Sports Injuries: How to Treat the Mind and Body

For athletes and fitness seekers, sports injuries are par for the course. The fact that they’re commonplace if not somewhat inevitable does not make them any easier to cope with. The best way to address sports injuries is to avoid them in the first place by properly warming up before exercise, cooling down and stretching afterwards, and most importantly, listening to your body when it’s telling you to pull off the throttle. Unfortunately, most of us don’t learn (and apply) this good sense until we’ve experienced a sports injury that sidelines us long enough to feel beyond frustrated to the point of resolve—I’m going to treat my body better from this point onward.

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So, what do you do when you find yourself injured? Do you go with tried and true techniques like RICE (Rest, Ice, Compression, and Elevation)? Or more high-tech therapy methods like ultrasound? And what about the all too often neglected mental aspect of recovering from sports injuries? The answer: all of the above.

The Tried and True: RICE

Most athletes are familiar with the term RICE. RICE is a crucial first step in post-injury triage. Rest, ice, compression and elevation are particularly important in the first 24-48 hours following sports injuries. Rest means exactly what it sounds like—significantly pulling back on your normal activity levels immediately following an injury and continue to moderate for a period of time after that agreed upon by you and your doctor. Step one of this tried and true method is often the hardest part for active individuals and can have the most challenging psychological effects—less endorphins means lower energy and more frustration. While difficult, stepping on the brakes then modifying for days, weeks or hopefully not week, is absolutely essential to proper, lasting recovery.

Ice, compression and elevation are all about reducing inflammation localized at the site of damage, not only providing comfort but also speeding your body’s healing time. All three are important immediately after injury but can also be used as you starting gearing back up and exercising again. If you’ve never given compression tape a try, next time you’re heading out to train wrap your injured area snuggly (without cutting off your circulation) and see how you feel. You might be surprised what a little targeted pressure and passive support can do.

Scientific Therapy

So you’ve gotten through the first two days post-incident using RICE, but you’re still in pain. Now what? Time to see a doctor, or if your healthcare doesn’t require a primary care physician’s reference, maybe go straight to a trusted physical therapist (PT). Whether seeing a doctor or PT, a medical professional will help determine your action plan for getting back in the game.  Quite often they can also provide a timeline for when you can expect to start feeling “normal” again, which is most people’s top concern when it comes to sports injuries.

A doctor or PT will likely suggest a multi-faceted course of action including light stretching, modified exercises (both assisted and unassisted), and possibly some more high-tech options like ultrasound therapy. Ultrasound therapy may help accelerate the healing and repair process of soft tissues (think hamstrings, gluteal muscles, lower back, etc). Ultrasound, a.k.a. sound waves of a high frequency, causes tissues to vibrate, which ultimately produces heat within ligaments, tendons, scar tissue and fibrous joint capsules. This heat is thought to reduce inflammation by attracting protective mast cells and increasing blood flow to the site of injury. It may also increase collagen production, an essential process for tissue repair because it is the primary protein component in soft tissues. Though studies are mixed, ultrasound is a worthwhile therapeutic option to explore with your physical therapist as a part of your overall strategy for pain reduction and the healing process for sports injuries.

The Mind-Body Connection

It is no secret that athletes (and all humans) have ego. It can be really hard to admit to yourself, let alone others, that sports injuries range from frustrating to utterly devastating. Apart from the diminished endorphins experienced in the wake of injury, the affected individual may grapple with something akin to the Kübler-Ross model, more commonly referred to as the “five stages of grief.” You may laugh but sports injuries have serious psychological impacts and you’re wise to give them the attention they deserve or they will undoubtedly hinder your path to recovery.

This series of five emotional stages starts with denial and leads to anger, bargaining and depression before reaching the ultimate stage of acceptance. When it comes to sports injuries, not everyone will experience every stage in this model. Denial usually sounds something like, “I’ll be back at it in no time” or “it’s probably nothing. I’ll just ice it and be good to go tomorrow.” Nobody wants to deal with the realization that they might be out of commission for an unknown stretch of time, thus we often move into the anger phase. Anger may rise up and fall away pretty quickly, but a majority of the time it rears its feisty head in one way or another—hopefully you surround yourself with compassionate and empathic people when you go on the woe-is-me war path. Once the anger subsides, the “if onlys” arrive—a.k.a. bargaining. If only I had pulled back when I felt that first tweak of pain; if only I hadn’t run those extra 5 miles; If only, well, you get the idea. We all do it, but those questions get you nowhere other than mad at yourself and exhausted by all that mental circling. Perhaps it is that fatigue that makes way for depression. When depression settles in post-injury, it is a weight that can be hard to shake. It’s important to surround yourself with good friends, good doctors, and a good outlook at this stage in the process in order to move into the world of acceptance ASAP. Acceptance should be called forward motion. It’s all about putting one foot in front of the other and taking concrete, positive steps toward healing your body and spirit.

Some of us get from stage one to stage five in a matter of days. For others it may take longer. The quickest way to get from denial to acceptance and avoid dwelling in the trenches of the less productive emotions is to learn about your injuries and ask questions. The better you understand your injury, the recovery time, the reasoning behind your treatment plan, alternative exercises you can safely do, the big no-nos, and how to know if you’ve gotten worse in some way, the easier it will be to move forward. By understanding your injury and knowing what to expect during the recovery process you will experience much less anxiety and feel a sense of control over the outcome.

Finally, don’t underestimate the power of positive thinking. If your self-talk is self-defeating you’re going to get in your own way. A positive outlook is arguably the most important factor influencing your path to recovery. Healing can’t happen if you don’t listen to what your body and mind need and attend to those needs compassionately and with conviction. Remember, the body is an amazing machine. You will be amazed at how quickly it remembers how strong, fast and enduring it was prior to your injury.

View the STACK Media version of my article here.

Post-Workout Recovery Fuel: The Golden Rule

Diet crazes may come and go, but one macronutrient has always remained largely unscathed by the mainstream fitness and nutrition media.

Protein is an essential part of our daily diet, forming the structural basis of our muscles, skin, nails and hair, amongst other functions. True, this macronutrient is mighty important, but the hype it gets and the marketing power that is thrown behind protein powders and other supplements could make you think the entire American population is suffering from protein deficiency.

That is just not the case. In fact, most of us get more than enough protein through our regular daily food intake—including vegetarians and savvy vegans.

For most people, the RDA for protein intake is 0.8-1.0 grams of protein per kilogram of body weight (2.2kg/1lb). If you’re an athlete or someone performing high-intensity physical activity (e.g. training for a marathon), you should bump that RDA up a few notches to 1.1-1.4 grams of protein per kilogram of body weight (Williams 2006).  In other words, a 135 lb woman should consume between 68 to 86 grams of protein, while a 180 lb man should target 90 to 195 grams. When we get too much protein, excess is converted into carbohydrates or fat and can stress the liver and kidneys. Eventually excess protein substrate is doomed to be a waste, excreted through urination.

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The ideal food intake breakdown for athletes is to get 25-35% of your calories from fat, 15-20% from protein, and 55-60% from carbohydrates. For the sake of comparison, the once very popular ZONE Diet encourages a 30:40:30 ratio, or double the amount of protein according to RDA standards and not nearly enough carbohydrates to fuel your muscles’ glycogen stores for exercise. While these ratios are helpful for me as a nutrition coach, most people just want to be told how much protein they need after a workout.

This question always prompts my Golden Rule for Post-Workout Recovery Fuel: consume 10 grams of protein within one hour of intense physical activity for improved muscle repair.

Ideally, your post-workout snack or meal would fit into that 25-35%:15-20%:%55-60% ratio of fats:proteins:carbs. Most Clif bars fit the bill when you’re on the go with 45g carbs (5g of which are dietary fiber), 10g protein, 5g fat, and only 250 calories. And if you’re looking for something lighter—maybe saving room for that brunch in a couple hours—Clif Builder’s Snack Size are my go-to. The still have that 10g grams of protein your body needs, are a mere 130 calories, and provide a good source of iron, magnesium, zinc and calcium, as well as vitamins A, C, E and K and many of the B vitamins that are so essential to our metabolism.

I’m a big fan of Clif bars not only for their impressive nutritional profiles but also because of the company’s ethos. Clif is a 1% for the Planet member, they use 100% recycled materials for their packaging, and their bars never contain ingredients like artificial sweeteners, sugar alcohols, or trans fats.

Please keep in mind that these kind of bars should not be viewed as a regular meal replacement. Whole grains, fruits and veggies, beans and other sources of lean protein are essential to a well-balanced, healthy diet. That said, they are definitely a MOARyoga-approved, convenient way to fulfill the protein needs of your muscles in that one-hour post-workout window.

References:
Williams, Melvin H. Nutrition for Health, Fitness and Sport: 8th Edition. McGraw-Hill. May 2006.

MOAR’s Daily Dozen: The Full Sequence

Over the last 12 days, I’ve broken down my Daily Dozen Yoga Poses for Post-Athletic Recovery.  If you’ve been following along with the daily poses, it’s now time to string them together. The whole sequence should take you between 20-25 minutes, holding each pose for 10 deep breaths.  If you can work these stretches into your routine three to five days a week, you’ll be well on your way to a more flexible, strong and injury-free body.

To recap…

MOAR’s Daily Dozen:

  1. Hero’s Pose (toes tucked + untucked)
  2. High Plank w/ Flipped Hands
  3. Dolphin
  4. Wide-Legged Forward Fold
  5. Low Lunge w/ Twist
  6. Half Split
  7. Prone Shoulder Opener
  8. Plow
  9. Half Pigeon
  10. Seated Spinal Twist
  11. Reclining Thread the Needle
  12. Reclining Shoelace
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1: Hero’s Pose (toes tucked + untucked)
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2: High Plank w/ Flipped Hands
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3: Dolphin
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4: Wide-Legged Forward Fold
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5: Low Lunge w/ Twist
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6: Half Split
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7: Prone Shoulder Opener
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8: Plow
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9: Half Pigeon
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10: Seated Spinal Twist
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11: Reclining Figure-4
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12: Reclining Shoelace

Pair this preventative and repairing sequence with my tips for pre- and post-workout fueling to keep injuries and fatigue at bay. With proper post-athletic stretching and nutrition you’re bound to stay at the top of your game, ready to tackle the next test of your endurance and strength.

MOAR’s Daily Dozen: 12 Yoga Poses for Post-Athletic Recovery to Do Every Day

Over the next 12 days, I am going to walk you through my Daily Dozen Yoga Poses for Post-Athletic Recovery.  Work on each pose for a few minutes each day and at the end of the 12 days try stringing them together, holding 10 breaths per side (if applicable). The whole sequence should take you between 20-25 minutes. My suggestion? Do it while watching an episode of Modern Family or Arrested Development and make it a happy ritual rather than a chore.

Wide Legged Forward Fold

MOAR’s Daily Dozen:

  1. Hero’s Pose
  2. High Plank w/ Flipped Hands
  3. Dolphin
  4. Wide-Legged Forward Fold
  5. Low Lunge w/ Twist
  6. Half Split
  7. Prone Shoulder Opener
  8. Plow
  9. Half Pigeon
  10.  Seated Spinal Twist
  11. Reclining Figure-4
  12. Reclining Shoelace

These postures were specifically selected to help fortify your body against the top ten sports-related injuries, which are in no particular order…

  1. Achilles tendonitis
  2. Plantar fasciitis
  3. Ankle sprains
  4. Wrist problems
  5. Shoulder pain
  6. Hamstring pulls
  7. Hip pain
  8. Knee injuries
  9. Lower back strain
  10.  Neck strain

If you lead an active lifestyle, chances are you have dealt with at least half of that list. The best way to prevent these common sports-related injuries is to work on increasing your flexibility and ROM (range of motion) on a daily basis. We are constantly stressing our muscles, joints, ligaments and tendons and most of us barely do two minutes of stretching post-physical activity, let alone a solid 20 minutes.

Check back every day for a new posture how-to and learn about the different injuries it will help you prevent and treat. At the end of the 12 days, I encourage you to come back to this post and try the entire sequence in succession. If you can work these stretches into your routine three to five days a week, you’ll be well on your way to a flexible, strong and injury-free body.

As always, I welcome your feedback and would love to hear what you think!

MOARfit Clinic: Nutrition for Athletes

Last week, I put on my first MOARfit Nutrition for Athletes clinic at Earth Treks Climbing Center in Columbia, MD in partnership with Relay Foods (more on this awesome company later in the post). With my attentive audience of 35 rock climbers, I discussed healthy, non-processed options for optimal energy fueling pre-, during- and post- workout. I also covered topics ranging from proper nutrition for specific goals for weight loss, muscle gain, and healthy tendons/ligaments to information on a vegetarian or vegan lifestyle.  Keep reading and you’ll get a nice snapshot of my most important takeaways for proper sports nutrition. Finally, the best part, I demoed two of my MOARfit recipes (below): one for pre-workout fuel and one for post-workout recovery.

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Rules to Live By for Pre-, During- and Post-Workout Fueling:

PRE-WORKOUT DURING WORKOUT POST-WORKOUT
  • Lots of water (and avoid diuretics)
  • High carb, low fat and low protein
  • Solid meals 3-4 hours ahead of event
  • Liquid or light meals 1-3 hours before
  • Consume complex, nutrient-dense carbs  (e.g. oatmeal and dried fruit) but avoid too much fiber (GI upset)
  • Eat foods you can easily digest
  • Stomach should be relatively empty prior to physical activity
  • For early starts, eat your heaviest meal the night before
  • Don’t skip meals for late-day events
  • Fluid replacement for athletic events lasting longer than 30 min
  • Carb replacement for athletic events lasting longer than 1 hour (to replenish glycogen)
  • Additional sodium (an important electrolyte) may be necessary for physical activities lasting more than 4 hours (tournaments, ultramarathons, etc)
  • 10-20 g of protein within 1 hour after physical activity to improve muscle repair
  • Carb-rich meal within 2 hours following event
  • Fluid and electrolyte replacement (sodium, potassium, calcium)
  • Ideal recovery meal is 3:1 carb to protein (e.g. Ezekiel bread w/ raw honey and almond butter, a banana, and 8 oz unsweetened soy milk)

My Key Takeaways:

  • Ideal caloric intake breakdown for athletes: 25-35% fat: 15-20% protein: 55-60% carbs
  • Post-workout you only need 10g protein for muscle repair and no more than 20g (unless you are in a weight training program); most American diets already surpass the RDA
  • Turmeric, basil and cinnamon have powerful anti-inflammatory properties to help muscles and joints. Ginger has been shown to relieve muscle pain and calm an upset stomach.
  • Our body needs fats for peak physical performance because they help us absorb vitamins A, D, K and E which are important for bone density, repairing muscle cells and promoting blood clotting. Some good fats are avocados, olive oil, walnuts, and raw almond butter.
  • You do not need supplements but if you take them, do your research: supplementwatch.org
  • Eat whole, healthy, real foods. Avoid hype and health claims, and ingredients that are unfamiliar, unpronounceable, number more than 5, or that contain high-fructose corn syrup.

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The Recipes: Pre- and Post-Workout Fuel

(1) MOAR’S PRE-WORKOUT HIPPIE FUEL (AKA GRANOLA):

(makes six ½-cup servings)

What You’ll Need:

  • 1 Tbs coconut oil
  • 1 cup gluten-free rolled oats
  • ¼ cup unsweetened shredded coconut
  • ¼ cup walnuts pieces
  • 2 Tbs whole chia seeds
  • ¼ cup dried cherries, unsweetened
  • ¼ cup dark chocolate bits (dairy-free)
  • 2 Tbs raw honey
  • ¼ cup raw almond butter, unsalted
  • 1 tsp ground cinnamon
  • ¼ tsp cayenne (or more to taste)

How to Make It:

Preheat oven to 325F. Heat coconut oil in a medium saucepan over medium heat. Add oats, coconut and walnuts to pan, cooking for 5-8 min until toasty but not burnt. Remove from heat. Add chia seeds, cherries, chocolate, honey and almond butter to the warm dry ingredients. Give everything a good stir until it all comes together. Spread mixture in an even layer across a baking sheet. Bake for 35-40 min until crunchy (stirring once halfway through). Dust with cinnamon and cayenne, toss and let cool.

Nutrition Facts: 330 kcal; 20 g fat; 37 g carbs (7.6 g dietary fiber); 7 g protein

(2) MOAR’S POST-WORKOUT RECOVERY GREENIE:

(makes two 16-oz servings)

What You’ll Need:

  • 10-oz rice milk
  • ½ small avocado
  • 1 medium banana (ripe)
  • 2 Tbs basil (~10 leaves)
  • ½ lime, juiced
  • 1” fresh ginger, peeled & sliced
  • 1 tsp ground cinnamon
  • 2 Tbs whole chia seeds
  • 5 Tbs hemp protein powder
  • 2 ½ cups kale, chopped (2 handfuls)
  • 1 cup fresh or frozen pineapple
  • ½ cup ice (1 cup of fresh pineapple)

How to Make It:

Add all ingredients in the order listed to your blender. Blend at high speed until smooth.

Nutrition Facts: 338 kcal; 15.3 g fat; 42.8 g carbs (20.5 g dietary fiber); 19 g protein

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SHOUT OUTS:

The workshop was a success, in no small part thanks to my amazing partner Relay Foods. Relay is a super convenient online grocery store where you’ll find all the stuff you need from the best local stores, restaurants, and farms in and around your own neighborhood. I got almost all of my recipe ingredients from these guys and was very much pleased/impressed by the quality. If you’re going to try out my recipes, I’d encourage you to also try out Relay Foods. I’ve saved my shopping list called “Nutrition for Athletes” to make it even easier for you to get things going.

I also want to add that this event could not have happened were it not for the great staff at Earth Treks Columbia who share my belief that athletic performance and nutrition go hand-in-hand. Big thanks to everyone out there in Maryland!

If you’re interested in having me do a Nutrition for Athletes clinic at your gym, yoga studio, school or other venue, please contact me directly via email: [email protected].

Lean, Mean Moderation

In a recent yoga training, we discussed in-depth the concept of duality. In the context of spirituality, it is often synonymous with a dichotomy such as right versus wrong, or good versus evil. Yoga—which literally means to “yoke”—is all about overcoming these everyday dualities through union. Broadly extrapolating this concept, I’d say we create these black and white scenarios in all aspects of our lives. Consequently, our understanding of things like good nutrition and optimal exercise becomes limited to extremes, and excludes the important acknowledgment and application of moderation. Moderation is a theme I will often come back to in this blog. On this sunny fall afternoon, however, I’d like to focus in on protein and carbs.

In the health world, more often than not, carbs are demonized as the enemy of a lean, mean physique. Diets like Atkins and South Beach expound varying degrees of anti-carb sentiments. From the kitchen in my office to the lounge area at my yoga studio, I overhear people all the time boasting about how they haven’t touched a carb in a week, or ate nothing but chicken breasts and steamed broccoli for dinner last night (boring!). Their audience inevitably nods in complicit condemnation of these evil nutrients and most likely has gnawing guilt over the delicious Taylor’s sub or Georgetown cupcake they devoured that day.

Credit: Dave Dreas

Here’s where I’d like to weigh in: carbs are not the enemy. In fact, I hate to break it to you, but carbs, fat and protein can all make you gain weight. That’s because our cells can only take so much of any one nutrient before they reach capacity and store the surplus as fat. Therefore carbs are not necessarily the culprit. Instead, overeating–i.e. excess calories–is what’s gonna get you every time. Moreover, if you’re an athlete, or do daily endurance or high-intensity exercise, your body needs carbs. They are the body’s first go-to for energy when you hit the field, pavement or mat and will be key to your performance.

That being said, not all carbs are created equal. Research indicates it’s best to limit high-glycemic index (HGI) carbs–think candy, cookies, and anything white and doughy. This is because your body burns through those in no time, rapidly leaving you lethargic and hungry. On the other hand, low-glycemic index (LGI) carbs–think most fruits and veggies, yogurt, beans and quinoa–are often fiber-filled and take much longer to break down, warding off hunger and keeping your energy levels up for a longer period of time. Post workout, your body needs to replenish its glycogen levels, so either go for LGI carbs or combine healthier HGI carbs with lean protein (e.g. a mango banana smoothie with protein powder). For athletes those options truly are six-of-one/half-dozen-of-another, as you don’t really have to worry about HGI carbs. For the rest of us, when it comes to recovery, I’d recommend sticking with LGI carbs whenever possible. Tip: for post-yoga refueling I make sure to pack an apple or banana (which, p.s., is a borderline HGI fruit) to tide me over until I can get a good, balanced meal in.

For more info on the differences between HGI and LGI fruits or veggies, click here.

In my opinion, the most important thing to keep in mind is that while these are sound nutrition principles worth understanding, life has to be about moderation. I love bread. I eat toast almost every morning, bake my own loaves on the weekends (recipe to come!) and even do the inexplicable Italian thing of eating bread with my pasta. If you truly dislike carbs or have a gluten allergy then, absolutely, steer clear. Otherwise, if you’re more like me, don’t go cold turkey because your diet will be unsustainable. Fuel your body’s daily needs with good carbs and savor those tastier treats periodically. Life is to be enjoyed.