Best Drinks for Hydration

Keeping hydrated is important to maintain a healthy functioning body. This study examines different fluids to find the most effective hydrator.

Maughan 2016

Staying hydrated is important to us all. Following an intense workout or long run a high volume of water will have been lost through sweat. Keeping well hydrated has been shown in studies to help with brain function, recovering from injury, muscle growth, improving sleep and mental health.

What’s your go to drink to keep hydrated?

There was a study published in 2016 by Ron Maughan, investigated the beverage hydration index. Fluids that are consumed need to be retained. If you’re drinking a big glass of water but the peeing the same volume out, this is not effective hydration.

Maughan was looking at several different fluids, using water as the base to compare the other drinks from. Following the consumption of fluid, urine was measured over 2 hours and then compared with the volume consumed. There were some obvious results like coffee having a poor hydration index. Some surprising results with milk being one of the better fluids retained, results close to expensive electrolyte drinks. It is thought that the milk content slows down the absorption of water, which results in less fluid extracted by the kidneys.

Important to consider when trying to rehydrate. Other than just drinking water consider putting in some lemon or a small amount of sea salt (the potassium and sodium help slow down the water absorption). This was the first study of its kind. Hopefully there’ll be future studies about post exercise related hydration drinks.

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Original Abstract

BACKGROUND: The identification of beverages that promote longer-term fluid retention and maintenance of fluid balance is of real clinical and practical benefit in situations in which free access to fluids is limited or when frequent breaks for urination are not desirable. The postingestion diuretic response is likely to be influenced by several beverage characteristics, including the volume ingested, energy density, electrolyte content, and the presence of diuretic agents.

OBJECTIVE:This study investigated the effects of 13 different commonly consumed drinks on urine output and fluid balance when ingested in a euhydrated state, with a view to establishing a beverage hydration index (BHI), i.e., the volume of urine produced after drinking expressed relative to a standard treatment (still water) for each beverage.

DESIGN: Each subject (n = 72, euhydrated and fasted male subjects) ingested 1 L still water or 1 of 3 other commercially available beverages over a period of 30 min. Urine output was then collected for the subsequent 4 h. The BHI was corrected for the water content of drinks and was calculated as the amount of water retained at 2 h after ingestion relative to that observed after the ingestion of still water.

RESULTS: Total urine masses (mean ± SD) over 4 h were smaller than the still-water control (1337 ± 330 g) after an oral rehydration solution (ORS) (1038 ± 333 g, P < 0.001), full-fat milk (1052 ± 267 g, P < 0.001), and skimmed milk (1049 ± 334 g, P < 0.001). Cumulative urine output at 4 h after ingestion of cola, diet cola, hot tea, iced tea, coffee, lager, orange juice, sparkling water, and a sports drink were not different from the response to water ingestion. The mean BHI at 2 h was 1.54 ± 0.74 for the ORS, 1.50 ± 0.58 for full-fat milk, and 1.58 ± 0.60 for skimmed milk.

CONCLUSIONS: BHI may be a useful measure to identify the short-term hydration potential of different beverages when ingested in a euhydrated state.

Maughan et al, (2016) A randomized trial to assess the potential of different beverages to
affect hydration status: development of a beverage hydration index. Am J Clin Nutr

Recovering from DOMS

Delayed muscle soreness after intense exercise is expected. There are proven ways of reducing these pains quickly to get back into your normal level of training

Your future is created by what you do today, not tomorrow

So we’ve discussed the specific differences of muscle soreness after a workout and soreness from an injury. When you get Delayed Onset Muscle Soreness (DOMS) it is quite annoying trying to continue with training. Knowing that with DOMS we get the following problems.

  • Strength can be reduced by up to 50%
  • Range of movement will be limited
  • Pain will last between 48-72 hours

Understanding these limitations, its important to scale the weight, the depths and distances to accommodate for these temporary draw backs. But there are ways of accelerating the recovery or at least making it more tolerable.

Protein BCAA glutamine1Proteins 

Amino acids are the building blocks of proteins. As muscle damage is the precursor to DOMS, supplying it with a good source of Amino acids has been show to assist in recovery. While having a well balanced diet, additional supplements of glutamine and BCAA’s can reduce the inevitable weakness post workout. It may even help with soreness. (1,2,3,4)

Vitamin D

vitamin-d-en-fb.jpgGetting a little bit of sunshine might not be enough. The latest NZ Ministry of Health stats showed 32% of the population had lower than normal Vit-D levels. There is a link between people low in vitamin D and increased pain sensitivities (5). Taking supplements of Vitamin D3 may help additional soreness.

1023029.jpgHeat

Jumping in the spa pool or a using the hot water bottle. Heat is always soothing but it has longer lasting benefits to use heat with DOMS for the overall recovery (6,7).

Tart Cherry Juice

Tart cherry Juice muscle.jpgThis one is an unusual remedy but the benefits have been shown in this study (8). Following Exercise there was a 22% less weakness from the cherry drinking group, but no effect on pain. There are many natural anti inflammatory agents in cherries that is thought to help.

CoffeeCoffee Muscle soreness

I for one am pleased this is on the list, it gives me more reason to drink it! Studies have shown that caffeine helps lower pain levels and improve weakness during DOMS (9,10). Also helping increase number of reps compared to control groups.

Compression sleeveCompression Garments

Not necessarily for training, but post workout studies show that wearing compression tights or tops can reduce weakness and pain levels (11,12).

backsquat technqueTraining with DOMS

Even following the above strategies you will still have soreness and weakness. Consider this when training. You want to ensure your training for quality not quantity. Studies show training with soreness is acceptable and will temporarily reduce pain levels (13,14).

Myofascial Rolling (Foam Roller/Lacrosse ball)

Using foam rollers and lacrosse balls into tight tissues is a good way of preparing tissue for working through full ranges of movement. Through changes to mechanorecptors and nociceptors. There are studies showing benefit post workout and regular intervals during 48-72hours of DOMS (15,16).

References

  1. Song-Gyu, (2013), Combined effect of branched-chain amino acids and taurine supplementation on delayed onset muscle soreness and muscle damage in high-intensity eccentric exercise. J Int Soc Sports Nutri
  2. Volek et al, (2013), BCAAs reduce muscle soreness (DOMS) J Int Soc Sports Nutr.
  3. Tajari et al, (2010), Assessment of the effect of L-glutamine supplementation on DOMS Brit J Sports Med
  4. Glyn et al, (2012), Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study. J Int Soc of Sports Nutri
  5. Plotnikoff et al, (2003), Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc
  6. Mayer et al. (2006), Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehab
  7. Petrofsky et al, (2017), The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness. Cl J of Sport Med
  8. Connolly et al, (2006), Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damageBr J Sports Med.
  9. Maridakis et al, (2007), Caffeine attenuates delayed-onset muscle pain and force loss following eccentric exercise. J Pain
  10. Hurley et al, (2013),  The Effect of Caffeine Ingestion on Delayed Onset Muscle Soreness. J Strength Cond Res
  11. Hill et al, (2014), Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Brit J of Sports Med
  12. Armstrong et al (2015), Compression socks and functional recovery following marathon running: a randomized controlled trial. J Strength and Con Res
  13. Zainuddin et al, (2006), Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Appl Physiol Nutr Metab
  14. Trevor et al, (2008), Effects of a 30-min running performed daily after downhill running on recovery of muscle function and running economy. J Sci and Med Sport,
  15. Pearcey et al, (2015), Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Ath Training
  16. MacDonald et al, (2014). Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports & Exs

Sleep Deprivation and Exercise

Trying to balance a busy life, the easiest thing to neglect can be sleep. Trying to exercise in this state can produce poor results.

Souiss 2013 & Rae 2017

How many of us burn the candle at both ends? Balancing a busy workload, maintaining a healthy and social lifestyle. What often leads to sleep deprivation.

These two studies demonstrate the impact of sleep deprivation on performance.

Souiss tested his judo athletes with a number of measures including grip strength, anaerobic capacity and isometric test of elbow flexion. Tests were performed at 9am and 4pm after a judo match. There were 3 scenarios, full sleep (7.5hrs), partial sleep early (10pm-2am) and late (3am-6am).

The results showed with a full sleep performance was better in the afternoon. But with both groups with only partial sleep performance dropped in both the morning and afternoon. The partial sleep group woken early performed worse later in the afternoon.

Rae’s study of cyclists, measuring their strength the day after high intensity interval training, one group with full sleep (7.5hrs) and partial sleep (4hrs). They tested 24 hours later, testing peak power output and surveying fatigue and motivation.

These results showed that with sleep deprivation peak performance output reduced compared with normal sleep. Also sleep deprived felt more tired and less motivated to train. This is just from one night of disrupted sleep.

Sitting back and thinking about the relationship of sleep and performance these results seem pretty obvious. Giving your self normal levels of sleep can improve performance and brain function. Try and make sleep more of a priority in the life balance. The choices we make, dictate the lives we live.

 

Souissi et al, (2013) Effects of time-of-day and partial sleep deprivation on short-term maximal performances of judo competitors. J Strength Cond Res.

Rae et al, (2017), One night of partial sleep deprivation impairs recovery from a single exercise training session. Eur J Appl Physiol.

Continue reading “Sleep Deprivation and Exercise”

Understanding shin splints

There is no satisfaction without a struggle first

Those that have experienced shin splints know how frustrating it can be to train. Whether it’s running, skipping or box jumping. Pain can be so intense that we stop doing these movements for a short period or permanently out of fear. With shin pain, there are many different factors that cause it. This is why having it assessed and treated appropriately can help you ease back into these activities with more control over symptoms.

  • Shin splints is a vague term used to describe overuse or repetitive strain of structures in the lower leg.
  • In athletics and military, “shin splints” can affect up to 35% and is more prominent with females. (1)

Take a look at the several muscles in the shaft of the lower leg, and the layers we have in our bone.

It’s very easy to label the condition as “shin splints”. But looking at the different structures involved with shin pain a more accurate diagnosis would help direct treatment and management of the problem. Shin pain can also be produced by other conditions.  Another reason to get assessed.

Shin splints (other conditions)

Bony shin splints

The outer layer of bone called the periosteum has a great blood and nerve supply. This makes it a common area for feeling shin pain. When training under normal stresses with adequate rest the density of bone increases which allows us to tolerate running for longer. If stress forces increase with little rest time in between, inflammation and pain develops. Pain ignored for long enough could result in a stress fracture.

Rest period of stress fracture: Depending on the severity and nature of the fracture it may take 4-12 weeks. Having it assessed and possibly X-rayed will help guide the timeframe.

Rest period for inflammation of the bone: This requires a shorter rest time but should be closely monitored to ensure we identify the cause of extra stress to the bone. Usual rest periods will be 4-6 weeks.

Muscular shin splints

Compartments of lower leg.gif

Muscles of the lower leg are held within compartments wrapped up by fascia. During running for example these compartments build up in pressure. As the pressure rises, oxygen levels lower, toxicity builds and then results in pain. A condition known as Exertional Compartment Syndrome (ECS). If ignored this could lead to chronic exertional compartment syndrome which often requires surgery . 

Rest period for ECS: Similar to the inflammation of bone, it may require between 2-6 weeks of rest. In this time, it is about identifying the issues causing the problem and building up a tolerance to the activity.

Tendon shin splints

Tendons are the pulleys of muscles, they connect to specific bony points to cause a movement. Inflammation of the tendon can be cause by excessively loading the tendon . Three tendons that lead to shin related pain are the Achilles, tibialis posterior and the peronei. Most common being tibialis posterior.

Shin splints tendinopathy

The Tibialis posterior muscle supports the arch and if it fails can result in many changes to the foot and ankle. Catching this fault early will allow you to correct the problem easier.

Rest period for a tendinopathy: This really depends on the length of time you’ve suffered, the severity and foot mechanics. Recovery time can take up to 12 weeks. Giving time to offload the tendon and building up stress’ again.

Managing shin splints

As mentioned above, it’s important to make a clear diagnosis to provide adequate rest and adjust back into your activity. Along with normal hands-on therapy and exercise prescription, physio can help shin pain specifically through adjustments made to the following:

  • Training error – over training, excessive distances, change in running surface.
  • Poor foot mechanics – A foot with a high arch or that rolls in poses a higher risk for stress fractures and tendon pathologies when running.
  • Footwear – Shoes lacking adequate arch support for an unstable foot causes muscles/tendons to work harder.
  • Running form – Analysing running form will help identify weak structures and correct poor patterns.
  • Movement and balance control – Good balance at the ankle, knee, hip and a strong “core” of your trunk muscles play vital roles in evenly distributing the force.
  • Muscle flexibility – Tightness of muscles can put excessive load on the tibia while running.
  • Ankle mobility – Increased ankle range of movement with joint mobilisations and stretches can reduce stresses on the lower leg.
  • Muscle strength and endurance – The strength of a muscle helps maintain a good position while running or jumping. But it also requires stamina to repeatedly hold position.

Returning to running

Returning to normal running with shin splints is always an uphill battle and is never a smooth transition. It’s a learning experience, understanding what your body can withstand and tailoring your rehab appropriately. It can be frustrating, but having patience with the process will get you back into your activity.

Improving press position

The final part to the 4 shoulder positions that give us stability. The press position is used in so many ways, failing to find a good press shape can produce poor results and pose a risk to injury.

This is the final part of the 4 shoulder shapes we should all be able to achieve. Creating these shapes provides more efficient transitions when under load, making it easier and posing less risk to the shoulder.

So we’ve opened up the over head, front rack and hang shape. The last position is a press. Think of so many positions, bench press, rowing, burpee, chest to bar pull up, muscle up, ring dip….. If we create a poor, unstable position from this point it will make the movement much more difficult.

With the press we need to achieve full shoulder extension without the elbows flaring. Rarely do we get full extension in the shoulder. Even when sat at a desk typing were put in a perfect opportunity to hold the press position, but we get too flexed through the spine and the keyboard is placed to far away.

The other movement is internal rotation, which was part of our hang position. Good internal rotation at the shoulder will stop the elbows from flaring.

The last part being the lack of mobility of our lower cervical and upper thoracic spine. Which when stiff takes us into a rounded shoulder position. Trying to mobilise this area will help improve shoulder and head position.

Below are a series of mobility exercises to help with these directions.


Barbell hold – With the bar racked up to shoulder level and secure in the rack. Reach back with both hands, hold onto the bar and gentle lean forwards till you feel a stretch in the front of the chest and shoulders. Hold for 2 minutes. Gradually work your hands closer together.

Peanut lower cervical – This one you’ll have to get hold of a peanut (two lacrosse balls stuck together). Place the peanut at the base of the neck. Lift the hips to the ceiling. Some gentle rocking or arm movements through flexion or behind the back will help mobilise this point. 2 minutes

Lats smash with LaX ball – Take the ball under the arm pit into the meaty portion at the back, which is your lats. Roll into the lats with the arm in over head position lying on your side. 2 minutes.

Band hold – The other alternative to the bar hold is a band hold. Same position but hold the band behind you. Hold the stretch for 2 minutes.

CrossFit – How can Physio help?

CrossFit has its share of injuries like any sport. An experienced physio with knowledge of the training can get an athlete functioning pain free quickly and performing back to their best.

To perform at your best you need a strong mindset, great coaching staff that are strict with your technique and an experienced physio to prevent aches and pains

Most Kiwi’s are pretty tough, with a ‘she’ll be right” mentality when it comes to injury. You’d think that would be a perfect combination with the image CrossFit portrays. But when you’ve been carrying that niggle for so long and it starts getting worse, it could shut you down completely from training.

Physio and CrossFit work well together

Physio’s are specialists in movement analysis and CrossFit itself is a training regime that goes through gross fundamental movement patterns. So putting yourself through these movements and identifying your weakness’ gives me a lot more insight into where your problem could be coming from.

What are the common complaints?

There have been interesting studies done over the last few years into injuries within CrossFit. Interestingly the studies correlated similar with the same common areas being involved:

  • Shoulder
  • Lower back
  • Knee

Some injuries being severe enough to stop some from working, training and competing. These are the most common areas of injury I see come into the clinic from CrossFit, but I also see others suffering from:

  • Neck and thoracic strains
  • Ankle sprains and hypomobility
  • Hip impingement
  • Patella dysfunction from quad heavy squats
  • Wrist strains

How can Physiotherapy help?

As a physio it’s my job to get you functioning pain free as quickly as possible. Being a Crossfitter myself, who performs daily and understands the training styles, philosophy and terminology I can relate to the frustrations that you may face with limitations in training. Also working on site I can take you into the gym, look at techniques of different movements and provide you with additional drills to perform before your WOD.

What do I offer a CrossFit athlete?

  • An assessment of your movement patterns looking for weakness, asymmetry and any underlying mobility issues.
  • Hands on therapy for immediate pain relief, this may involve soft tissue massage, joint mobilisations and dry needling.
  • Localised taping of problem areas to assist you during your next training session
  • Diagnosis and ongoing management for acute or severe injuries, including referrals for further tests such as x-rays/ultrasounds, scans or to a specialist.
  • Educating you on what caused your injury or pain and steps to prevent further problems.
  • A personalised rehabilitation program – listing corrective, strengthening and stretching exercises to assist your recovery.
  • Liaising with and providing regular updates of your progress directly to your coach or trainer to ensure you get a coordinated approach to your rehabilitation. This also ensures that you are scaling or modifying WOD’s as required.

For an appointment, call on 095290990 

Montalvo et al (2017) Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit. Journal of Sports Science and Medicine

Keogh et al (2016) The Epidemiology of Injuries Across the Weight-Training Sports. Sports Medicine

Weisenthal et al (2014) Injury rate and patterns among CrossFit athletes. Journal of Orthopaedic Sports Medicine, Arthroscopy, and Knee Athroplasty

Improving front rack position

Improving the front rack position can help us in so many movements. This page shows a number of stretches that will improve shoulder mobility. and help prevent injury.

This is the second part of the shoulder, expanding on a previous post about 4 important shoulder positions that we should all be aiming to achieve. It’s quite important that you can find these positions comfortably, especially under load, as it will help to limit the risk of injury but also make it easier for you to transition out of it.

So, we’re all now great with our over head position. Can you now transition back down to a front rack? à la thrusters, hand stand push ups or catching the wall ball into the squat. Front rack is the most complexed out of the 4 positions as there are so many structures feeding into that position.

With Front rack most of us struggle with finding that shoulder external rotation to get the hands outside of the shoulders while keeping the elbows high. This helps line the hands into a stable platform for the bar.

The forearms are often tight making it hard for the wrists to fully extend. How many of us get achy wrists after front squats? Create that stable platform with good wrist extension.

Our triceps can also restrict the elbow from going into full flexion. And finally good Thoracic mobility as mentioned in the over head position. It will impact achieving extension and getting the maximum lift through the elbows.

Below are a series of mobility exercises to improve that Front Rack position.


Stick external rotation stretch – Grab a stick, hold it outside the arm. Lift your elbow and pull the stick from underneath your arm, across the body. This will pull your hand out further and you will feel the shoulder wind up. Hold for 1 minute. To take this further by repeating a hold-relax method, pulling the stick inwards for 5 seconds then relaxing further into external rotation .

Banded External rotation – Put the elbow into the band, take the hand on the inside of the band and hold on. Keep the elbow close to your head and drive the arm pit forwards. Hold the stretch for 2 minutes.

Wrist Flexor stretch – Kneeling on the floor, with palms facing away, put your hands down on the floor and take the wrists into extension, moving your body backwards. Hold for 2 minutes. Next get the band and place the hand in the same position. Have the band pull away while doing small oscillating wrist extensions into the stretch. Repeat for 1-2 minutes.

Triceps smash – Excuse the facial expressions in this video, I don’t always look that way! Resting the tricep on the bar while flexing and extending the elbow. Start at the triceps tendon (above the elbow) repeat 10-12 reps then move higher up the muscle. To increase the pain….I mean load, use the band to get fascia tacked down to the bar.

Thoracic Mobility as mentioned above it’s important to extend at the Thoracic below are two basics.

Myofascial Release

Myofascia interweaves through our muscles and takes up to 80% of muscle mass. Consider this when you’re doing your stretching and but not getting the results you wanted, it’s possibly due to fascial restrictions.

What is Myofascia?

Fascia is the largest system in the body with the appearance of spider’s web. Fascia is very densely woven from the top of the head to our toes, covering and interpenetrating every muscle, bone, nerve, artery and vein, all our internal organs including the heart, lungs, brain and spinal cord. In this way, you can begin to see that each part of the body is connected to every other part by the fascia, like a fitted suit.

How would it affect me?

Myofascia interweaves through our muscles and takes up to 80% of muscle mass. Consider this when you’re doing your stretching and but not getting the results you wanted, it’s possibly due to fascial restrictions.

I’d like you to try something. Reach behind your back with your right hand, grab a handful of the shirt/top in the middle of your back. Now try and lift your left hand above your head, it will likely be restricted and wind up in certain areas. Think about the tightness and restriction you might feel doing an overhead lift or in the back when squatting, it could be the fascia pulling on these areas.

One study has shown that tightness in the posterior neck muscles can cause a significant decrease in hamstring length and strength. (1)

What causes it to get tight?

Postural adaptations, trauma, inflammatory responses, and surgical procedures create myofascial restrictions that can produce tensile pressures of approximately 2,000 pounds per square inch on pain sensitive structures that do not show up in many of the standard tests (x-rays, MRI scans, etc.)

What does Myofascial release involve?

The MFR technique appears quite light as it puts a slow sustained shearing force on the superficial layer of fascia that lies beneath the skin. The superficial layer taps into other deeper structures within muscle and other systems of the body. There is no oil used as it allows for more feedback detecting for fascial restrictions into the therapist’s hands. There is extensive evidence that shows myofascial release is an effective tool in improving flexibility and reducing pain (2,3,4,5)

How does it differ from a deep tissue massage?

With DTM this is more directed to muscle tissue that has adhesions or is tightened and needs deep pressure to bring back some length and lower its tone. Although the deep pressure can be painful depending on how sensitive the tissue is and pain tolerances of the individual.

 

  1. McPartland et al (1996) Rectus capitis posterior minor: a small but important suboccipital muscle, Journal of Bodywork and Movement Therapies
  2. Hsieh et al,  (2002) Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Spine.
  3. Wong, K.-K. et al, (2016) Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men – a study of dynamic ultrasound. Physiotherapy
  4. LeBauer et al, (2008) The effect of myofascial release (MFR) on an adult with idiopathic scoliosis. J Bodyw Mov Ther.
  5. Ajimsha et al (2012) Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Arch. Phys. Med. Rehabi.
  6. Ajimsha, M.S. et al, (2014) Effectiveness of Myofascial release in the management of chronic low back pain in nursing professionals Journal of Bodywork and Movement Therapies