Coming Back From a Sports Injury

Using a stretch band—At the Healthy You Fitness Center, Felix Rosario of Allentown demonstrates how to increase strength after a shoulder injury.

Ever twisted an ankle or wrenched your back playing sports? Millions of recreational athletes sustain injuries like these—and in many cases, physical therapy alone is enough to get them back in the game. Physical therapists treat all types of injuries, in all kinds of athletes from weekend warriors to pros. Your doctor will probably prescribe two to three sessions a week for a few weeks (or months, for more serious injuries). You needn’t spend all that time at the gym; in most cases, your therapist will teach you exercises to do at home. “When you first meet, the therapist will evaluate your injury, take your medical history, listen to your fitness goals and help you develop a plan,” says sports medicine physician Laura Dunne, M.D.Typically, therapy involves:

Reducing inflammation—Therapists often use the RICE technique (rest, ice, compression and elevation).

Restoring range of motion—“Your therapist may manually stretch your muscles after warming them up,” says physical therapist Vincent Hudson.

Rebuilding muscle strength—This often involves equipment like free weights, exercise bands or machines.

Insurance and Medicare usually cover at least part of the cost. Depending on your needs, physical therapists have many other approaches including massage and gentle electrical stimulation.

Physical therapy doesn’t just help you recover, it’s also preventive. “If you try to return to normal activity without the proper rehab, you can re-injure yourself,” says orthopedic surgeon Neal Stansbury, M.D. “Therapy makes the chances of recurrence much lower.”

Published from Healthy You Magazine, January-February 2008

Energy Drinks and Your Heart

About Our Expert

Laura Dunne, M.D., is a family medicine physician with Lehigh Valley Health Network.

• Do energy drinks hurt your heart?
• How powerful are the stimulants in energy drinks?
• Are there other risks from drinking energy drinks?
• What happens when you mix energy drinks with alcohol?
• What are better alternatives?

Q: Do energy drinks hurt your heart?

A: Most healthy people can have an energy drink (Jolt, Red Bull or Rockstar, for example) without experiencing any problems. But energy drinks contain huge amounts of legal stimulants such as caffeine, and have been shown to boost both blood pressure and heart rate, especially if you drink them regularly. In some people, they cause heart palpitations. Even healthy young people who drank two cans of a relatively mild energy drink every day for a week in one study saw their blood pressure and heart rate increase about 10 percent for several hours after drinking. That could be dangerous for people with high blood pressure or heart disease, so you should avoid energy drinks if you have any cardiovascular risks.

Q: How powerful are the stimulants in energy drinks?

A: Most energy drinks contain between 120 to 200 mg of caffeine, and some contain as much as 300 or even 500 mg. That's far more than the 34 mg in a can of cola or the 100 mg in a cup of coffee. Besides high levels of caffeine, a lot of drinks contain other stimulants such as taurine (an amino acid) and guarana (an herb that contains even more caffeine). It can be difficult to know the total dose of stimulants you're getting because amounts often aren't listed on the label.

Q: Are there other risks from drinking energy drinks?

A: They can make you dehydrated, keep you from sleeping and cause headaches. And because they're served cold, people tend to drink them fast, which can give you a quick surge of energy followed by a sudden drop (sometimes called a jolt-and-crash response). Some people, especially younger adults, like to mix energy drinks with alcohol, which raises its own set of dangers.

Q: What happens when you mix energy drinks with alcohol?

A: The stimulants counteract alcohol's tendency to cause drowsiness, which would otherwise make you stop drinking. Some younger adults deliberately use energy drinks to bypass this natural inhibition so they can party longer. Some manufacturers are now making premixed alcoholic energy drinks and specifically targeting the young adult market. Drinking these products makes you increasingly impaired as your blood alcohol level rises, but the stimulants mask your intoxication so it feels like you're in better shape than you really are. People who mix alcohol and energy drinks are significantly more likely to drink heavily, ride in a car with an intoxicated driver, engage in unhealthy sexual behavior, become injured or require medical treatment-in addition to increasing the cardiac risks of arrythmia and high blood pressure.

Q: What are better alternatives?

A: Fatigue is the first sign of dehydration, so instead of picking up an energy drink, use water to help you refuel. Beyond water, sports drinks like Gatorade can give you some simple sugars as well as fluid. More recently, newer brands like Odwalla and Special K have come out with protein drinks. They have more staying power than sugar-based drinks because the body uses protein energy over a longer period of time than sugar. But some of these drinks can be high in calories, which is another reason to stick with water.

What Sports Can Do for Your Daughter

Serious golfers—Stani Schiavone, 16, of Bangor (left) is one of the top 60 junior female golfers in the world. AmyLoughney, 23, of Macungie finished strongly in the U.S.Women’s Amateur Championship. Read about them here:

Girls on the go—(top) Shannon, 16, of Macungie plays field hockey, (middle) Nicole, 10, of Breinigsville enjoys softball and (bottom) Chelsea, 12, of Bethlehem moves a basketball down the court.

Gone is the day when girls sat on the sidelines. Today, they have more and more opportunities to play team sports—and reap the many benefits to their physical health, emotional well-being and future success in life. Researchers have discovered that organized sports can do dramatic things for your daughter, including:

Give her a head start on lifelong health. “Youth obesity is at an all-time high, and the best solution is more physical activity,” says John Graham, director of Healthy You Fitness Centers for Lehigh Valley Health Network. “Female athletes develop lifestyle habits that reduce their risk for obesity, type 2 diabetes, osteoporosis, heart disease and other chronic conditions.”

As little as four hours of exercise a week may reduce a teen girl’s breast cancer risk by up to 60 percent. Research suggests that girls who lead a physically active life also reduce their chances of developing Alzheimer’s disease in later years. And girl athletes tend not to fall into self-destructive behavior. They have one of the lowest rates of tobacco use for their age, and are less likely to abuse drugs, have sex and get pregnant.

Boost her self-esteem. Exercise and sports help create positive feelings about body image and self-confidence. “Girls who participate in sports are competitors and achievers,” says Graham’s colleague, sports medicine physician Laura Dunne, M.D. “They create friendships with girls who have the same attitude.”

Make her happy. Sports participation creates such a sense of well-being that it’s been viewed as a natural antidepressant. Research shows that physical activity can help reduce symptoms of stress and depression among girls and that female athletes are at lower risk for considering suicide.

Offer her an academic edge. Girls in sports tend to get better grades—including in math and science—and have fewer disciplinary issues and lower dropout rates than non-athletic girls. High school female athletes earn higher standardized test scores and are more likely to go on to college.

Prepare her for the workforce. Eighty percent of women executives in Fort une 500 companies participated in sports during childhood. “Sports teach girls how to set goals and be prepared for a highly competitive work environment,” Dunne says. “Through athletics, they learn how to set priorities, budget time and become better organizers. They also learn the critical skill of collaborating with others for the overall success of a team.”

How can you get your daughter in the game? “Setting a good example is very important,” Graham says. “Get outside and do anything physical together—play catch, tag, have fun with it.”

You also can spark your daughter’s imagination by watching women’s sports together. Attend high school games in your community, and follow women’s professional golf tournaments and Olympic events on television. Exposing her to all types of sports will help her discover which ones appeal to her personally.

Finally, be supportive when she shows interest. Encourage sports participation and help her stick with it when the going gets tough. A parent’s support can make all the difference in getting a young girl enthusiastically onto the playing field.

Published from Healthy You Magazine, May June 2009

Beware Sports Supplements!

They promise bigger muscles and better endurance. But sports supplements—over-the-counter pills, drinks and powders marketed as athletic boosters—can do more harm than good. “Many contain substances that are banned or unsafe above a certain level,” says Laura Dunne, M.D., a family and sports medicine physician at Lehigh Valley Health Network.

Sports-supplement use is rampant among teen boys lured by the chance to grow six-pack abs or be the team superstar. “They’re learning about supplements from bodybuilding magazines, other kids and even coaches,” says John Graham, director of Healthy You Fitness Centers. What users aren’t told is that the FDA doesn’t regulate these supplements. So untested products can be marketed in drugstores and online using false claims, tainted research and paid endorsements.

Substances to avoid include:

Creatine—This naturally occurring muscle-builder is sometimes added to protein and amino-acid supplements. “Without a foundation of good nutrition and adequate water intake, it can cause muscle cramps and kidney problems,” Graham says.

Steroid precursors—Substances like DHEA (dehydroepiandrosterone) and “andro” (androstenedione) are converted by the body into steroids (synthetic testosterone). They can cause aggressive behavior, stunted growth, and heart and liver damage.

Stimulants—Ephedrine and other stimulants give a temporary energy boost, but can raise blood pressure and heart rate and lead to dehydration and heat stroke.

Supplements are dangerous at any age, but especially for young users, who tend to underplay their health risks. “Monitor your child for signs of use, including increased aggression or acne, rapid weight gain, and muscle size out of proportion to peers,” Dunne says.

“If your child is taking a supplement, find out who advocated it,” Graham says. Check the label for banned substances (you can get a list at www.usantidoping.org), but be aware that products aren’t required to list all ingredients.

Talk with your child about the long-term effects of sports supplements. Discuss fair competition—taking them is like cheating. “While you can’t control the decisions of young adults over age 18, you can still point out the dangers,” Graham says. If they choose to use supplements anyway, these should carry the NSF label. (NSF International tests products for banned substances.)

Finally, athletes young and old should learn about healthier fitness alternatives. Food, not supplements, is the best source of protein and other vital nutrients, “and there’s no chance of getting added substances,” Dunne says. Likewise, strength training is better than supplements for muscle-building.

Published from Healthy You Magazine, January February 2010

Steroids and Young Athletes

Many young athletes are so focused on winning the game, topping their personal best or pleasing coaches and parents they’re willing to do almost anything—including using performance- enhancing drugs like anabolic steroids.

“They perceive, often incorrectly, that their opponents use these drugs, so they must use them to stay competitive,” says John Graham, exercise physiologist at Lehigh Valley Health Network. “Coaches and parents sometimes contribute to the problem by having unreal expectations.”

Steroids are a faster and easier way to gain strength and body mass than old-fashioned sweat, says Graham’s colleague, sports medicine specialist Laura Dunne, M.D. But they are dangerous. They can cause physical and psychological problems (see box), and put athletes at greater risk for injuries to muscles, ligaments, tendons and joints.

“And they’re illegal if not prescribed by a doctor for medical reasons,” Dunne says. “Young athletes who obtain steroids illegally risk jail, infection and toxic overdose.”

In spite of that, steroid use is on the rise among college, high school and even middle school athletes. Recreational players and those wanting to improve their physique also turn to this quick fix. Steroids are readily available online and from dealers in gyms and other places—sometimes even from unethical coaches and health professionals.

Can athletes really compete without steroids?

“Absolutely,” Graham says. “You can maximize performance through proper nutrition and strength-training. An experienced trainer develops realistic goals based on your sport, skills and abilities, and monitors your progress. You learn how to strength-train properly and increase your speed, agility and power.”

Unfortunately, the people who need the highest level of coaching often get the least, says Jay Hoffman, Ph.D., of The College of New Jersey, a national expert on steroid abuse. “Because people who work with children are not required to be certified, it’s important for you to be part of your child’s training,” he says. “Make sure teachers, coaches and trainers are educated to work with young athletes. Ideally, they should have an exercise science background and be a certified strength and conditioning specialist. Become educated with your children, and have them share with you what they learn. Then relax and enjoy the game.”

Published from Healthy You Magazine, September-October 2008