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.
With the competitive season looming, chiropractor Dr. Alexander Jimenez�gives insights & examines the current best thinking on vaccination for athletes, and makes recommendations for sports clinicians.
Without doubt, vaccination is one of the greatest triumphs of modern medicine. Many serious diseases that used to routinely maim or kill large numbers of people are no longer a threat. More than that, vaccination can prevent outbreaks of less serious illness, which although not life threatening, are still unpleasant, leading to missed time from work and school.
Anyone with young children or who has travelled extensively abroad will (hopefully) understand that a programme of vaccination is either required or recommended. When it comes to the travelling athlete however, the situation is rather more complex. While the basic vaccinations (eg typhoid, hepatitis etc when travelling to certain regions of the tropics) are of course still required, clinicians will also want to ensure that their athletes stay as well as possible to compete at their full potential. A mild illness that is an inconvenience to a tourist may be a disaster for an athlete focusing on the peak of his/her season!
Sports clinicians may therefore wish to consider extra vaccinations to minimise the risk of more minor conditions. However, this approach raises a whole new set of issues. For example, which additional vaccinations may be use for athletes who regularly travel abroad? What are the possible side effects of these extra vaccinations and how should vaccines be timed to maximise immunity during the competition, while minimising disruption to training in the run up to competition?
Athletes Are Different
There exists some uncertainty about the most appropriate vaccination regimens in athletes among team doctors and other physicians because general public health vaccination guidelines cannot be easily transferred to elite athletes. Complicating factors include the typical circumstances of athletes� daily life, such as frequent travelling to foreign countries or close contact with teammates and opponents, which might indicate the need for a modification of recommended vaccination schedules. In addition, intense physical activity of training and competition with its possible effects on the immune function can affect decisions about execution and timing of vaccination.
Other complicating factors are that vaccination recommendations are formulated around a public health policy rather than for specific individuals and are likely to change over time(1-3). Also, there�s the issue of cost effectiveness; the majority of vaccines that are not generally recommended are not recommended because the medical benefit is not regarded sufficiently balanced with the costs if implemented across the whole population. This is despite the fact that they may be potentially beneficial in specific individuals(4,5). It�s also important to understand that generalised recommendations take no account of the implications of the effects of illness in athletes, which can be far more profound and far reaching than in the general public (see Box 1).
Further reasons as to why athletes are different when it comes to vaccination include the following:
Athletes are often in close contact with opponents and teammates, which increases the risk of transmission of many diseases, particularly respiratory- transmitted diseases(9,10). Typically, a contact of less than 1-2 metres distance is necessary to transmit diseases such as influenza or other respiratory- transmissible agents such as varicella(11,12).
For blood-borne diseases, the transmission risk due to sport is less pronounced but athletes are still at higher risk than the general population(13,14).
Even healthy non-vaccinated athletes being exposed to an infectious agent (eg contact with a diseased individual) may have to be excluded from training and competition for medical reasons. Usually, such an exclusion has to last for the complete incubation period of a disease, which may be up to three weeks.
Putting all these factors together, the recommendation is that elite, competitive athletes should be vaccinated more aggressively than the general public(15).
Which Vaccinations?
The decision as to which vaccinations are given prior to foreign travel will depend on a number of factors, including the travel�destination(s), the nature of the sport and the health/vaccination history of the individual involved. Regardless of these factors however, it is recommended that ALL adult athletes are routinely vaccinated against the following:
4. Influenza
5. Hepatitis A and B
6. Measles, mumps and varicella (if immunity is not already proven by a natural infection)
Of these, numbers 1-5 should be given as inactivated vaccines while measles, mumps and varicella (chickenpox) should be given as live vaccines(15). A full discussion on the detailed considerations regarding each and every possible vaccination is beyond the scope of this article (readers are directed to a full and recent review of this topic by Luke and D�Hemecourt(15)). However, Table 1 summarises most of the key recommendations.
Vaccination Timing
Timing of vaccinations should be chosen in order to minimise interference with training and competition, and to ensure the immune reaction is not temporarily impaired. Inactivated vaccines generally cause side effects within two days following vaccination. This is in contrast to live vaccinations where the peak of side effects is most likely to occur after 10-14 days when replication of the vaccines is at a maximum. Unless a vaccination needs to be administered urgently, the best time therefore for vaccination is at the onset of resting periods � for example at the beginning of the winter off season.
When a vaccination has to be carried out within a training and/or competition period (eg influenza), there is no major medical problem with training undertaken shortly before or after vaccination. However, it is recommended to vaccinate shortly after a competition in order to make the period of time to the next competition as long as possible. Many vaccinations given via injection can cause local pain and inflammation at the injection site. Clinicians may therefore wish to time vaccine administration so as to not coincide with delayed onset muscle soreness (DOMS) following strenuous exercise.
Vaccination Techniques
Dependent on the injection site, some sport- specific impairments may result (for example buttock pain in runners following a gluteal injection). Obviously, it is advisable to use the non-dominant side for injections in unilateral disciplines such as racquet sports. For vaccines that can be administered using either the intramuscular or the subcutaneous route, the intramuscular option seems to be preferable as it yields higher titer rate (more antibody production) and a lower risk of granuloma.
Injection into the deltoid muscle is preferred if possible, although other muscle sites are possible. Regardless, it is important that the athlete is sitting or lying, and the muscle is completely relaxed. Studies indicate that the use of longer needles (25 mm) and a fast speed of injection/ withdrawal of the needle (1-2 seconds) are associated with less pain(37). Also, an angle of injection of 90 degrees may also help reduce pain in intramuscular injections.
Syncopes or collapses following vaccination are uncommon but may occur; some studies on influenza vaccination suggest the frequency of syncope in younger athletes to be around 1%(38). However, the syncope itself may be less important than secondary injuries caused by the collapse such as skull fracture and cerebral haemorrhage. Given that the majority of syncopes (80 %) occur within 15 min of vaccine administration, it is recommended that athletes are observed for a period of 15-30 minutes following vaccination. This recommendation may be particularly important for endurance athletes because there are indications that, in these athletes, vasovagally-induced syncopes are more frequent(39).
Vaccination Schedule
The recommended vaccination schedules for disease prevention will be dependent on the previous vaccination record and disease history of the athlete in question. Also, some schedules are dependent of the type/brand of vaccines used and recommendations may also differ according to public health policy in each country. Readers are directed to the summary given by Luke and D�Hemecour(15); there are also some excellent downloadable resources on the US Centre for Disease Control and Prevention (CDC) � www.cdc.gov/vaccines/ schedules/hcp/adult.html.
Summary
The vaccination requirements for elite athletes are not the same as that for the general public. Not only are these athletes�potentially exposed to more disease pathogens as a result of international travel, even the mildest episode of illness that would be barely noticeable to most of us can be devastating for elite athletic performance. For these reasons, sports clinicians and doctors should take a much more aggressive approach to vaccination of their athletes. Together with steps to reduce exposure and the correct vaccination techniques and timing, clinicians can maximise the potential of their athletes to perform at all times of year across all regions of the globe.
References
1. World Health Organization. WHO vaccinepreventable
diseases: monitoring system. 2012
global summary 2013. www.who.int/
immunization_monitoring/data/data_subject/
en/index.html accessed 5th Feb 2017
2. Sta�ndige Impfkommission (STIKO).
Empfehlungen der Sta�ndigen Impfkommission
(STIKO) am Robert Koch-Institut. Epi Bull.
2012;283�10
3. Centers for Disease Control and Prevention.
General recommendations on immunization�
recommendations of the Advisory Committee
on Immunization Practices (ACIP). MMWR
Recomm Rep. 2011;60:1�64
4. Vaccine. 2013;31:6046�9
5. Pharmacoeconomics. 2005;23:855�74
6. J Exp Med. 1970;131:1121�36
7. Am Heart J. 1989;117:1298�302
8. Eur J Epidemiol. 1989;5:348�50
9. Clin J Sport Med. 2011;21:67�70
10. Sports Med. 1997;24:1�7
11. J Infect Dis. 2013;207:1037�46
12. Lancet. 1990;336:1315
13. Br J Sports Med. 2004;38:678�84
14. Clin Sports Med. 2007;26:425�31.
15. Sports Med 2014; 44:1361�1376
16. Vector Borne Zoonotic Dis 2004;4(1):61�70
17. www.nhs.uk/Conditions/Lymedisease/Pages/Introduction.aspx#symptoms accessed Feb 2017
18. J Infect Dis 1999;180(3):900�3
19. Ann N Y Acad Sci 2003;990: 295�30
20. J Infect Dis 1984;150(4):480�8
21. N Engl J Med 2001;345(2):79�84
22. Pediatrics. 2013;131:e1716�22.
23. Euro Surveill. 2005;10(6):E050609.2
24. Euro Surveill. 2013;18(7):20467
25. Centers for Disease Control and
Prevention. Epidemiology and prevention of
vaccine-preventable diseases. The pink
book:course textbook. 12th ed.; 2012.
26. World Health Organisation. Poliomyelitis;
2014. www.who.int/topics/poliomyelitis/en/
27. Clin Exp Rheumatol. 2001;19:724�6
28. JAMA. 1997;278:551�6
29. Clin Infect Dis. 2004;38:771�9
30. Travel Med. 1998;5:14�7
31. Cochrane Database Syst Rev.
2014;1:CD001261
32. Curr Opin Infect Dis. 2012;25:489�99
33. Drugs. 2013;73:1147�55
34. Hum Vaccin Immunother. 2014;10:995�1007
35. Popul Health Metr. 2013;11:17.
36. Vaccine. 2009;27(Suppl 2):B51�63
37. Arch Dis Child. 2007;92:1105�8
38. Vaccine. 2013;31:6107�12
39. Prog Cardiovasc Dis. 2012;54:438�44
A new UK study has found that obesity in childhood has long-term health implications that could last well into adulthood.
Carried out by a team from the University of Surrey, the researchers collected data from 18 studies which included over 300,000 children in total with an average age of 10.
The team looked at the measurements of the children’s body mass index (BMI), waist circumference and skin fold thickness, and compared them to results from the same participants 25 years later as adults.
They found that participants who were obese as children were predisposed to ‘pre-diabetes’ — a condition in which the body cannot adequately metabolize glucose and which can lead to diabetes — and thickening of arteries in adulthood.
An increase in the thickening of these arteries also increases an individual’s risk of experiencing a cardiovascular condition such as heart disease in later life.
The children’s BMI was also found to be a good predictor of high blood pressure in adulthood, and could also help predict other illnesses later in life that are associated with obesity.
However, due to the limited data available the team were unable to determine if waist circumference and skin fold thickness were also indicators of future health conditions.
Commenting on the findings lead author Dr Martin Whyte said, “It is worrying that obesity is becoming endemic in our society.”
“The adverse effects of adult obesity are well known but what we have found is that obesity in childhood can cause lasting arterial damage which could potentially lead to life threatening illness. This is something that we need to address to protect adult health and reduce pressure on the NHS.”
Childhood obesity is on the increase in the UK, with figures from the NHS National Child Measurement Programme indicating that 19.8 percent of 10-11 year olds were classed as obese in 2015/16, a rise of 0.7 percent on the previous year.
The findings can be found online published in the journal Obesity Reviews.
Still taking sleeping pills to get a good night’s rest? New research suggests there’s a better way: Hit the gym.
Rush University clinical psychologist Kelly Glazer Baron tells CNN a growing body of evidence over the past decade has confirmed that regular exercise helps people sleep better than medication.
“In one study we did, for example, older women suffering from insomnia said their sleep improved from poor to good when they exercised. They had more energy and were less depressed,” he said.
Most sleep studies have confirmed sleep quality is enhanced in people who get the recommended amount of exercise — 2½ hours a week of moderate-intensity aerobic exercise, along with strength or resistance training.
Brisk walking, light biking, and using a treadmill or elliptical machine all increase heart rate and cardiovascular fitness, which aids sleep quality.
Experts also recommend not exercising within six hours of bedtime, which can hinder sleep.
Scoliosis is defined as the abnormal, lateral deviation of the spine with a minimal Cobb angle of 10� in the coronal plane. It may be characterized as either non structural or structural scoliosis.
Non-structural scoliosis is identified as a non-progressive curve resulting from a leg length discrepancy, herniated disc or improper bearing which can be corrected by removing the causing factor. Structural scoliosis is identified by not only its vertebral distorted shape, but by a vertebral rotation towards the convex side, where the spinal processes also rotate toward the concave side, additionally, including rib deformity along with the convex sided ribs shifting posterior and superior while the concave sided ribs changing anterior and inferior.
After diagnosis, a person with scoliosis may present a pelvis that is not leveled in the transverse plane with unequal shoulder height, a thoracic or lumbar hump, and an asymmetrical lumbar triangle, loss of lumbar lordosis or loss of balance in the sagittal and coronal planes.
Scoliosis in the Modern World
Scoliosis approximately affects up to 2 to 3 percent of the population and it may be classified as congenital, neuromuscular, degenerative or idiopathic. Furthermore, scoliosis diagnosed after skeletal maturity, between the ages of 20 to 50, known as adult scoliosis, amounts up to 6 to 10 percent of the population. Adult scoliosis is divided into four types: Primary degenerative scoliosis resulting from the asymmetrical erosion of the disc, endplates and/or facet joints; progressive idiopathic scoliosis not previously treated or post-surgical; secondary adult curvature due to a pelvic obliquity; and secondary adult curvature due to metabolic bone disease.
According to research studies, the clinical presentation associated with adult scoliosis requiring immediate medical attention from a healthcare professional includes: back pain which manifests as muscle soreness, muscular exhaustion or mechanical instability; symptoms of radicular pain present during standing or walking; neurological deficits; and curve progression resulting in from axial overload or vertebral bodies with osteoporosis.
Literature has described a variety of treatments for scoliosis predicated on surgical and non-surgical classification, dependent on the severity and the character of the curvature as well as the danger of progression. Surgical intervention is an alternative treatment option for individuals that have completed the growth cycle and whose curve is greater than 50� and or whose curve is above 45� and are still in the growth cycle. Bracing and projecting is utilized for people in the growth interval and whose curve is between 20� and 40�. An individual with a curve of less than 25� and has completed growing might be observed throughout their life for curvature progression of 5� in one year, which can be determined to need surgical intervention.
Many healthcare professionals recommend surgery for scoliosis rather than an alternative, non-surgical treatment for scoliosis. In a study by Brigham and Mooney, a progressive exercise plan focusing on exercises combined with torso turning exercises were utilized to raise the strength in patients with scoliosis measuring 15�to 41�. The results showed a 20% � 23% improvement in the curvature without any type of bracing or casting.
Prevalence of the Schroth Method for Scoliosis
In comparison to America, conservative measures are more vigorously executed worldwide. Along with plans, such as for example SEAS (Scientific Exercise Method Of Scoliosis), FITS (Functional Individual Therapy of Scoliosis), Dobosiewicz method, ASCO (Anti-Scoliosis Shaking-Decompression) procedure, Lyonaise method, and physiologic�, the Schroth method is a scoliosis treatment approach which attempts to conservatively treat the spinal condition by emphasizing patient specific postural analysis and corrections in a multidimensional plane. In line with the method first created by Katharina Schroth, the torso is divided into three and sometimes four vertically stacked anatomical blocks. As an outcome of scoliosis, these blocks deviate in the vertical line and laterally shift and rotate against each other creating areas of convexities and concavities.
Depending on sensorimotor and kinesthetic principles, patients utilize proprioceptive and exteroceptive stimulus (visual, tactile, verbal) to achieve the proper spinal alignment through corrective breathing patterns and postures. This is a big element of the Schroth method for scoliosis. Three dimensional postural corrections and remedial exercises are used to achieve spinal de-rotation, de-flexion and elongation in order to re-gain postural symmetry and muscular equilibrium as well as for the stabilization of the corrected bearing through isotonic and isometric tension and reflex holding of muscles. Simultaneous performance of rotational angular respiration (RAB) helps correct the placement of the ribs by directing air into the thoracic concavities. Through the specific exercises of the Schroth method for scoliosis, patients learn to lift themselves out of passive alignments and endure a position that is corrected throughout their day-to-day activities.
The Schroth Method for Scoliosis
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Lower Back Pain After Auto Injury
After being involved in an automobile accident, neck injuries and aggravated conditions, such as whiplash, are some of the most commonly reported types of injuries, due to the force of the impact. A study discovered, however, that the seat of a vehicle can often lead to injuries as well, causing lower back pain and other symptoms. Lower back pain is also among one of the most common types of automobile accident injuries in the U.S. alone.
Losing weight comes down to simple arithmetic: Eat fewer calories than you burn off.
Here’s a good way you can accomplish this without going hungry.
Switch out high-calorie foods for low-calorie options to cut calories without cutting portion sizes. Dairy food is a good place to start, according to the U.S. Department of Agriculture.
If you’re still using whole milk and cream, make gradual changes to lower-fat versions. Start by switching from whole milk to 2 percent milk for your coffee, on your cereal and in recipes. Then take the next step down to 1 percent milk and, eventually, to fat-free or skim milk. You can make similar switches with other dairy products, like yogurt and cottage cheese.
Mix in your own fresh fruit or a few drops of vanilla extract to a serving of no-fat plain Greek yogurt to make you forget about higher-calorie choices. You’ll get twice the protein of regular yogurts without the added sugar (and calories) of flavored varieties.
Are you craving cheese? Choose types that are naturally lower in fat, like feta, string, goat and ricotta cheese. Also try reduced-fat versions of your favorites, like cheddar.
Milk is a great source of protein and other nutrients — like calcium — needed for bone health. And it’s usually fortified with vitamin D, essential to maximizing that calcium.
The bottom line? Keep the dairy, but ditch the fat.
When the weather starts getting warmer, most of us immediately ramp up our ab and glute exercises. But what about your arms? Here, Health’s contributing fitness editor Tracy Anderson demonstrates a challenging arm workout you can do anywhere—no equipment necessary.
Tracy notes that the key to strong arms is all about working different parts, not just isolated areas. These bodyweight exercises offer incredibly challenging resistance to get your shoulders, biceps, and triceps in shape for summer. Watch this video to see six of Tracy’s favorite arm-sculpting moves.
No time to watch? Here’s a breakdown of the workout:
Move 1: Start by lying on the ground. Push up into a plank position, then twist your body, creating an award pushup position. Press back up into a full plank and extend your top leg. Lower your body down and extend your leg up again. Do this 30 times. You’re going to start to feel your back arm really working, because you’re twisting your body weight to the back arm, while the front one is just stabilizing. Be sure to do both sides.
Move 2: Get into a full plank position, then straighten one leg to the back. Lift one leg and dangle your knee. Tuck it in towards your chest, then cross it over your other leg, and extend your leg into the air behind you.
Move 3: Get into a plank position. Alternate bringing your knees underneath your body, crossing diagonally, and tapping your knee with the opposite hand. Use your arms to stabilize yourself during this move.
Move 4: Get into a tabletop position. Reach one arm into the sky while pushing your hips up. Twist your body down into a high plank, then press your outside leg up into the air.
Move 5: Get into a plank position. Bend your knee and rest your outer leg on the ground in a twisted position. From here, lift your knee up and extend it out behind you. Keep twisting, lowering, and lifting for 30 reps.
Move 6: Get into a wide leg plank. Lower down to one forearm, then switch to the other. Next, energetically push your body back up using just one arm.
It’s no secret that sitting at a desk all day isn’t good for you. A sedentary lifestyle can lead to weight gain, which may then lead to a host of other issues. Research has shown that sitting too much throughout the day can lead to a number of different health problems, including obesity, heart problems, and diabetes.
However, there are things you can do to offset the health risks of sitting at your desk, such as getting up to take frequent walks. But even if you can’t leave your chair, there are even plenty of movement exercises you can do right from your desk, such as chair yoga. You could also take advantage of the time to work on some mobility training—a form of exercise that focuses on improving your stability, range of motion, and loosening your muscles so you can perform better during any workout.
Frank Baptise, founder of Frankly Fitness, is a big fan of mobility training as an effective way to help promote healthy joints, balance, and flexibility in your body. Here, he demonstrates six simple yet effective moves to try at your desk. All you need is a stress ball and a desk chair!
Don’t have time to watch? Here’s a quick rundown of Baptiste’s go-to mobility moves:
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