All month long, we’ve been honoring National Physical Therapy Month by educating our readers about how physical therapy works and the many ways it can benefit you. In the third newsletter of our series, we offer a brief overview of the crucial role that physical therapy frequently plays in the management of orthopedic problems.

Orthopedics is a branch of medicine that addresses issues related to the musculoskeletal system, which includes the bones, joints, ligaments, tendons, and muscles. Issues that develop in these parts of the body are usually due to a traumatic incident, overuse, or natural bodily changes, and they can be treated in a number of different ways. The most effective orthopedic care requires several important components, and physical therapy is considered an integral facet at many stages of the treatment process.

With or without surgery, physical therapy is typically involved

When most people hear the word ‘orthopedics,’ the first thing that comes to mind is often an orthopedic surgeon. But while surgery may be recommended for severe and/or long–term injuries and conditions—especially for very active athletes—it is absolutely not necessary in all cases. Treatment approaches for orthopedic injuries include both conservative management strategies (like medications, injections, and physical and occupational therapy) as well as more invasive options like surgery.

The main reason that physical therapy is a core component of orthopedics and why the two overlap so much is that they both work towards the same overall goals. When a patient suffers from an orthopedic injury, certain parts of their musculoskeletal system are disrupted, which will lead to pain and a limited ability to function normally. The goal of both physical therapy and orthopedics is to address and fix these problems within the musculoskeletal system so the patient can go on to function fully once again.

Physical therapy can therefore be utilized in a few ways to address an orthopedic injury:

• A patient experiences an orthopedic injury and goes directly to a physical therapist
• A patient gets injured and sees an orthopedic physician (orthopedist) who then refers the patient to a physical therapist
• The orthopedist recommends surgery for the patient, and then prescribes a course of physical therapy prior to the procedure (“prehabilitation”)
• The orthopedist recommends surgery and prescribes physical therapy as part of the post–surgical rehabilitation program

How a physical therapist addresses the patient’s orthopedic injury depends on the injury present and at what stage treatment begins, but most treatment programs share a number of similarities. For example, all treatment programs are based on an initial evaluation of each patient for strength, flexibility, balance, posture, and several other physical measures that will provide a clearer picture of their condition for the physical therapist. From there, the therapist will develop a sense of the goals the patient would like to achieve then shapes treatment around their injury, abilities, and goals.

If physical therapy is initiated exclusive of surgery, therapists will aim to improve strength, flexibility, and functioning through various exercises, pain–relieving interventions, and hands–on techniques from the therapist. A primary goal is always to avoid surgery, but it may be necessary for patients that fail to improve or have severe injuries. If this is the case, the treatment program will either prepare a patient for what’s to come after the procedure is completed or help speed up the recovery process and bring the patient back to full strength as quickly and safely as possible. Once again, it’s all about correcting any musculoskeletal problems and rebalancing the body, so that every patient can move and function normally after the procedure.

Returning to pre–injury fitness levels

Another goal of physical therapy for orthopedic conditions is to help each patient return to their prior level of physical activity. For those who were actively involved in sports or a regular fitness regimen, this will typically require targeted functional training that mimics the movements and patterns involved in the particular activity. Returning to these levels can be challenging, especially when surgery is involved, but it serves as the guiding principle of all physical therapy–based strategies. And through dedication and commitment to the prescribed management program, most patients can expect to eventually reach their pre–injury capabilities once again.

Certain physical therapists actually specialize in orthopedic care and work exclusively with orthopedic surgeons, but most physical therapists are capable of treating the wide range of orthopedic injuries. Therefore, if you’re currently affected by an orthopedic injury of any type, there’s a strong chance that physical therapy will play a major role in your recovery. To reduce your chances of needing surgery, see a physical therapist first, and fast, and see for yourself what a personalized path to orthopedic care can do for you.

October is National Physical Therapy Month, which gives physical therapists nationwide an opportunity to highlight and celebrate the countless benefits that our profession can provide. In honor of this important month, we’d like to discuss the dangers of using opioids for pain and explain why physical therapy is a much safer and more effective option.

Any amount of pain can be a nuisance to your life, especially when it lasts for a while. Everyone deals with pain differently, and there are a number of options available to treat it. One is narcotics and pain medications like opioids, which have been garnering significant national attention on account of the devastating problems that they have played a major role in creating.

Opioid use in the U.S. is alarmingly disproportionate to the rest of the world

In addition to the coronavirus pandemic, the U.S. has also been encumbered by an opioid epidemic for many years due to the over–prescription of these drugs. Although our country represents less than 5% of the world’s population, we consume more than 80% of the global supply of opioids. The number of opioid prescriptions increased by 600% from 1997–2007, and there has been a threefold increase in the abuse of these drugs over the past few years.

These shocking figures show just how big of a problem opioid use is in the U.S. While there are many patients that truly need opioids due to pain that can’t be treated with anything else, many others are using them for the wrong reasons. These individuals are usually looking for a “magic bullet” to immediately fix them, and opioids can often give them the most immediate short–term relief, even if it doesn’t solve their problem. In other cases, patients are prescribed opioids to help them deal with pain following surgery. Sadly, this can also have some negative effects.

Studies have shown that patients who continue to use opioids after surgery have worse outcomes than those who don’t. This has been seen with a greater number of symptoms, more stress, more disability, and higher tolerance for opioids. This higher tolerance for opioids is very dangerous and can lead to addiction if the drugs are taken for long enough. This is why many people who are prescribed opioids after surgery or for an injury eventually develop addictions. They often become too reliant on the drugs during their recovery and are unable to stop taking them afterwards.

Physical therapy effectively addresses pain instead of ‘masking’ it

Physical therapy, on the other hand, offers a wide range of benefits that far outweigh any risks involved. Unlike narcotics, which are only meant to mask the perception of pain, physical therapists prescribe interventions that are designed to improve the mobility and stability of a painful area. In effect, this approach works towards correcting the structural issues responsible for the patient’s pain in a safe and gradual manner.

In addition, physical therapy teaches patients how to accurately perform a variety of exercises on their own to target their painful condition. All patients are instructed to continue performing these exercises after completing their treatment program, which gives them the opportunity to keep improving and experience a successful long–term outcome.

Physical therapy is appropriate for all ages and activity levels, and it can be used to address just about any condition, injury, or disorder that affects movement. For these reasons, we strongly recommend seeing a physical therapist quickly if pain is getting in the middle of you and the things you love. Following this route will also reduce your chances of being prescribed opioids at any point.

In our next newsletter, we discuss the ways that physical therapists can help you overcome orthopedic problems and return to your desired level of physical activity.

National Physical Therapy Month is celebrated every October, with its focus on educating the public about how physical therapy can change patients lives for the better. To work towards this goal, we’d like to share our insight on why physical therapy is usually the best treatment option available if you are in pain of any sort.

Moving more will lead to less pain

We all deal with bouts of pain from time to time, which can often make tasks that are otherwise mindless and routine become difficult and challenging. Regardless of the level of pain, most individuals will need to make adjustments of some sort to the way they navigate the world throughout each day. When this is the case, exercising or moving your body in ways that might aggravate pain may sound like the last thing you’d want to do to get better, but targeted movement is actually the key to improving.

There are a great many conditions that can result in a painful sensation, which is usually your body’s way of telling you that something isn’t working properly. From back and neck pain to arthritis, frozen shoulder, and plantar fasciitis, pain can manifest in a multitude of ways. And for most individuals who find themselves in pain, the temptation is usually to move as little as possible to avoid making it worse. Unfortunately, moving less and reducing physical activity levels will have the opposite effect.

Despite your natural tendencies, moving the painful parts of your body in a structured manner will go on to alleviate pain in most cases. This is where physical therapy comes in.

The role of a physical therapist is to first identify the source of your pain and extent of your limitations by performing a thorough evaluation. Based on these findings, the physical therapist will then design a personalized treatment program that addresses your impairments and considers your physical abilities, preferences, and goals. And though it may be hard to find the motivation to see a physical therapist at first, doing so when your condition is in an aggravated state helps them better understand what’s going on.

Prescribing a program that works for each patient

Physical therapists are movement experts who are proficient at selecting the most appropriate interventions for each patient based on their unique condition. Programs will vary depending on a number of factors, but most will consist of some—if not all—of the following components:

• Patient education
• Pain–relieving modalities like ice and electrical stimulation
• Stretching exercises to increase flexibility
• Strengthening exercises to build back strength
• Manual (hands–on) therapy techniques like massage, mobilization, and manipulation
• Functional training, especially for athletes and worker’s compensation patients
• Balance and vestibular training
• Posture correction

Physical therapists will also encourage regular physical activity (about 150 minutes of moderate–intensity exercise or 75 minutes of vigorous–intensity exercise per week) to increase your strength, endurance, and joint stability and flexibility. Frequent exercise will also help control your pain and allow you to maintain an ability to move and function to your full capacity. Physical therapists will monitor your activity progress and offer continual feedback as you progress to ensure that you’re moving at the right pace and not overdoing it. They will also modify your program if needed to keep your pain levels at a minimum, so you can continue to work independently towards less pain and more function.

As with many things, the first step is the hardest, but it can also be the game–changer you’re seeking. So, if pain is currently holding you back and you’re interested in making a change, we strongly encourage seeing a physical therapist soon for a personalized approach to treatment that will get you moving again, and quickly.

In our next newsletter, we explore how physical therapy stacks up against opioids, another pain management option that usually does more harm than good.

As we discussed in our second newsletter this month, diagnostic tests like X–rays should only be performed when a red flag is detected, meaning that the healthcare professional notices signs of a potentially serious underlying condition during the initial evaluation. Despite this, many X–rays continue to be performed on patients with conditions like back pain even when no red flags are identified.

Large groups of chiropractors, for example, including the International Chiropractic Association, promote the use of routine or repeat X–rays to assess the structure and function of the spine. This practice has been used for over 100 years, and it’s unclear if doing so is associated with any benefits for patients with back pain. With this in mind, a study was conducted to evaluate whether chiropractors’ routine or repeat use of spinal X–rays without red flags have any noticeable impact on patients’ outcomes.

This particular study was a systematic review, in which researchers performed a thorough search for any studies with data on patients who visited a chiropractor and were referred to undergo an X–ray of any region of their spine in the absence of red flags. They were specifically interested in patient outcomes that were associated with chiropractic approaches that used these X–rays for diagnosing or assessing the patients’ condition. Once identified, they analyzed the results of these studies to determine if there was a clinical utility of X–rays for patients with back pain. Clinical utility was defined as “the degree to which the use of a test is associated with changing health outcomes through diagnosis or selecting an appropriate treatment.”

No evidence found in 23 studies to support the use of X–rays

The search process originally identified 959 articles, and researchers screened 176 of these to land on a total of 23 studies that met the necessary criteria and were included in the review.

Researchers were unable to identify any studies that investigated the clinical utility of spinal X–rays in the absence of red flags for evaluating the spine. Similarly, no studies were identified that investigated whether findings from repeat spinal X–rays are valid markers of significant changes when monitoring patients with back pain. These findings suggest that X–rays of the spine without red flags do not appear to be beneficial for patients. The study also points out that X–rays expose patients to some radiation, and although the amount used in a single X–ray is generally considered to be safe, no dose of radiation exists that is not without risk. This risk also increases proportionally with the dose, meaning that X–rays could pose dangers for patients when used repeatedly over time. Taken together, given the lack of benefit to patients and associated radiation risks, this study provides additional evidence as to why X–rays should not be recommended for patients with back pain in the absence of red flags. Doing so exposes patients to harmful radiation and does not appear to have any noticeable impact on their clinical outcomes.

Therefore, patients with back pain are encouraged to not request X–rays and other diagnostic imaging tests from their doctors. They should also be sure to discuss the risks, benefits, and costs of any test being ordered to diagnose or assess their condition before proceeding.

Additionally, patients should strongly consider seeing a physical therapist first rather than their primary care doctor or a surgeon. Physical therapists avoid the overuse of diagnostic tests and only order them when it is deemed absolutely necessary in light of the associated risks and costs. Instead of spending time in search of a diagnosis, they will get patients started on a treatment program from the get-go that will address their limitations and teach them to use their own movements to overcome their pain and disability. So if you are currently dealing with back pain or any other musculoskeletal condition, we urge you to contact our clinic to schedule an initial visit and get started on your path to recovery.

As we explained in our last newsletter, diagnostic imaging tests can be a vital tool that helps doctors more clearly understand what’s happening in the body in order to reach or confirm a diagnosis. But simply because these tests are helpful does not mean they should be used at all times, or even frequently. For musculoskeletal disorders—like back, neck, and knee pain—imaging tests should be used when certain criteria are met, yet statistics on their use paint a much different picture.

The overuse of diagnostic testing for musculoskeletal disorders is part of a much larger trend in the healthcare industry. According to one article, about $800 billion of healthcare spending is spent on unnecessary diagnostic tests, procedures, and extra days in the hospital. For musculoskeletal disorders, back pain typically garners the most attention because it is so common and because it serves as one of the clearest examples of excessive diagnostic testing use.

Low back pain is one of the most common overall ailments and will affect up to 80% of individuals at some point in their life. Imaging tests are only recommended when a “red flag” is present, which include signs of severe or worsening nerve damage, serious underlying problems like cancer or spinal infections, unexplained weight loss, loss of bladder or bowel control, and abnormal reflexes. If none of these red flags are present, an imaging test is not usually required, but many patients with back pain continue to have MRIs of their spine for one reason or another.

Despite the existence of guidelines that recommend against MRIs, except for in these rare cases, there is data that shows many patients with back pain are initially being prescribed diagnostic imaging tests without first attempting less expensive and less invasive treatments like physical therapy. In fact, one study estimated that the use of MRIs for low back pain increased by as much as 300% between 1994-2006. And while it may seem as if the overuse of these helpful tests is generally harmless, the inverse is actually true.

For starters, imaging tests—particularly MRIs and CT scans—are extremely expensive. The average cost of an MRI is $1,119, with some costing as much as $3,000, which is significantly higher than any other comparable countries. CT scans and X-rays also expose patients to potentially harmful levels of radiation that could otherwise be avoided. But perhaps most importantly, imaging tests can do more harm than good for many patients. This is because they don’t always identify the cause of patients’ pain—especially for low back pain—and often reveal “abnormalities” unrelated to the pain that may be misconstrued as a cause. An important study highlights why this is true, as it reviewed the MRIs and CT scans of more than 3,000 individuals with no signs of back pain. Results revealed the following:

• 20-year-olds: 37% had “disc degeneration” and 30% had “disc bulging”
• 50-year-olds: 80% had “disc degeneration” and 60% had “disc bulging”
• 80-year-olds: 96% had “disc degeneration” and 84% had “disc bulging”

These results show that disc degeneration and disc bulging are extremely common in most people without back pain, and the likelihood of having these “abnormalities” increases significantly with age. Therefore, many patients with back pain may be told that they have disc degeneration or disc bulging and believe this to be the reason for their pain, while the truth is that it is likely a sign of the natural aging process instead.

Another extremely unfortunate consequence of this testing is that many patients go on to receive invasive, dangerous, and expensive interventions based on the results of their tests, even if the procedure won’t actually resolve their pain. In our next newsletter, we’ll explore the repercussions of overusing diagnostic imaging tests in more detail and explain why this can all be avoided by seeing a physical therapist first.

As we explained in our last newsletter, diagnostic imaging tests can be a vital tool that helps doctors more clearly understand what’s happening in the body in order to reach or confirm a diagnosis. But simply because these tests are helpful does not mean they should be used at all times, or even frequently. For musculoskeletal disorders—like back, neck, and knee pain—imaging tests should be used when certain criteria are met, yet statistics on their use paint a much different picture.

The overuse of diagnostic testing for musculoskeletal disorders is part of a much larger trend in the healthcare industry. According to one article, about $800 billion of healthcare spending is spent on unnecessary diagnostic tests, procedures, and extra days in the hospital. For musculoskeletal disorders, back pain typically garners the most attention because it is so common and because it serves as one of the clearest examples of excessive diagnostic testing use.

Low back pain is one of the most common overall ailments and will affect up to 80% of individuals at some point in their life. Imaging tests are only recommended when a “red flag” is present, which include signs of severe or worsening nerve damage, serious underlying problems like cancer or spinal infections, unexplained weight loss, loss of bladder or bowel control, and abnormal reflexes. If none of these red flags are present, an imaging test is not usually required, but many patients with back pain continue to have MRIs of their spine for one reason or another.

Despite the existence of guidelines that recommend against MRIs, except for in these rare cases, there is data that shows many patients with back pain are initially being prescribed diagnostic imaging tests without first attempting less expensive and less invasive treatments like physical therapy. In fact, one study estimated that the use of MRIs for low back pain increased by as much as 300% between 1994-2006. And while it may seem as if the overuse of these helpful tests is generally harmless, the inverse is actually true.

For starters, imaging tests—particularly MRIs and CT scans—are extremely expensive. The average cost of an MRI is $1,119, with some costing as much as $3,000, which is significantly higher than any other comparable countries. CT scans and X-rays also expose patients to potentially harmful levels of radiation that could otherwise be avoided. But perhaps most importantly, imaging tests can do more harm than good for many patients. This is because they don’t always identify the cause of patients’ pain—especially for low back pain—and often reveal “abnormalities” unrelated to the pain that may be misconstrued as a cause. An important study highlights why this is true, as it reviewed the MRIs and CT scans of more than 3,000 individuals with no signs of back pain. Results revealed the following:

• 20-year-olds: 37% had “disc degeneration” and 30% had “disc bulging”
• 50-year-olds: 80% had “disc degeneration” and 60% had “disc bulging”
• 80-year-olds: 96% had “disc degeneration” and 84% had “disc bulging”

These results show that disc degeneration and disc bulging are extremely common in most people without back pain, and the likelihood of having these “abnormalities” increases significantly with age. Therefore, many patients with back pain may be told that they have disc degeneration or disc bulging and believe this to be the reason for their pain, while the truth is that it is likely a sign of the natural aging process instead.

Another extremely unfortunate consequence of this testing is that many patients go on to receive invasive, dangerous, and expensive interventions based on the results of their tests, even if the procedure won’t actually resolve their pain. In our next newsletter, we’ll explore the repercussions of overusing diagnostic imaging tests in more detail and explain why this can all be avoided by seeing a physical therapist first.

When dealing with pain of any sort, physical therapists and medical doctors have a number of tools at their disposal to help determine the cause and what needs to be done to address it. A thorough physical examination that involves a variety of objective and subjective assessments of strength, flexibility, balance, and other variables is always the first and most important step of reaching an accurate diagnosis. But in some cases, additional testing may also be performed.

If your doctor is still uncertain of what is causing your pain or if a severe injury was sustained, she may recommend having a diagnostic imaging test to obtain more information. These non–invasive techniques let the doctor see inside your body to get a clearer picture of your bones, muscles, tendons, and ligaments. This can help to determine if any of these structures look damaged and are possibly contributing to your pain. Diagnostic imaging tests include x–rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans, which all use slightly different methods to produce images of the internal structures of the body.

• X–rays
• The most commonly used diagnostic test; readily available in many doctor’s offices
• Sends a type of electromagnetic radiation called X–rays through the body
• Bones and other dense matter appear white or light because they absorb the radiation, while less dense soft tissues (like ligaments and tendons) and bone fractures look darker because they let radiation pass–through
• X–rays do not show as much detail as more sophisticated tests but are often used as a starting point
• You are exposed to radiation which can, in some cases, cause harmful effects to cells of the body
• CT scan
• Combines X–rays with computer technology to produce a more detailed image that includes the size, shape, and position of structures deep in the body
• During the test, an X–ray tube will rotate slowly around you and take several pictures from all directions, which are displayed on a computer screen
• May be needed for problems with small, bony structures or severe trauma
• You are exposed to a much higher dose of radiation than with an x–ray, which in some cases, can cause harmful effects to cells of the body
• Costs more and takes more time than regular X–rays
• MRI
• Uses magnetic fields and computerized technology instead of radiation to take high–resolution pictures of bones and soft tissue
• Involves lying on a table that slides into the MRI scanner. MRIs employ powerful magnets which produce a strong magnetic field that forces protons in the body to align with that field. When a radiofrequency current is then pulsed through the patient, the protons are stimulated, and spin out of equilibrium, straining against the pull of the magnetic field; a computer records how these tissues respond to these radio pulses and then translates the data into a detailed picture
• May be used in helping to diagnose torn ligaments and cartilage, torn rotator cuffs, herniated disks, osteonecrosis, bone tumors, and other problems
• Other
• Ultrasound: is a radiation–free technique that uses high–frequency sound waves that echo off body structures to diagnose a variety of conditions
• Bone scan: shows bone activity throughout the body by injecting a small amount of radioactive material into a vein, which is absorbed by areas forming new bone (like fractures and bone tumors) and can be identified by a scan of the body several hours later

Each of these techniques can serve a unique and important role in the diagnosis of many conditions, but there are only certain situations in which they should be used. In our next newsletter, we’ll look into why diagnostic imaging tests are being overused and the downsides of this ongoing trend.

As we explained in our first newsletter this month, sports injuries are unfortunate but also a common occurrence for athletes. A range of factors can contribute to an athlete’s risk for injury, including their participation in a higher level of activity without first preparing through a tailored training program.

Returning to any sport after an extended absence can be dangerous no matter what physical condition you happen to be in. The reason is that even if you’re in good shape, your body may not be prepared for the particular dynamics involved in the sport. Every sport requires a very specific set of movements, and in order to perform them, specific areas of the body need to be appropriately prepared with proper strength and flexibility. Overworking any muscle groups or ligaments that are not yet adapted to these movements can result in damage to these structures and injury.

The pandemic has temporarily suspended most organized sports, because of this there is likely to be an uptick in sports injuries when things return to normal circumstances. Without organized sports functioning now, many individuals have not been keeping up with the same level of training as they had before the pandemic. If they jump back into their sport too aggressively, it could prove to have a dangerous outcome. Below are some of the most common sports–related injuries that may be seen frequently during the return to the sporting world ahead:

• Baseball: sprains and tears of the ulnar collateral ligament, Little League elbow and Little League shoulder
• Softball: shoulder tendinitis, back and/or neck pain
• Tennis: tennis elbow, rotator cuff injuries
• Golf: back pain, golfer’s elbow, shoulder pain
• Track & field/running: runner’s knee, jumper’s knee, IT band syndrome
• Swimming: swimmer’s shoulder, hip pain, back pain
• Lacrosse: ACL tears, muscle strains
• Soccer: strains and sprains to the lower leg, especially the ACL

Why you should see a physical therapist first and fast

If an injury does occur, the smartest and safest decision you can make is to see a physical therapist right away. Physical therapists are movement experts with a thorough understanding of the biomechanics involved in all sports. As such, they can help patients prepare for the demands of their respective sport to prevent injury, and if an injury does occur, guide them through a comprehensive rehabilitation program. All programs are personalized to the unique demands of each patient’s particular sport, as well as their tolerance to various interventions, abilities, and goals. As a result, the management plan will differ from patient to patient, but a general overview of this process follows:

• First, your physical therapist will perform a thorough interview and physical examination to identify the source of your pain and establish a diagnosis
• Next, he or she will assess your strength, flexibility, agility, and endurance to develop a better sense of your current fitness level
• In addition, you’ll be asked additional questions about the sport you participate in, your level of involvement, and what you’d like to achieve through physical therapy
• Based on all of this information, your therapist will create an individualized treatment program designed to target your limitations and impairments
• Treatment may involve stretching and strengthening exercises, joint mobilization, soft tissue mobilization, and sport–specific interventions that mimic the dynamic movements involved in your respective sport
• The intensity of the program will gradually increase based on your progress
• Your physical therapist will determine when you’re ready to return to your sport and if any additional precautions are needed upon your return

Seeing a physical therapist is the safest and most effective way to recover from a sports–related injury and doing so quickly has been associated with better outcomes. This is why we strongly recommended consulting with us if you notice any signs of pain or soreness at any stage in your return to sports participation.

Most serious athletes are aware that healthy nutritional habits should be a part of any complete exercise plan. Training well must be balanced by eating well, or the athlete could be missing out on the maximum physical and mental benefits that this optimal fitness level can bring about.

But one pitfall that some athletes can fall into is focusing too heavily on what they consume before a workout and neglecting the post–workout meal. The truth is that both are equally important, and eating properly after exercise is key to helping the body to replenish its energy stores and regrow muscle proteins that have been lost during exertion. Doing this effectively can lead to a quicker recovery and better preparedness for the next workout, which generally means a lower risk for injury, too.

Below are some tips to guide your post–workout meal so you can maximize your performance with a reduced injury risk:

Macronutrients: Protein, carbs, and fats

When you work out, your muscles use up a compound called glycogen, which is a form of glucose that is stored until it’s needed. As a result, your muscles are partially short on glycogen after exercise, and some of the proteins in muscles also get broken down due to exertion. Once your body begins the recovery phase after exercising, it actively works to rebuild these lost glycogen stores and regrow the damaged muscle proteins. Consuming the right nutrients soon after physical activity can accelerate this process and help with new muscle growth. This is why you should focus on getting appropriate amounts of protein, carbs, and fats during this time:

Protein

• Consuming enough protein after a workout gives the body amino acids needed to repair and rebuild those that have been damaged; this will in turn help to repair and build muscle
• Tip: aim for about 0.14–0.23 grams of protein per pound of bodyweight very soon after each workout; research has shown that ingesting 20–40 grams of protein seems to maximize the body's ability to recover after exercise

Carbs

• The rate that glycogen is used depends on the sport or activity, endurance sports generally cause the body to use more than strength training
• Eating carbohydrates after exercising helps to replenish this lost glycogen, consuming them along with protein is even more effective for maximizing protein and glycogen synthesis
• Tip: aim for 0.5–0.7 grams of carbs per pound of body weight within 30 minutes after training, and try to consume a carbs–to–protein ratio of 3:1

Fats

• Although it’s true that fats will slow down digestion and the absorption of your post–workout meal, eating them will not impede the benefits of a well–balanced meal with protein and carbohydrates
• Tip: limit the amount of fat you eat after a workout, but don’t neglect them entirely
• Final tip: timing matters, and it’s generally recommended that you eat your post–workout meal within 45 minutes, and preferably no longer than two hours later

Supplements

Many athletes use supplements like creatine, protein, and caffeine to build muscle or improve their performance. Supplements may serve a beneficial role for some, but as their name suggests, they should only be used in addition to a well–devised and complete nutritional plan.

Protein

• Protein in the form of shakes and powders is extremely popular, particularly in high–school age boys who are looking to bulk up, but it doesn’t appear that protein supplements are any better than the natural protein derived from food
• Some protein supplements also provide extra calories, which can actually translate to more fat
• Tip: skip the supplements and focus more on getting protein from healthy food sources like chicken, salmon, tuna, Greek yoghurt, eggs, and protein bars

Creatine

• Creatine is used to boost performance and strengthen muscles by facilitating the intake of water into muscles
• While it’s use is generally safe in adults, it has not been researched in younger populations
• In addition, some supplements contain various experimental stimulants, which can be dangerous and potentially lead to serious side effects
• Tip: as with protein supplements, it may be best to steer clear of creatine and instead make efforts to get proper training, nutrition, and sleep

Caffeine

• Some research has suggested that consuming caffeine after a workout can lead to more glycogen in muscles, and therefore a better recovery, compared to carbs alone
• But caffeine is also a stressor that increases cortisol levels, and the amount of caffeine used in the study above was the equivalent of 5–6 cups of coffee
• Tip: if you’re exercising earlier in the day and a cup of coffee is a normal part of your routine, it won’t likely do any harm; but consuming large amounts of caffeine later in the day could have some negative effects and should, therefore, be avoided

In our next newsletter, we look into how a physical therapist can help you recover from sports–related injuries.

On all levels of sports, consistent and varied efforts are made to reduce the incidence of injuries. Warm–ups and group stretching routines are commonplace on most sports teams, while some organizations taking it a step further by implementing targeted injury–prevention programs specific to that sport. But which of these methods truly have an impact on injury avoidance and which may not be worth the time? And what role does specializing in a single sport play in an athlete’s injury risk profile?

Below, we aim to answer these and other questions related to the prevention of sports injuries.

Does stretching reduce the risk for injuries?

Stretching is easily the most popular pre–activity ritual of all athletes across the sports spectrum. This is why it may come as a shock to hear that in the majority of cases, stretching does not have the effect that most believe it has.

There are two types of stretching: static and dynamic. Static stretching is what most comes to mind when most people think about stretching. It involves the lengthening of a muscle until a stretch is felt or discomfort is reached, and then holding it for a period of time (usually 10–30 seconds). Dynamic stretching, on the other hand, involves actively performing a set of movements that resemble those involved in the sport to prepare the body for the demands of the activity that is about to come.

According to one systematic review, which analyzed the findings of 12 studies on these types of stretching, both static and dynamic stretching were found to improve athletic performance, but the effects were only small to moderate. In addition, static stretching had no detectable impact on the risk for injuries, while no data was available for dynamic stretching.

Other research has also suggested that dynamic stretches before a practice or game can improve athletic performance and possibly even lower injury risk, while static stretching has been found to potentially impair athletic performance. Thus, it’s recommended stretching should be considered optional before exercise and be based on personal preference. If you do decide to stretch at this time, avoid static stretches and instead complete a warm–up for at least 10 minutes that involves light aerobic activity and some dynamic stretching.

What about injury–prevention programs?

Another strategy to reduce injury risk is a more focused effort through carefully designed injury prevention programs. These types of programs are based around a single injury or group of injuries that are most common in a particular sport and aim to address any strength or mobility limitations that will make them more likely to occur. The goal is to train the athlete’s body to be fully equipped and prepared for the demands of the particular sport, thereby reducing injury risk.

One study that reviewed eight high–powered studies called meta–analyses on prevention programs for anterior cruciate ligament (ACL) tears, which are one of the most common and devastating injuries in sports. Six of these meta–analyses only included data on female athletes. Results showed that the prevention program led to a 50% reduction in the risk for all ACL injuries in all athletes and a 67% reduction for non–contact ACL injuries in females. While additional research is needed on male athletes, these findings strongly suggest ACL injury–prevention programs may be beneficial in sports that involve lots of high–impact landing and twisting movements. A program similar to those used in these studies can potentially be implemented during team warm–ups.

Does strength training have a similar effect on injury risk?

Strength training is also popular not only for improving overall fitness, but as a means to prevent injury. The concept is that stronger muscles will allow an athlete to better manage the “load” of their sport, which is how aggressively their tissues are challenged during performance.

To evaluate the effectiveness of strength training on injury prevention, a systematic review and meta–analysis was performed on six studies called randomized–controlled trials. Although the interventions used and populations studied differed between these trials, all six showed that strength training consistently reduced the risk for both acute and overuse injuries. In addition, a relationship was identified in which more frequent performance of these programs was associated with an even greater their injury risk. The quality of this evidence was also primarily rated as high and no negative side effects were detected. Therefore, strength training could serve as another effective intervention to mitigate injury risk in athletes.

What risk does specializing in one sport pose for young athletes?

About 72% of school–age children—nearly 29 million—participate in at least one organized sport, and this involvement is associated with a variety of physical and mental benefits. Many of these young athletes only participate in one sport and are often involved in practices, competitions, camps, and other forms of training throughout the entire year. This is called single–sport specialization, which is believed to help them eventually become elite athletes in the long term; however, it may not be the best approach for their overall development.

Research is plentiful on this topic, and according to one study, sport specialization is associated with overuse injuries, burnout, and social isolation. It can also lead to reduced motor skill development and may cause athletes to quit sports at a young age. For these reasons, young athletes should be encouraged to participate in a variety of sports during their early years so that they can develop a variety of motor skills and also identify the sports that they most enjoy. For those that do decide to specialize in one sport, participation (in hours) should not exceed their age, and those that engage in more than 16 hours of intense training per week should be monitored for signs of burnout and overtraining, which can lead to injury.

What role does sleep play in injury risk?

Adequate sleep is a crucial component of optimal overall health for all individuals, but it is particularly important for athletes. Fatigue is a major risk factor for injuries, and sleep deprivation contributes significantly to chronic pain. Good sleep habits, on the other hand, can boost athletic performance and will likely reduce injury rates.

According to one study performed on endurance sports athletes, getting less than seven hours of sleep over two weeks was associated with a significant increase in the risk for new injuries, while getting more than seven hours was linked to a significant decrease in injury risk. Hitting this mark is difficult for many athletes with busy schedules, but practicing good sleep habits is a key to exercise performance that should not be overlooked.

In our next newsletter, we’ll look at the role of nutrition in post–workout recovery.