Title and Text-Orange - Cayuga Medical Center

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Injury Prevention for the Figure
Jake Veigel, MD
[email protected]
• To become familiar with basic injury
prevention practices and strategies that work
– Warm-up
– Strength and conditioning
– Rest, recovery, training, and monitoring
– Nutrition and hydration
Top 5 Myths of Injury Prevention
• Injuries just happen and are not preventable
• Stretching prevents injuries
• Males athletes sustain more injuries than
female athletes
• Protective equipment only makes athletes
more aggressive
• Braces work
What is the Greatest Predictor of
• Prior Injury
Stress fractures
Knee injuries
Ankle sprains
Low back injuries
Shoulder disorders
Heat illness
What is the Second Greatest Predictor
of Injury???
• Exposure
– Practice time
– Games played
– Duration of season
– Lack of off-Season
– Years participated
– Age of the athlete
What Types of Injuries Are
• Acute Injuries
• Overuse Injuries
Stress Fractures
Overuse Joint Pain
Injury Causes
• Mechanical stress beyond strength of tissues
• Improper technique
– shifts or creates high loads on structures not meant to
carry these loads
• Training errors (on or off the ice)
• Inappropriate nutrition
Individual Stress
Strength Imbalances
Active Warm-up
Active warm-up
– Increase heart rate,
blood flow, muscle
temperature, and
breathing rate
– Improves
Active Warm-up
• Athletes that use active warm-ups have
decreases in injury rates
– Warm up activities that practice
coordination and control are effective in
decreasing acute injuries, overuse injuries
and injury severity (over 1800 adolescent
soccer players).
Soligard et al British Medical Journal 2008, 2009
Active Warm-up (off-ice)
• Includes
Jogging, jump rope, side steps, carioca, bench stepping
Dynamic stretching
Hops , jumps, leaps, skips
Balance activities (one legged standing)
Strength and Conditioning
• Children can participate in strength training safely,
program must be designed for their age and maturity
– The program should be simple to understand and primarily consist of
multi-joint exercises
– The program should be a balanced full body workout
– The youth must be properly supervised at all times
– The youth must be able to follow directions and obey rules
– Safety is above all else (i.e. proper spotting, maintained equipment
and facility, etc.)
Strength and Conditioning
• General Guidelines are:
• 2 to 3 times per week
• Moderate loads only with higher reps (13-15)
• Typically 1 to 3 sets, though very little information specific to
children is available
• Focus on whole body, particularly at young age and skaters new to
strength training
• Always include a warm up
Vaughn & Micheli. Phys Med Rehabil Clin N Am. 2008.
Strength and Conditioning
• Include aerobic (20+ minutes 70
to 90% max HR), anaerobic (high
intensity intervals with rest
periods), and flexibility as part
of a total program
• Basic nutrition is needed for growth and
– Keeps bones strong
– Provides fuel for brain
– Provides energy for muscles and allows muscle growth
• Skaters have additional nutritional needs
Inadequate Nutrition
• Weak bones
• Inadequate growth of
muscles, bones
• Poor strength
• Fatigue and inattention
– Mistakes, poor technique, poor
performance and susceptibility to
• At least 2,000 calories
– Teenage Athletes need 2200 to 6000 depending on sport
and gender
• 55-60% should be carbohydrates (1100 calories)
– Whole grains
– Vegetables
– Fruits
– Beans
Hoch et al (2008) Nutritional Requirements for the Child and Teenage
Athlete, Phys Med Rehab Clin N am
• 12 to 15% of calories should be protein (240-300 calories)
– 2g/kg/day for active children
• Lean meat, beans, nuts, whole grains
– Too much protein:
• Tends to compromise carb intake
• Can lead to dehydration, weight gain, stress on kidneys and liver
– Protein intake after intense exercise improves muscle
• Peanut butter, cheese, yogurt
• Add carbs (cheese and crackers, yogurt and granola) to refuel and
• 20 to 25% of athlete’s diet should be fat
– Fats contain essential vitamins and are necessary for menstrual
– Fats are major energy source for light and moderate intensity exercise
Eat to Train
• Low glycemic index foods are best several hours
before intense training
– Whole grains, apples, vegetables
• High glycemic index are great right after and up to 2
hours after intense training
– Raisins, bananas, pasta, sports drink, white bread
– Chocolate milk
Nutrition for Adolescents
• Proper nutrient intake from
foods is essential for active
– Calcium is needed for bone
health and muscle contractions
• Suggested 1300 mg per day
(about 4 /12 cups of milk or
6.5 ox cheese)
• Need vitamin D to absorb
• Only 13.5% of girls get
enough calcium per day
• Iron necessary for oxygen delivery to
muscles by blood
– Suggested 8 mg day for girls and
boy, 11-15 for adolescents
– Eat lean red meet or dark poultry,
leafy greens, beans
– Avoid caffeine, drink OJ
– Insufficient iron increase risk for
anemia which can result in poor
performance during exercise
Vitamin D
• Vitamin D is needed for
bone health and the
immune and
cardiovascular systems
– Obtained from fish, eggs, fortified milk,
sunlight (UV radiation)
– Athletes who train indoors and live in
northern climates are at risk for vitamin
D insufficiency
• Fluids & Electrolytes
– Athletes rarely drink enough to balance sweat loss
– Dehydration decreases aerobic capacity and mental
– Recommendations for fluids are:
Drink fluids and be well hydrated 24 hours before exercise
14 to 20 oz about 2 to 3 hours before exercise
Drink 6 to 12 oz at 15 to 20 minute intervals during exercise
Children are more at risk for dehydration than adults
Keys to Success
• Be pro-active not reactive
• Focus on balance, agility, and jumping
exercises for conditioning
• Incorporate balance, agility, jumping exercises
as key parts of each warm-up
• Follow-rules and support safe sport practices
• Utilize appropriate safety equipment
Dr. Veigel’s Wish List
• All athletes would incorporate dynamic warm up
• Athletes would institute year round balance, agility,
plyometrics, and functional strength training
• An off-season for young athletes
• Safe rules need to be enforced/supported
• All athletes would get enough sleep
• All athletes would get appropriate nutrition