Return to Sports  & Nutrition

                               Dr. Vijay Bathina

                     Chief Consultant- Sports Physio

                                Return To Play

Return to play refers to the point in recovery from an injury when a person is able to go back to playing sports or participate in an activity at a preinjury level.

No one likes to be sidelined with an injury. One of the goals of sports medicine is to try to get an athlete back into action as soon as possible. Returning too soon, before adequate healing or recovery has taken place, can put you at risk for reinjury and possibly an even longer down time.

With the right game plan for sports injuries—from early diagnosis and treatment to full functional rehabilitation—you can often safely accelerate your return to play.

A Lesson From the Pros

Why does it seem that professional athletes return to play so much faster than the average person or athlete? Professional athletes are usually in tremendous physical condition at the time of injury. This fitness level helps them in many ways. Studies have shown that good conditioning can not only prevent injuries, it can also lessen the severity of an injury and speed recovery.

Professional athletes also get prompt treatment when an injury occurs, and this lessens the acute phase of the injury. Early treatment means that there is less swelling, stiffness, and loss of muscle tone. In addition, professional athletes work extremely hard with a physical therapist and/or certified athletic trainer during their recovery.

Many professional athletes bring to their recovery what they bring to their sport—a positive attitude. Although you may not have access to the same resources that professional athletes have, you can harness the power of a positive attitude for your own benefit during recovery.

Tips From the Pros to Speed Your Recovery

• Maintain balanced physical conditioning
• Make sure that injuries are recognized early and treated promptly
• Participate in a full functional rehabilitation program
• Stay fit while injured
• Keep a positive, upbeat mental attitude

Your Recovery Plan

Phases

Recovery from an injury involves a series of logical steps from the time of the injury until you are able to be back on the field or court. Each step should be outlined and monitored by your physician and physical therapist.

During the acute phase of injury, the focus should be on minimizing swelling. This involves the RICE formula (Rest, Ice, Compression, and Elevation), along with a limitation of activities. Depending on the type and severity of your injury, treatment may also involve surgery, bracing, or even casting.

During the acute period, it is very important to maintain overall conditioning while the injury heals. Creative techniques can be used to safely work around the injury. For example, a runner with a leg injury can often run in water or use a stationary bicycle to maintain conditioning. Even if one leg is in a cast, the rest of the body can be exercised by performing strength-training exercises. Do not wait until your injury is healed to get back into shape.

In the next phase of recovery, you should work on regaining full motion and strength of the injured limb or joint. Your physician, therapist, or certified athletic trainer will outline an exact plan. For most injuries, gentle protective range-of-motion exercises can be started almost immediately. Muscle tone can be maintained with the use of electrical stimulation or simple strengthening exercises.

When strength returns to normal, functional drills can be started. For lower extremity injuries, this may include brisk walking, jumping rope, hopping, or light jogging. For upper extremity injuries, light throwing or easy ground strokes can be performed. Specific exercises for balance and agility can bring back the coordination that may have been lost in the injury.

Once you have progressed with motion, strength, endurance, and agility, and are tolerating functional drills, you can try higher levels of sport-specific movement patterns. This is monitored by your physical therapist or certified athletic trainer. You may find that tape, braces, or supports help during this transition time.
Only when you are practicing hard without significant difficulty, and the healing has progressed to the point where the likelihood of injury or harm is low, are you ready to return to play. During these final phases of recovery, you should be closely monitored. Special attention should be given to adequate warm up prior to the activity and icing after the activity.

A Word Of Caution

Following the rational progression of recovery not only lessens the chance of reinjury but also assures that you will be able to perform at your best when you return to play. All too often, athletes think they are ready to return as soon as the limp or the swelling subsides. They may feel good, but they are probably only 70% to 75% recovered. This invites reinjury.

Sports medicine experts are working on methods to help athletes get close to 100% recovery as quickly as safety allows. There is often tremendous pressure to get the athlete back as soon as possible, but the athlete's health and safety must be placed above all other concerns.

A systematic recovery plan is successfully used every day, at all levels of play, from the recreational athlete to the elite professional or Olympic athlete.

                           Sports Nutrition 

                             Varsha Raju

                         Sports Nutritionist

Athletes who want a winning edge need the right nutrition. When you give your body the right fuel by drinking enough water and eating a balanced diet, you will make the most of your athletic talents and gain more strength, power, and endurance when you train.

This article contains some general sports nutrition guidelines. To achieve top performance, your diet should be based on a variety of factors including your age, weight, physical condition, and the type of exercise you are doing. Consult your doctor for individualized sports nutrition advice.

Hydration

Water is the most important nutrient for athletes. Water comprises about 60% of body weight and is essential for almost every bodily function. Because your body cannot make or store water, you must replace the water that you lose in your urine and sweat.

Everyone should drink at least two quarts (64 oz.) of water each day—and athletes need even more. To stay hydrated and avoid overheating, drink plenty of fluids before, during, and after sports or exercise. When you work out or compete, especially in hot weather, try to replace the amount of water you lose in sweat by drinking the same amount of fluid.

Stay hydrated by drinking plenty of fluids before, during, and after exercise.

Drinking cool water is the best way to keep hydrated during workouts or events that last an hour or less. Sports drinks made up of 6% to 10% carbohydrates can help you stay hydrated during longer events. Most sports drinks should be diluted with approximately 50% water.

Because thirst is not a reliable way to tell if you need water, be sure to drink even if you are not thirsty. You will not start feeling thirsty until you have already lost about 2% of your body weight—enough to hurt performance. Also, if you stop drinking water as soon as your thirst is satisfied you will get only about half the amount you really need.

The following tips will help you stay hydrated:

• Drink small amounts of water frequently rather than large amounts less often.
• Drink cool beverages to lower your core body temperature and reduce sweating.
• Track your sweat loss by weighing yourself both before and after exercise. For every pound lost through sweat, drink 16 to 24 oz. of water. Your body weight should be back to normal before your next workout.
• Pay attention to the amount and color of your urine. A large volume of clear urine is a sign that you are well-hydrated. Smaller amounts or dark yellow urine can indicate dehydration.

Fuel Sources

A balanced diet is another key to sports nutrition. Eating the right combination of fuel (calories) from carbohydrates, proteins, and fats will give you energy for top performance.

Carbohydrates

Carbohydrates—the most important source of fuel—should provide about 60% to 70% of your daily calories. Carbohydrates are found in many foods, including:

• Fruits
• Vegetables
• Pasta
• Bread
• Cereal
• Rice

Eating fruit, or another food high in carbohydrates, will help you maintain energy during competition.

Your body converts the sugars and starches in carbohydrates into energy (glucose) or stores it in your liver and muscle tissues (glycogen). This gives you endurance and power for high-intensity, short-duration activities.
If your body runs out of carbohydrate fuel during exercise it will burn fat and protein for energy—causing your performance level to drop. This may happen if you start exercising without enough stored muscle glycogen or if you exercise intensely for longer than an hour without eating more carbohydrates. It may also happen if you do multiple repetitions of high-intensity, short-duration exercises or if you participate in multiple events or training sessions in a single day.
The following tips will help you maintain carbohydrate fuel so that you can stay energized and perform at your best:

• Start your exercise or competition with glycogen-loaded muscles by eating carbohydrates for at least several days before the event.
• To replenish energy and delay fatigue, eat additional carbohydrates when you exercise or compete for longer than one hour.

Proteins

Proteins should provide about 12% to 15% of your daily calories. Proteins are found in many foods, including:

• Meat
• Fish
• Poultry
• Eggs
• Beans
• Nuts
• Dairy products

Proteins give your body the power to build new tissues and fluids among other functions. Your body cannot store extra protein so it burns it for energy or converts it to fat. The amount of protein you need depends, in part, on your:

Good sources of protein include meat, cheese, eggs, and nuts

• Level of fitness. Physically active people need more protein than those who do not exercise. You also need more protein when you start an exercise program.
• Exercise type, intensity, and duration.Endurance athletes often burn protein for fuel, as do bodybuilders and other athletes who perform intense strength-building activities.
• Total daily calories. Your body burns more protein if you do not consume enough calories to maintain your body weight. This can happen if you eat too little or exercise too much.
• Carbohydrate intake. Your body may use protein for energy if you exercise with low levels of muscle glycogen or if you do repeated training sessions without eating more carbohydrates. When you start with enough muscle glycogen, protein supplies about 5% of your energy; otherwise, it may supply up to 10%.

Fats

Fats should provide no more than 20% to 30% of your daily calories. Saturated fats come from animal-based foods, such as meats, eggs, milk, and cheese. Unsaturated fats are found in vegetable products such as corn oil.

Your body needs small amounts of fat for certain critical functions and as an alternative energy source to glucose. Eating too much fat, however, is associated with heart disease, some cancers, and other major health problems. Also, if you are eating too much fat, it probably means that you are not eating enough carbohydrates.
How your body uses fat for energy depends on the intensity and duration of exercise. For example, when you rest or exercise at low to moderate intensity, fat is the primary fuel source. As you increase the intensity of your exercise your body uses more carbohydrates for fuel. If your body uses up its glycogen supply and you continue exercising you will burn fat for energy, decreasing the intensity of your exercise.

Nutrition before Competition

What you eat several days before an endurance activity affects performance. The food you eat on the morning of a sports competition can ward off hunger, keep blood sugar levels adequate, and aid hydration. Try to avoid eating high-protein or high-fat foods on the day of an event since this can put stress on your kidneys and take a long time to digest.

To perform at your highest level, follow these general nutrition guidelines before an event:

• Eat a meal high in carbohydrates.
• Eat solid foods 3 to 4 hours before an event. Drink liquids 2 to 3 hours before an event.
• Choose easily digestible foods, rather than fried or high-fat foods.
• Avoid sugary foods and drinks within one hour of the event.
• Drink enough fluids to ensure hydration. A good guideline to follow is: Drink 20 oz. of water 1 to 2 hours before exercise and an additional 10 to 15 oz. within 15 to 30 minutes of the event. Replenishing fluids lost to sweat is the primary concern during an athletic event. Drink 3 to 6 ounces of water or diluted sports drink every 10 to 20 minutes throughout competition.

Carbohydrate Loading

To avoid running out of carbohydrates for energy, some endurance athletes—including long-distance runners, swimmers, and bicyclists—load their muscles with glycogen. To do this they eat extra carbohydrates and exercise to energy depletion several days before an event. To "carbohydrate load" before an event:

• First, exercise to muscle fatigue. Your workout must be identical to the upcoming event to deplete the right muscles.
• Next, eat a high-carbohydrate diet (70% to 80% carbohydrates, 10% to 15% protein, and 10% to15% fat), and do little or no exercise for three days before the event.

Some endurance athletes believe that following this carbohydrate-loading regimen will ensure that muscles loaded with unused glycogen will be available to work for longer periods of time during competition. Consult your doctor for advice before trying a carbohydrate-loading diet.