Health and Nutrition

Muscular Injuries

BERT R. MANDELBAUM is an MD at the Santa Monica Orthopaedic Sports Medicine Research Foundation in Santa Monica (USA), a member of the USSF Sports Medicine Committee, a lead physician for the US National Teams and an instructor and lecturer on medical matters for FIFA.

HOLLY J. SILVERS is an MPT at the Santa Monica Orthopaedic Sports Medicine Research Foundation in Santa Monica (USA)

Muscular injuries in football players are a common phenomenon. Acute traumatic injuries to muscle and tendon can account for 50% of all injuries. Muscle strains (muscles are strained and ligaments are sprained!) are commonly associated with an athlete strongly contracting the muscle while simultaneously stretching it (e.g. slide tackling with a straight knee). The strain occurs when the muscle's ability to handle the outside load is exhausted. The muscle's ability to absorb shock is overcome. The muscle injury can range from breaking a few fibers (myofibrils), a tear in the outer covering (fascia) or a complete muscle rupture. They most commonly occur where the muscle and the tendon meet (musculotendinous junction). Muscle strains often involve muscles that cross two joints, like the rectus femoris of the quadricep, biceps femoris of the hamstring and the gastrocnemius of the calf.

Types of muscle strain

Contusion injuries occur upon impact when the muscle is forcefully pressed against another player, the ground or goalpost. Bleeding will quickly ensue due to increased blood flow from exercising. Bleeding can be subdivided into two groups:

(1) intra-muscular (within the muscle membrane)
(2) inter-muscular (outside of the muscle membrane).

Intra-muscular bleeding usually occurs more on the outer portion of the muscle and has an intact membrane (fascia), which limits the extent of the bleeding. These athletes will experience pain and immobility (stiffness). This is difficult to treat secondary to the decreased ability for the muscle fascia to rapidly expand with increasing blood volume. Inter-muscular bleeding occurs when the outer covering (fascia) of the muscle has been damaged. These athletes will experience less pain and stiffness due to the ability for the blood to disperse outside of the fascial membrane. Delayed onset muscle soreness (DOMS) occurs when there is a sudden change in activity level. Symptoms usually begin 12 to 24 hours after exercise and include pain, weakness, fatigue, deep stiffness, and decreased mobility of the involved body part. Symptoms usually last from 1 to 2 days and can be treated with rest, ice, and compression. DOMS usually occurs after prolonged eccentric (lengthening) activity of the muscle that leads to changes in the myofibril.

Signs and symptoms of a muscle strain are as follows:

• Pain with contraction

• Pain with stretching

• Bruising (ecchymosis)

•• Swelling (edema)

When muscles are injured, they go through a four-step process. This includes initial inflammation, cell proliferation (granulation), remodeling, and maturation of tissue. Non-steroidal anti-inflammatory medicines, physical modalities such as ice or ultrasound, and therapeutic exercise are used in the rehabilitation to decrease the inflammatory response.

Causes

Muscle strains may be caused by one or a number of factors including:

• inadequate warm-up program
• insufficient flexibility
• insufficient muscular strength
• poor coordination
• fatigue
• a premature return to play after rehabilitation of a prior injury.

Ideally, you should warm-up for 10 to 15 minutes prior to initiation of play. This brief warm-up allows for the intramuscular temperature to rise sufficiently and allows for adequate deformation of the collagen and the musculotendinous junction. It should be followed by a thorough stretching session that allows a 30 to 60 second stretch of all major muscle groups. These stretches should be static in nature - do not bounce during a stretch.

Treatment of muscle injuries
Acute muscle injuries should be initially treated using the RICE pneumonic:

• rest
• ice
• compression of the injured muscle
• elevation of the injured area above the level of the heart.

Non-steroidal anti-inflammatory mediations are effective in decreasing the pain and swelling that accompanies a muscle strain without compromising the strength of the muscle. If the lower extremity has been injured, it may be appropriate to utilize crutches or another assistive device to unweight the affected body part. Immobilization of the injured extremity will limit the activity of the sarcomeres within the muscle and can accelerate the healing response. It is important to immobilize the affected muscle in a lengthened position. It should be noted that prolonged immobilization of an extremity can lead to disuse atrophy and subsequent weakness of the muscle. This course of treatment should not exceed 96 hours (4 days) after the initial injury in an extreme case. After this time, gentle mobilization of the injured area should begin. Rehabilitative exercises should begin when tolerated after a minor muscle strain. The program should be initially focused on passive mobility and static exercises (contraction of the involved muscle with no movement). Gentle low-load cycling and pool rehabilitation may be introduced 3 to 7 days after injury. Gradually introduce dynamic (movement based) exercises with low resistance. As healing progresses, one can increase the amount of resistance lifted with a concentric (shortening) muscular contraction. If these activities can be completed without the initiation of pain, eccentric (lengthening) exercises may be included to the rehabilitation program. If the athlete is unable to tense the muscle due to a complete tear, external electrical muscle stimulus may be utilized.

The more complex problems: In the more complex situation and if the muscle strain is intra-muscular (intact muscle fascia), the use of ultrasound or MRI examinations may help characterizing the injury details. Surgical intervention is rarely needed in the case of muscle strain.

Generally, comprehensive rehabilitation will allow the athlete to heal in a timely and efficient fashion. However, in rare situations, if the bleeding causes an increase in the pressure (compartment syndrome) of the muscle membrane, surgical drainage and fasciotomy may be necessary. If rehabilitation is unsuccessful (i.e. torn hamstring muscle), surgical intervention may be indicated. If the blood from a contusion begins to calcify, a condition known as myositis ossificans may develop. This usually occurs 4-6 weeks after injury when the blood begins to ossify and prevents optimal functioning of the involved muscle. Generally rehabilitation will reduce symptoms and the athlete can return to play in 2 to 3 months. If rehabilitation is unsuccessful, surgery may be indicated to remove the ossification.

Prevention

In general, prevention of muscle injury is always the goal and can be achieved through a:

• comprehensive pre-season conditioning program
• thorough warm-up
• attention to stretching to enhance muscular flexibility
• progressive strengthening exercises
• proper nutrition and hydration

If an injury does occur, a conservative rehabilitation program with an athletic trainer or physical therapist should be sought out. Upon completion of the prescribed therapeutic intervention, the athlete will be able to return to his/her prior level of play without risking further injury.

Nutrition

This is taken from an article from Erin O’Neill, a graduate assistant strength and conditioning coach at Virginia Tech.

Athletic Nutrition for Young Athletes

In a period when many parents enroll their children in organized sports, it is imperative that basic nutrition guidelines for young athletes be followed. This will help these children to progress to their desirable potentials. Along with their improvement in performance, a healthy diet may reduce injury, reduce recovery time between competitions, make them feel better both physically and mentally, and create healthy eating habits for life.

The guidelines to youth sport nutrition focus on getting the athlete enough energy and the right kinds of energy for the rigorous demands on their active bodies. A child should always receive a good meal at least an hour or two before practice or competition. In addition, you must encourage your youth athlete to eat a lot of food frequently. They need more fuel than the normal adult population due to their growth alone, but when physical activity comes into play, an increased amount of energy is called for. An effective way to ensure that your athlete does not go hungry is to place nonperishable items such as pretzels or sports bars in their book bags or practice gear bags. Even extra calories, such as those found in fruits or a sports drink, during practice is highly recommended.

The food pyramid is an excellent guide for parents to follow when deciding on what to feed their young athletes. Youngsters should be ingesting plenty of carbohydrates with unsaturated fat. Fruits, vegetables, whole grains and easily digestible foods are recommended. Junk foods, which are high in simple sugars and saturated fats, should be avoided, especially before activity. The sugars may create a quick burst of energy followed by a dive in energy levels. The fatty foods are hard to digest. For the adolescent athlete, it is important to watch calcium and iron levels. In periods of rapid growth, athletes are especially susceptible to deficiencies in these areas. Most importantly, proper hydration must be stressed. Dehydration greatly hampers performance and may even lead to heat stress or even heat stroke in extreme cases. Water (or sports drinks or diluted fruit juice) should always be on hand and readily available for young athletes at practices and competitions.

Lastly, refueling your athlete after activity is equally important but it is often overlooked. Nutritious meals help speed up the recovery process and replace nutrients that have been lost. If the athletes are rewarded for their performances in the way of sweets or fast food, it must be stressed that they should only receive these treats after their game and not as a replacement for regular meals. Following these guidelines will result in a youth athlete who can perform at optimal levels.

Nutrition & Soccer Performance

You wouldn't put low octane gasoline in a race car, would you? Yet, even today, with all the research on nutrition and athletic performance, athletes still fail to realize the connection between the food they eat and their ability to compete in sports. The time for a reminder is now.

Proteins, fats and carbohydrates are the main components of your diet. Protein supplies amino acids for many processes in the body, but supplies little energy for exercise. Despite all the bad press, fat is a necessary ingredient. Fat insulates nerves, carries substances in the blood, packs organs and serves as a warehouse for energy, some of which is used to play soccer. Carbohydrate is the main source of energy in your diet. How much carbohydrate you eat will directly affect your ability to run and is the subject of this article.

Carbohydrate is found in many foods like vegetables, fruits, breads, grains, pasta, and dairy products. When eaten, carbohydrates are broken down into glucose and stored in your liver and muscles as a string of glucose molecules called glycogen. If your ability to run far and fast is related to how much gas you have in your tank (glycogen in your muscles), then the more you have stored, the farther and faster you can run. In addition, if you eat properly after heavy training, you can actually store more glycogen than if you ate improperly. So you could cover even more distance at a fast pace. Is fat used for energy in soccer? Yes, during low intensity work like walking and slow jogging. You won't run out of fat for fuel, but you can run out of glycogen. You need glycogen to go fast - remember, soccer is not played at a walk.

Do we know anything about muscle glycogen and soccer? Plenty.

1. Most soccer players make poor food choices (too much protein and fat) so they enter games with less than a full tank of gas (less muscle glycogen than most athletes should have).

2. Most of the glycogen in the muscles is used in the first half of a game. By the end of the game, glycogen levels are almost zero. Your sprints get shorter and less frequent as the game goes on.

3. The more glycogen, the further and faster players run. A research study showed that players who ate lots of carbohydrate ran the most and only walked about 25% of the total distance. Players who ate a "normal" meal covered about 25% less distance and covered most of it at a walk. Can you guess who won this game?

Any suggestions for soccer players when choosing foods to eat?

• Choose foods with the highest carbohydrate and lowest fat count. Carbohydrates should make up 55-65% of the diet. Choose, for example, bagels over sliced bread, baked potato over french fries, a high carbohydrate cereal over a low carbohydrate cereal (read those labels!).

• A teenage or adult athlete should eat 450-600 grams of carbohydrate a day (spread it out over 24 hours-think you can eat that amount of spaghetti in one sitting? That's over 2 dry pounds of spaghetti!). Younger players would eat less because they are smaller. The rough formula is 7-10 grams/kg/day.

• If you make poor food choices and train regularly, you can't refill your glycogen levels before tomorrow's practice. Thus, glycogen levels stair-step down as the week goes on. It is important to eat plenty of carbohydrates during training, not just for matches.

• Your muscles are the most "thirsty" for glycogen right after exercise.

So try to eat a good supply of carbohydrates within the first 2 hours after play. Don't wait. Have carbohydrate rich foods available right after a game. This is especially important if you are playing in a tournament with many games in a short time. Give yourself every advantage and refuel for the next games. Choose fruit juices, carbohydrate replacement drinks, bagels and jam, fresh or dried fruit, uncooked "Chex Mix" types of finger food. If candy is acceptable to your parents, choose "clear" candy like "gummi" bears, jelly beans, etc. (chocolate-based candy has too much fat and calories). Stay away from the chips, burgers, fries, nachos, etc.; too much fat and not enough carbohydrates.

The smart athlete will try to give himself or herself every advantage to help their team to win. Knowing you are going into a game with a "full tank of gas" means you are ready for the highest demands of the game. Also, if you have eaten properly and are playing a team who played yesterday (who likely hasn't eaten properly), you know you are at an advantage and will be fresher in the second half.

This sports science article comes from the Sports Medicine Section at the Duke University Medical Center and UNC Hospitals. The authors are members of the US Soccer Sports Medicine Committee including from UNC Dr. William E. Garrett, Jr (US National Teams Physician and Committee Chairman), and John Lohnes. From Duke are Dr. Don Kirkendall (exercise physiologist) and Patty Marchak (athletic trainer for 1996 US Women's Olympic Team).

Proper Hydration

Proper hydration is an extremely vital part of soccer especially when playing multiple games in a short time frame. Players, parents and coaches must be aware of the special significance that hydration plays in a players’ performance. Outlined below are some tips and guidelines on proper hydration.

When a soccer player opens the refrigerator door or surveys the supermarket shelf to grab a drink to take to practice or a game, what choices does he or she have? The beverages that parents put in the fridge matter, especially when rehydrating active youth and teens. By the time most people become thirsty, they have lost important fluids and electrolytes (sodium and potassium), and may already be dehydrated. So it’s important to think about the most suitable beverages for active youth and teens before they drink.

How Much Do You Know About H2O? Water is an OK beverage, especially when nothing else is available. However, water has its limitations. It does not provide energy, which may be needed in a stop and go sport like soccer. Also, in an active situation most people, including kids, will stop drinking water before their fluid needs are met. Often this is because water lacks the taste appeal of a lightly flavored beverage. If given a choice, kids and teens will drink much more of a flavored beverage than a glass of water. As a result, recent studies have shown that if given water, kids and teens may not drink enough to prevent dehydration.

Know The Score About Sports Drinks. A properly formulated sports drink is a good choice for athletes of all ages—whether it’s for big brother after a soccer game or for little sister after playing in the yard all day—because it supplies energy and electrolytes that encourage them to drink by "turning on" their thirst. Recently published research by Oded Bar-Or, M.D., a Professor of Pediatrics at McMaster University, indicates that during exercise, children stayed better hydrated when they drank a sports drink compared to drinking plain or flavored water. The reason: children voluntarily drank more of the sports drink, which contained carbohydrate and sodium.

Ruth Carey, R.D., sports nutritionist and youth soccer coach, adds, "I’ve spent a lot of time on the sidelines of soccer games and parents, knowing my sports nutrition background, often ask my opinion on what kids should drink before, during and after activity. I tell them water is fine, but that I prefer to give my kids a flavored sports drink like Gatorade because they drink more and stay better hydrated." Somewhat surprising, sports drinks only contain half the sugar and calories of many other beverage choices, including fruit juices and regular soft drinks. Sports drinks also have less sodium than a glass of milk or a slice of bread.

The Juicy Story. Fruit juices are typically fine for children after the playing is over. They often contain important vitamins. However, juice isn’t always the best choice when rehydrating before or during activity. The high sugar content in juice can slow fluid absorption and increase the chance of a stomachache. No one wants to be sidelined because of a stomachache in the middle of a soccer game.

Carbonation: Forget the Fizz: Carbonated soft drinks, which are also high in sugar, are not appropriate during or after prolonged activity. The "fizz" in a carbonated beverage may cause a "burning" sensation in the mouth and may prevent your child from chugging enough fluids. Research shows that even a small amount of carbonation can also upset the stomach and cause a bloated feeling during exercise.

To Keep Your Players Cooled and Fueled Throughout the Summer Months, Follow these Tips:

• To help guard against the heat and dehydration, encourage your kids and teens to drink fluids before, during, and after sports and activities.

• Whether it’s extremely hot or not, have them drink on a schedule (approximately every 15 to 20 minutes during physical activity), because dehydration begins before they’re thirsty

• To keep beverages chilled for game day or other outside activity, freeze half of the fluid in the squeeze bottle the day before the game, and then add the rest of the fluid on game day.

The information herein was obtained from the website of Spirit United Soccer Club.