Calling It Like It Is

If anyone was watching the FIFA World Cup final match this past weekend, they know that a referee’s job is not always easy. With a final match record 14 yellow cards and one red, emotions were riding high. So how do officials handle highly charged scenarios?

The referee plays a key role in soccer matches. His vigilance, concentration and authority on the pitch ensure the respect of the players and adherence – or enforcement of the Laws of the Game. This is true for any officiated sport. According to Sports Officials Canada and their Code of Conduct, officials are charged with emphasizing the spirit of the competition rather than its outcome, striving to provide a sportsman-like environment, and placing the safety and welfare of competitors above all else.

The following tips to prevent and resolve conflict are central to providing a competition focused on the sport itself as opposed to the personality of those participating.

Tips to prevent conflict:

• Prevention is always better than cure! If action is taken early in the game, conflict is less likely to occur
• Make competitors aware of your presence by reacting immediately to rule infringements (when appropriate)
• Remain objective, no matter what prior knowledge of participants/teams an official has.
• Be definite and firm with decisions and communication
• Look sharp and act sharp - this will gain respect as an official
• Don’t take criticisms personally. Remember that coaches and participants are seeing the game from a different perspective to the officials
• At the beginning of the competition, provide structure and guidance, but also start a dialogue with the participants.
• Acknowledge the participant’s abilities and experience, and invite constructive viewpoints from some participants
• Speak clearly and firmly in heated situations. This will indicate confidence in managing the situation
• Keep cool if the situation starts to get a bit heated

Tips to resolve conflict:

• Be professional
• Remain calm
• Address the problem, not the emotions
• Focus on the person
• Be fair - avoid team or individual bias at all costs
• Be confident and open
• Be firm

References from the SIRC Collection:
Grunska, Jerry (2010). Enough is Enough: Where Should Officials Draw the Line on Coaches? Referee, 35 (2), p.62-63.

Weighty matters

The latest position stand from the American College of Sports Medicine (ACSM) on weight loss and the prevention of weight regain highlights the continuing battle with obesity and overweight in the North American population. According to the statement “overweight and obesity affects more than 66% of the adult population and is associated with a variety of chronic diseases”. The Canadian Academy of Sports & Exercise Medicine (CASEM) discussion paper on physical inactivity in children and adolescents indicates that “over the past several decades, obesity has increased by 54% in children 6 to 11 years old and 39% in adolescents 12 to 17 years old”.

Recommendations from these organizations for weight loss and preventing weight gain include:

• 150-250 minutes per week of moderately vigorous physical activity should be sufficient for preventing weight gain greater than 3%
• physical activity lasting longer than 150 minutes per week usually results in modest weight lossc
• consistent physical activity is the best predictor of sustained weight management following weight loss
• most studies demonstrate that combining caloric restriction (diet) and physical activity in a weight management program has encouraging weight loss results
• exercise programs combining aerobic training and resistance exercise show superior results for weight and fat loss

All the more reason for us to get out there and get active!

For more information on physical activity and body weight contact SIRC.

7 Canadian Power Plants

In the heart of flu season, protecting yourself from illness is very important. In the January/February edition of Canadian Running from the SIRC Collection, there is an article on 7 power plants to help boost your immune system. The 7 plants that are about can be grown right here in Canada. Whether you decide to use the plant as food, herb, or extract is up to you. If you want a little extract help for the immune system, an extract is the easy way to go. If you are looking for one-time boost go for the food options.

• Echinacea – a prairie coneflower, has chemicals in the leaves and roots are thought to increase white blood cell production and antiviral protein messengers. It is best used in on-and-off cycles to help prevent getting sick, and in immediate use when you already sick.
• Ginseng – Its root has shown that it can increase physical stamina and deter colds. Best used as a pre-emptive boost to the immune system, it should also be used in on-and-off cycles and no longer than 3 continuous months without consulting a health care provider
• Grapes – The seeds are good for you! In grape seeds and skin is found a nutrient, Resveratrol. Resveratrol is a great antioxidant which strengthens white blood cell membranes. Eating whole grapes can create a stronger immune system.
• Garlic – The bad breath cannot be hidden, but is another super-food that helps strengthen the immune system. It can be taken as an extract, fresh food, or the less effective odour-free option.
• Cranberry – They are a natural source of antioxidants that help counter the oxidative stress running. The easiest source is through consuming 100% juice. If it’s too tart to drink, dilute it with water.
• Goldenseal – It enhances the effect of other herbs. When used with Echinacea, it increases the production of antibodies and speeds recovery from the common cold. Take caution when using, it is a powerful force. So follow the directions with care.
• Elderberry – A producer of cold and flu antibodies, it has been used for a long time to help treat congestion of the lung and sinuses. Use of store bought extracts or juice are effective in treating, and preventing infection.

Reference from the SIRC Collection:
Lister, Patience. (2011). Power Plants. Canadian Running, 4(Jan/Feb 2011), 62-63.

“The Warning Signs” - Sudden Cardiac Death

The sad facts are that at least 700 Canadians under the age of 35 die from Sudden Cardiac Death (SCD) annually, and 50% of those who die suddenly experience at least one of the “The Warning Signs” prior to their deaths. Early medical intervention is the key to preventing SCD in children and young adults since many cardiac arrhythmia disorders are genetic and with proper medical assessment, many of these disorders are identifiable and treatable.

SCD in youth is a non-traumatic and unexpected sudden cardiac arrest that occurs within 6 hours of a previously normal state of health. They are the third leading cause of death in youth behind only suicides and accidents. The Canadian Sudden Arrhythmia Death Syndromes Foundation (SADS), a registered Canadian charity, is the only patient advocacy group in Canada dedicated to supporting families affected by inherited cardiac rhythm disorders and committed to raising awareness about “The Warning Signs” for these devastating disorders.

Knowing “The Warning Signs” can help save a life before the condition becomes fatal. They are:

• Fainting (syncope) or seizure during physical activity
• Fainting (syncope) or seizure resulting from emotional excitement, emotional distress or startle
• Family history of unexpected sudden death during physical activity or during a seizure, or any other unexplained sudden death of an otherwise healthy young person

SADS promotes on-going collaborative efforts to educate any group who works with youth including sports organizations, school boards and recreational centres, and this week in Ottawa, SADS will host the “Living with Inherited Cardiac Rhythm Disorders” Conference.

While recognizing “The Warning Signs” is the road to prevention, needing to react immediately at the time of a cardiac arrest is crucial to the survival of the patient as it can all happen so fast. So acting upon the policy recommendation identified in the Canadian Heart Health Action Plan, the Canadian Government has invested in a $10 million initiative dedicated to helping cover the cost of putting a life-saving Automated External Defibrillators (AED) in every hockey arena and recreational centre in Canada that does not have one, and will support training for attendants in using them.

Online resource:
Cardiovascular Screening of Canadian Athletes for Prevention of Sudden Death: Review, Rationale & Recommendations

Contact SIRC for more information about Sudden Cardiac Death in sport!

A Different Kind of Athlete

Athletes. They come in all shapes, size and types. They are high performance, professional, amateur, recreational, college and high school. They are also industrial. Unlike the sporting athlete who is physically trained to participate in their sport, encouraged to take the appropriate amount of rest, receives professional sports medicine and nutritional advice, the industrial athlete is not. They do not have the luxury to rest for a few days after many sessions of physical labour, and most often do not receive physical support services. Injuries to the industrial athlete can cause down time in production, lost revenue, and an increase in injury claims.

The “Industrial Athlete” is an industrial fitness and rehabilitation service provider for the company whose employees’ normal work day in the manual material handling (MMH) world requires repetitive carrying, lifting, twisting, turning and moving, often under extreme conditions. Companies such as Cintas, reported by Report on Business Magazine as one of Canada’s Best Employers, have incorporated a new training initiative for thousands of their employees, who wash and move products such as heavy mats and uniforms, to some 800,000 businesses across North America. In an effort to reduce the risk of injuries to their service representatives on the road, and workers in the plants and  distribution centers, Cintas uses the Industrial Athlete Sports Medicine Model program which includes daily warm ups (“Stretch and Flex” exercises), proper lifting and carrying training, rehabilitation, advice on nutrition, and how to achieve the all important work-life balance. For this effort, Cintas’ Workers’ Compensation premiums are 22 percent better than the industry average.

Companies that have implemented similar programs have found that employees are responsive to exercises and appreciate that getting their bodies ready for work makes good sense. So treat employees like professional athletes by respecting them as industrial athletes. This not only affects the bottom line financially, it also allows workers to lead safer, more comfortable lives on and off the job.

Contact SIRC for more information on athlete injury prevention!

Overtraining

Overtraining occurs when athletes go beyond their training regiments and do not allow enough time for the body to recover. This can damage muscles, tendons, and ligaments and even have a mental effect on the athlete. There are also cases when athletes become ill right before their major event due to overtraining. This is often caused by athletes who are already at their capacity training too hard in an effort to feel as though they’ve achieved their full training potential and thus depleting their reserves and compromising their immune systems.

One general principle known to all elite athletes and coaches training for major events is overload training. Athletes train for long hours and at high intensities. Overload is usually followed by a taper for recovery. However, when an athlete uses all they’ve got but still try to give more without the proper taper, the athlete will have depleted all their resources and become fatigued. If overload has gone wrong, this depletion does not help performance and may actually cause it to drop. Overtraining has occurred.

Overreaching is often a term heard in the context of overtraining. Overreaching is seen as short-term overtraining and refers to training that involves a brief period of overload, with inadequate recovery, that exceeds the athlete’s adaptive capacity. It is often debated whether overreaching is a normal part of training, however, monitoring this kind of training in order for the positive results to come out as opposed to the potential damaging results of burnout becomes the key factor.

Beyond the physical impacts of overtraining such as illness and injury, some of the risks of overtraining include guilt about not working hard enough, disruption of sleep, anxiety/stress, feelings of fatigue, burnout and maladaptive responses to poor performance.The problem here is discerning whether these are short-term effects of intense training or long-term effects of overtraining.

Athletes who are susceptible to overtraining can show the following characteristics, behaviours and attitudes

• Extreme perfectionist, extremely strong athletic identity
• Lack of knowledge or awareness regarding the importance of recovery
• Unrealistic expectations

The best way to prevent overtraining is to get rid of the notion that more is always better. Once an athlete has completed his training exercise the most simple and recommended part of the cycle is rest.

Source from the SIRC Collection:
Richardson, Sean O., Andersen, Mark B., and Morris, Tony. Overtraining Athletes: Personal Journeys in Sport. Champaign, Ill.: Human Kinetics Publishers; c2008.

Exercising for Two!

Congratulations!!! You just found out you are pregnant and you are looking forward to all the exciting changes to happen over the next few months. But most of all you are now “eating for two” so this is an excuse to eat whatever you want whenever you want.

Although this is the belief among many pregnant women it is not true. Now more than ever you should be taking care of your body, watching what you eat and exercising regularly. Excess weight gain is becoming a major issue among pregnant women and it can lead to gestational diabetes and hypertension.

 The benefits of exercising while pregnant are substantial for prevention, labour and mental health.

•  Prevention 
•  Excessive weight gain 
• Post partum weight retention 
• Gestational diabetes 
• Obesity
• Heart disease 
• Labour
• Physical discomfort and complications during labour and delivery are lower in active women
• You will have greater stamina to get through labour 
• Recovery tends to be shorter 
• Mental Health 
• Better self-image 
• Fewer depressive symptoms 
• May help prevent postpartum depression 

For women in a healthy low-risk pregnancy it is encouraged to participate in mild to moderate intensity exercise. This will pose no threat to the mother or fetus. The best kind of exercise is aerobic activity (using large muscle groups). A great example is walking!

A great guideline to follow is the F.I.T.T. principles:

• Frequency (F) - 3 to 4 times a week 
• Intensity (I) – this is monitored by heart rate or the “talk test” (pregnant women should be able to have a conversation while exercising and not be out of breath) 
• Time (T) – 15-30 minutes of intense work out preceded by a warm up and followed by a cool down 
• Type (T) - activities should be low-impact and non-weight bearing 

It is also important to do muscle conditioning exercises while pregnant, however extra caution should be taken:

• Do not exercise laying on your back (after 16 weeks) 
• Avoid bouncing exercises
• Stretches should be controlled
• Avoid abdominal exercises
• Correct posture and neutral pelvic alignment
• Avoid holding breath 
• High repetition should only be done with low weights

It is extremely important before beginning any exercise regime, but especially when pregnant, that you consult your health care professional before commencing.

For additional resources:

• PARmed-X Pregnancy – Canadian Society for Exercise Physiology (CSEP) 
• Exercise and Pregnancy (2008) –Canadian Academy of Sport and Exercise Medicine (CASEM) 
• Exercise and Pregnancy Discussion Paper (2008) –Canadian Academy of Sport and Exercise Medicine (CASEM)
• Pregnancy and Sport – SIRC Newsletter
• Healthy Pregnancy - Health Canada’s website 

References from the SIRC Collection
Mottola, M. (2011) Exercise and Pregnancy: Canadian Guidelines for Health Care Professionals. August 2011, 22(4).

No shoes, no problem?

In 1960, Abebe Bikila ran an Olympic marathon in record time ... shoeless (2:15:16). He did not do it for the freedom of barefoot running but rather could not get a pair proper fitting shoes.

There are many arguments being made from both sides of shoes versus barefoot/minimalist debate. While there have been claims that running shoes are causing more injuries, this has not been proven. And on the other side of the fence there is also no evidence that shoes prevent injury either.  With little proof that shoes are bad and barefoot is good, and equally little that proves the converse either, where does that leave us?

Many cite their reason for kicking off their shoes and running as that it is just plain fun. “Our feet have so many nerve endings… Reflexology has its roots in our feet, and running barefoot is a free foot massage,” – Rod Beggs, President of the East Canada chapter of the running society.

 The most common injury reported by chiropractors is from runners trying barefoot or minimalist shoes who have failed to alter their gait appropriately to minimize impact. This causes runners to get shin splints and stress fractures. The body will eventually be able to cope with running barefoot by reinforcing tissue along the lines of the strain.

 The key to running without shoes is having the proper technique. Studies have shown the hitting the ground with the heel first produces more impact force than with mid foot strike. Another important thing to remember is to land over your center of mass to reduce impact on the body.

If you’ve been used to running with shoes your whole life and are looking to start running barefoot or using minimalist shoes, it is important to take it slow in order to let your body transition. Your feet have always been used to cushioning while running, therefore the muscles in your feet aren’t ready to have those cushions removed without strengthening and hardening them along the way.

Reference from the SIRC Collection:
Karnis, K. (2012). Minimalist Running: A Step in the Barefoot Direction. iRun, (1). 22-24.

Barefoot/Minimalist Running Research
Barefoot Running Research

SIRC at the CASEM Conference!

The SIRC virtual resource centre is on the road this week in Kelowna, BC attending the Canadian Academy of Sport and Exercise Medicine (CASEM) conference. It is great talking to the sports medicine community and helping them out with their questions in the area of sport medicine and preventive health interventions.

Some of the topics being discussed include:

• Exercise as a modality for chronic disease prevention 
• Exercise as disease management 
• Concussion research, prevention and management (including adaptations for women and youth) 
• Ethics for team physicians 
• Anterior Cruciate Ligament (ACL) research 
• Advocating for healthy lifestyles 

SIRC is pleased to be in partnership with CASEM to support medical professionals working in the area of sport and active living through SIRC membership.

Great conference CASEM!!

It's all fun and games...

We all know that playing sports is fun and good for your health. What is not commonly known is that there are a growing number of athletes that suffer from preventable eye injuries every year. Eye injuries occur more frequently in the summer months, when people are likely to be outside playing recreational sports — often without protective equipment.

Types of eye injuries:

1. Blunt - or impact injuries result from a direct blow to the eye. Usually from sporting equipment, ball, racket, or stick and sometimes from another player.
2. Penetrating - or piercing injuries result from objects cutting into the eye. Sharp objects like glass, debris or fingernails. These types of injuries need to be treated immediately and require medical attention.
3. Radiation - injuries are caused by intense sunlight and are most common in snow and water sports. Goggles or sport sunglasses with SPF protection will do well to protect your eyes from this injury.

Sports are a risky business!

Lower-risk: running, track, swimming, cycling and gymnastics
Higher-risk: baseball, racquetball, badminton, football, tennis, squash, lacrosse, basketball, soft ball, water polo, hockey and rugby
Very high-risk: martial arts, boxing, and wrestling

How do I know if an eye injury requires medical attention? 

Quite often eye injuries can be treated at home, but if you are in any doubt, don't hesitate to contact your family physician or optometrist. Penetrating or piercing eye injuries will always require immediate medical attention. Signs that may indicate serious injury - decrease or loss of vision, flashes of light, a dark curtain or veil across one part of your eye (indication of retinal detachment), floaters (shadows or dark objects float across your visual field), light sensitivity, pain with eye movement, red eye, and double vision.

Prevention

• Wear protective eyewear or a face shield and helmet combination
• Ensure eyewear is made of polycarbonate
• Frames must be sturdy and contain a posterior rim so that the lens can't dislodge backward into your eye
• Eyewear should have SPF protection
• Best option is to obtain protective eyewear from an optometrist or optician. These lenses can be prescription or non-prescription depending on your needs.

The good news is that eye injuries can be easily prevented if you take the proper precautions. Parents and athletes participating in sports that have a high risk of eye injuries should ensure that any purchase of protective gear meets the required standards of their sport.

References from the SIRC Collection:

1. Curreri A, Corrales G. Eye Trauma in Boxing. Clinics In Sports Medicine. October 2009;28(4):591-607. 
2. Eime R, Owen N, Finch C. Protective Eyewear Promotion: Applying Principles of Behaviour Change in the Design of a Squash Injury Prevention Programme. Sports Medicine. 2004;34(10):629-638.
3. Jones J. Protecting Your Eyes During Sports. Hughston Health Alert. Winter2011 2011;23(1):6.
4. Leivo T, Puusaari I, Mäkitie T. Sports-related eye injuries: floorball endangers the eyes of young players. Scandinavian Journal Of Medicine & Science In Sports. October 2007;17(5):556-563. 
5. Nelson B, Huchun A, Tuzman J. FACIAL INJURIES IN SPORTS. Sports Medicine Update. January 2007;:2-5.
6. Pujalte G. Eye Injuries in Sports. Athletic Therapy Today. September 2010;15(5):14-18.
7. Wang R. Blunt Injury to the Eye. Black Belt. March 2013;51(2):38.
8. Zagelbaum B. Sports-related eye trauma. Managing common injuries. Physician & Sportsmedicine. September 1993;21(9):25-28;31-32;35-37;40;42.

Match Point: Treating and Preventing Tennis Elbow

Tennis elbow is a very common sport related injury. Despite its name the injury can occur in a number of different sports. While usually a fairly minor injury, the resulting pain, discomfort, and potential weakness can prevent a person from participating in their activity of choice. Thankfully if the individual is knowledgeable, tennis elbow can be easily treated and potentially prevented.

Before you can treat tennis elbow it is important to have an understanding of exactly what the injury is and what the symptoms are. Tennis elbow (lateral epicondylitis) is an injury to the tendon that attaches all the extensor muscles for your wrist and fingers to the outside of your elbow. Although this article is focusing on tennis elbow, golfer’s elbow (medial epicondylitis) is a similar injury that affects the tendon attaching the flexor muscles to the inside of the elbow; it therefore has similar symptoms and treatment just with a different location.

Symptoms of Tennis Elbow 

• Inflammation and pain localized to the outer area of the elbow 
• Reduced grip strength 
• Pain when you bend the wrist and straighten the elbow 

 Tennis elbow is an injury caused by repetitive movements and therefore can best be treated by no longer taking part in the activity or sport that is forcing the repetitive motion. Unfortunately for some people that may not be an option, in these cases there are many treatment options to consider:

• RICE (rest, ice, compression and elevation) is a great strategy to help minimize the symptoms of tennis elbow and speed recovery. 
• Anti-inflammatory medications can help relieve the pain associated with the injury. 
• Braces for the elbow can help reduce the stress placed on the tendon. Surprisingly a wrist brace can also be helpful as it limits the use of the muscles that are pulling on the tendon. 

Obviously the best way to deal with tennis elbow is to avoid it altogether. If you play a sport or have a repetitive activity that puts lots of strain on the muscles in your wrist and fingers, racquet sports are the biggest offenders, then you need to plan ahead. Here are a few things to help avoid tennis elbow:

• Ensure you have proper form while engaging in your sport or activity can help reduce the risk of injury. 
• Fatigue can lead to improper form which increases the potential for injury; by strengthening the muscles involved you can limit fatigue. 
• Use a brace for the elbow or wrist to reduce stress on the tendon. This can be done during prolonged periods of your activity or sport even before you show signs of the injury. 

When it comes to tennis elbow the best defence is awareness, look into whether any activities or sports you take part in may put you at risk for the injury. If you display any of the symptoms treat immediately, if the injury persists or the pain is severe please see your doctor right away. With proper awareness and treatment you will be able to return faster from injury and reduce the chances of it recurring.

References from the SIRC Collection: 

1. Aronen, J. (2012). How to reverse effects of reverse tennis elbow. Handball, 62(1), 66-67. 
2. Aronen, J. (2008). Serving up some help to treat tennis elbow. Handball, 58(4), 66-67. 
3. Howe, D.K. (2007). Tendon Trauma. American Fitness, 25(6), 9. 
4. Knudson, D.V. (2004). Biomechanical studies on the mechanism of tennis elbow. Engineering Of Sport 5, 1(1), 135-141. 
5. Reynolds, L. & Rolf, R.H. (2013). Health and Handball: My Elbow Hurts. Handball, 63(3), 34-35.
6. STRETCHING AIDS In Tennis Elbow Prevention. (2009). 
7. Tennis Life, 19. Waseem, M., Nuhmani, S.S., Ram, C.S., & Sachin, Y. (2012). Lateral epicondylitis: A review of the literature. Journal Of Back & Musculoskeletal Rehabilitation, 25(2), 131-142.