think you don't burn easily...well you're all wrong!
Watch this enlightening video with an ultraviolet camera, showing how sun exposure affects your skin.

Dandelions on the soccer field? Those are ok...right, Violet?
5. Check field conditions
This should be up to the schools and the coach for youth sports, but sometimes things are getting revamped when they need to be. Make sure things are up to snuff before your kid heads out on the playing field. Adults, you should know better when you are playing sports later in life.

     6. Check equipment

Wondering where her sun hat is while playing ball.
   If you are like me, you haven't pumped your bike tires since you last did an outdoor ride or oiled your glove since last fall or summer.
I am so bad about leaving my bike on the trainer and letting the front tire go totally flat, and then as soon as the weather turns nice, I get frustrated when it takes me an hour to get everything ready to go for an outdoor ride. BUT, it is definitely worth it to pump the tires, check air pressure, make sure your flat kit has everything you need, and that everything is functioning properly since your last time out. This goes for every sport, especially for kids. Make sure they have the right equipment to help prevent injuries.

7. Consider body type and any changes
That bike is too big for you, Violet!
This is especially important for youth sports, but it applies to adults as well. Adults may not be in the same shape they were the last time they decided to play a certain sport or enter a certain level of training. Even elite athletes need to recognize physiologic changes and hormonal differences since the last season or big event. For ladies even menstrual cycle can affect training, as well as adaptation after pregnancy or miscarriage, premenopausal changes, etc. For men, different amounts of muscle mass or endurance training can affect testosterone level and athletic performance. So please talk to your health professional or your experienced trainer or coach about these when setting your goals and training regimens. For kids, especially around the time of puberty, parents and pediatricians need to consider the stage of puberty and the growth velocity that has occurred over the last year. I will write another blog specifically on this topic, but being at a younger bone age or a younger stage of puberty compared to other kids in the same grade can put a child at a disadvantage not just for athletic performance but for athletic injuries. This is most important for contact sports. Talk to your doctor and make sure a check-up happens to see where your child is with regard to Tanner Stage (or SMR Sexual Maturity Rating). Yes, that means putting on a gown and getting your private parts checked. All pediatricians should be doing it with the annual health maintenance exam. Parents please ask if they are not.

8. Know your stuff!
This is supposedly going to be a great website for parents especially to check what sports need what prep prior to gearing up for spring training or any season, for that matter. However, right now it is still under construction. Check back later and see what info they add:

9. Try something new
A great way to cross-train is to keep yourself doing some different sports at different times of year. Yes, we all have that sport that we love the most, but getting better sometimes means a little time of from it, and this gives you time to enjoy something else! This is also a good way to avoid over-use-injuries. We should probably have a couple blogs on those coming up.

10. Be inspired
I was running recently and saw two women running with reflective jackets. One read “Guide” and the other “Blind-Deaf.” So these two ladies deserve a super shout-out because they were moving fast! Total inspiration. I spent some time on my run wondering what it would be like to run a race and not be able to hear any of the fans cheer. It makes you think you are pretty fortunate to have what you have, and it also makes you applaud these ladies for getting out and running and exercising their ability to stay fit, despite life’s obstacles. Great job! You better bet I will be thinking of them in some of my upcoming races, trying that much harder because I can hear and see people cheering for me and know how special that gift is.

We love animals and we love running! Help us support
the Bronx Zoo!!!!!!! :-D
I find that sometimes signing up for even a small race is a good way to enjoy the nice weather and get yourself exercising when you otherwise wouldn’t. Our family signs up for the Indianapolis Mini Marathon every year, and I definitely wouldn’t have been running much recently without having this race on my calendar. I have been taking a training break, which means running a half-marathon only this year lol. Violet and I also decided to do her first race at the end of this month- a run for the Bronx Zoo. I think it’s a win-win. We get to go to the zoo, Violet gets a ride in the Enterprise (our jogging stroller), I get exercise, and the zoo gets some financial support from the fundraising. If you are local and interested in joining us for the run, check out this link. If interested in donating, go here.

Von Duvillard et al. Fluids and hydration in prolonged endurance performance. Nutrition. 2004 Jul-Aug;20(7-8):651-6.

On deck:
-Back Pain (I am not forgetting you, Charles! we Will try to do this one next)
-Overuse Injuries
-Neurodevelopment and Youth Sports Training
-Ankle exam and injuries for providers
-Knee exam and injuries for providers

Friday, January 8, 2016

Intoeing Part II: The Pluses and Minuses of Pigeon-toed Anatomy in Athletes

Last blog we went over the different causes of intoeing in kids. Now we review what intoeing means for athletes.

Studies have shown that low to normal thigh-foot angles and intoeing while sprinting correlate with sprinting ability. Meaning, if your anatomy is such that your thigh-foot angle is low and makes you prone to intoeing and you continue to intoe while you sprint, you may be a better sprinter than those who don’t! Or, you may just be overcoming your anatomy and sprinting well despite your intoeing. It is hard to say which the case is. Have observational studies shown more sprinters who do well because they are pigeon-toed, or do sprinters just happen to have some pigeon-toers who sprint well? Usain Bolt has been noted not to intoe while sprinting. Andre Agassi and Michael Jordan, two athletes who have excelled in sports that require lateral movement (i.e. tennis and basketball) are pigeon-toed. Biomechanically speaking, lateral movement is easier when done with toes turned inward. Is this the case with sprinting?
Violet can't figure out if her rain/snow
boots make her intoe more or not.
She runs pretty fast in them!

The theory to explain the mechanism based on biomechanics and physics from the leading exercise physiologists goes something like this – runners land on the outside of the foot and roll their foot inward from heel-strike to toe-off. People with intoeing have less of this maneuver because they already land partially rotated due to their anatomy. They have less give in the foot and ankle joint when they strike, and the stiffer foot means less energy is absorbed and more energy is dissipated. Running speed is increased when an athlete’s body has the capacity to handle the impact of the forces that occur when the foot strikes the ground, forces that are 3 to 6 times bodyweight. A stiffer foot enables the athlete to absorb these forces and quickly accelerate in the opposite direction.

Some folks propose that intoeing, associated with having flat feet (pes planus) and bow legs, may lead to being faster, but it also leads to more ankle, knee, and hip injuries. The theory being that intoeing feet don’t cushion the force, so even though they are faster, the musculoskeletal system incurs the consequences of that impact. A recent literature review actually showed that there is a low association between pes planus and lower extremity musculoskeletal injury. I haven’t found anything that directly reviewed intoeing with lower extremity injuries, but since the theory is based on the association between intoeing and pes planus, I think we can safely say that there is low evidence to support it. So, dream on, athletes, for those pigeon-toes.
Violet checking out a runner's gait
and trying to decide if they are
hyperpronating or not. There's a lot
less entertainment during winter jogging
stroller runs because fewer people and
fewer animals are out. Why aren't they
as crazy as us, sweet girl?


Budt et al. The relationship between foot posture and lower limb kinematics during walking: A systematic review. Gait Posture. 2013 Jul;38(3):363-72.

Feigenbaum et al. The association of foot arch posture and prior history of shoulder or elbow surgery in elite-level baseball pitchers. J Orthop Sports Phys Ther. 2013 Nov;43(11):814-20.

Fuchs R and Staheli L. Sprinting and Intoeing. Journal of Pediatric Orthopaedics. July/Aug 1996: 16;4 – 489-491.

Tong et al. Association between foot tye and lower extremity injuries: systematic literature review with meta-analysis. J Orthop Sports Phys Ther. 2013 )ct;43(10):700-14.

Zafiropoulos et al. Flat food and femoral anteversion in children—a prospective study. Foot (Edinb). 2009 Mar;19(1):50-4.