Performance Nutrition

Proper nutrition is a huge part of good health and most of what I know about nutrition is based on an overwhelming desire to stay healthy  And lest I seem self-righteous about my personal pursuit of good health, let me state for the record that it goes back to when I was 5 years old and my father had his first heart attack.

Back then, there wasn't a lot you could do if you had a heart attack.  He was told to sit mostly, and to participate only in sedentary activities.   He never saw me play high school football--the doctors were afraid he would get too excited.

They even told him he shouldn't hold his arms over his head.   We dried clothes on a clothesline and he couldn't even hang wet clothes on the line.  Hobbies were paint-by-number painting and making fishing lures.  We had honeybees and he would watch from a lawn chair while I did the work.

He started taking anti-coagulant medicine, which he took for the rest of his life. Fried food was forever banned from our table.  Instead, it was skim milk, corn oil margarine that we had to drive to Knoxville to find, lots of fruits and vegetables, and nary an egg to be found.

That's how I grew up and it stuck with me.  So all my dedication to good health and healthy eating is merely paranoia--I didn't want to end up like my dad, quite handicapped in what he could do.

So I've made a point to eat smart ever since.  Oh, I backslide from time to time but 95% of my diet has been healthy.

Nutrition is a big part of sports performance as well.  The old saying is "garbage in, garbage out."  You need good fuel in your engine to perform well.

Nutrition science seems to change all the time (although I'm still waiting for someone to declare the bacon is good for you), but the basics stay the same:  Limit fried foods, eat lots of fruits and vegetables, more fish and chicken. 

I'm also convinced that  we should eat more fresh food, prepared simply... that we should rely on what I call "real" food.   Food with a short shelf life and an even shorter ingredient list.  Food that hasn't been processed, canned, or frozen.

Do you know everything that is on the label found on your food?  Too often, you find additives, preservatives, and a whole lot of things that you need a chemistry degree to understand.  If it goes in your mouth, know what is in it. 

Have you looked at the ingredients in margarine?  It's about a molecule away from being plastic.  I prefer butter.  Pure. Simple.  Food.

What is the only thing to fail pretty much every test ever invented for determining if something was bad for us and yet got government approval?  Artificial sweetener.  So what do we use if we're trying to lose weight?  Yep--artificial sweetener.  Just doesn't seem prudent.

Carbohydrates are still the cornerstone for athletic performance.  There just isn't a better way to provide our body with the fuel it needs to perform.  But genetically engineered grains that have dramatically increased the gluten content have created a huge problem for a lot of folks.  Gluten-intolerance is a serious medical problem.  

I see more people growing their own food and our own Farmer's Market is clear evidence that people are looking for fresh food.  At my house, we're spending more time on our garden.  Tomatoes, peppers, cucumbers, squash.  We also grow blueberries, blackberries, cherries, apples, and pears. 

It takes more effort and it costs more in the short run but I'm convinced that in the long run, you'll save money  by being healthier throughout your lifetime.  

Specialization and Professionalism in Youth Sports

About a month ago, I had the good fortune to visit the Birmingham office of world-renowned orthopedic surgeon Jim Andrews.  You may have heard of him.  He's operated on a lot of professional athletes.

He's the one that reconstructed the knee of Robert Griffin III, better known as RG3.  He rebuilt the destroyed shoulder of Drew Brees.  Most said that Brees would never play again.

Tiger Woods.  Michael Jordan.  Trent Richardson.  Adrian Peterson, Tom Brady, Albert Pujols, Jack Nicklaus, Brett Favre, Bo Jackson, Reggie Bush, Hope Solo, and the list goes on and on.

So you get the idea that maybe Dr. Andrews is a big deal and you're right.  And since all these athletes whose careers depend on his work seek him out, you might assume that he's good.  You'd be right there too.

Although he does more surgery on average Joe's than all the pro's, I wasn't there seeking his professional services.  And I can claim only a minor acquaintance with the good doctor.  I was there visiting with my friend Kevin Wilk, Dr. Andrews' right-hand-man who runs the physical therapy clinic downstairs.  

Currently, Dr. Andrews is on a crusade to reduce sports injuries in young folks.  Dr. Andrews says "I started seeing a sharp increase in youth sports injuries, particularly baseball, starting around 2000."

We've seen the same thing around here and a group of our athletic trainers was talking about that topic just the other day.   We all agreed that we had never seen as many ACL injuries on pre-high school age kids. 

The same is true for Ulnar Collateral Ligament (UCL) injuries.  That's the elbow ligament that leads to the "Tommy John Surgery."  We're seeing more of those injuries at all levels.  At last count, 17 Major League Baseball players had serious UCL injuries since spring training this year.

According to Dr. Andrews, the two main reasons for the sharp increase in youth sports injuries are specialization and professionalism.

Specialization means playing the same sport year-round.  At some point, everybody is going to focus on one sport.  I would suggest that point should not arrive until sometime after high school graduation.

Playing the same sport year round is just too much, especially for children and adolescents.  Playing the same sport leads quickly to overuse and overuse is the main ingredient to many injuries, most certainly for the UCL injuries that we're seeing.

Young athletes need diversity to properly develop the all-important athleticism.  They need core strength and balanced musculature.  They need time off from sport.  Diversity, stability, and proper rest will cause in a big drop in these injuries.  

Professionalism is training young kids the same way professional athletes train.  Think about it--some of these kids are going through the same kind of workouts that a professional athlete would do.  Parents are hiring personal trainers with the hope/promise that a college scholarship and professional career are going to be the result.

They are most often wrong.  Less than 1% of high school athletes make it to college athletics.  Less than that are on any kind of scholarship.  And about .6% of college athletes on full scholarship make it to the pro's.  

You're better off hiring an English coach, a science coach, and a math coach.  There are a lot more academic scholarships than athletic scholarships.

There are exceptions.   Good personal trainers can motivate a youngster that may not be prone to exercise regularly.  Just like good teachers everywhere, they can teach the right way to do things.

Throwing a curveball is a very complex endeavor.  Good mechanics are essential and are best taught by a professional instructor.

Dr. Andrews says that "my rule of thumb is, don't throw the curveball until you can shave, until your bone structure has matured...."  Other Andrews Rules:  Avoid the radar gun and be careful with showcases.  He calls them "show-off" cases and injuries are rampant in those.

I would add that kids should play everything they have time for, avoid those activities that cost thousands of dollars per year, and make sure it's always fun.

When it stops being fun, go do something else. 

The Early Bird Gets The Worm

I get up early. I don't want to say how early but very early. If I told you, you'd think I'm crazy, lying, or bragging (or all three). 

I enjoy sleep but there's just so much that I want to get done.  I've cut my work day back already.  I only work half a day now.  12 hours a day is enough for anybody.

Until last Sunday, we had this crazy robin that banged on our window at 6:30 every morning.  I am not around to hear it very often but I was this past weekend and if it weren't against Tennessee state law, that might have been one dead robin.

This bird would bang into our bedroom window, fly back to the railing a few feet away, then do it again.   For probably 30 minutes.   Every day.  We assumed that it saw its reflection in the window and thought it was another bird in its territory.

Talk about a headache!   I finally put some netting up across the window and it seems to have stopped the head banging.

You might ask,  what's a reasonable sane man of your age doing getting up at an obscene hour?   There are really two reasons.

One of my favorite parts of the work day is getting to the clinic before everyone else.   I have my breakfast.  I fix a cup of coffee.  I look at the patient schedule for the day.   If time permits, I work on paperwork, the bane of the existence of health care folks everywhere.

The other reason is to exercise. Let me go on the record as stating that early mornings are the absolute best time for getting in your exercise.

Yes, it works for me and it's not like I don't like to sleep in.  I can sleep till 7 AM on a weekend with the best of them.   My biologic clock never lets me go later than that though.

But exercising at the first part of your day takes away many of the excuses that crop up during the course of the day.   Work out at lunch time?  Maybe you don't get enough time and then there's the whole thing about going back to work still sweating.

After work?  Life too often gets in the way.   The kids have an event and need to get there or the yard needs mowing or something.   Just too many excuses. 

In the evening?   It might work for some but not many.  My son-in-law will often take off on his bike after the kids are bathed in bed, sometimes hitting the road at 9 PM or so.   Don't worry--he's lit up like a Christmas tree out there.   But I don't think he does it out of preference.  I think it's just that it's about the only time he has time to get his exercise in.

For most people, there are just too many family responsibilities to head to the gym in the evening.  And that often means it just doesn't get done.

My bike rides are almost always in the morning too.   If your summer exercise is outdoors, then the temperatures are much better in the morning.

It wasn't too long ago that I said here that the best exercise for you is the one that you will do...the one that you will stick with.   There is also considerable evidence that exercising at the first part of your day kicks your metabolism up for most of the day, burning more calories not just when you're exercising but for a good part of the day.

In other words, if weight loss is one of the reasons you exercise, mornings are probably your best time.

So set your clock early and let your day start with your daily exercise.  You don't need some crazy robin to get you out of bed. 

Can't Never Did Do Nothing

My dad was not an educated man.  He quit school after the 6th grade to go to work to support his family.  He never quit until his heart wouldn't let him anymore.

When he joined the Navy and headed off to war in 1942, he was the old man on the boat at 29.  His lack of formal education certainly didn't get in the way in the south Pacific.

He always worked hard.  He asked for the nastiest, most dangerous job available at the factory where he spent most of his adult life because it paid more.

My dad was a smart man.  Oh, his handwriting revealed some problems with the written word but make no mistake about it--he was smart.  I often wonder what he could have done with the opportunities that education gives us.  A laywer?  A doctor?  Who knows.

My dad left a legacy of hard work and integrity.  If he said he would do something, he did it.

I was asked recently what I thought my "legacy" would be when I'm gone.  Not that I plan on going anywhere for a long time but it is an intriguing game.

I concluded that there is nothing we can do to determine our legacy for our legacy is really who we are, not what we have done.   A legacy is more than memories and lessons. 

My dad certainly left me great memories.  Camping on Tellico River.  Road trips in the family car before there were interstates.  Gardening.  Beekeeping.  Fishing.

And lessons.   He taught me to always do things the right way.  At 10, building a treehouse in my backyard with him sitting at the base of the tree in a lawn chair, telling me how to do it right because his diseased heart wouldn't allow him to show me. 

But the thing that he used to say that taught me the most, has helped me most profoundly, and rings as loudly today as it did then was this:  "Can't never did do nothing."

That may be his ultimate legacy to me.  Terrible grammar for certain yet he really was a well spoken man.  I think I inherited my dislike of all double negatives from him. 

Can't never did do nothing.  To understand it, you must break it down.  Read it like this-"can't" never did do nothing.  In other words, saying that you can't do something doesn't accomplish anything.  Maybe that's better grammar but the message isn't as good.

Can't never did do nothing.  The message is clear.  Don't quit.  Don't give up.  Don't tell me that you can't do something.  Find a way.  Figure it out.  

Can't never did do nothing.  A quote made for the sports pages.  I think it might be the best message that we can ever give to young athletes.

At my last birthday, my daughter gave me a card that had this:  

    I said, "I can't."  You said, "try again."

    I said "it's too hard."  You said, "don't give up."

    I said "what if I fall."  You said, "I'll be there to catch you."

Don't tell me can't.

Eatin' Possum

I read a piece in the newspaper a couple of weeks ago about Possums.  You could tell that the author wasn't  from around here because he kept referring to them as O-Possums.   I haven't heard them called that since...well, never.

But here's the part that blew my mind.  The article said that Possums are eaten commonly in the South.  Are you kidding me?!?   We don't eat possum. 

Now I must admit that I did taste Possum once.  The dad of my good friend Killdee Johnson cooked one up one time just to show us boys what it was like.

So, you ask, what was it like?  Awful.  Greasy.  Really beyond awful.

I grew up eating wild game.  Rabbit shot by my dad was a staple at our table.  Crappie.  The occasional squirrel.  We even made rabbit burgers.  I have friends that love deer meat.

Us boys were always out hunting or fishing something.  Killdee's dad would cook whatever we brought in.  Carp?  Yep.  Nasty.  Tasted like bad mud.  Barbecued groundhog hams weren't too bad.  Wouldn't touch the crow he cooked one time.  I think it was part of a joke.

But there has never been a time when Possum was on the table.  Not at my house or any house I have ever known then or since.

So let's just throw out all the rest of those Southern stereotypes. 

Like that we talk funny. 

I'll admit that growing up, one of the things that bothered me was when somebody would say "you-uns."  It embarrassed me for a family member to use that term.  If you're from around here, you know what I'm saying.  If not, ask somebody.

Then I found out that this really has its origins in Scotland and that since much of this area was settled by the Scottish, it was actually true to our heritage to say "you-uns."

Or that we're kinda, you know, slow.  That one may have come from the way many of us are slow to respond, deliberate in our answers.  I don't know about you, but many of the mistakes in my life have happened when I didn't slow down to think things through.

Spouting out the first thing that comes into your brain just isn't wise.  I've got a buddy from well north of the Mason-Dixon line that just spouts out whatever he's thinking.  His mouth keeps him in trouble and makes him few friends.

If slow means dumb, well I think we've pretty much answered that one.  Some of the world's greatest artists, writers, scientists, doctors, architects, you name it, have come from the South.   

That we're all "backwoods hicks."  Or "country bumpkins." Call us what you want to, nobody (and I do mean nobody) retires and moves north.    We already had that part figured out.

Dealing With Shin Splints

With the track season being in full swing and with better weather pushing people outside to run and hike, I'm seeing a lot more problem with Shin Splints.  Shin Splints are best described as aching pain on the front part of the lower leg.

Shin Splints are a very complex problem, influenced by a number of things, but at the core of most cases are impact forces.   What are impact forces?  Basically, it is pounding on the legs from walking, jumping, or running. 

There is a lot of speculation and no small amount of research that has looked at exactly what a Shin Splint might be.  Many studies have offered that it is an injury at the point where the tendons that attach to the front of the shin.

Others have indicated that it is an injury to the bone (tibia) itself.  I would suggest that it is likely both. 

In my experience, the consistent common denominator are impact forces on the lower leg.   So let's look at those.    

Most of the people that get Shin Splints are runners.  If you think about it, the running gait is really just a series of hops from one leg to the other.  If one is running a marathon, that's about 33,000 hops.  

Hikers get Shin Splints too and a big factor there is descending, when you are really sort of falling forward and catching yourself with your leading leg.  A load (backpack) on your back just makes it worse.

In both of those, you are really pounding on your feet, ankles, and lower legs.   But lots of people run lots of miles and there are hikers all over these hills every single day and none of them are any worse for the wear.

I would suggest that there are two problems that can lead to the development of Shin Splints.  The first of these are the "too's."   Too many miles.  Too many hills.  Too fast.

Big changes in your running program are almost always a mistake.  Any good coach will tell you to increase your mileage gradually.  You don't run 2 miles at a time, several days a week and then suddenly double your mileage.  The extra impact forces can lead to problems...like Shin Splints.

The other big factor is the way the foot hits the ground.

I'm not a big fan of running barefoot or with the thin foot covering popular today.  I'm not much of a fan of the "minimalist" running shoes either.  I do know that a lot of people do well with these things but most people need the support that good running shoes give them.

And more people than you could possibly imagine have mechanical issues at their feet that increase those same impact forces.  Flat footed people, for sure.  Just listen to them run.  Slap, slap, slap--the sound is revealing.

A lot of runners and hikers are also "pronators," which can best be explained as an inturning of the middle of your foot during the middle of the stance phase of gait. 

One of the things that I do in my clinic is to do a video analysis of the running gait, video-taping a runner while they run barefoot on a treadmill.  Often, it is only in stop action that you can see how much pronation you get in a foot that appears to have a really great arch.  I've been surprised more than once.

The solution then comes from more support to the arch of the foot.   The first choice is the "over-the-counter" arch support.  I recommend them almost every single day.  Look for one that isn't really spongy.  It really should have some firmness to it.

If the OTC arch supports don't work or if the problem is too complex, it may take custom orthotics to fix the problem.  With custom orthotics, a mold is taken of the foot and an orthotic is made from that mold that only fits that person. 

With good orthotics, those insufficiencies in the way the foot hits the ground can be corrected and those darn impact forces can be minimized. 

Please Let Me Introduce Myself...

In case we haven't been formally introduced, let me introduce myself.  My name is Joe Black but it is usually spoken as though it were only one word, as in JoeBlack.   Growing up, I never got to be called "Joe."  It was always my full name.  Such is the life of someone that goes by a single syllable first and last name.

I am a physical therapist and an athletic trainer.  Among that bucket load of acronyms after my name is "SCS," which stands for Sports Clinical Specialist, something that physical therapists can get after working in a sports setting for several years and passing a day-long exam (I took it 30 years ago and don't really want to take it again).

Also in that list is "DPT," which stands for Doctor of Physical Therapy.   Until 2003, most physical therapy degrees were Masters degrees.  In 2003, those changed to the Doctoral level program.  At 52, I entered the University of Tennessee-Chattanooga's Doctoral program, graduating in 2008. 

So yes, it is now Dr. Black but about the only time I invoke that one is when a patient is being particularly difficult. 

Throughout my career, sports have been the primary focus of my practice.  I've worked with the Maryville College athletic department since 1982 and with Maryville High School since 1984.  My sub-specialty has been extremity orthopedics.  For most of the last 20 years, most of what I have seen has been  knees, shoulders, and feet and ankles.

Oh, in sports, you have to treat everything so I've seen my share of concussions, hip problems, and yes, back and neck problems.  And that's where I'm going with today's column.

I have been taking care of Blount County folks since 1977 (with a 2 year gap to go to West Virginia) and have appeared in this spot for 29 years.  I've spoken to dozens of civic groups and have been a part of athletic health care for many, many years but there are still a lot of folks that simply don't know what I do.

Just last week, I got stopped in a restaurant (I'm always getting stopped in restaurants) and asked a question about a young athlete.  This parent told me that the young man, a football player, was having back problems and wanted to know where he should take him.

This fellow is a local physician but didn't seem to know that back care is a big part of what physical therapists do.  In fact, the #1 problem seen by physical therapists is back pain.

This may seem like a self-serving piece but  I would like to suggest that it is simply educational.  There are just too many gaps in what people know about physical therapy.  And the bottom line is that physical therapists are highly trained in the care and treatment of those with back and neck problems.

Although some might like to reduce us to the modalities that we sometimes use, my profession is SO much more.  We use a wide variety of techniques, all based on evidence--evidence that proves that physical therapy is an effective approach to treating back and neck problems.

Exercise is a huge part of what we do but manual therapy techniques, biomechanics, and education are all important parts as well.  Our goal is to get you better and then to give you the tools to stay better. 

I work for Blount Memorial and manage our Total Rehabilitation outpatient clinics. At each of our clinics, we have one person that is designated as a "spinal care specialist" but in reality, the basic training for all physical therapists covers care of the spine.

 I also don't mind telling you that there are now several other physical therapy clinics around here that do good work.  And the #1 diagnosis that we all see is back pain.   I'd believe that it's because we get good results.  

So the next time that you are looking for a place to take care of your back or neck problem, let me respectfully suggest that you consider the physical therapist.