Pulse Magazine Summer 06

pulsepulseThe Magazine of The Sport Medicine Council of Alberta

Summer 2006

How can Athletes Mentally Prepare themselves for Competition?

Training & Nutrition for Amateur Wrestlers

Returning to Sport aft er an ACL Injury

Competition Nutrition

pulseFall 2006 Vol. 19 No. 3

SMCA Board of Directors

President Dr. Gordon Bell, Ph.D.

Past -President Koralee Samaroden, BPE, PFLC

Vice-President Dwayne Laing, BPE, CAT (c)

Treasurer Darren Turchansky, CA

Secretary Jennifer HanonASSM Rep Position Currently VacantSPC Rep Gabrielle Cave, BSc., P.T., MCPA

AATA Rep Breda Lau, CAT (c)

SSAA Rep Dr. Gordon Bell, Ph.D.

SNS Rep Jane Dawson-Edwards, R.D.

Member at Large Ray Kardas

SMCA Employees

Executive Director Jennifer JohnsonAccounts Manager Janice Peters, BCom

Director of Programs & Services Michael Pugh, BPE

Pulse Magazine Published by:

Sport Medicine Council of Alberta 11759 - Groat Road

Edmonton, Alberta, CanadaT5M 3K6

Phone: (780) 415 - 0812Fax (780) 422 - 3093

Website: www.sportmedab.caEmail: [email protected]

Contents copyright 2006 by SMCA. Articles may not be reprinted without permission. The opinions are those of the respective authors are not necessarily those of the SMCA.

ISSN: 1181-9812Publication agreement no. 40038086

2 SMCA Pulse Summer 2006

ofTableContents

Training & Nutrition for Amateur Wrestling

Writt en by: S. Anderson, G. Landry, R. Hellickson, K. Sossin

Pages 6-10

Latest News from the SMCA...........................Page 3

Reaction Time Analyses in the Sprint Starts

By: Brian MarajAdded Authors: A. Brown and D. Collins, Ph.D.

Return to Play Guidelines Aft er Anterior Cruciate Ligament Surgery

Writt en by: G. Myklebust & R. Bahr

Pages 11-13

Competition Nutrition

Writt en by: Sport Nutrition Advisory Committ ee

Pages 14 & 15

• Aft er fi ve years at The Sport Medicine Council of Alberta, Ryan Petersen has decidedly resigned from his duties as Executive Director. An exceptional leader and advocate for safe participation in sport, Ryan will defi nitely be missed. On behalf of our Board of Directors and Staff , we wish Ryan all the best in his future endeavors and thank him for his dedication and hard work at the council. Ryan’s replacement, Jennifer Johnson, the former Projects Coordinator for the council, will assume his duties beginning August 1st.

• The SMCA is also excited to have Marcus Paterson, a graphic design graduate from the University of Alberta, working in our offi ce. Marcus was hired as our summer Communications Coordinator, responsible for the design and layout of our publications, such as Pulse Magazine and the Sports Nutrition Level 1 Workbook and Presentation.

• Almost three years has lapsed since the last Sports Nutrition Course was held at the SMCA, but that will soon change. The SMCA is extremely excited to announce the arrival of the Sports Nutrition Level 1 Course, which we will begin off ering in November 2006. The revised course will provide invaluable information on hydration and nutrition and how they pertain to sport. The course will not only have a new look, but we will not be off ering a workbook for participants, complete with exercises, activities, charts and schedules to keep the recreational or competitive athlete in tune with their hydration and nutrition needs. Please check our online course schedule beginning mid-October at htt p://www.sportmedab.ca/courses.php for dates, times and registration procedures.

• Over the summer, thanks to the generous support of the Community Initiatives Granting program through Alberta Lott eries, we have been refurbishing our Sport Medicine Resource Library. We’ve purged old resources and added new dvds, textbooks and cd-roms on a variety of sport medicine related topics. Look for a new Sport Medicine Resource Library handbook, which will contain all the new titles, available for download on our website at www.sportmedab.ca/library.html.

Latest NewsFrom

SMCATheIt’s that time again…to renew your SMCA Membership! The SMCA wants to make this process as quick and painless as possible, so here are three ways you can do it:

1. By Phone – just give us a call and give us your personal information and pay your fee by visa.

2. Online – go to the membership page of our website htt p://www.sportmedab.ca/membership.html, download the form and either fax it or mail it to us.

3. Wait for the renewal application form to come to you in the mail. Simply fi ll it out, enclose payment and send it back in the self-addressed stamped envelope.

Whatever method you choose, please complete your renewal by October 15, 2006!

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Learning how to perform optimally for competition can be a challenge. There are oft en numerous distractions and unique circumstances surrounding most competition events, many of which, young athletes are unfamiliar with. Coaches and parents can play an important role in helping with mentally preparation, in order to maximize performance.

Preparation Before the EventLeading up to a competition, it is important to provide athletes with the mental tools so that they can learn to manage their own performance and create their optimal level of mental readiness. Strategies such as goal sett ing, imagery, thought management, and emotional control can be learned through practical exercises that incorporate these elements into the athlete’s practice and daily routines. Athletes can then use these tools to develop their personal routines and plans for achieving mental readiness for competition. These plans can be refi ned and adjusted during the pre-competition phase as athletes engage in practices, and other tournaments and competitions leading up to the “big event”.

Develop refocusing strategiesAthletes and coaches should also learn to apply the tools to develop refocusing strategies for challenging and unexpected events arising during their performance. Coaches will oft en facilitate the athletes’ use of refocusing strategies by structuring challenges within the practice environment or by simulating competition conditions. Athletes’ personal routines and their process for achieving optimal mental state are foundational elements of the mental training process. It is from this foundation that athletes can begin to explore focusing and refocusing beyond the context of the performance and apply their plans to deal with elements within the competition experience itself.

Anticipate and Plan for DistractionsAn additional part of the preparation for competition involves anticipating potential distractions and impediments to performance and focus. There is signifi cant power in having anticipated an issue before it happens. If something occurs that has already been identifi ed, then the energy and impact of the issue is lessened and an awareness of alternative responses to the situation heightened. Plans need to be established ahead of time for how to deal with the major distractions. Moreover, athletes need to have a general strategy for identifying and coping with the unexpected.

One suggestion might be to develop a chart to analyze and prepare for diffi cult conditions. Athletes and coaches can brainstorm a list of competitive and/or event-related conditions and for each consider the following:

1. The most challenging possibility (e.g., not playing as much; family and friends having unrealistic expectations of the athlete’s performance);

2. The best way of preparing for it (e.g., clarify team roles and expectations; outline the athletes goals and expectations ahead of time);

3. How the condition might serve as an advantage (e.g., chance to watch other teams weaknesses; opportunity to communicate specifi c goals to family and friends).

Teams can then examine the probability of the event occurring and the possible impact the event might have on performance. Elements that have a high probability and high impact should be explored further and specifi c plans devised.

“Less is more”In the fi nal stages of preparation for competition, it is important to adhere to the “less is more” att itude. The tendency is to want to over-prepare for the event by squeezing in a number of competitions and practices as the “big event” approaches. Athletes need to be well rested and mentally relaxed in order to perform optimally. Moreover, major changes or adjustments to training, performance or personal routines should be minimized at this point. Small refi nements may be necessary but the key is to stick with the elements that have been working. Oft en this minimalization is achieved with a simple tapering plan, but it is important that both coaches and athletes are aware of the concept and mindful of its implementation.

Laura G. Farres, Ph.D

Preparing Mentallyfor Competition


Preparation at the CompetitionThere are several things that young athletes and coaches can do to prepare while at the competition itself. The strategies are aimed at creating confi dence and focus within an unfamiliar and potentially stressful sett ing.

Come with a Clear Performance Goal in MindThere is a signifi cant diff erence between having a competition “Performance” and a competition “Experience”. A competition “Performance” implies a clear focus on the task at hand and a commitment to choices that will give the best possible chance for optimal performance to occur. Conversely, a competition “Experience” implies taking in the sights and sounds of the competition without a clear goal or focus. Ultimately, it will be important to fi nd a balance between the two and allow opportunity to absorb the event atmosphere. But to succeed on a performance level, teams will need to direct their focus completely on the task. Orlick (2002) suggests answering the following two questions to strengthen confi dence and belief and help direct focus at this point:

1. Why can I - develop a list of reasons why the individual or team can achieve the goal they have set out.

2. How I will - identify how the goals will be achieved during the games and what specifi cally has to be focused on to achieve those goals.

Get Familiar with the Surroundings Athletes and coaches should also take steps to familiarize themselves with the surroundings and with everything that is important to them specifi cally: Find the cafeteria or nearest food outlet, identify a meeting place, and, if you have to travel to the competition, explore the distance from the accommodation to the competition venue. Personalizing particular areas can also help. Bringing things from home, placing posters or team slogans in sleeping areas or dressing rooms can help create feelings of comfort, familiarity and a sense of control. Visiting the competition venue prior to the event can also be benefi cial. It helps athletes and coaches get used to the surroundings and any nuances surrounding the facility. If there is opportunity, it can also be benefi cial to access the venue when there is no one else around. This opportunity can provide athletes with a chance to walk through or think about their pre-competition plans and preparation strategies within the physical sett ing. They can also imagine temselves performing while in the venue thus creating feelings of familiarity and comfort before competition even starts.

Prepare a Daily SchedulePreparing a daily schedule is another useful tool to use while at a competition. The schedule should be writt en out and posted and a copy given to each person. Part of mental preparation is knowing what to expect throughout the course of the day and writt en schedules can facilitate that preparation. Knowing specifi c times for team meetings, free time, and family and friends, allows athletes the opportunity to fi t their personal preparation plans within that schedule. Similarly, it promotes a focus on the present, which can be very helpful. While at the competition, it is easy to get caught up in all the distractions and elements surrounding performance. Knowing when things are going to occur allows athletes the opportunity to focus on exactly what they are doing in the moment rather than wondering when a particular event is going to occur.

Stick with routines and plansIt is also important to remember to stick with regular routines and plans. A tremendous amount of time and eff ort will have gone into team preparation. Individuals and teams need to be respectful of this preparation and adhere to the routines and plans that have been devised. All too oft en, individuals will move away from the very elements that they have worked so hard to establish and then are confused as to why their performance has altered.

Expect the UnexpectedThings never go exactly as planned. It is inevitable that something unexpected or unusual will happen. Both athletes and coaches need to maintain a sense of humour or achieve a level of perspective when things out of the ordinary occur. At these times it will be useful to utilize preplanned refocusing strategies. Further, some crisis or setback could also arise. During those times, it will be important to problem solve and fi nd alternate ways to push through the issue. Open communication between athletes and coaches will be important at this point. Lessons need to be drawn and adjustments made to maintain and regain mental readiness and optimal focus.

Schedule Physical and Mental Recovery OpportunitiesA fi nal suggestion is to provide ample opportunity for both physical and mental recovery and regeneration over the course of the competition. Encourage concrete strategies to relax or to shift their focus away from performance and competition. Reading books, listening to music, meditating are just a few examples of strategies used to take mental breaks and reenergize the mind and body. Some competition events may last over several days. In these cases, it is particularly important to manage the emotion and excitement over the entire period in order maintain a consistent level of energy over the long haul. Proper recovery is also about appropriate choices. Athletes and coaches need to be mindful of the choices that will facilitate their performances versus take away from the ability to achieve the performance goals that have been set out.

ConclusionTo be optimally prepared mentally, the key is to have a clear goal for the event, adhere to personal plans and preparation strategies, stay in the moment, and minimize the impact of distractions. Remaining positive and optimistic, even in the face of adversity, and managing emotions daily are addition strategies that can make a big diff erence once competition arrives. For the teams who are prepared for the experience, competitions provide exciting opportunities to showcase abilities and are important learning opportunities for young athletes. Laura Farres holds a Ph.D. in Education from the University of Ott awa. She has a private consulting practice, Mind in Motion Consulting, and is a certifi ed mental trainer with the Canadian Mental Training Registry. Most recently, Dr. Farres was at the 2003 Canada Winter Games as the mental training consultant to Team BC.

Copyright held by SportMedBC. For information contact 604-730-7252.

Article retrieved from the Sport Med BC Website and reprinted with

permission from Sport Med BC


Key Points

• In most cases, children over 10 years of age can begin serious training for wrestling. For overall development and appreciation of various sports, children should not specialize in wrestling until they are in college but should be exposed to a wide variety of athletic endeavors.

• Youngsters who have a competitive nature, natural athletic ability, and good parental support tend to become successful wrestlers.

• Recent rules changes have had the positive eff ect of emphasizing year-round conditioning and nutrition to maintain a constant

body weight rather than the former practice of using in-season cycles of rapid body weight loss and gain.

• Some of the best overall training strategies for wrestlers include the use of repetitive wrestling drills with a comparably skilled or somewhat more skilled partner and continual att ention to correcting weaknesses. For young wrestlers, it is important that practice sessions be varied so they become enjoyable. This can help prevent early burnout.

• Wrestlers should consume a balanced, relatively high-carbohydrate diet on a daily basis. Meal-replacement beverages can be useful in the hours before competition to minimize bulk in the gastrointestinal tract and aft er competition when appetite

Scott Anderson, A.T.C.Department of Athletics

Oklahoma University

Greg Landry, M.D.Medical School and Department of Athletics

University of Wisconsin-Madison Madison, Wisconsin

Russ Hellickson, M.A.Department of Athletics

The Ohio State University Columbus, Ohio

Karen Sossin, M.S., C.D.N.Nutrition Consultant,

New York State Public High School Athletic Association

West Islip, New York

For Amateur Wrestling

Training &Nutrition


may be suppressed. High-carbohydrate supplements are helpful between competitions, especially in tournament situations, to speed restoration of glycogen stores in the body. Sports drinks can help ensure adequate bodily hydration before and during practice sessions and tournaments and can accelerate rehydration aft er a practice or a match..

Introduction Amateur wrestling is one of the oldest sports on record, pitt ing one competitor against another in a batt le of skill, strength, power, endurance, and intelligence. Although amateur wrestling may not have the “bone-crushing excitement” that appears to draw fans to professional wrestling, those who are familiar with the challenges of amateur wrestling can appreciate the skills employed to misdirect the opponent, to take the opponent down without placing oneself in jeopardy, and to turn the opponent’s shoulders to the mat when the opponent has no intention of allowing that to happen. To achieve success in amateur wrestling, you must be able in split-second intervals to direct the laws of physics against your opponent before the opponent can employ them against you. In the end, although teammates can be psychologically supportive, your success or failure depends only on how well you can combat your opponent.

Because wrestlers must compete in pre-specifi ed body-weight classes, they must carefully regulate their dietary intakes of energy, carbohydrate, fat, and protein. In addition, they should resist the lure of wrestling in low body-weight classes that may require them to lose body weight rapidly by dehydration to qualify for the weight class. Fortunately, recent rules changes requiring the regular monitoring of body fat and hydration status have reduced this practice of rapid dehydration. Finally, wrestling is a contact sport and can result in serious injury to muscles, bones, and joints. There are also opportunities for the spread of contagious skin diseases, including strains of the Herpes virus. Strength training, appropriate hygienic practices, and certain medications can help minimize these problems.

We asked a group of expert panelists to discuss these and other issues associated with amateur wrestling. Scott Anderson is head athletic trainer at the University of Oklahoma, a perennially strong intercollegiate wrestling power. Russ Hellickson is head wrestling coach at The Ohio State University; he was a silver medalist in the 1976 Montreal Olympics and has produced many NCAA champions in his coaching career. He has been a television commentator for Olympic wrestling since 1984. Greg Landry is a pediatrician at the University of Wisconsin-Madison Medical School and is a team physician for the university’s athletic teams. Dr. Landry was instrumental in helping to develop Wisconsin’s high-school program on minimal wrestling weight, the fi rst in the nation. Karen Sossin is a nutrition consultant to the New York Public High School Athletic Association and has writt en a chapter on nutrition for wrestling in a new book, Sports Nutrition: A Guide for the Professional Working With Active People, published by the American Dietetic Association..

1. What is the earliest age at which a child should begin participating in wrestling?

Landry: Playing around on the mat can occur as early as four or fi ve years of age, but true competition should wait until the kids are at least seven or eight years old. Many children do not really enjoy competition until 10 or 11.

Anderson: Wrestling prior to age 10 may lead to burnout. Among

the factors that have been associated with athletic “burnout” are: 1) Very high self- and external expectations; 2) A “win-at-all cost” att itude; 3) Parental pressure; 4) Long practices with litt le variety; 5) Inconsistent coaching practices; 6) Overuse injuries; 7) Excessive time demands; and 8) Love from others determined by winning or losing.

Too oft en, children, especially boys, are in eff ect being “red-shirted” by delaying their entry into school or by repeating an early grade so that they will presumably be more physically mature during their years of high school sport participation. The current trend towards early specialization in sport participation is a concern. The policy of the American Academy of Pediatrics is that children involved in sports should be encouraged to participate in a variety of diff erent activities and develop a wide range of skills. Their view is that young athletes who specialize in just one sport may be denied the benefi ts of varied activity while facing additional physical, physiologic, and psychologic demands from intense training and competition.

2. What traits predispose a child to succeed in wrestling, both from an enjoyment standpoint and a win-loss standpoint?

Anderson: As always, natural ability is a key component, and the athlete must have a competitive nature, seeking to prove oneself against the best. Success is oft en determined by the quality of parental involvement. Balanced parental support can be a sustaining, encouraging force. Self-determination is a key to success in any sport but especially so in an individual sport such as wrestling, which may entail many hours of solitary training and conditioning. A desire to learn and a willingness to accept instructions are crucial, as are a continual striving to improve and a strong work ethic - win, lose, or draw.

Landry: There is no question that wrestling att racts kids who are innately intense. The youngster with some natural body control and good balance will also be apt to be successful in wrestling.

3. How have the approaches to training and nutrition changed now that guidelines for weight-class selection are in place at the NCAA level and among many state high-school associations?

Hellickson: The old approach was to lift weights in the off -season to maximize muscle size and strength with the expectation that the wrestler could maintain or at least minimize losses in strength during the season by focusing on dehydration to “make weight.” With the advent of body-fat testing and tests for hydration, this strategy has disappeared. You can’t fool the calipers or the tests for urine specifi c gravity. Wrestlers and coaches now are much more likely to maintain a year-round approach to controlling body weight. At the expense of exclusive and intensive strength training, wrestlers now include an aerobic component to their training as a calorie burner to help keep body fat low. A wrestler who focuses exclusively on pumping iron may move himself up a weight class or two and out of the starting lineup. If he gets too big, he does not have enough time in the competitive season to reduce his weight to make the weight class within the constraints of the NCAA guidelines.

Anderson: I agree with Coach Hellickson that the rules changes have served to increase year-round, rather than seasonal,


adherence to nutritional and conditioning programs. There is an increased focus on nutrition and education for the athlete, with more emphasis on lifestyle diet and more consistent maintenance of body weight within a narrower range around the competition weight than had been the case before the new guidelines.

Landry: Restrictions on weight cutt ing have helped wrestlers spend more time on training and technique rather than weight cutt ing. The smart wrestlers still pay close att ention to diet and weight control on a day-to-day basis to prevent the need for rapid weight loss. The wrestlers look healthier at weigh-ins and seem to be enjoying the sport to a greater degree.

Sossin: Similar to what was done in Wisconsin in 1989, the New York State Public High School Athletic Association established a Wrestling Minimum Weight Certifi cation Program in 1998. Coaches now participate in statewide instruction by dietitians on weight loss and weight maintenance, hydration, and sports nutrition principles for peak performance. As a result of the program, the lines of communication have opened, and coaches all around the state now have nutritionists that they know and can consult for assistance.

4. What coaching methods and training strategies have proven to be successful for advancing the skills of young wrestlers?

Hellickson: Talent alone can make a wrestler good, but persistent practice of technique with a good drill partner is essential to make a wrestler great. Drilling of maneuvers over and over allows a wrestler to simulate as many situations as possible in preparation for whatever he may face in a match. A wrestler needs three or four att acks with four or fi ve methods of fi nishing the att ack. He can never predict how an opponent will react, but by simulating in practice as many positions and responses as possible, a wrestler will be able to execute a successful fi nish that scores points. Drilling speeds for new technique should be slow at the start, but eventually the wrestler should be executing at speeds similar to those used in competition. The partner needs to react in ways to provide the off ensive wrestler the proper feel of position, pressure, and leverage. Reactions will vary too, to simulate all scenarios. The key here is repetition. Repetitions engrain the motor skills so the wrestler doesn’t think about execution for a specifi c defense; he spontaneously reacts to score.

Landry: Young athletes need to have fun, so it important to make any drill into a game or contest. The younger wrestler has a shorter att ention span and will need to change drills or activities more frequently than will the older wrestler.

Anderson: An individual wrestler must be willing to make adaptations in personal style to meet the increasing levels of competition by addressing weaknesses, working tirelessly until the weaknesses are eliminated, and then sequentially att acking and eliminating other weaknesses.Wrestlers who do this eventually have very few weaknesses, thereby becoming highly skilled and successful wrestlers.

5. Caulifl ower ear and skin infections are unique ailments in this sport. What precautions should be taken to minimize the risks of these and other types of injury in wrestling?

Landry: Caulifl ower ear is preventable by the consistent use of a snug-fi tt ing headgear. Loose-fi tt ing headgear slides on the ear

and can cause injury. Oft en, a wrestler gets careless, leaves the headgear off during a brief time on the mat, and injures the ear.

Some of the bacterial and fungal skin infections are preventable by frequent mat washing with a good antiseptic soap. This will not prevent Herpes virus infections that are transmitt ed by skin-to-skin contact. Competitors should seek medical att ention for any rash to help prevent its spread to teammates. Newer antimicrobials have helped us minimize the time off the mat for the wrestler with a skin infection.

Anderson: I agree with Dr. Landry that a well-fi tt ed ear protector is the best prevention against formation of caulifl ower ear. A proactive plan emphasizing prevention is imperative, especially for warding off skin infections. Cleanliness is paramount for both the wrestler and the facility. Wrestlers should shower aft er every workout with emphasis on cleansing both the hair and the body. Mats should be cleaned with an appropriately formulated cleanser at least twice daily, more oft en with heavy use. Proper cleaning measures should also be taken with laundry. As infections will occur despite the best preventive techniques, isolation of the infected wrestler must continue to be practiced. The prophylactic use of drugs (valacyclovir, acyclovir) to suppress outbreaks of Herpes infections has some research support and is gaining popularity as a means to control recurrent outbreaks of the disease.

Hellickson: Wrestling is the ultimate contact sport, and in such a sport, injuries are bound to occur. By maintaining a strength training program with proper techniques that maximize fl exibility, wrestlers can help prevent injuries and experience a prompt recovery if and when an injury does occur. In the event of an injury, a wrestler is well advised to give the limb or joint time for rest and recovery. The same goes for skin infections; take the time to heal, and prevent spreading a permanent skin condition to others on the team. There is litt le sense in wrestling too soon and risking further injury. I’d prefer that a wrestler take a litt le more time for recovery, even if it means missing a match or two, and come back at full strength and health for the most critical part of the season.

6. What nutrition practices do you recommend during in-season training?

Sossin: Once an appropriate and realistic wrestling weight has been established and achieved, nutrition emphasis should be on maintaining and stabilizing weight to achieve peak performance. In order to accomplish this, the following guidelines for wrestlers are recommended:

• Following the Canada Food Guide, choose a training diet that is high in complex carbohydrates (55-60% of total energy), moderate in protein (20%), and low in fat (20-25%). • Drink to stay hydrated, and replace 150% of sweat loss (body weight loss) aft er exercise. • Before a match, consume a high-carbohydrate, easily digested meal. • Eat or drink carbohydrates to replenish glycogen aft er practice or matches. • Maintain strength and energy by avoiding weight cycling or rapid weight loss. • Eat small-to-moderate sized meals every 3-4 hours to help maintain steady glucose levels and avoid “crashing.” This will help control appetite and reduce binge eating.


It is important for wrestlers to avoid the common restrictive eating patt erns prior to competition, followed by binge eating aft erwards. This patt ern is detrimental both to athletic performance and to psychological well being. Wrestlers who are in tune with their body needs are much more likely to be successful and enjoy the sport of wrestling to its full potential!

I believe that meal replacement drinks such as GatorPro are valuable adjuncts to a wrestler’s diet. They can be benefi cial when consumed before a match because they keep weight gain to a minimum due to the low stool residue, yet they provide needed calories and fl uids. They are also absorbed more quickly than solids and can be consumed closer to competition. The wrestler must experiment in advance to determine which drinks best suit their individual needs. High-carbohydrate drinks such as Gatorade may be more appropriate as a recovery carbohydrate following exercise, when sometimes appetite is reduced. I do not recommend other dietary supplements other than a well-balanced multi-vitamin-mineral supplement.

Hellickson: It is tough in the college environment to get wrestlers to comply with decent nutrition strategies. We fi nd that wrestlers eat far too many meals in fast food restaurants. It’s not that they don’t have the knowledge of what to eat; rather, they have a lack of organization and discipline. The key is the well-balanced diet and ensuring that enough energy is consumed during the day. We recommended that our wrestlers eat three-to-four small meals, including breakfast, every day. When the wrestlers don’t eat the right balance of carbohydrate, protein, and fat, it shows; their performance in practice is poor, and they contribute nothing to preparation for competition. We especially urge wrestlers to get adequate amounts of carbohydrate. The fad diets that encourage protein at the expense of carbohydrate might promote weight loss, but they drain wrestlers of energy for intense training. I do not recommend using dietary supplements other than multi-vitamin, multi-mineral tablets that contain micronutrients in reasonable amounts. In tournament situations when competition spans several days, we will use a high-carbohydrate beverage such as GatorLode because we know that it will help speed energy recovery during the hour or so between matches.

Landry: Ingestion of a carbohydrate source immediately aft er exercise to replenish glycogen stores is important during training. An energy drink or meal replacement drink is oft en a convenient way to provide the carbohydrate source. I do not recommend any other nutritional supplements for wrestlers. Most are ingesting enough protein and don’t need supplements. Creatine is not a good supplement for most wrestlers, and I discourage its use.

Anderson: I support the idea that wrestlers should eat a well-balanced, high-carbohydrate diet based on the Food Guide Pyramid. Aft er workouts and competitions, I recommend high-carbohydrate meals or drinks to help restore muscle glycogen. We use meal replacement drinks like GatorPro aft er weigh-ins and aft er competitions, especially in tournaments.

7. What hydration strategies are most eff ective for preparing athletes for dual meets and tournament competition?

Sossin: I spend a lot of time discussing hydration with wrestlers and coaches. The wrestlers are reminded to drink before they feel thirsty and to establish a drinking schedule that works for each individual. I recommend that wrestlers begin hydrating the night

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before a match or a practice session. They should drink two cups of fl uid 2 hours before, and then another cup 15 minutes before the match begins. In long practice sessions or in tournament sett ings between matches, especially in hot, humid environments, wrestlers should consume a cup of fl uid about every 30 minutes. Sports drinks containing 6-8% carbohydrate solutions can be especially benefi cial during dual meets and tournaments. They not only provide the needed fl uids, but the carbohydrate can enhance performance. Additionally, there is a tendency to drink more of a sports drink than of tap water. I always remind wrestlers to take notice of the color of their urine and to drink enough so that it is pale yellow. They should also watch out for a strong urine odor that could refl ect dehydration.

Wrestlers should also weigh themselves before and aft er each workout or match. While rehydrating, a certain amount of the water consumed is always lost in the urine. Therefore, sweat loss, as indicated by body weight loss, should be replaced with at least 24 ounces of fl uid for each pound (16 ounces) lost. Caff eine in soda, coff ee, and iced tea should be avoided because it accelerates urine production. To help speed rehydration, wrestlers should make certain to consume salty foods and beverages such as sport drinks that contain sodium chloride (salt). The salt helps the body retain more of the fl uids that are consumed.

Landry: Most wrestlers have learned to sip on a water bott le or sports drink throughout the day. Like other athletes, the smart ones began sipping before they are thirsty so that they will not fall behind.

Anderson: I recommend using Gatorade before and aft er matches to help maintain both hydration and energy levels in the

wrestlers.

8. Strength and power are important factors in wrestling performance. What is your opinion about the value of weight training or other types of resistance training during the season?

Hellickson: Despite the need to regulate body weight, we emphasize weight training and strength development, but we do so across the entire season as much as is reasonable. Certainly with a full load of classes and dual meets every week, the wrestler cannot lift with the same intensity or number of training sessions per week during the season. In the off -season and pre-season, we encourage strength training three-to-four times per week. In season, we shift to circuit training to hit all muscle groups at least once a week. Empirical evidence shows that the wrestlers become weaker if they aren’t lift ing as the season progresses. As a part of strength development, we push our wrestlers to run hills and do sprint work, both of which fi t the sport-specifi c nature of wrestling: short explosive eff orts to develop power and strength in the lower body. This is key to the lift s and hip forces generated in the sport.

Landry: Weight training is an important part of training for wrestling. It is a power sport, and the wrestler with the most power has a bett er chance of winning. It is diffi cult to build power exclusively by drills on the mat.

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So, you need to attend Physical Therapy…Ermineskin Physical Therapy was established in 1985 with the aim of serving the ambulatory Physical Therapy needs of the citizens of Edmonton and area. In 2003 we changed our name to South Edmonton Physical Therapy & Sport Rehab Inc. to better refl ect our location and services.

Our team of Physical Therapists are all graduates of a recognized university program and are members of the College of Physical Therapists of Alberta.

We treat many diff erent problems from back and neck pain to joint replacement surgery and motor vehicle accident injuries, as well as many other problems associated with keeping the human body moving.

We are accredited by the Rehabilitation Accreditation Commission (CARF).

www.southedmontonphysio.ca

South Edmonton Physical Therapy & Sport Rehab Inc.3010 - 106 St Edmonton • 780-438-0001

Article retrieved from the Gatorade Sports Science Institute’s Website:

htt p://www.gssiweb.org


Doctors should question whether return to high level pivoting sports is in the athlete’s best interest aft er ACL reconstruction.

“When can I play again, Doc?” is the emotionally charged, quintessential question asked by nearly every athlete aft er anterior cruciate ligament (ACL) injury. Invariably, the same question is one of the fi rst asked by parents, team mates, coaches, and—in the case of the high profi le athlete—the media. This implies that, to meet the expectations of the athlete and his/her surroundings, swift surgical intervention and accelerated rehabilitation becomes a priority. Therefore it is not surprising if the time to return to play is the standard by which orthopaedic surgeons measure themselves and are measured in sports circles.

Measured by this standard, sports medicine has made giant advances in ACL treatment programs during the previous decades. We have progressed from open surgery to arthroscopic surgery, from extended casting to short term bracing, from conservative to accelerated rehabilitation programmes, and from long hospital stays to outpatient surgery. When an athlete is injured today, it is expected that arthroscopic surgery will take place a few weeks aft er injury, that rehabilitation is started immediately, and that the patient is able to return to sport in four to nine months. The “best” surgeons and physiotherapists are rumoured to return players even sooner.

“Are there other criteria whereby we should measure treatment outcome than the time to return to sport?”

Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical Education, Oslo, Norway

After Anterior Cruciate Ligament Surgery

Return to PlayGuidelines

G Myklebust and R Bahr

Lost in the need to succeed and with the fear of defeat deeply embedded in our decision making processes, it is no wonder that we rarely ask: “Is it time to quit? Is it safe to return patients to pivoting sports? What are the long term results of our treatment programmes? Are there other criteria whereby we should measure treatment outcome than the time to return to sport?” Should we not consider the risks of a graft rupture or additional knee lesions and the likelihood of the development of early osteoarthritis (OA) when advising the athlete aft er the initial injury.

To bett er address these issues, we have searched the literature for follow up studies aft er ACL injury examining the rate of return to sport, the reinjury risk, and/or the prevalence of OA (see table 1 for details on search terms and procedures). We have included studies of patients treated non-operatively or with reconstructive surgery who have been followed from 4 to 14 years aft er the initial injury.

Return to Sport aft er ACL InjuryFor athletes who wish to return to pivoting sports, the typical advice is an ACL reconstruction aft er 4–8 weeks when full range of motion is established and there is no joint swelling. The purpose of an ACL reconstruction is to give the athlete a mechanically stable knee and to reduce the risk of subsequent injury to the menisci and cartilage by reducing anteroposterior joint motion.4 A number of short term studies have shown good to excellent knee function aft er reconstruction, whether hamstrings or patellar tendon graft s are used. The same studies also confi rm that most patients (65–88%) are able to return to sport within the fi rst year. Thus it is fair to state that surgery is eff ective in allowing injured athletes to resume their sports career.

Also, some athletes are able to return to high level pivoting sports without surgery. Among patients treated non-operatively, the return rate ranges from 19% to 82%. The athletes who successfully return to sport aft er non-operative treatment probably represent a selected group with functionally stable knees and a strong motivation to continue pivoting sport despite their injury.

If athletes can return to sport with or without ACL reconstruction, how long are they able to keep playing aft er the initial injury? Most studies deal with ACL reconstructed patients, and the results vary between studies with a range from 8% to 82%. However, it is not always clear whether the authors are reporting an initial return rate or the proportion still playing at the time of follow up.

Nevertheless, a few studies may be of particular interest, because they follow sports specifi c patient populations and report data on patients treated with and without surgery. Also, these studies mainly include elite athletes who can be assumed to be well motivated to continue their sports career. Thus the data may provide a realistic estimate of what to expect aft er returning to sport aft er injury. Myklebust et al found in a 6–11 year follow up of ACL injured team handball players that 58% of the reconstructed players and 82% of the conservatively treated patients were able to return to their preinjury level.

In the 10–13 year follow up study with a mixed sport population, Fink et al1 found a 44% reduction in high risk sports participation in the surgically treated group compared with a 70% reduction among the conservatively treated. In the longest follow up to date, von Porat et al showed that, aft er 14 years, 6% in the operatively treated group and 1% in the conservatively treated group were still playing soccer. However, from these studies it is not possible to determine whether the players retired because of the injury


or whether the retirement rate was higher than can be expected. Clearly, athletes may quit for reasons unrelated to their knee injury.

In the only study in which the reduction in sport participation can be related to a control group, Roos et al reported on elite soccer players three to seven years aft er the ACL injury. They found that 30% were active in soccer aft er three years compared with 80% in an uninjured control population. In addition, they showed that, aft er seven years, none of the injured elite players were active regardless of the type of treatment. It seems fair to conclude that, although the initial return rate is high, regardless of treatment, previously injured athletes retire at a higher rate than athletes without previous ACL injuries. The reason for this may be that many of the athletes who return to sport experience signifi cant knee problems, such as instability, reduced range of motion, and/or pain.

Reinjury Rate Aft er SurgeryOne of the potential concerns with returning to sport is that the reinjury rate to the reconstructed ACL or to other structures (menisci, cartilage, or other ligaments) may be unacceptably high. Only few studies have examined reinjury risk, and they report a wide range of rerupture rates ranging from 2.3% to 13%. The highest ACL rerupture risk (13%) was found by Myklebust et al in their study of team handball players. However, one reason for the high risk seen in this study may be that team handball in itself is a high risk sport. Six of the 50 players who returned to team handball (9%) experienced an ACL tear in their contralateral, previously uninjured knee during the observation period. A similar reinjury rate was reported by Drogset and Grøntvedt, who found that 12% of their patients suff ered a reinjury during an eight year follow up period, all during pivoting sports.

However, these results, as well as studies reporting lower rerupture rates, must be interpreted with caution. Firstly, the population at risk is not known, because it clearly depends on the proportion returning to sport and the number of years they continued to play. Secondly, bias must be considered when there is a signifi cant loss to follow up as is evident in most of the studies. Thus, we do not know if there is an increased risk of reinjury to the reconstructed ACL compared with a healthy knee, nor do we know the rate of meniscus or cartilage injury associated with return to sport. Nevertheless, it is clear that nearly all of the reruptures reported in the papers shown in table 1 occurred while pivoting sports were being played.

“Returning to pivoting sport without a reconstruction results in considerable risk of injury to the menisci and cartilage”

Further damage to the knee with continued sports participation is of course also a concern in non-operatively treated patients. Myklebust et al showed that 22% of the non-operatively treated players who returned to sport underwent additional surgery for an injured meniscus compared with 12% in the operatively treated players. Returning to pivoting sport without a reconstruction results in considerable risk of injury to the menisci and cartilage.

Prevalence of OAUsing the rate of return to sports or even the reinjury risk as measures of treatment success may be grossly misleading. An ACL injury entails a signifi cant risk of OA, and it may be that the initial injury itself is an important determinant of the development of OA, no matt er what treatment is used or how the

knee is loaded during subsequent years.

Another important factor is that isolated ACL injury is a rare occurrence. Bone bruises are evident in 80–90% of ACL injured knees, although their signifi cance for future knee function is not clear. Meniscal injuries are found in 75%, and loss of meniscal tissue is an important risk factor for future degenerative joint disease of the knee. Other structures such as ligaments and capsular tissues—for example, the posterolateral structures—are oft en injured and may contribute to future OA. Assuming that treatment of ACL injury by reconstructing the ACL with tendon, repairing articular cartilage injuries with procedures forming fi brocartilage, and suturing the meniscus restores the knee to normality may not be true. Aft er ACL injury, the biochemical markers do not return to normal even aft er many years.

Also, sports participation in itself, even without a history of injury, results in a moderate increase in the risk of hip and knee OA. Thus it seems reasonable to hypothesise that this risk would be exacerbated in a previously injured knee where joint motion and cartilage loading patt erns are signifi cantly diff erent from the intact knee, despite proper rehabilitation or surgical intervention.

Figure 1 shows the risk of developing radiological signs of OA with time aft er an ACL injury. Aft er 10 years, approximately half of the patients display signs of OA. An extrapolation of these results indicates that nearly all patients will have OA aft er 15–20 years. A recent study showed that all athletes undergoing revision ACL surgery had OA when they were re-examined 37 (12–58) months aft er the reoperation (because this study includes patients with two or more ACL injuries, it could not be included in fi g 1 or table 1). It seems that a high frequency of radiographic changes is the rule rather than the exception aft er ACL injury.

These fi ndings raise two important questions. Firstly, is there a diff erence in the risk of OA between surgically treated and non-operatively treated patients? Unfortunately, there are no prospective trials in which patients have been randomised to a reconstruction or non-operative treatment. In the three follow


up studies that include surgically and non-operatively treated patients there may be a selection bias, which makes it diffi cult to interpret the results. Nevertheless, as shown in fi g 1, the prevalence of OA does not seem to depend on whether an ACL reconstruction was performed or not. von Porat et al reported 78% OA prevalence in both groups aft er 14 years, Fink et al 78% v 83% aft er 10–13 years, and Myklebust et al 42% v 46% aft er 6–11 years. Thus there is no evidence to suggest that ligament reconstruction prevents future OA.

The second question is: is there an increased risk of OA in athletes who return to sports compared with those who choose to retire? For obvious reasons, there is no study in which athletes have been randomised to continued sports participation or early retirement. Furthermore, although it would have been interesting to compare OA prevalence between athletes who chose to retire and those who continued to play, these data have not been reported in the available studies. Therefore there is an urgent need to establish large prospective studies to follow cohorts of athletes with ACL injury. Using a multivariate approach, it will then be possible to assess the independent eff ects of treatment methods, associated injuries to the menisci and cartilage at the time of injury, graft choice, reinjuries, and continued sports participation, to mention a few factors that could be important for the development of early OA.

Time to QuitIn 1970 Kennedy stated that “the ACL is the most common cause of the ex-athlete.” In other words, the treatment off ered at the time did not permit athletes to go back to sport. This is no longer the case, at least in the short term, thanks to major advances in surgical treatment and rehabilitation programmes. As shown above, most elite athletes are initially able to resume their sports career. However, the data also show that the retirement rate may

be higher among athletes with a previous ACL injury compared with healthy athletes. Furthermore, it is apparent that there is a signifi cant risk of reinjury to the graft , as well as the menisci and cartilage with continued sports participation. Finally, there are convincing data to show that nearly all patients will develop OA with time.

Thus it seems reasonable to question whether return to high level pivoting sports really is in the athlete’s best interest—if long term knee health is the primary concern. The relevant issue that needs to be addressed is: what are the additional risks of further injuries and early OA associated with return to sport? We cannot answer this question properly from the available data. Until we can, as physicians and physiotherapists working with this patient group, it is our obligation to provide adequate information of the potential consequences of returning to pivoting sports. We must enable the athlete to make an informed decision with all necessary information available, including the caveats related to future risk of knee problems and OA. This includes clearly pointing out that ACL surgery can only be expected to improve knee stability, but that ACL surgery does litt le or nothing to secure a future healthy knee. The answer to the question “When can I play again, Doc?” is straightforward and can be comfortably stated by most doctors: “Probably within 1 to 9 months depending on the treatment that is best for you ...” BUT let us take a moment to talk about the more diffi cult question I am going to ask you: “Should you return to sport?”


Article retrieved from the British Journal of Sports Medicine Website

www.bjsm.bmjjournals.com

You’ve been training hard, you’re mentally ready, your equipment is tuned-up, and you have one last item to think about – what are you going to eat on your competition day?

For most athletes their day-to-day training diet should be similar to their day of competing, however, there can be challenges when it comes to competition nutrition.

Diet-related challenges when competing include: • fl uid and food during travel to competition(s) • events away from home which require eating in restaurants or preparing your own meals • pre-competition anxiety or excitement negatively aff ecting appetite • unaccustomed climate (e.g., increased temperatures and/or humidity) possibly leading to dehydration and heat illness • numerous events with litt le time to eat between competitions (e.g., tournaments, track or swim meets) • endurance competitions that are longer than usual training days (e.g., marathon, triathlon, etc.) • concern that dietary supplements may lead to a positive doping test

You’re not alone if faced with some of these diet-related challengesduring competitive events. A number of resources are available tohelp guide your nutrition during competitions. This overview willdescribe dietary fundamentals to help you achieve personal bestperformances in competition.

Follow Your “Usual” Dietary RoutineFirst things fi rst, whenever possible, stick with your usual trainingdiet on your competition day. Eating well should never STARTon your day of competing! By consuming familiar foods you willbe confi dent that your nutrition game plan is suited for you.

Travel to Competitive EventsIn many cases, you will have to drive or fl y long distances to your

competition site. Travel presents a variety of challenges for athletes, especially when a competition is on the line. Once again, select familiar foods with the emphasis on a higher carbohydrate diet (e.g., grain products, vegetables, fruit, milk, yogurt, legumes, sport drinks, and sport bars) to top up energy (i.e. glycogen) stores. When driving to a competition, frequent stops will ensure that you stretch and move around. Predictable driving breaks may encourage you to consume fl uids to stay hydrated, because you know there will be bathroom breaks enroute. Appropriate healthy, portable snacks are always a good idea for travelling.

Restaurant Choices and Preparing Your Own MealsEducating athletes about suitable food selection from a varietyof restaurants is highly recommended, especially for youngcompetitors. Restaurant choices should include ample healthycarbohydrates with moderate amounts of low-fat protein. High fatrestaurant selections (e.g., French fries, cream sauces) and highsugar foods (e.g., soft drinks, slushy frozen drinks, candy) shouldbe discouraged.

At some competitions you may have accommodations where you can prepare your own meals. Coaches need to realize that some athletes may need guidance to learn basic cooking skills, help plan meals, and supervise grocery shopping. It’s never too early to start learning life skills!

Pre-event Meal and Snack TimingIndividual dietary diff erences are most obvious when it comes topre-competition nutrition. Nonetheless, the purpose of eatingbefore competing is to: • ensure ample energy is available (elevate blood glucose) • prevent hunger • continue to hydrate

Regardless of dietary diff erences, the pre-event meal and/or snackshould contain mostly carbohydrates with a small amount of low-

Compet i t ioNutrition


Writt en By:

Sport Nutrition Advisory Committ ee

Coaching Association of Canada

fat protein – for easy digestion. The larger the pre-event meal, themore time you will need to allow before your competition.

Prior to competing, generally allow: * 3–4 hours to partially digest a big meal * 2–3 hours for a moderate-sized meal * less than 2 hours for a pre-event snack

Some foods and fl uids may negatively aff ect sport performances. Before competition avoid:

pop, frozen slushy drinks, candy, candybars, chips, and other high fat and/or high sugar

snack foods.Preventing Heat IllnessA competition can be easily lost due to over-heating fromdehydration. Some of the consequences of dehydration includemuscle cramps, elevated heart rate, reduced speed and endurance.Therefore, consume ample fl uids before, during, and aft ercompeting.

Consider the following hydration guidelines: * Drink 500 mL of fl uid 2 hours prior to your event * Drink 250–500 mL 45 to 30 minutes prior to your event * Drink 150–350 mL every 15 to 20 minutes during your event

A variety of factors will increase your sweat losses and subsequently risk of dehydration. For example, high exercise intensity, long duration events, heat, humidity, and possibly high winds can all increase the risk of dehydration. It is imperative that you drink at regular intervals during competition to prevent dehydration-heat illness.

Maximizing EnduranceWhether participating in an endurance event or competing in anumber of events with litt le rest – as a competitive athlete you may be challenged to sustain high energy levels. Athletes fatigue when blood glucose is too low, when stored energy is used up (i.e. muscle glycogen), when dehydrated and/or when producing too much lactic acid (i.e. “muscle burn”). To maintain energy and perform at your best, sip a sport drink, or eat a few bites of a sport bar or fruit at regular intervals during your event.

Always experiment in training to determine which foods and/orfl uids are best tolerated during activities. In some cases, you mayneed to bring “tolerated” foods and fl uids with you to yourcompetition site, rather than relying on what the concessionstand has to off er.

Food and Fluid to Maximize Endurance:sport drinks, water, sport bars, sport gels, fruit, cereal

bars, granola bars, fruit leather, trail mix

Nutrition Between Competitive EventsDuring some competitions, you may have anywhere from a fewminutes to several hours between events. Pre-organization withappropriate foods is critical to perform at your best. In other words, you may be recovering from one competition while preparing for your next event.

Similar guidelines as the “Pre-event Meal and Snack Timing”suggestions apply between competitive events – it all depends onthe timing of your competitions. If you know your competition

schedule in advance, develop a precise dietary plan around yourscheduled events. This strategy will help alleviate any guessworkregarding your nutrition.

Less than 90 Minutes Between Events:• choose mostly carbohydrates with ample fl uids

• e.g., water, sport drinks, sport bars, fruit, unsweetened juices, bagels, low-fat muffi ns, cereal bars, granola bars, trail mix, fruit leather, nuts, pretzels, canned Boost™ or

Ensure™ or Breakfast Anytime™

More than 90 Minutes Between Events:• mini-meal with ample fl uids like water, juice or milk• e.g., 1/2 to full submarine sandwich OR peanut butt er

and crackers OR low-fat muffi n and cheese• consider food safety – KEEP HOT FOODS HOT and

COLD FOODS COLD!

Post-competition Recovery DietAt the end of a competitive event or day of competing, emphasizerecovery nutrition, especially if the competition resumes in the next day or so. During or immediately aft er your cool-down, reach for high glycemic carbohydrates (e.g., sport drinks, bread or bread products, pasta, rice, potatoes). High glycemic carbohydrates will help to restore glycogen quickly. Suffi cient fl uids are important to re-hydrate eff ectively, and protein is essential to repair muscle damage from physical exertion. In addition, include fruits and vegetables as they contain key nutrients (e.g., electrolytes – potassium, antioxidants – vitamin C) to support full exercise recovery.

Example Exercise Recovery Meals:• bagel and powershake (made with milk, fruit, yogurt or

ice cream, skim milk powder or protein powder), water• sport drink, chicken fajitas and brown rice, salad, water• chocolate milk, fi sh or steak, baked potato, whole wheat

bun, vegetables, water

Cautionary Dietary SupplementsAt some competitions in Canada or in other countries, athletes may be randomly chosen or required to participate in a doping control procedure. It is therefore the athlete’s responsibility to avoid taking any foods or dietary supplements that may lead to a positive doping outcome. Information about the World Anti-Doping Agency’s list of prohibited substances – “Substance Classifi cation Booklet” – is available at www.cces.ca and www.wada.com.

Competing in sport can be a positive and rewarding experience.With careful planning, nutrition can help lead to personal bestresults!

www.coach.ca15 SMCA Pulse Summer 2006

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