Wimbledon Injuries

In what seems to be an annual occurrence, Wimbledon organisers have again had to come out and defend the courts. After last year’s injury laden first week, early signs are that players are not faring better this year. But could there be another reason for these injuries, rather than the playing surface?

A study by McCurdie et al. (2017) looked at injury data from 2003-2012 at The Championships. They found that female players suffered more injuries per 1000 sets played than males (23.4 v 17.7) as shown in the graph below.

Can these injuries be attributed to the court?

Interestingly, McCurdie et al. published a breakdown of injury type. Their results showed a high percentage of injuries sustained at The Championships had been sustained prior to the tournament, whether acutely, recurring or chronic (the below table shows the breakdown).

In 2016, Tim Gabbett looked at the effect of workload and injury. His paper proposes the training-injury prevention paradox.

Gabbett suggests that physically hard (and appropriate) training may protect against injuries as high training loads are generally associated with better developed fitness and thus, good performance. One cost of high training load is often considered to be soft tissue injury risk. To address this risk, training loads could be reduced to decrease the incidence of injury, however low training loads (in the form of reduced training volumes) have also been associated with increased injury risk.

The competitive schedule

The schedule of modern tennis is so fierce (eg. Eastbourne finished the day before Wimbledon’s opening day), it is possible that a reduced training load and increased competitive load may be contributing to the injuries sustained, particularly at Wimbledon.

Sources:

Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 2016;50:273-280.

McCurdie I, Smith S, Bell PH, et al. Tennis injury data from The Championships, Wimbledon, from 2003 to 2012. Br J Sports Med 2017;51:607-611.


Arthritis and weather

You probably know someone who swears they can predict the weather by their arthritis pain. You may even be one of these people. There’s plenty of anecdotal evidence about the relationship between arthritis symptoms and weather.

Most people who believe their arthritis pain is affected by weather say they feel more pain in cold, rainy weather than in warm, dry weather. There is some research to support the arthritis-weather connection, but some studies fail to provide conclusive evidence.

A 2015 study by Timmermans et al. of 810 people with osteoarthritis, published in Journal of Rheumatology, found significant links between humidity, temperature and joint pain. The effect of humidity on pain was stronger when the weather was colder. In essence, they found that wet, winter days are no fun. Another 2015 study of 133 rheumatoid arthritis patients published in Rheumatology International found that their disease activity (swollen joints, pain) was lower when their days were sunny and dry (Savage et al., 2015).

According to the Arthritis Foundation

Some studies show a relationship between barometric pressure – a measure that refers to the weight of the air – and arthritis pain. A 2014 study of 222 patients with osteoarthritis of the hip seemed to support that barometric pressure and relative humidity influence symptoms (Dorleijn et al., 2014).

Changes in barometric pressure seem to be more important for pain levels than the actual barometric pressure, meaning that either a cold front or warm front coming in can ramp up the ache in your joints. But once the weather has settled in, pain will reduce. One study showed that each 10-degree temperature drop was linked with an incremental increase in pain. And that rising barometric pressure also triggered pain in people with arthritis (McAlindon et al., 2007).

The human body is made up of 70 to 80% water

It’s hardly surprising that changes in barometric pressure can have an effect on arthritis, and living in places in the world that have fewer barometric changes can lead to a more comfortable life for arthritis sufferers. No wonder that so many older folk move to warmer climates.

Sources:

Weather and Arthritis Pain

Dorleijn, D. M., Luijsterburg, P. A., Burdorf, A., Rozendaal, R. M., Verhaar, J. A., Bos, P. K., & Bierma-Zeinstra, S. M. (2014). Associations between weather conditions and clinical symptoms in patients with hip osteoarthritis: a 2-year cohort study. PAIN®155(4), 808-813.

McAlindon, T., Formica, M., Schmid, C. H., & Fletcher, J. (2007). Changes in barometric pressure and ambient temperature influence osteoarthritis pain. The American journal of medicine120(5), 429-434.

Savage, E. M., McCormick, D., McDonald, S., Moore, O., Stevenson, M., & Cairns, A. P. (2015). Does rheumatoid arthritis disease activity correlate with weather conditions?. Rheumatology international35(5), 887-890.

Timmermans, E. J., Schaap, L. A., Herbolsheimer, F., Dennison, E. M., Maggi, S., et al. (2015). The influence of weather conditions on joint pain in older people with osteoarthritis: results from the European project on OSteoArthritis. The Journal of rheumatology42(10), 1885-1892.


Why we must stop counting calories

One portion of grapes: 60 calories. Three rich tea biscuits: 160 calories. One serving of cereal: 220 calories. Sound familiar? You’ve probably tried counting calories to lose weight—and maybe it even worked, at first anyway. Over time, though, those pounds climbed back on because of one important point: Calorie counting doesn’t work. Kim has worked with many patients where weight is an issue and agrees with Jonathan Bailor, author of the new book, The Calorie Myth. In fact, it’s one of the worst strategies you can use when you want to lose weight.

“I used to count calories too”

“I’d try to eat 6,000 a day because I wanted to bulk up,” says Bailor. A personal trainer at the time, Bailor’s clients were mainly women over 35 who wanted to slim down, and his advice to them was the same as what he gave himself: Count calories, but stick to 1,200 a day to lose weight. The results weren’t good for anyone. “I was getting sick and fat, and these women, even on such restricted diets, were also getting sick and fat. I stopped training because I realized that advising them to count calories was actually hurting them.”

Bailor says he noticed a disconnection between research and what experts, including him, were teaching others about counting calories, which led to his book.

Yes, calories exist

Calories are essentially a measure of how much “energy” a food contains, and if you eat too many you will gain weight. But they’re not the whole picture, not even close. Case in point: “I can sell pink slime laced with high fructose corn syrup, shrink the serving size down to 100 calories, and tell you it’s healthy because it doesn’t have many calories,” says Bailor.

 

Myth: All calories are equal

Your body doesn’t treat all calories the same way. High-quality calories come from foods that are rich in nutrients, like broccoli, leafy greens, avocados, nuts, chicken, eggs, and grass-fed beef. They fill you up quickly and keep you full for a long time, says Bailor. They also trigger the release of hormones that tell the body to burn fat, your body has to work harder to break down fibre versus processed foods. On the other hand, a diet filled with processed foods, added sugar, and refined grains aren’t inherently satisfying, so you’re more likely to overeat. They also prompt your body to store fat, he says.

Myth: 3,500 calories = 1 pound

Unfortunately, your body doesn’t run on maths. “It runs on biology,” says Bailor. The reason you can’t cut out a daily 100-calorie latte and lose 10 pounds (or won’t necessarily gain 10 pounds if you start drinking one every day) is because calories are only a small portion of the equation. Your body works hard to keep you in a set weight range by regulating your appetite and metabolism through your hormones, genes, and brain. If you eat too much one day, your body would burn more calories and lower your appetite to compensate. The lesson? If you overeat one day, the key is not to freak out and continue to overeat. That will make you gain weight.

Myth: Cut calories to lose weight.

Dieting only tackles the symptom (e.g., you need to lose weight) rather than the underlying cause (e.g., what’s keeping you from being slim). Think of it like a clogged sink, says Bailor. “What if your plumber came in and said the cure for the clog was to stop using your sink?” It fixed the symptom (the sink’s not going to overflow) but not the cause (what’s causing the clog?). The cause of that clog is, you guessed it, eating poor quality foods that throw your fat-burning, appetite-taming hormones out of sync.

Myth: Eating 1200 calories or less will make you slim.

Actually, says Bailor, “counting calories leads to failure 95.4% of the time, and often leaves people fatter.” He notes that he sees many menopausal women consume 1,000 calories a day and yet, they still can’t lose weight. If you starve yourself, your body slows down your metabolism and burns muscle rather than fat. Start eating normally again after a restrictive diet, and you’ll gain more weight because you have a pokey metabolism that can’t do its job.

The bottom line on calories:

When you eat healthy foods, you don’t have to count calories. As long as you feed your body what it needs, it’ll take care of the rest, including keeping you at a healthy weight. So relax about keeping a calorie journal and focus on quality over quantity. High quality foods include non-starchy vegetables (leafy greens, mushrooms), nutrient-dense proteins (seafood, low-fat plain Greek yogurt), and whole-food fats (avocado and flax seeds). One thing they all have in common? You don’t need a nutrition label to tell you they’re healthy.

 

Gluteal Weakness

Hip or Knee painIf you’re suffering from bad knees, clicking hips or backache, the culprit may be lazy, under-used gluteal (buttock) muscles.

An increasingly sedentary lifestyle is being blamed for a condition dubbed Dormant Bottom Syndrome (DBS) by an American medic. It’s becoming a more and more prevalent problem due to the amount of time we all spend sitting down, whether it’s at a desk or relaxing at home or in the garden.

DBS develops when the gluteal muscles in your backside (three, known collectively as the glutes) are weak and the hip flexors – muscles that control the movement of your hips – are tight. This leads to muscles and joints around them taking the strain, which can cause all sorts of injuries to the back, hips, knees and elsewhere.

The stronger and more resilient your glute muscles are, the better control you will have over your hip, knee, ankle and foot, meaning less chance of overloading and injuring these joints and structures around them when you run, jump, hop, skip, dance or prance around a square pitch, an oval field, a circular track, a straight line, a diagonal line, whether you’re kicking a ball, throwing or hitting something with a bat, stick or racquet or even pushing or pulling someone/something.

So in a nutshell the glutes are vitally important to pay that little extra time and attention to, in particular the one called Gluteus Medius.

The gluteus medius is mainly responsible for keeping everything in relatively good alignment and stabilising the pelvis when one leg comes of the floor, which it does a lot, for example when walking we spend approx 55% of the time on one leg, this goes up to 85% when running.

If you’re suffering from a lazy bottom there are exercises you can do to remedy the problem. Squats, lunges and bridges can all help, as can straight leg deadlifts – where you keep your legs, arms and back straight and hinge at the waist to lift and lower a weight. However, it is easy to do these exercises using the wrong muscles, and then only make the problem worse. The key is to slowly retrain the body.

Other good exercises which are easy to do are different versions of Theraband walks. For these you will need a glute band – this is a simple piece of Theraband or similar stretchy band tied in a loop. The glute band should be about 6-9 inches when tied and should be slightly taut when you have it around your ankles and are standing with your feet about 3 inches apart.

The Crab Walk

  • Stand sideways, with the band around your ankles
  • Keeping your toes turned outward, pull your legs apart wide
  • Squat down bending the knees, keeping your back straight and keeping your knees turned out slightly in the same alignment as your toes
  • Side step by bringing one foot in half way keeping the leg alignment and not leaning over with your top half
  • Do 10-15 side steps one way and then return in the other direction
  • Think not a waddle but a glide…

https://www.youtube.com/watch?v=JDHiqwItrsM&feature=youtu.be

The Waltz Walk

  • Stand in the same squat stance as the Crab walk but facing forwards
  • Bring one foot in towards the other, then push it out forwards and to the side roughly at a 45 degree angle (like a mini side lunge)
  • Repeat with the opposite leg, keeping the low squat position, not moving, leaning the top half of your body and keeping the knee alignment over the 2-3rd toes
  • Do 10-15 steps forwards and then reverse by walking backwards immediately 10-15 steps

https://www.youtube.com/watch?v=JzGBo_oeS40&feature=youtu.be

The ‘Pee’d your Pants’ Walk

  • Stand in the same squat stance as the Waltz Walk but this time keep up on the balls of your feet, great for the ankles as well.
  • Walk forward in this squat position on the balls of your feet, keeping your leg and knees apart as if walking on railway tracks
  • Do not let your heels touch the floor
  • Do 10-15 steps forwards then reverse by walking backwards immediately

https://www.youtube.com/watch?v=wJaXqyXKXdU&feature=youtu.be

Sources: www.dailymail.co.uk; thesportsphysio.wordpress.com

 


Diets and Slimming

Obesity

Forget those strict regimes of self-denial that are truly impossible to keep up, what’s needed is an eating regime that you can follow for life and that fits in with your own personal lifestyle.  The western world is obsessed with diets we have become overfed and under nourished, obesity is now at worrying levels in both adults and children and un-realistic images of super thin models and muscle men give us a distorted view of what is to be fit and healthy.

The successful slimmer loses weight slowly with the key being to establish a way of eating and exercising that becomes second nature and lasts a life-time. It is when we feel well in ourselves that going back to our old patterns is no longer a consideration.

The aim of an effective regime is to bring about weight loss by reducing the amount of calories we take in from food and drink, and increasing the amount of calories we burn through exercise. What is very important here is that we want to lose fat not muscle, some people think that means cutting all fat from the diet, far from it, if you reduce good fats in the diet you can become hungry and many low fat foods are high is sugar. If you don’t burn off that sugar, the body will store it as fat.  It’s all about getting the right balance and eating certain foods in moderation.

The Myths 

Some slimming plans are scientifically based whilst others can be quite dangerous.  Crash diets or detox diets if done incorrectly and not under supervision at best can cause water and protein to be lost rather than fat and at worst can lead to liver and kidney issues and disordered eating. Faddy regimes do not encourage healthy eating habits or establish safe and permanent weight loss.

Healthy slimming regime

Any programme undertaken, whether it includes smoothies, protein shakes, salads etc. must contain all the nutrients the body needs. To achieve this, vegetables, fruit, lean, meats, fish, pulses, etc. need to be included. Cakes, biscuits, sugary foods, alcohol and processed fats have no value and therefore need to be excluded. It all sounds very simple and fundamentally it is.  However we are all individuals and what works for your friend may not work for you.  This is where personalised nutrition comes in.

Personalised nutrition is where a programme is worked out especially for you, taking in to account your lifestyle and food choices.  A regime that includes lots of fruit and veg when you suffer with IBS or other digestive issues could be quite unhelpful and living off smoothies made with too many high sugar fruits could be more harmful than anything else.

Keep a food diary of everything you eat and drink and the times for a period of four weeks.  This will show you a pattern of eating, some things such as eating late at night or skipping breakfast or snacking on high calories treats throughout the day need to be addressed but when choosing the regime that works for you think about what you do already and adapt. You will be far more successful than trying something that is completely different and almost impossible to stick to.

If you would like further help to devise a plan especially for you, come in to clinic and see Kim, she will be only too happy to work with you to achieve your goals.

 


Genes in sport

DNAGenetics is becoming hard to ignore, with genetic discoveries becoming more regular and the increasing use of genetic testing. But is exercise and sporting potential influenced by our genes?

It has now thought that a high percentage of the variance in the athlete status is explained by genetic factors, meaning Usain Bolt, Mo Farah and Dennis Kimetto, for example, all have a genetic make up which predisposes them to sporting potential. In 2009 a scientific study looked at endurance performance and a multitude of genes in athletes compared to a control group. They found that 66% of the elite endurance runners tested carried eight or more endurance-related genes.

In addition to this, the dominance of Jamaicans and Americans of west African and Caribbean descent in world class sprinting has sparked intense debate about whether running at speeds that push the limits of what is humanly possible is all in the genes.

It is an idea that has its attractions. After all, it does seem baffling that the tiny island nation of Jamaica with a population reaching barely 2.8 million can consistently produce world-beating sprinters, while the whole of Europe can hardly register more than a handful of athletes in the top 100. It is thought that this is due to the presence of ACTN3 – the “speed gene” as it has been dubbed. This gene makes fast-twitch muscles twitch fast. Lacking the ACTN3 protein does not seem to have any harmful health effects but does affect running ability. Scientists conclude that it is almost impossible for someone who lacks the ACTN3 protein to become an elite sprinter. The so-called sprint gene is more common in those of West African descent than in Europeans, according to a study published in the American Journal of Human Genetics.

Is genetic testing useful in sport? It depends on a few factors. What genes are being tested, why are they being tested and how many genes are being tested?

Genes have now been coded and studied which can assist athletes and coaches in planning training sessions, know how long recovery is likely to take from training sessions and potentially whether the athlete is susceptible to certain injuries. It is a contemporary notion that training can be tailored and prescribed based on somebody’s genes. An Australian rugby league team claim they have done just that and gained a competitive advantage over their rivals by using genetic testing to design players’ training programmes.

Although the genetics of sport is now well beyond academic interest, it is important not to look too closely at single genes as some genes may be present but can be reliant on certain nutrition to be effective. It is also the case for performance; just because a gene is present, training still needs to be done to gain optimal performance.

 

Sources: articles.chicagotribune.com; www.geneticliteracyproject.org; Functional Sports Nutrition – May/June 2014