Anatomy

Lateral ankle sprains are one of the most common injuries in athletics.

There are a couple reasons why lateral ankle sprains occur so often. First, the anatomy of the ankle provides a bony block on the inside, which forces the ankle to lean to the outside. Second, the musculature and ligaments on the inside of the ankle are much more secure and thicker than those on the outside. Finally, in a normal walking pattern, or gait, most of the weight is placed on the outside of the foot when it is placed on the ground, naturally causing an inversion at the ankle joint.

In a typical lateral ankle sprain, the most common ligament that is damaged is the anterior talofibular ligament. The
name describes exactly where it is; it connects the talus bone of the ankle to the fibula in the lower leg. In a more severe sprain, the calcaneofibular ligament may also be injured. Two other ligaments, the anterior and posterior tibiofibular ligaments, may be injured as well. When these ligaments are sprained it is known as a high ankle sprain. The deltoid ligament is located on the inside of the ankle and is stronger and less often injured than the other ligaments of the ankle.

Signs and Symptoms

There are generally 3 grading classifications of ankle sprains. However, different texts, clinicians, and physicians may have or use different scales. Commonly, most ankle sprains result in some amount of swelling and bruising, loss of range of motion, and moderate pain.

• Grade 1 Ankle Sprain- The ligament is stretched, causing microscopic damage to the tissue. There is generally only a limited amount of swelling and pain. Most patients can put some weight on the foot and don’t need crutches, however, they most likely will not be able to run or jump. On average grade 1 ankle sprains, with proper rehabilitation will heal in about 7 to 10 days.
• Grade 2 Ankle Sprain- This level of ankle sprain is more severe and there is a greater amount of pain. The injury results in a partial tear of one or more ligaments and causes moderate swelling and bruising in the area. Crutches are often needed because of the irregular gait and pain with weight bearing. Depending on the severity, a patient with a grade 2 ankle sprain can take anywhere from 2 to 4 weeks to heal and return to previous levels of activity.
• Grade 3 Ankle Sprain- A complete tear of one or more of the ankle’s ligaments. There may be severe bruising, swelling, and little or no range of motion in the ankle joint shortly after injury. Patients that have completely torn the ligament sometimes need surgery. The ankle may be very unstable and crutches and/or a walking boot usually are needed. At least 4 to 6+ weeks of rehab and treatment will be required for proper healing.

Treatment

It is extremely important to give the proper treatment immediately after an ankle injury occurs. Often an increase in swelling causes more pain and a longer healing time. To prevent ankle swelling, the “RICE” technique is used. ‘R’ stands for rest.  The patient should refrain from activity for a minimum of one day to prevent more damage. Using crutches is a form of resting the ankle. ‘I’ is for ice. Ice is used to decrease blood flow, resulting in a decrease in swelling when used immediately. Ice should be used 20 minutes out of every 2 hours for at least the first 48 hours after injury. Never heat a freshly sprained ankle. The ice also helps to numb the area and decrease pain levels. ‘C’ is for compression. Putting pressure on the entire ankle will help prevent and push any swelling out of the area. Use an elastic bandage and wrap from the toes all the way to the calf. Overlap the elastic wrap and do not leave any holes in the heel or elsewhere, as swelling will occur in these spots. Finally, the ‘E’ is for elevation. Gravity plays a large role in the amount of ankle swelling that occurs. Keeping the ankle elevated, preferably above the heart, assists in keeping extra blood flow and fluid out of the area.

Over time, atrophy can occur in muscles if they are not used to move the ankle joint. Muscle atrophy and weakening can occur within days of injury so it is critical that the patient does rehabilitative range of motion exercises in the first few days after injury. Examples include spelling out words by making the shapes of letters with the foot, or basic up and down ankle pumps. In time, the pain will decrease and more rigorous strengthening exercises should be implemented, as well as continuing towards obtaining full range of motion. When returning to sports or fitness activities after rehabilitation is completed, an ankle brace, or daily ankle tapings can be beneficial to prevent re-injury. Research has shown that both of these preventative actions help decrease the patient’s chances of re-injuring the ankle.

By: Allison Fretthold, ATC
Allison graduated as a certified athletic trainer from the Mercyhurst University Sports Medicine Department in 2011. She has worked at various levels of athletics, varying from small high school settings to major Division 1 universities. She attended Ohio University for her master’s degree and currently works as an athletic trainer at River Valley High School in Gallipolis, Ohio.

The National Institutes of Health describe fad diets as severely restricted calorie intake for rapid weight loss. These types of diets do not mean you will keep the weight off. Crash diets require you to eat fewer calories than you need to live. This behavior trains your metabolism to slow down to conserve energy. Once you have completed your crash diet you are left with a body that burns calories much slower than before you started, resulting in weight gain.

Why do people give into the fad diet gimmick?

Eating healthy portions and exercise can help you lose weight. Stay away from Fad Diets.

Two words: Instant Gratification. It’s as simple as that. We are humans that constantly want and need to see results immediately, no matter what the consequences reap. If something is really worth it you should want to work hard for it. Hopefully you are not sitting there thinking, “Yeah, I am so happy my friend, parent, or significant other got me the job I have.”  I hope you are thinking “I worked hard to be where I am today, to have what I do.”  So, why wouldn’t you do the same for your own body?

The companies that advertise their quick weight loss fad diet gimmicks just want your money and do a great job at getting it. Companies also like to use celebrities to market their product. How realistic is that? Celebrities are a limited number of the general population and are not perfect models of how we should look. These companies play on our insecurities and self image to make a buck. Let’s stop their income and start a lifetime of happiness and health the safer way!

What happens once the fad diet is over?

Once rapid weight loss occurs and the diet is over, typically people return to their old habits of not eating properly and exercising. The weight that is lost is usually water weight and precious muscle. Weight that is lost is gained back rapidly, usually as fat, because the person did not learn how to eat properly.

How Do I Spot a Fad Diet?

While there is no set approach to identifying a fad diet, many have the following characteristics:

1. Recommendations that promise a quick fix.
2. Dire warnings of dangers from a single food group, product, or regimen.
3. Claims that sound too good to be true.
4. Simplistic conclusions drawn from a complex study.
5. Recommendations based on a single study or testimonials.
6. Dramatic statements that are refuted by reputable scientific organizations.
7. Lists of ‘good’ and ‘bad’ foods.
8. Recommendations made to help sell a product.
9. Recommendations based on studies published without review by other researchers.
10. Recommendations from studies that ignore differences among individuals or groups.
11. Eliminating 1 or more of the 5 food groups.

So what is the key to losing weight and maintaining weight loss?

First and foremost, awareness of caloric intake! I am not saying count every single calorie that you ingest; however, you should be more aware of what you are eating and how much. You can start by keeping a food log. You can find many fitness and diet logs to help you out online.

That brings us to the second key: Portion Control! Portions have increased drastically over the past 40 years.  A study from the American Journal of Public Health states ‘researchers found that cookies are 700% bigger than USDA standards’.

Last but not least, you need to have a regular exercise routine. Everyone has to start somewhere, but to maintain a healthy weight you need a combination of cardiovascular exercise, strength training, and proper nutrition. The American College of Sports Medicine recommends at least 20 minutes of physical activity per day, and working toward 60 minutes per day. There are many great fitness tools and apps available to you on the web for tracking your weight loss and exercise progress. WebMD has a wonderful fitness tracker tool available for the general population. If you are able to, seek the services of a health professional like a Registered Dietician, Health Fitness Specialist (HFS), or Certified Personal Trainer (CPT) to help personally guide you.  They can be a wealth of knowledge! Check out the ACSM’s (American College of Sports Medicine) website for more information regarding exercise for the general population at ACSM.org.

Quick Facts:

• People who eat several small meals a day are able to lose weight and maintain weight better than someone who does not, especially if the snacks are protein packed.  Eating more often keeps your metabolism in high gear. HEALTHY SNACKING IS OKAY!
• Low fat does not necessarily mean low calorie! Just because it says low fat on the label does not mean it is the best option for you! Be aware of how many calories are in each serving and try not to over indulge because it says low fat! They all add up!
• People who drink more water burn more calories! When you are dehydrated your metabolism lags! Add a cup of water to each meal you eat to get your daily intake. It will also create a sense of fullness and cause you to eat smaller portions at the meal as well.
• Slow and steady weight loss (1-2 pounds per week) is the safest way to lose weight and maintain weight loss. Rapid increases and decreases in weight make it harder for your body to stabilize a proper weight for you. One pound equals 3,500 calories! WOAH! To lose one pound per week you need to burn 500 calories more per day than you eat (7days X 500 calories = 3,500 calories or 1 pound lost). The recommended approach for this strategy is to cut 250 calories from your food intake and burn 250 extra calories by working out each day.  Now that doesn’t sound so hard does it?
• It is not too late to start a diet and exercise program! Starting is always the hardest part, but there are many tools and people to support you through your journey!  Take control of your life and be as healthy as you can be!

Flexibility is an important part of a fitness program for athletes of any age

Flexibility, the ability of a joint to move freely through a full range of motion, is a key contributor in injury prevention and should be an important part of any fitness program. When performed regularly and correctly, flexibility can decrease the likelihood of injury and increase overall performance. Stretching is the best way to increase flexibility and should be performed daily to increase the range of motion of joints, decrease the probability of delayed-onset muscle soreness (soreness that appears 1-2 days after an intense workout), and enhance quality of life and graceful movement. Furthermore stretching can also assist in the development of motor skills, improve body positioning and strength for sports, and relieve aches and pains from stress or being in a stagnant position for a long period of time. Stretching is also a very important component of general fitness and wellness as we age.

Factors Affecting Flexibility

Flexibility varies from person to person. Everyone has a specific predetermined range of motion and degree of flexibility. From this range, gains can either be made if stretching is performed correctly or lost if it is not maintained. Flexibility is joint specific. This means that a person can be flexible in one joint and at the same time lack flexibility in another. This makes determining or scoring an individual’s overall range of motion very difficult. Some joints allow motion in only one plane such as flexion and extension, as the hinge joints perform in the fingers. On the other hand, ball and socket joints located in the shoulder and hip allow movement in many different directions, such as flexion, extension, adduction, abduction, internal rotation, and external rotation. The following factors can also affect flexibility:

Heredity; Some people are born with joints, muscles, and tissues that are looser or tighter than the average individual

Level of physical activity; Usually with activity and training flexibility can be improved

Joint structure; The type of joint, and position of bones and tissues to one another, can affect the pull of muscles and your ability to stretch and gain flexibility

Tendons, cartilage, and ligaments; A torn or stretched ligament or tendon can make a joint more flexible and even unstable

Lifestyle; A sedentary lifestyle or jobs that require long periods of sitting can decrease flexibility and lead to tightness over time

Skin; Skin thickness and scars can impede stretching

Previous or current tissue or joint injury; Scar tissue, swelling, and previous surgeries can reduce the extensibility and movement of tissues and joints

Amount of adipose tissue (fat); Extra body fat will limit flexibility

Body temperature; Warmer bodies and muscles tend to be more flexible

Age; Children are usually more flexible than adults

Gender; Women are often more flexible than men

When designing a flexibility program you must take all these factors as well as the type of joint, the individual’s goals, and lifestyle into account. Attempting to over stretch or increase range of motion in muscles or a joint that has an obstruction or barrier will only result in injury or damage to the individual. Additionally, stretching a joint that is damaged or has a large degree of laxity already will only harm the individual and predispose them to further injury. Hyperflexibility is the term given to flexibility beyond a joint’s normal range of motion, and may predispose these individuals to subluxation and dislocation injuries.

Approaches to Stretching

There are six main approaches to stretching: static, active, ballistic, dynamic, passive, and PNF stretching. All six are great contributors to increasing flexibility and can be effective when implemented in the correct situation and workout program. A solid routine will use an effective combination of stretching techniques to ensure appropriate maintenance and gains in lifelong flexibility.

Static stretching involves a technique in which a muscle is stretched while the body is at rest. This stretch involves the individual slowly and gently taking the muscle to a point of resistance and discomfort and holding that position. For the best results static stretches should consist of 3 to 5 sets of 10 to 20 second holds. This method is probably the most popular and effective stretching method for increasing flexibility.

Active stretching is a method in which you put yourself in a stretched position and hold it there with no assistance other than using the strength of your agonist (opposite) muscles. This method is based on the fact that when a muscle contracts the opposite muscle relaxes. An example would be contracting your toes and foot upward toward your head, allowing the muscles in the back of your leg and calf to relax and stretch.

Ballistic stretching is a technique in which muscles are stretched by an extreme force generated as the body part is repeatedly bounced, swung, or jerked. This type of stretching can be effective, but also dangerous as it can create injury. Because of the injury risk involved with ballistic stretching most fitness individuals do not recommend its use in a workout routine.

Dynamic stretching is similar to ballistic stretching, except it is more controlled, gentle, and rhythmic. In dynamic stretching the body is warmed up gradually and flexibility is slowly gained and increased using a series of controlled reaches, bends, and swings through a full range of motion. A lunge is a good example of a dynamic stretch that when performed correctly can stretch multiple muscles in your legs and hips in one motion.

Passive stretching is a technique in which muscles are stretched using an outside source or person. Having your body stretched by an outside force may occur during rehabilitative therapy when someone helps you stretch, when using devices designed to help athletes stretch, or by using your opposite hand to hold the body part in a stretched position.

PNF (proprioceptive neuromuscular facilitation) stretching involves muscles being stretched by the use of combinations of alternating contractions and stretches. This method is more complex and usually involves guidance and training from fitness professionals prior to performing. One of the most common PNF stretching techniques is the contract-relax-stretch method. This routine consists of stretching a muscle passively, then performing an isometric contraction of the same muscle while in a stretched position, relaxing the muscle, and then finally passively stretching the muscle again to a new length.

Flexibility Tidbits

• Muscle tissue is the key to developing flexibility since it can be lengthened with regular stretching
• A warm muscle may be as much as 20% more flexible than a cold one.  Think of your muscle as a noodle.  It is hard to stretch and bend an uncooked (cold) noodle, but once cooked (warmed up) it is able to bend and move more freely.
• During athletic participation it is best to stretch after a light warm-up, and then again following an after workout cool down
• Avoid severe painful stretching and breath holding during stretches
• Stretching multiple times per day is the best method to maintain and gain flexibility
• In the United States, approximately 80% of all low back problems stem from improper alignment of the vertebral column and pelvic girdle due to poor flexibility

By: Douglas R. Curnes MS, CPT and Bryan S. Bentz MS, ATC

Douglas R. Curnes MS, CPT is a National Endurance Sports Trainers Association (NESTA) Certified Personal Trainer, and is a contributor of articles to the www.Hat-Trick-Sports.com website. He routinely designs individualized workout programs and provides sports specific training advice to top caliber athletes.

MRSA Infection Skin Abscess

Methicillin-resistant staphylococcus aureus (MRSA) is quickly developing into a widespread threat to athletes in all sports as well as the general population. MRSA is a very serious infection that was once confined mostly to hospitals. The infection has recently crossed over to the general population, and is now infecting athletes of all sports and levels.

Bacterial infections in athletes are very common and can greatly hamper their ability to compete and perform at their best, but these infections are usually easily treated with antibiotics such as penicillin, amoxicillin, methicillin, and oxacillin. MRSA is a staphylococcal bacterial infection (commonly known as a staph infection) that has become resistant to many of these antibiotics that doctors commonly prescribe to treat bacterial infections. This creates a very serious problem for both the athlete and the doctors that provide their medical care. There are a few high-powered new antibiotics that currently exist to treat this infection, but if the bacterial strain mutates further and builds up resistance to these drugs too, doctor’s treatment options will be further limited.

The spread and occurrences of MRSA in athletics is increasing. Prior to 2002, resistant staph infections were virtually unheard of in such a healthy population. Many of the first athletic cases were reported in football. Now football players from the high school level to the pros have had outbreaks. Many collegiate teams, including national championship caliber programs, have also had major problems controlling the spread of this infection. MRSA is usually spread by direct person-to-person contact. MRSA is commonly found on the skin or in the nose of healthy people. Having the bacteria present in or on your body does not mean that you will develop infection, and many people live healthy lives without ever developing an infection. Sports such as football, wrestling, and soccer are among the highest risk to spread the infection due to the constant bumping, hitting, and contact with teammates and opponents. These sports generally also have exposed areas of skin and open wounds when practicing or competing that may come in close contact with other athletes. MRSA requires contact to be spread from person to person and is not spread through the air. However, it can be spread by direct contact with contaminated towels or equipment that athletes may share or use during workouts. Once an infection develops in an athlete it can quickly spread throughout a team and to opponents.

Many MRSA infections start as a small skin lesion or pimple, but the bacteria can also travel through the blood stream and settle into internal tissues, such as bone. Skin infections often occur in the area of a previous wound that allowed the bacteria to enter the body. Wounds such as turf burn abrasions, fingernail scratches, or even a small open blister or pimple could allow the infection to enter and manifest. When infected, the first symptoms may yield a small painful red swollen spider bite or boil looking skin lesion. If left untreated the infection will spread to surrounding tissues creating a pus filled abscess. Without treatment the infection then may advance and spread to the bloodstream making it harder to treat and control. Advanced infection symptoms may include shortness of breath, chills, and fever and ultimately could result in death if not properly treated.

Treatment for MRSA requires proper diagnosis. Any infection that does not heal in a timely matter, does not respond to antibiotic therapy, or that is draining pus or other fluid should have MRSA ruled out as a possibility. Diagnosis of MRSA requires a culture of the infected area. The culture is then sent to a lab that will determine if the infection is an antibiotic resistant strain such as MRSA. Many physicians also advocate a sterile incision into the wound to allow proper drainage of pus. The wound should then be covered and treated with special antibiotic ointments and observed during the healing process for worsening or spread to surrounding tissues. Wound dressings should be kept clean and dry and changed twice a day. Hospitalization may be required in some cases. Return to play should not be considered until the wound is healed of all infection and the athlete is no longer at risk of spreading the bacteria to teammates and opponents.

To prevent the spread of MRSA and staphylococcal infections among athletes follow these guidelines:

DO NOT:

• Share shower towels
• Share razors and equipment
• Share deodorant
• Share balms or ointments among teammates or friends
• Share blankets or pillows at tournaments or on the bus
• Lay on the floor of the locker room
• Use community towels on the sidelines to be shared among athletes, including ice buckets and wet towels to cool athletes (use single use disposable towels instead or do not directly touch athletes)
• Use whirlpools and other common use medical equipment when infected
• Share beds with friends or teammates without changing the linens first

DO:

• Clean equipment, weights, mats, and work-out machines after each individual use, not each session
• Maintain a clean locker room, including showers, floors, and carpets
• Occasionally wipe down and disinfect meeting rooms, desks, and common areas
• Encourage showering and hair washing with hot water and antibacterial soaps and shampoos after every practice, competition, or workout
• Frequently wash uniforms, practice gear (including pads and sports braces), and towels in hot water. Add bleach if you can without ruining your clothes
• Avoid close direct contact with infected individuals
• Finish all antibiotics prescribed to you by your doctor, unless your doctor tells you otherwise
• Use gloves when handling, washing, or moving bloody or sweaty equipment, jerseys, or bandages. Throw away used bandages and bloody gauze in red bio-hazard bags
• Train athletes, coaches, and medical staff to recognize potentially infected wounds and administer basic first aid treatment for wounds
• Keep all wounds (even small abrasions, turf burns, or scratches) bandaged and covered with an antibiotic ointment when participating. If a wound can not be adequately covered consider excluding the athlete from participation
• Report any skin abnormalities, lesions, or wounds to your doctor or certified athletic trainer
• Place and use alcohol-based hand sanitizers in athletic facilities and in medical bags
• Have medical staff and coaches wash with soap and water, or use an alcohol-based hand sanitizer, after contact with each patient/ athlete that is bleeding or very sweaty

MRSA is a serious problem that has crossed over from the hospital setting to the general population and athletics. Though it is a threat to athletes and the people they come in contact with, it can often be prevented. By being aware of the signs and symptoms of MRSA, using good hygiene, and carefully following the prevention steps listed above many MRSA cases can be avoided, allowing athletes to continue their training routines and to perform at their top level.

Image: Andy Newson / FreeDigitalPhotos.net

• Good nutrition consists of a behavior change and time management. It is easy to eat unhealthy. Eating healthy takes initiative.

• Obtain a hobby. Avoid sitting around and munching. If you have to munch, replace foods like chips and soda with foods like pretzels and water or real fruit juices.

• Replace unhealthy habits with good habits and unhealthy foods with healthy ones.

• Use so called “bad” foods only as a reward and enjoy it without feeling guilty.

• Avoid eating late at night and right before bed. Try to consume your calories in the morning and early afternoon so that your body can use the necessary calories throughout the day as an energy source.

• Learn when, how often, and what your body needs to run and train efficiently by taking a cognitive notice of your energy levels during activity and rest. LEARN HOW YOUR BODY WORKS.

• Be smart when you eat out. The majority of places you go to eat out will have healthy food choices on the menu, choose wisely and use caution and control!

• EAT SLOW: Enjoy your food and let your body use energy to digest.  Eating slower helps kick on the body’s sense of fullness before you have over-stuffed yourself.

• Eat wholesome, real foods. Stay away from high preservative, high sodium, high sugar, and high fat foods.

• Get plenty of water. Drinking water throughout the day helps flush the body of unwanted wastes, and provides adequate hydration for training sessions.

• This sounds funny, however, it is very true! Leave the “F” word out of your diet. Try to only eat foods that are prepared baked, boiled, broiled, or grilled. Stay away from fried and fatty foods.

By: Douglas R. Curnes MS, CPT

Douglas R. Curnes MS, CPT is a National Endurance Sports Trainers Association (NESTA) Certified Personal Trainer, and is a contributor of articles to the www.Hat-Trick-Sports.com website. He routinely designs individualized workout programs and provides sports specific training advice to top caliber athletes.