When Muscles Break Down Too Much

from http://www.technion.ac.%20il/

After a talk I gave to a group of basketball players on their way to an international tournament, a young lady came up to me and asked me if I knew about rhabdomyolysis. She had been diagnosed and treated for it in a hospital and was worried that it might happen again. I told her that, while I was familiar with it, I needed to do a little research first before getting back to her.

Here's what I found:

Exertional rhabdomyolysis is a rare illness that happens when a person has an intense physical activity that breaks down their muscles. While there is always a little muscle breakdown that occurs with heavy exercise, this is much more severe. The muscles cells break apart and the injured muscles release myoglobin, creatine kinase and other muscle cell contents into the blood stream.

Mild and moderate cases can cause high levels of sodium, potassium, phosphorous and calcium in the blood. This can lead to pain and swelling of the muscles, stomachache, nausea and back pain. In more severe cases (very rare), the myoglobin gets into the urine, causing it to become a dark tea or brown color. When the myoglobin is this concentrated, it can injure the kidneys. In fact, if left untreated really severe cases can lead to clots in the blood, kidney failure and even death.

Now this doesn't happen very often. Most players can push themselves during workouts and games without having to worry about it. But there are some things to avoid if you want to decrease the chance of this happening to you.

Things that INCREASE a person’s risk for exertional rhabdomyolysis/make it MORE likely to happen include:

* high temperatures and humidity levels,
* poor physical conditioning
* not drinking enough fluid
* taking certain medicines like aspirin
* cocaine or alcohol abuse and/or
* recent viral illness (cold, flu).
* Having Sickle cell trait

Things that REDUCE the risk of exertional rhabdomyolysis/ make it LESS likely to happen include:

* Limiting exercise that pushes you to the brink of your ability
* Limiting exercise in higher than average temperatures
* Making sure that you consume enough carbohydrates and that you have sufficient rest periods to enhance the body’s ability to convert the carbohydrate to glycogen
* Keeping well hydrated at all times

If you're a basketball player with a history of kidney disease, heat exhaustion and/or previous case of rhabdomyolysis, you should see a doctor (and get blood and urine testing) if you experience brown discoloration of your urine, have back or stomach pain, or pain and swelling in your legs or arms that comes after a period of high intensity exercise. You might need intravenous (IV) fluids and be admitted to the hospital to make sure you recover well and future exercise might need to be adjusted to keep it from happening again.

Again, I don't want to keep anyone from playing the game. Just use the recommendations above to reduce your risk, use your common sense and, if you think you might be suffering from this condition, get help from your doctor.

A "Tri" for an Eye

A recent Parade Magazine article , encouraged readers who play sports to wear protective lenses designed for their particular sport. In a previous blog entry on this subject, I only mentioned the use of polycarbonate lenses.

If you're playing basketball and need to wear protective eyewear like Rec-Specs, you might consider trying out a newer material, called Trivex.

Trivex is somehwat stronger, clearer, and lighter than polycarbonate.

Most importantly for basketball players, Trivex lenses reportedly decrease the distortion that occurs when objects are viewed away from the optical center. This might make objects in your peripheral vision more clear, improving your on-court vision.

Would it help enough to justify its higher cost (Some websites list Trivex about $25 to $40 more expensive than polycarbonate)? There's no good data on that yet.

But if it's important to you, you might consider using Trivex instead of polycarbonate lenses the next time you need new sport glasses.

Things That Go Bump in the Knee

A colleague of mine who is doing good work for youth basketball in the U.S. asked me some questions about Osgood-Schlatter Disease recently.

In response, I sent him a handout which he will soon publish in an interview script. If you already receive his newsletter, wait for my next post, but if you don't, then read on to learn more about a common condition that is close to my heart (and both my knees, as I had it back when I was 12).

What is it?
Osgood-Schlatter Disease (OSD) is a common overuse injury that causes pain, swelling and tenderness just below the kneecap. The tender point is the “tibial tuberosity”, where the kneecap tendon attaches to the tibia (shinbone).
Knee pain from OSD worsens with activity, kneeling, and trauma to the tender point below the knee. The tender point may start to stick out, causing a bump in the bone below the kneecap. While the pain is a temporary condition and generally improves with rest, the bump below the knee may remain.

Who gets it?
It occurs in children (especially gym rats) who participate in sports that require lots of running and jumping (like basketball) while they are going through their growth spurts. In boys, this usually occurs between the ages of 13 to 15 and in girls, it usually happens between the ages of 10-12. The pain occurs gradually over time as the young athlete continues to play and grow.

Why does it happen?
During running, jumping and landing, the front thigh muscles (quadriceps) pull on the kneecap and the kneecap tendon. If the amount of activity is too great, it can start to pull the tendon off the raised area of the tibia/shin bone where it attaches, causing inflammation of the growth cartilage, pain at the site and a bony bump under the knee. During rapid growth (a growth spurt), tendons can become tighter, leading to a loss of flexibility and more pull where they attach to the bones.

How long does it last?
The pain of OSD can come and go, depending upon the degree of injury and the player’s activity level. While OSD can last months to years, it is a temporary condition that improves with a decrease in activity and usually goes away when a child has finished their growth spurt.

How do you know it’s OSD?
On a visit to your local doctor, they should examine your knees and hips for strength, swelling, stability, pain, and range of motion. They’ll look for the tenderness (and bump) below the knee. They may also get an x-ray of your knees (and hips). No blood tests or advanced imaging (CT scan, MRI) are usually needed. If the history, physical exam, and x-ray findings all suggest OSD, then the diagnosis is made.

What can you do about OSD?
Once the diagnosis is made, then you can decide upon the best treatment plan for you. While it can be extremely frustrating, the best treatment is REST.

In milder cases, you can use a knee pad to protect the tender point, making sure you stretch the thigh muscles frequently, and use ice and non-steroidal anti-inflammatory medicines (like ibuprofen) after a game/practice to reduce the pain and swelling. You can also try wearing a patellar strap to decrease the tension on the tender point area. In most cases, playing with mild OSD should not cause it to last any longer or cause damage. But if the pain makes it hard to just get through everyday life activities like walking or climbing a set of stairs, then your body is telling you something and you need to listen to it and stop playing for a while.

If you do the above, but the pain doesn’t go away, your doctor might put you in a knee brace or on crutches to rest your leg. That doesn’t mean you should stop exercising – I’d suggest you consider staying in shape by swimming, doing aquatic therapy, or bicycle riding (if OK’d by your local doctor). Once the pain is gone and you’re cleared by your doctor, make sure that you also work to improve your strength, flexibility, balance, and conditioning before you return to playing.

DON’T keep playing through severe pain. This might worsen the condition and even cause the bone to break off at the tender point. Playing with pain and swelling in your knee will also make you more likely to sustain a different injury in the knee, hip or ankle.
In the very rare case where the pain continues even after your growth spurt is over, a bone doctor can perform surgery that fixes the problem and takes away the pain.

What can you do to prevent it?
Stretching the quadriceps muscle on the front of the thigh helps to reduce the pull of the muscle on the kneecap and tender point. You can also work to strengthen and stretch the hamstring muscles on the back of your thighs (which, by the way, can also help you run faster). Making sure you warm your muscles up well before exercise and stretch and cool down afterwards can also help. Remember, it’s the repetitive stress on the knee during a growth spurt that causes this condition and makes the pain worse. The best treatment for this condition is a temporary reduction in playing and practicing.

Protein Problem?

I was just reading an article about the misconceptions that high school athletes have about protein supplement use.

The article, scheduled to be published next month in the Journal of Strength and Conditioning Research, asked high school football players about the importance of using protein supplements when training to improve athletic ability.

As they predicted these athletes had many inaccurate beliefs about using protein supplements, including:

"Protein supplements are necessary to gain weight through weight lifting" - FALSE - you can gain muscle mass while weight training from protein in a food or a supplement.

"Protein supplements are better than a high-protein food for gaining weight through weight training" - FALSE - There's no advantage of protein found in supplements over protein found in food.

"Protein supplements are a good source of energy during a workout" - FALSE - Carbohydrates (mostly) and fat (in some cases) are what keeps you going during a workout or game. Protein is a muscle building block, not a fuel.

"Taking protein supplements will stop me from gaining unwanted fat on my body" - FALSE - If you take in too many calories (either as carbohydrate, fat, or protein) you will store those extra calories as fat.

So how best to get the protein you need?

According to the authors of this article, strength athletes need between 1.6 and 1.7 grams of protein for every kilogram (2.2 pounds) of body weight. Most adolescent boys eat this much in an average day. If you want to take a protein shake after a workout, that's OK, but you're paying $$ for the convenience.

Are there any dangers in taking too much protein?

The jury is still out, but some of the potential bad effects of too much protein include:

• excess fat gain


• dehydration


• gout


• kidney damage


• diarrhea


• bloating


• colon cancer

What should I eat?

Try to use high-protein, low-fat foods like:

• cheese made with skim milk


• skim milk


• low-fat yogurt


• chicken


• turkey


• fish

Who should I talk to if I want more information?

I'd go with an expert like a registered dietician who has special training in sports nutrition. Don't know where to find one? Look here.

Back in the Game

Melissa Majchrzak/NBAE /Getty Images

A recent article in the journal Practical Pain Management reported that 15% of basketball players have lost time from play due to low back pain.



While this is nowhere near the rates for ankle, finger, and knee injuries, it's still worth taking a closer look.


Basketball is a game of quick actions and reactions, and when your back "is out of whack" so is your game - it can adversely affect your shot, your defense, your ability to box out, you name it.


Here are some of the most common back injuries in basketball:

muscle sprain/strain - a pulled muscle or ligament (attaches bone to bone) in your back.

delayed-onset muscle pain - muscle soreness from overuse that is usually worst about 2 days after exercise.

contusions - bruises from getting elbowed or hitting something hard (the floor, another player)

disc herniations - more common in older (30+) players, these injuries can cause shooting electrical shock-like pain in the back and down the leg while also causing weakness and/or numbness in the legs.

piriformis syndrome - occurs when a tight muscle in your buttocks irritates a nerve that causes pain to shoot down your leg (similar to pain from a disc herniation).

sacroiliac joint pain- soreness in the low back where the tailbone and hip bones join together.

stress fractures - tiny breaks in the backbones caused by muscle weakness and overuse .

spondylolysis/spondylolisthesis - fractures of the backbones that lead to slippage of one backbone over the other .

So what can you do?


The best step is to do what you can to prevent a low back injury from ever happening. Work on maintaining and increasing your aerobic conditionining, flexibility and strength (not just in your back but in your hips, legs, shoulders, and abdomen). Make sure you wear proper shoes and play on safe surfaces.


If you sustain an injury, see a local health care provider who can perform a history and physical exam and additional tests (x-rays, ultrasound, bone scans, CT or MRI scans or other tests) to help make the correct diagnosis.


Treatment and rehabilitation will depend on the diagnosis, but generally, relative rest is an important part of any recovery program. Therapy from an athletic trainer or physical therapist may include ice packs early on and heating pads later in the process. Over the counter medicines like ibuprofen (or steroid injections in more severe cases) can help reduce some of the inflammation and pain, allowing you to tolerate soft tissue mobilization (therapeutic massage), stretching, and strengthening programs.


You can maintain your cardiovascular fitness by doing aquatic therapy (aqua jogging, for example) elliptical trainers, and/or recumbent bicycling.


Above all, make sure that you are fully recovered, in good cardiovascular shape, and strong and flexible as this will help you perform at your best and avoid further injury when you get back in the game.

"The Best" Sport

A recent poll of over 200 professional athletes from a variety of sports by ESPN Magazine showed I'm not alone in my belief that basketball is "the best" sport in the world.

Here are some of their results:

WHO IS THE BEST CURRENTLY ACTIVE ATHLETE?
1. LeBron James (22)

2. Tiger Woods (19)

3. Kobe Bryant (7)

4. Dwight Howard (4)

5. LaDainian Tomlinson (2)

WHO'S THE GREATEST RETIRED ATHLETE?
1. Michael Jordan (53)

2. Bo Jackson (17)

3. Deion Sanders (7)

4. Carl Lewis (4)

5. Muhammad Ali (2)

WHAT SPORT HAS THE BEST ATHLETES?
1. Basketball (78)

2. Football (42)

3. Baseball (12)

4. Hockey (8)

5. Gymnastics (6)

For the full results, go to http://sports.espn.go.com/espnmag/story?id=3424124

No Excuses

Welcome to June.

School's (almost) out, the gyms get hotter, and it's time to start your summer workout sessions.

For those times you think about doing something else, take a moment and (re)consider how important it is to improve your game.

Who are you doing this for?

Your parents? Your coach? Your brother/sister/aunt/uncle/grandparent/friend, etc.?

Nope, it's got to be for you. Something that you want to do.

Take a look at this video and know that I've heard all these excuses before.

So get out there, work hard, rest up, eat well, and then get out there again.

No excuses.