Posted: Thursday, September 17, 2015
I know, why in the world am I writing a blog post about a Dallas player? We know Dez Bryant is out next week after surgery on his 5th metatarsal. But will he be back for the November 8th game against Philadelphia which is 7 weeks away?
Here is what we know. He fractured his 5th metatarsal Sunday and had surgery Monday. The team is giving a time frame of 4-6 weeks to return. What we don’t know if it’s it a mid-shaft fracture, a tuberosity fracture, a Jones fracture, or a diaphyseal fracture. These are all different fractures with different treatment options, return to play considerations, and complications.
In a pro athlete, surgery to stabilize the fracture is almost always done regardless of the type of fracture. Screw fixation allows earlier weight bearing and rehabilitation, decreases the risk of malunion/non-union, and ultimately helps with a faster return to sports. Complications following surgery include malunion/non-union of the fracture, bending or breaking of the screw, re-fracture, and persistent pain that can limit athletic ability.
What does Dez’s rehab program look likely following surgery? Weight bearing typically begins around 7-10 days post-surgery. Running is often started around 6 weeks if early healing is occurring and the athlete doesn’t have pain. CT scans can be helpful to document healing of the fracture. Typical return to play in a high level athlete is 8-12 weeks. With Dez Bryant, the Cowboys will throw the kitchen sink at him to help speed up his recovery. This will likely include a bone stimulator to facilitate fracture healing; accelerated rehabilitation to regain flexibility, strength and balance as well as maintain fitness and football specific skills; and possibly other modalities that “may” influence recovery such as hyperbaric treatment, laser therapy, etc.
A study published in 2015 in Foot & Ankle International looked at 25 consecutive NFL players who underwent surgery for 5th metatarsal fractures by a single surgeon. There was a 100% return to play with an average return in 8.7 weeks (range 5.9-13.6). The fastest return to play was 5.9 weeks. However, the fastest return to play for a wide receiver was 8 weeks. Re-fracture was fairly low with only 4 players experiencing re-fractures.
So, will Dez be ready to play against the Eagles on November 8th? The statistics are not in his favor. And if he does play, it will likely be his first game back. Will he be performing at his pre-injury level by then? Time will tell but the research shows that Eagles will likely be putting together a game plan against a Dallas team that won’t include Dez Bryant.
Phill.com Sports Doc
POSTED: Thursday, August 15, 2013, 6:00 AM
Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
Gatorade, Powerade, Accelerade, Lucozade, Sqwincher, EFS, Recharge, All Sport, Levelen… as you can see there are endless sports drinks on the market. These drinks say they can increase performance, decrease cramping, and speed recovery. What does the research say?
Pre-activity sports drinks
There are numerous pre-activity sports drinks on the market that claim they improve performance through numerous methods including increased energy, maintaining hydration, and adding to carbohydrate stores. Let’s look at the main components, (caffeine, carbohydrates) and see what the research shows.
We all know how that our morning cup of coffee helps start the day off on the right foot. But does it help to run faster or cycle longer? A 2012 article in the Journal of Strength & Conditioning Research showed “that acute ingestion of a caffeine-containing energy drink can enhance resistance exercise performance to failure and positively enhance psychophysiological factors related to exertion in trained men.”
There are numerous articles that support the use of caffeine performance enhancing supplement. Keep in mind that more is not better when it comes to caffeine and there can be negative side effects of excessive caffeine consumption. So please speak with your physician or a nutritionist about how much caffeine is safe and effective. And for NCAA athletes please consult your school’s athletic trainer as you can test positive if you’re over a certain limit.
Carbohydrates are thought to have a role in pre-, during, and post-exercise performance and recovery. Pre-activity carbohydrates are thought to top off one’s energy stores. A study in the Journal of Strength and Conditioning Research in 2013 showed that pre-activity “sports drinks allow higher stroke frequency during play, with decreased rates of perceived exertion” in tennis players.
What we don’t know is what is the optimal amount of carbohydrates and where do we get them from. Is there one drink that’s better than another or can we just get them from a healthy pre-activity snack? There is also concern for how an athlete feels eating and drinking prior to activity. Will it make them feel bloated? Can they tolerate a sports drink but not an energy bar? The general guideline is to have some form of carbohydrates pre-activity that your GI system can tolerate well.
During Activity Drinks
These can be broken down into two categories: energy replacement through carbohydrates and electrolyte replacement to limit cramping and dehydration.
Carbohydrates during activity are thought to supplement the body’s energy stores helping to maintain performance levels over longer periods of exercise. A 2011 article in the Journal of Sports Sciences recommends “Carbohydrate intake during exercise should be scaled according to the characteristics of the event. During sustained high-intensity sports lasting about 1 hour, small amounts of carbohydrate, including even mouth-rinsing, enhance performance via central nervous system effects. While 30-60 grams per hour is an appropriate target for sports of longer duration, events greater than 2.5 hours may benefit from higher intakes of up to 90 grams per hour.” Once again, the type and amount of carbohydrates is still unknown with recommendations of what the athlete tolerates from a GI perspective being most important.
What causes cramping in athletes? Is it dehydration, sodium loss, or something else? An article in the British Journal of Sports Medicine 2013 states “Significant and serious hypohydration (dehydration) with moderate electrolyte losses does not alter cramp susceptibility when fatigue and exercise intensity are controlled. Neuromuscular control may be more important in the onset of muscle cramps than dehydration or electrolyte losses.”
For cramping, the majority of sports drinks are isotonic or hypotonic meaning they have the same or fewer electrolytes than what is in your body normally. So not only do these drinks not replace lost electrolytes but they can pull electrolytes out of the body. Exceptions to this are sports drinks like Levelen that are based off of sweat testing and replace specific electrolytes lost by the individual.
So what’s the bottom line? For the average athlete who is working out for 60 minutes or less water is just fine. If it’s greater than 60 minutes or in a hot and humid environment, a sports drink comprising of both carbohydrates and electrolytes may be beneficial. Otherwise, these sports drinks tend to be nothing more than empty calories.
Post activities drinks are comprised mainly of carbohydrates and protein. The goal is to replenish what is lost immediately post-exercise. It is assumed that this helps in recovery. However, two studies dispute this common thought process.
A 2006 study in the Journal of Sports Medicine and Physical Fitness showed that “supplementation with a sports drink during recovery showed a significant short-term subjective positive effect compared with placebo. However, no effects were seen on physical performance or signs of overtraining.”
Another study in International Journal of Sport Nutrition and Exercise Metabolism 2008 concluded that ”consuming a carbohydrate + protein or carbohydrate beverage immediately after novel eccentric exercise failed to enhance recovery of exercise-induced muscle injury differently than what was observed with a placebo drink.” What we thought was common knowledge regarding carbohydrate replacement post exercise may not be backed up by science.
Pre-activity, caffeine can have positive benefit and one should have some sort of carbohydrates 30-60 minutes before activity. During activity, most people are fine with just water unless you’re competing for greater than 60 minutes, are in a hot and humid environment, or are prone to cramping. Lastly, for post-activity recovery you can probably skip the protein drink and just head home for a healthy well balanced meal.
Philly.com Sports Doc
POSTED: Wednesday, July 17, 2013
Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
Every athlete wants an edge. What’s the newest thing out there that will help me run faster, recover quicker, and play longer? How do I know which claims are fact and which are fiction? Let’s take a look and see what the research says.
2XU, Skins, CEP, CW-X, 110%....They’re everywhere. Running stores, basketball players’ elbows, and even on athletes during plane flights. They feel good. To some they look cool. But are they really doing anything? The claims: reduced muscle fatigue, reduced exercise induced muscle damage (EIMD), accelerated recovery processes, faster lactic acid removal, increased strength and power, improved endurance, etc. Let’s look at the two main reasons for wearing them: sports performance and sports recovery.
A 2013 study in the European Journal of Applied Physiology stated that “none of the blood or physical markers of recovery indicates any benefit of wearing compression garments post-exercise. However, muscle soreness and perceived recovery indicators suggest a psychological benefit may exist.” The majority of research articles support this saying any benefit from a physiological standpoint is trivial but the perceived benefit may be significant. Anyone who has worked with professional athletes knows that it’s as much mental as it is physical. If they think something is helping then they’ll play better and in the end that’s really what matters. So the rest of us have to decide if a $100 pair of recovery tights is worth the placebo effect.
A January 2013 article in the International Journal of Sports Physiology and Performance showed that “results indicated small effect sizes for the application of compression clothing during exercise for short-duration sprints (10-60 m), vertical-jump height, extending time to exhaustion (such as running at VO2max or during incremental tests), and time-trial performance (3-60 min)." Another article in the May 2013 edition of the same journal showed that “Wearing compression garments during cycling may result in trivial performance improvements of ~1% and may enhance oxygen delivery to the exercising muscles.” As these two studies show, there is conflicting results to date whether compression garments show performance enhancement benefits. But once again, if you think it works and you don’t mind paying for it then go for it.
Magnet therapy is a $500 million annual business in the US. Some of the touted benefits include improved blood flow and decreased pain. Much of the theory is based on the magnetic principles of iron. However, iron in blood is diamagnetic which means it is actually repelled by magnetics.
An article in the Journal of Orthopedic and Sports Physical Therapy in 2002 showed no difference in blood flow of the forearm with magnets compared to placebo. Another claim is that magnets help with swelling by attracting water molecules in the body. This can be disproven by the simple fact that even during an MRI scan there is no change in water dynamics in the body. Some companies claim that magnets can help with nerve conduction but once again even the strong magnets used in MRIs are not powerful enough to effect nerve conduction.
Regarding pain, research does show mixed results. A study in the Archives of Physical Medicine and Rehabilitation showed significant pain reduction in post-polio patients using magnet therapy where another study in the Journal of the American Medical Association showed no benefit in the treatment of low back pain. Many of the studies showing positive benefit had small sample sizes, lacked true control groups, and used magnets that were more powerful than the magnet necklaces worn by most individuals. So to sum it all up, there seems to be no real benefit from magnets other than possible pain relief, which may be just a placebo effect. But if it helps with your pain and you think they look stylish, then give it a try.
Next time: Kinesiotape, vibration plates and more.