Bone Health and Calcium

We’ve all heard from childhood that we should drink milk for healthy bones. Milk is one of the most common sources of calcium which is a vital ingredient in bone development and maintenance. Many people stray from consuming milk as they enter adulthood for a variety of reasons whether it is fat content, lactose issues or preferences for other beverages. While it is most commonly found in milk and dairy products such as yogurt and cheese, calcium can be found in alternative sources such as calcium-fortified soy milk and juices, as well as breakfast cereals, spinach, broccoli and almonds. However, you would need larger quantities of these products to achieve the recommended amount of calcium (10 cups of spinach; 3.5 cups of broccoli, about 88 almonds). Calcium supplements are also available and can help boost intake, they do not contain the protein found in milk or soy milk or the other nutrients they contain. It is also important to know that dairy sources of calcium also contain Vitamin D which enhances the absorption of calcium and is needed not only to protect bone health but also to reduce the risk of high blood pressure, diabetes, and heart disease; enhance immune function and reduce inflammation. Vitamin D is not readily available naturally in other foods. Active individuals and athletes are recommended to check with their health care provider to make sure that they have adequate Vitamin D levels.

Paying attention to bone health should be a life-long effort. Whether you have young developing bones or you are concerned about developing bone issues such as osteoporosis, bones require a matching life-long intake of calcium.

Reference from the SIRC Collection: Clark, Nancy (2009). Calcium concerns. Ultr-FIT, 19(8), 40-41.

Nutrients for Busy Athletes

Most athletes, professional and recreational, often eat relatively well but with busy lifestyles it can be very useful to be informed of a few of the key nutrients you can target for optimal health. We all know that we need to eat more fruits and vegetables, drink more water and choose low fat foods but did you know you may be missing some key nutrients including, calcium, zinc, iron and essential fats? 

Calcium: Before you skip over this section, it is common to think that we all get enough calcium, yet the reality is that we need at least 3-4 servings a day to get the recommended intake.  If any of you enjoy plain black coffee and dislike yoghurt, chances are you are not getting enough calcium to achieve optimal bone health for your training load which can result in bone loss and and increased risk of stress fractures.  If you can't have dairy, try incorporating calcium enriched soy products to boost your dairy intake.

Zinc: Zinc is an often forgotten but essential nutrient that performs a number of important roles in the body including healing, immune function, and hormone production.  Try lean red meat, whole grain breads, breakfast cereals and shellfish.

Iron: Athletes can be susceptible to iron deficiency anemia (particularly women or endurance runners), therefore its extra important to ensure you get the optimal amounts of iron in your body.  Iron is the building block of hemoglobin which carries oxygen throughout the body.  When someone is anemic the muscles are starved for oxygen and this can negatively affect performance.  Lean red meat should be consumed 3-4 times a week, while this may seem like a lot, you don't need large portions to reap the benefits.

Essential Fats: Don't be afraid of fat!  Essential fatty acids (EFA) can help maintain healthy joints, regulate your metabolism and reduce inflammation.  Good fats can be found in all sorts of different foods including avocado, fatty fish, olive oil, nuts and tofu.

Keep in mind that balanced nutrition is an essential for everyone but is extra important for those who want to excel as a competitive athlete.

References from the SIRC Collection: 

1. Libin D. Fighting Fat Phobia. Black Belt. December 2011;49(12):34.
2. Mansfield B. Iron for Health and Fitness. Skitrax. Spring2012 2012;22(4):49.
3. Micheletti A, Rossi R, Rufini S. Zinc status in athletes: relation to diet and exercise./Niveau du zinc chez l'athlete en relation avec l'alimentation et l 'exercice pratique. Sports Medicine. 2001;31(8):577-582.
4. Nguyen V. Calcium for Athletes to Improve Bone Strength and Health. NSCA's Performance Training Journal. November 2010;9(6):11-13.
5. Seebohar B. OMEGA-3 FATS: ESSENTIAL TO HEALTH. Triathlon Life. Winter2009 2009;12(1):39.
6. Woodward G. Do you get enough calcium?. Australian Orienteer. June 2010;(158):25.

Exercise and bone health

It is well known that regular exercise is excellent for your heart, health and well-being. There is also plenty of evidence that proves that regular exercise is essential in warding off various health-related issues; what's not as well known is that people who perform non-weight bearing exercises such as cycling or swimming as their sole method of exercise could be putting themselves at risk for osteoporosis.

 
Bone is living tissue that responds to loads placed on it. If you perform  non-weight bearing exercises your bones won't retain their density like they would with a weight bearing exercise. If cycling or swimming is currently your only form of exercise, you can be proactive in preventing the disease by adding a little variation in your training.

• Weight bearing exercises such as walking, running, skiing, dancing or jumping all help to retain bone density
• Cross training
• Resistance or weight training
• Improving core strength
• A diet that meets your calcium and vitamin D requirements

A common misconception is that osteoporosis is a disease that is limited to aging women since low estrogen causes bone deterioration, in fact it can affect men as well. Care should be taken for young people in particular, since bones keep growing and do not reach peak density until the age of 30.

For those of you that have already been diagnosed with osteoporosis, it doesn't mean you have to stop moving. Instead, perform exercises that strengthen the back, core and hip, and ensure that you supplement your routine with alternate workouts. Before you run out and buy calcium supplements or change your training schedule, it is always a good idea to talk to your doctor for their recommendations first.

References from the SIRC Collection: 

1. Campion F, NeviII A, MedeIIi J, et al. Bone Status in Professional Cyclists. International Journal Of Sports Medicine. July 2010;31(7):511-515.
2. Cedaro R. Osteroprorosis And Cycling. Triathlon & Multi Sport Magazine. July 2, 2012;15(7):76-78.
3. CYCLISTS AT RISK FOR OSTEOPOROSIS. IDEA Fitness Journal. July 2009;6(7):12.
4. Giles M. Bone strength matters. Bicycling Australia. May 2006;(139):52-54.
5. Hamilton A. Cycling health: a bone of contention. Cycling Weekly. September 30, 2010;:50-51.
6. Hawkins K. Cycling: Bad for the Bones?. Bicycle Paper. August 2012;41(6):1-5.
7. Nichols J, Rauh M. LONGITUDINAL CHANGES IN BONE MINERAL DENSITY IN MALE MASTER CYCLISTS AND NONATHLETES. Journal Of Strength & Conditioning Research (Lippincott Williams & Wilkins). March 2011;25(3):727-734.

Introducing the 'sunshine' vitamin!

Canadian winters mean short days and bundling up against the cold, so getting the required amount of sunlight for absorbing Vitamin D can be difficult. Vitamin D (sometimes called the 'sunshine vitamin') is unique in that it requires the skin to be exposed to ultraviolet-B radiation for optimal absorption. Because it is present in very few foods and many people use sunscreen to protect themselves from the harmful effects of UV rays, it has become common for athletes to use supplements to obtain vitamin D.

Why should athletes consider vitamin D?

Vitamin D functions to maintain normal levels of calcium and phosphorus in the blood, as well as aiding in the absorption of calcium to form and maintain strong bones. Research suggests that it may be important for prevention of osteoporosis, hypertension, inflammation, asthma, and seasonal affective disorder.

Factors that may contribute to vitamin D deficiency include skin pigmentation, early or late day training, indoor training, geographic location and sunscreen use. Athletes that may be at higher risk are those that spend the most time indoors; gymnasts, ballet dancers, figure skaters, and wrestlers.

While vitamin D can be obtained in the diet, it would be difficult to consume the amount food you would need for optimal performance. For example, it would take six cups of orange juice or 14 eggs to get the recommended amount.

Foods that contain Vitamin D:

• Fatty fish (tuna, salmon, swordfish) and fish liver oils like cod liver
• Beef, egg yolks and some cheeses contain small amounts
• Fortified foods like milk, orange juice and cereal, although they include small amounts

A recent survey done by Statistics Canada found that 32% of the Canadian population have vitamin D levels that are below recommendations. Adding vitamin D supplements to your diet carries a low risk for side effects, however it's recommended that you talk to your coach and/or health professional first.

References from the SIRC Collection:

1. Asp K. Running on D. Runner's World. December 2009;44(12):36-37.
2. Close G, Fraser B. Vitamin D supplementation for athletes: Too much of a good thing?. Sport & Exercise Scientist. September 2012;(33):24-25.
3. HAMILTON B, CHALABI H. VITAMIN D: AN UPDATE FOR THE SPORTS MEDICINE PRACTITIONER. Sportex Medicine. January 2010;(43):11-16.
4. Larson-Meyer D, Willis K. Vitamin D and Athletes. Current Sports Medicine Reports (American College Of Sports Medicine). July 2010;9(4):220-226.
5. Shuler F, Wingate M, Moore G, Giangarra C. Sports Health Benefits of Vitamin D. Sports Health: A Multidisciplinary Approach. November 2012;4(6):496-501.
6. The Vegetarian Athlete. Running & Fitnews. May 2009;27(3):10-12.
7. Willis K, Peterson N, Larson-Meyer D. Should We Be Concerned About the Vitamin D Status of Athletes?. International Journal Of Sport Nutrition & Exercise Metabolism. April 2008;18(2):204-224.

Les fractures de stress

Les fractures de stress* sont une blessure fréquente chez les athlètes et sont le plus souvent associées à la pratique des sports impliquant de la course, des sauts et du stress répétitif. Une fracture de stress est une micro fracture d’un os qui se produit quand le rythme de guérison ne parvient pas à suivre le rythme de bris qui est provoqué par le stress répétitif imposé. Les fractures de stress se produisent le plus fréquemment au début d’une saison de sports* à cause de l’augmentation de l’activité physique nécessaire. Des études ont montré que les athlètes qui font du tennis, de l’athlétisme, de la gymnastique et du basketball sont particulièrement sujets à ce genre de blessure.

Les fractures de stress peuvent se produire de deux manières: 

1. La redistribution des forces d’impact qui provoquent un plus grand stress aux points centraux de l’os. 
2. L’action de traction du muscle dans l’os. 

Le tibia, qui est l’os le plus grand et le plus fort de la jambe inférieure, est l’endroit d’environ 50% de toutes les fractures de stress chez les athlètes. - Running & Fitnews 

Les symptômes d’une fracture de stress:

• Douleur locale dans l’os 
• La douleur est aggravée par l’activité physique et est soulagée par du repos 
• La zone peut être sensible au touché, avec une enflure et une rougeur occasionnelle

Récupération 

Une des plus grandes erreurs que font les athlètes après qu’on leur a découvert une fracture de stress est de reprendre l’entraînement* trop vite. Il est important de laisser le corps guérir et, si c’est précipité, il y a un plus grand risque que la blessure se reproduise. Selon la gravité d’une blessure, la procédure de la guérison peut prendre de huit à 17 semaines. Les cliniciens recommandent que l’entraînement commence lentement avec une faible intensité et sans douleur. L’entraînement croisé* est une excellente option pour la guérison et peut inclure courir en eau profonde, le cyclisme et le travail au gymnase.

Prévention

Les fractures de stress dont les mieux gérées en prenant des mesures préventives*. Les fractures de stress sont directement liées aux charges d’entraînement* et à quelle vitesse un athlète augmente la fréquence, l’intensité et la durée de son activité. Les os peuvent s’adapter au stress répétitif mais le stress extrême, s’il se produit trop souvent, peut accabler la capacité du corps à s’adapter. Avoir un horaire d’entraînement varié est essentiel pour la prévention ainsi qu’avoir les bons vêtements sportifs. Les coureurs de longue distance sont particulièrement sujets à ce genre de blessure et il est recommandé que les athlètes remplacent leurs souliers sportifs quand ils s’usent, après environ entre 700-1000 kilomètres ou 6 à 12 mois.

D’autres facteurs de risque en plus des horaires et des charges d’entraînement sont la nutrition et le genre. La déficience en calcium* et en vitamine D* diminue la densité des os, ce qui peut augmenter le risque de blessure. Pour les femmes athlètes*, l’aménorrée* (dans le cycle menstruel irrégulier), l’ostéoporose* et/ou une diète incorrecte* peuvent tous contribuer à l’apparition de fractures de stress.

Les entraîneurs et les athlètes doivent être conscients des effets du surentraînement et de l’importance de prendre quelques jours de repos. Si vous pensez que vous pouvez avoir une fracture de stress, n’oubliez pas que ce genre de blessure ne se guérit pas toute seule. Un bon diagnostique doit être fait par un médecin et, selon l’endroit et la gravité, les recommandations pour le traitement seront différentes. 

* Seulement disponible en anglais

Références de la collection de SIRC:

1. Avoiding a Stress Fracture is Largely up to You. Running & Fitnews. July 2012;30(4):9-13. 2. Dawson-Cook S. STRESS FRACTURES. American Fitness. September 2010;28(5):56-57.3. Ekstrand J, Torstveit M. Stress fractures in elite male football players. Scandinavian Journal Of Medicine & Science In Sports. June 2012;22(3):341-346. 4. Hunt A. IT'S JUST SHIN SPLINTS... RIGHT?. Triathlon Life. Winter2009 2009;12(1):54-56. 5. Moran D, Evans R, Hadad E. Imaging of Lower Extremity Stress Fracture Injuries. Sports Medicine. February 2013;43(2):345-356.6. POLLOCK N. STRESS FRACTURES IN SPORT. Sportex Medicine. October 2011;(50):20-24. 7. Poynton E. Stress Fractures. Modern Athlete & Coach. January 2011;49(1):16-17. 8. Smith R. Stress Fractures of the Hip in Young Athletes. Hughston Health Alert. Spring2007 2007;19(2):6.

Stress Fractures

Stress fractures are a common injury in athletes and are most often associated with participation in sports involving running, jumping or repetitive stress. A stress fracture is a micro fracture of a bone that results when the rate of healing is unable to keep up with the rate of breakdown that is being caused by repetitive stress placed upon it. Stress fractures occur most frequently at the beginning of a sports season due to the increase in physical activity that is required. Studies have shown that athletes participating in tennis, track and field, gymnastics, and basketball are particularly susceptible to this type of injury.

Stress fractures can occur in two ways:

1. The redistribution of impact forces resulting in increased stress at focal points in bone.
2. The action of muscle pull(s) across bone.

The tibia, which is the larger and stronger bone of the lower leg, is the site of approximately 50% of all stress fractures in athletes. - Running & Fitnews

 Symptoms of a stress fracture:

• Localized bone pain
• Pain is aggravated with physical activity and relieved with rest
• Area may be tender to the touch, with occasional swelling and redness

Recovery

One of the biggest mistakes athletes make after being diagnosed with a stress fracture is returning to training too quickly. It's important to let the body heal and if it's rushed, there is a greater risk that the injury will reoccur. Depending on the severity of an injury, the healing process can be anywhere from eight to seventeen weeks. Clinicians recommend that training begin slowly with a low intensity and be pain free. Cross training is a great option for recovery and may include deep water running, cycling and gym work.

Prevention

Stress fractures are managed best by taking preventative measures. Stress fractures are directly related to training loads and how fast an athlete increases the frequency, intensity, and duration of their activity. Bones can adapt to repetitive stress but extreme stress, if it occurs too often, can overwhelm the body's ability to adapt. Having a varied training schedule is essential for prevention as well as having the proper athletic gear. Distance runners are particularly susceptible to this type of injury and it's recommended that athletes replace athletic shoes as they wear out, approximately 700-1,000 kilometres or 6-12 months.

Other risk factors beyond training schedules and loads are nutrition and gender. Calcium and vitamin D deficiency decreases bone density which can increase the chance of injury. For female athletes, amenorrhea (infrequent menstrual cycle), osteoporosis and/or an improper diet can all contribute to the occurrence of stress fractures.

Coaches and athletes should be aware of the effects of overtraining and the importance of taking rest days. If you think you may have a stress fracture, keep in mind that this type of injury should not be self treated. Proper diagnosis should come from a physician and depending on the location and severity, recommendations for treatment will differ.

References from the SIRC Collection:

1. Avoiding a Stress Fracture is Largely up to You. Running & Fitnews. July 2012;30(4):9-13.
2. Dawson-Cook S. STRESS FRACTURES. American Fitness. September 2010;28(5):56-57.
3. Ekstrand J, Torstveit M. Stress fractures in elite male football players. Scandinavian Journal Of Medicine & Science In Sports. June 2012;22(3):341-346.
4. Hunt A. IT'S JUST SHIN SPLINTS... RIGHT?. Triathlon Life. Winter2009 2009;12(1):54-56.
5. Moran D, Evans R, Hadad E. Imaging of Lower Extremity Stress Fracture Injuries. Sports Medicine. February 2013;43(2):345-356.
6. POLLOCK N. STRESS FRACTURES IN SPORT. Sportex Medicine. October 2011;(50):20-24.
7. Poynton E. Stress Fractures. Modern Athlete & Coach. January 2011;49(1):16-17.
8. Smith R. Stress Fractures of the Hip in Young Athletes. Hughston Health Alert. Spring2007 2007;19(2):6.