Athletes
Sports Spine Specialist Chiropractic Team: Athletes strive to achieve their body’s maximum performance by participating in numerous training regimens consisting of strenuous exercises and physical activity and ensuring they meet all of their body’s nutritional requirements. Through proper fitness and nutrition, many individuals can condition themselves to excel in their specific sport. Our training programs are designed for athletes that look to gain a competitive edge in their sport.
We provide sport-specific services to help increase an athlete’s performance through mobility, strength, and endurance. Occasionally, however, the excess workouts can lead many to suffer injuries or develop underlying conditions. Dr. Alex Jimenez’s chronicle of articles for athletes displays in detail the many forms of complications affecting these professionals while focusing on the possible solutions and treatments to follow to achieve overall well-being.
by Dr Alex Jimenez | Diets, Fitness
Macaroni and cheese mixes made with powdered cheese contain high levels of potentially harmful chemicals called phthalates, according to a new study.
Phthalates, which can get into food from packaging and equipment used in manufacturing, have been linked to genital birth defects in infant boys and learning and behavior problems in older children, The New York Times reported.
Researchers tested different cheese products and found that all 10 varieties of macaroni and cheese included in the study had high levels of phthalates, even those labeled as organic.
“The phthalate concentrations in powder from mac and cheese mixes were more than four times higher than in block cheese and other natural cheeses like shredded cheese, string cheese and cottage cheese,” said Mike Belliveau, executive director of the Environmental Health Strategy Center, one of four advocacy groups that funded the report, according to The Times.
The other groups were the Ecology Center, Healthy Babies Bright Futures and Safer States.
“Our belief is that (phthalates are) in every mac ‘n’ cheese product – you can’t shop your way out of the problem,” Belliveau said.
He encouraged consumers to contact manufacturers and ask them to determine how phthalates are getting into their products and take action to prevent it. Nine of the cheese products tested were made by Kraft. Company officials did not respond to requests for comment on the study findings, The Times reported.
The U.S. government phthalates from children’s teething rings and rubber duck toys a decade ago.
by Dr Alex Jimenez | Diets, Fitness, Pregnancy
Pregnant women who drink non-diet sodas during pregnancy are more likely to have kids who carry extra body fat by age 7, researchers say.
In the study of more than 1,000 mother-child pairs, each additional serving of sugary soda per day consumed in pregnancy was associated with higher increments of waist size and body mass in kids years later.
“Sugary beverages have been linked to obesity in children and adults,” said study author Sheryl Rifas-Shiman of Harvard Medical School in Boston.
Although past research has tied sodas and some fruit drinks to excess weight gain, obesity, metabolic syndrome and type 2 diabetes, few have looked at beverage intake during pregnancy, she and her colleagues write in Pediatrics.
“Childhood obesity is widespread and hard to treat,” Rifas-Shiman told Reuters Health by email. “So it’s important to identify modifiable factors that occur prenatally and during infancy so prevention can start early.”
The researchers recruited 1,078 women from among patients at eight obstetric offices affiliated with Atrius Harvard Vanguard Medical Associates in eastern Massachusetts.
The study team had in-person meetings with each woman at the end of her first and second trimesters, as well as during the first few months after her baby was born. In addition, kids were assessed in early childhood, around age 3, and in mid-childhood, around age 8. Mothers also completed mailed questionnaires every year for the child’s first six birthdays.
At all visits, researchers collected information about both parents and details of the household. During pregnancy, women answered questionnaires about what they typically ate and drank, including how much regular and sugar-free soda, fruit juice, fruit drinks and water they consumed each day.
At the mid-childhood visit, when kids were between ages 6 and 11 years, the research team measured each child’s height, weight, waist circumference and skinfold thickness. With these measurements, they calculated body fat percentage and body mass index (BMI), a measure of weight relative to height.
When researchers looked at data gathered during pregnancy, they found that more than half of mothers had consumed more than half a serving a day of non-diet soda during pregnancy, and nearly 10 percent had consumed two or more servings a day.
Mothers who drank more sugary drinks during pregnancy tended to be younger, had higher prepregnancy BMI, lower education, lower income, shorter breastfeeding times and were more likely to have smoked during pregnancy.
About one quarter of the children were overweight or obese by mid-childhood, and BMI, waist circumference and skinfold thickness were highest among kids whose mothers drank at least two servings of sugary drinks per day.
Only regular sodas were associated with this difference. Juice, diet soda and water consumed during pregnancy weren’t linked to a higher BMI score in kids. The research team also didn’t see differences based on the mother’s weight, race or ethnicity, the child’s gender or the amount of soda children themselves drank.
“I was surprised that maternal intake seemed to be more important than child intake,” Rifas-Shiman noted.
In the future, she and colleagues plan to study the long-term effects of efforts to reduce sugary beverage intake during pregnancy. They’re now using new methods to analyze when children’s intake of sugary beverages matters the most for their weight and health.
“I was struck that the differences in children’s body composition were seen in relation to intake levels that appear unremarkable, even less than one serving per day,” said Sian Robinson of the University of Southampton in the UK, who wasn’t involved in the study.
“We need to know more about the long-term effects of maternal nutrition on offspring health,” she told Reuters Health by email. “Few intervention studies in pregnancy have longer-term follow-up data to describe the effects on children’s body composition.”
Several of these intervention studies have been completed recently, Robinson added, and that follow-up data will be available soon.
“The links between sugar-sweetened beverages and obesity are well-established,” she said. “But this new data suggests mothers’ consumption is important and has public health relevance.”
by Dr Alex Jimenez | Diets, Fitness
It’s hard to eat right all the time, but making small improvements by choosing healthier foods now and then may significantly boost one’s chances of living longer, said a US study Wednesday.
The report in the New England Journal of Medicine is the first to show that improving diet quality over at least a dozen years is associated with lower total and cardiovascular mortality.
Researchers at Harvard University tracked dietary changes in a population of nearly 74,000 health professionals who logged their eating habits every four years.
Researchers used a system of diet-quality scores to assess how much diets had improved.
For instance, a 20-percentile increase in scores could “be achieved by swapping out just one serving of red or processed meat for one daily serving of nuts or legumes,” said a summary of the research.
Over the 12-year span, those who ate a little better than they did at the start — primarily by consuming more whole grains, fruits, vegetables, and fatty fish — saw an eight to 17 percent lower risk of dying prematurely in the next 12 years.
Those whose diets got worse over time saw a higher risk of dying in the next 12 years of follow-up, on the order of a six to 12 percent increase.
“Our results highlight the long-term health benefits of improving diet quality with an emphasis on overall dietary patterns rather than on individual foods or nutrients,” said senior author Frank Hu, professor and chair of the Harvard Chan School Department of Nutrition.
“A healthy eating pattern can be adopted according to individuals’ food and cultural preferences and health conditions,” he added.
“There is no one-size-fits-all diet.”
by Dr Alex Jimenez | Diets, Fitness
The U.S. is one of the world’s laziest countries, according to a new Stanford University study that used smartphone measurements of the number of steps taken by people in 46 countries.
The study, published in the journal Nature, included 700,000 participants and was “1,000 times larger than any previous study on human movement,” co-leader and Stanford bioengineering professor Scott Delp said, the BBC reported.
Countries with the highest average number of steps walked included China, Ukraine, Japan, and No. 1 Hong Kong, with 6,880 steps walked per day on average, USA Today reported.
The U.S. ranked in the bottom half of countries represented, with 4,774 steps walked per day, just below the worldwide average of 4,961 steps. Indonesia had the least steps walked with 3,513 per day on average, USA Today reported.
The study found that countries where people walked a similar amount of steps each day had lower rates of obesity, whereas countries where some people walked a lot and others walked very little had higher rates of obesity. The U.S. falls into the latter category, with high levels of what the study called “activity inequality.”
The study analyzed a total of 68 million days’ worth of data and tracks people’s activity over longer periods of time than previous studies, the BBC said.
Women averaged about 1,000 fewer steps than men in the U.S., and suburban areas reported fewer steps on average than urban, city areas that are more pedestrian-friendly.
Researchers hope the data might help design towns, cities, and neighborhoods that encourage more physical activity.
by Dr Alex Jimenez | Diets, Fitness
Western diets, high in sugar and fat, cause liver inflammation, especially in males, according to a new animal study in The American Journal of Pathology. Inflammation was most pronounced in males that lacked farnesoid x receptor (FXR), a bile acid receptor.
The study also found that probiotics may prevent and treat the condition, keeping it from advancing to liver cancer.
“We know the transition from steatosis, or fatty liver, to steatohepatitis — inflammation in the fatty liver — plays a crucial role in liver injury and carcinogenesis,” said lead investigator Yu-Jui Yvonne Wan, Ph.D., Professor and Vice Chair of the Department of Pathology and Laboratory Medicine at UC Davis Health.
“Because the liver receives 70 percent of its blood supply from the intestine, it is important to understand how the gut contributes to liver disease development,” Wan said.
“Our data show that diet, gender, and different antibiotic treatments alter the gut microbiota as well as bile acid profile and have different effects on liver inflammation,” she said.
Wan used an FXR-deficient mouse model (FXR KO), which has become an important tool to better understand the role of diet and inflammation in the development of liver diseases, including cancer, because patients with cirrhosis or liver cancer also have low FXR levels.
Other studies have found that mice deficient in FXR spontaneously develop liver problems and tumors even when they are fed a normal diet.
In this study, FXR-deficient mice as well as wild mice were fed either a Western diet or a matching control diet for 10 months. Both Western diet-fed wild-type mice and control diet-fed FXR KO mice accumulated fat in the liver, which was more severe in males than females.
The study suggested that antibiotics might help block inflammation in control mice, but not in the FXR KO mice fed a Western diet. It also indicated that probiotics might also deter some of the inflammation.
“Our results suggest that probiotics and FXR agonists hold promise for the prevention and treatment of hepatic inflammation and progression into advanced liver diseases such as cancer,” Wan said.
A recent Australian study found that zinc may be a major key in fighting liver damage. An article published in Nature Communications found that zinc had the potential to be a simple and effective treatment against acute and chronic liver inflammation.
Other natural substances have been found to be effective against liver disease. A 2016 study conducted at the University of Southampton found that two cups of coffee a day reduced the risk of liver cirrhosis — scarring due to alcohol and viruses like hepatitis C — by 44 percent.
by Dr Alex Jimenez | Diets, Fitness
Australian researchers have found that exercising as a child could potentially counteract the damage of a high-fat diet later in life.
Carried out by a team from the Liggins Institute at the University of Auckland, the animal study looked at the effect of different diets and exercise programs on rats’ bone health and metabolism, focusing on the activity of the genes in bone marrow.
Rats were given either a high-fat diet and a wheel for extra exercise, a high-fat diet but no wheel, or a regular diet and no wheel.
High-fat diets in childhood are known to “turn up,” or increase, the activity of other genes that cause inflammation — the body’s natural self-protective response to acute infection or injury. Ongoing inflammation as a result of high-fat diets can damage cells and tissues, increasing the risk of obesity, heart disease, cancer among other conditions.
However, the team found that in the rats given a high-fat diet and an exercise wheel, the early extra physical activity caused inflammation-linked genes to be turned down, not turned up.
It appeared that exercise altered the way the rats’ bones metabolized energy from food, disrupting the body’s response to a high-calorie diet.
“What was remarkable was that these changes lasted long after the rats stopped doing that extra exercise — into their mid-life,” commented Dr Justin O’Sullivan, a molecular geneticist at the Institute.
“The bone marrow carried a ‘memory’ of the effects of exercise. This is the first demonstration of a long-lasting effect of exercise past puberty.”
“The rats still got fat,” he pointed out, “but that early extra exercise basically set them up so that even though they put on weight they didn’t have the same profile of negative effects that is common with a high fat diet.”
Dr O’Sullivan says that the results may help explain why even though obesity and diabetes are often linked, not everyone who is obese develops diabetes.
“It also strongly emphasizes the health benefits of exercise for children.”
The team are now carrying out further research, varying the exercise and looking at the even longer-term effects into old age in the hope of recreating their results.
by Dr Alex Jimenez | Athletes, Complex Injuries, Physical Rehabilitation, PUSH-as-Rx
In the first part of the 2-part article on femoro-acetabular impingement (FAI), chiropractor, Dr. Alexander Jimenez discussed FAI and how it can lead to insidious onset abdominal pain and damage the hip joint labrum, leading to early arthritic changes. Given that conservative management generally fails in young athletes and needs operation, part two describes the post-operative rehabilitation period required to take an athlete back to full competition.
The post-operative rehabilitation period is highly dependent on the magnitude of pathology and the subsequent procedure; weight-bearing development is consequently variably reported in the literature.
If the labrum is surgically repaired, then protected weight bearing is encouraged to allow the repair site in order to be protected during the early healing phase. Also, avoiding extremes of flexion (beyond 60�) and also internal/external rotation for the initial 4 to 6 weeks is important to safeguard the repaired labrum. Any positions that possibly create an impingement and boost inflammation ought to be prevented. These include:
- Deep squatting
- Prolonged sitting
- Low couch sitting
- Lifting off the ground
- Pivoting on a fixed foot
These positions are more safely tolerated following the six week post-operative period. But on account of the selection of hip flexion limitations imposed in the initial six months, usual activities of daily living are rather restricted, making yield to work and daily chores challenging if not impossible from the first few weeks following surgery. Therefore, the post- surgical patient does have to make substantial lifestyle changes and they need assistance in the first six weeks following surgery.
Special precautions in certain types of FAI processes. Reshaping of the femoral head- neck junction can weaken the rectal neck so particular care must be taken in this post- operative period. Fracture of the femoral neck is an unlikely but potentially serious complication after a reshaping process. The athlete may be allowed to bear full weight, but crutches are needed to avoid twisting movements during the initial four weeks after surgery. High impact pursuits and high torsion moves should be prevented in the first 3 months, as bone grafting requires around three weeks to attain full structural integrity.
Furthermore, if microfracture of this femoral head is also done for femoral head cartilage defects, then the athlete ought to be restricted to partial weight- bearing for two weeks so as to optimize the premature maturation of the fibrocartilaginous healing response.
Key points
1. Weight bearing status is dependent on the kind of reshaping procedure, whether the labrum was repaired, and also what the surgeon favors
2. Steer clear of hip flexion beyond 60� in the first 4-6 Weeks
3. Avoid extremes of rotation
Post-Surgical Rehab
Rehabilitation protocols provided in the literature have a tendency to be quite generic in their own advice and at best explain broad transitional phases during the rehab process. They usually describe the transition in weight bearing status, the development of gait through walking into jogging, and give general guidelines as to how to and when to progress activity based on a time dependant strategy.
They then progress describing transitions into twisting and affect actions — usually explained as beginning at 3 weeks following surgery — and generally the guidance is that the speed with which the athlete progresses is variable and might need yet another 1 to 3 months to get full return based on the game. Trainers are usually advised that return to sports after surgical correction of FAI can require 4 to 6 weeks. However it’s critical that progression through rehabilitation phases is driven more by subjective and objective measures during the transition phases. This allows the athlete and therapist to track load (type and quantity) and ascertain whether the joint arrangements are able to withstand changes in load securely.
Wahoff et al (2014) have provided some standards which may be utilized to guide the transition from one point to the next(1). They describe their rationale and supply a complete description of all of the cited tests in their printed clinical comment. Essentially, the exit criteria they offer in each phase are as follows;
So as to advance through the six clarified stages, the athlete may undergo extensive physiotherapy, focusing on hip range of movement exercises, manual therapy and trigger point releases, active stretching, potentially deloaded activities like hydrotherapy or Alta G walking/ running and strong hip rotator and gluteal strengthening exercises. Much of this will be ‘controlled’ and led by the wishes of the surgeon as they will provide the framework on if and what happens concerning loading.
But more direct physiotherapy Interventions have been devised to direct the physiotherapist through the rehabilitation protocol. The Takla-O�Donnell Protocol (TOP) is a validated physiotherapy intervention program which may be utilized to induce the arthroscopically handled FAI patient (Bennel et al)(2).)�This protocol is shown in box 2.
Hip Muscle Control
The focus of the rest of this article Will be to summarize some common yet powerful hip strengthening exercises which may be used to progress the hip muscle control throughout the rehabilitation phases.
Regaining hip muscle power, particularly in the heavy hip external rotator group, is imperative from the FAI recovering athlete. Good muscle endurance and strength in those muscle groups will ensure adequate hip joint compression happens with motion to reduce any shearing effect between the head of femur and acetabulum(3). The muscle groups needing focus are (see figure 5):
- Posterior fibres Gluteus Medius (PGMed)
- Gluteus minimus
- Superior and Inferior Gemellus
- Internal and External Obturator
- Quadratus Femoris
- Piriformis
There’s plenty of exercises that can be utilized to fortify the hip joint musculature. The chosen ones below are a sample of some effective exercises that can be used throughout the rehabilitation phases. However, the key requirements of the contained exercises include:
1. Performed in neutral stylish places to no more than 60 degrees hip flexion. This range of movement protects the hip joint from any possibly damaging impingement.
2. Minimal rotation of the hip, letting them be used in most stages of the rehabilitation process.
3. Performed isometrically or utilizing little oscillating concentric/eccentric contractions — to contract and hold to maintain the hip joint compacted and stable. This represents how these muscles work in individual function.
Summary
In many ways. hip joint labral tears, capsule sprains, cartilage and muscle accidents and bony architectural issues like FAI can all lead to debilitating hip pain. FAI is a real concern for the athlete as the existence of a bone abnormality may lead to a painful hip impingement, damage to the acetabular labrum and premature onset degeneration. FAI’s don’t respond to conservative management. If the athlete suffers debilitating pain that affects competition then the options are either to cease competition all together or have the FAI surgically corrected. Once corrected by the surgeon, regaining complete motion and muscle strength and ultimate game related functional skills will require some time. Hip rotator muscle strengthening must shape the foundation of all handling post-surgical FAI issues.
References
1. International Journal of Sports Physical Therapy. 9(6); pp 813-826
2. Arthroscopy. 2006;22(12):1304-1311
3. Int J Sports Phys Ther. 2012;7(1):20-30.
