By Barry J. Henry, M.D.
Those involved in the education and coaching of youth in this nation are sure to realize that athletes have to possess a combination of these four positive attributes to be competitive: enthusiasm, speed, stamina and skill. What appears to be causing many of the injuries in our youth today involves lack of stamina.
The issue of cumulative fatigue and over-training or under-training results in fatigue. Once the muscular system is fatigued, it no longer allows protection to the hard tissues of the body such as the ACL (Anterior Cruciate Ligament), rotator cuff tendons, bone, cartilage and other ligaments and tendons of the body. Fatigue of the muscle tissues can be predicted and monitored with current affordable technologies when applied in the practice and competitive arenas at the elementary, secondary and collegiate levels.
Combining this understanding of muscle fatigue and nutritional needs gives the athlete and educational/coaching staff an advantage for injury prevention and performance enhancement. This is exactly why many professional sporting teams in human and equine sports worldwide have utilized this information to improve performance and lower injury rates for the past decade. Therefore, the goal of our sports medicine practice in the realm of prevention is two-fold:
- Provide evidence-based, medical advice and objective data to individuals who strive to become better athletes.
- Encourage athletes to continue leading a physically active lifestyle even after their peak athletic years through a better understanding of how their body performs in sports-related activities.
Current literature and clinical sports medicine practices reveal that patient athletes recovering from an injury suffer from de-conditioning of the injured extremity and their overall physical fitness condition due to lack of activity caused by the injury. Uninjured athletes also have repetitive minor injuries and overtraining issues that can lead to major setbacks in training and competition.
Traditional rehabilitation programs such as physical therapy are designed to improve the condition of the injured extremity in the short-term, and it is to regain motion and strength. While improving the condition of the injured extremity, the patient's overall fitness and conditioning may continue to deteriorate from the change in his or her activity level. The lack of activity reduces the patient's endurance, and the patient athlete often becomes easily fatigued when trying to work at the level performed prior to the injury.
For example, one practice has developed an innovative program through a board-certified specialist who deals with lab fitness analysis. This is a physician-guided program that takes into consideration all aspects of the patient's health and fitness level. It is designed to help patients who have suffered from an injury by increasing their strength and stamina and educating them about recovery and metabolism of the muscle and bony tissues that then enables athletes to enjoy a faster complete recovery.
The lab fitness analysis program includes V02 metabolic testing to measure the amount of oxygen the body uses during different levels of activity. The test is performed while the patient exercises on a treadmill or bike and breathes into a mask.
The program includes a series of scientific tests while taking into consideration the patient's personal medical history. The V02 metabolic test includes a graded exercise test that increases in difficulty as the test progresses – similar to a cardiac stress test.
During the test, the patient's heart rate and V02 and lactate measurements are monitored and recorded to determine his or her anabolic threshold. As opposed to looking for heart damage in a medically ill patient, the goal is to find that point where the uninjured or recovering athletes start to perform at an anaerobic level. Thus, it reflects that threshold heart rate where fatigue will become evident and re-injury could likely occur.
The recorded information is used by a medical physician and his or her staff to develop detailed individual exercise prescription and nutritional guidelines for the athlete. The athlete is advised on how to utilize a heart-rate monitor device to follow simple training tasks and simple routines to achieve his or her fitness goal without increasing the risk of injury.
The patient athlete or uninjured members of athletic teams are instructed on the proper use of the heart-rate monitor, which is to be used while exercising at home, in practice or at the gym. The monitor has the capacity to store exercise files that can be downloaded and reviewed to adjust the patient's individualized program and to ensure compliance by the athlete.
New technologies utilized by programs such as the Houston Rockets; the New York Jets; and Notre Dame's football, hockey and soccer teams – to name a few – allow training staff to monitor up to 20 athletes simultaneously during play from up to 150 yards away – all on one laptop on the sidelines.
This program collects data and allows real time adjustments to be made with athletes during practice to avoid overtraining and injury, thus, increasing the likelihood of performance improvement. Consequently, this technology and data can be utilized as a performance enhancement tool as well as a rehab and injury prevention program.
In the case of rehabilitation from an orthopedic or sports-related injury, the lab fitness analysis program provides the patient with a prescription of exercise and nutritional guidelines to get him or her back to pre-injury fitness condition. The program improves the patient's endurance to the level needed to work out at full capacity and reduces the risk of further injury due to fatigue upon re-entry to the sport. In addition, the lab fitness analysis includes the following:
- Initial V02 (Threshold and/or maximum oxygen uptake during exercise)
- Initial RMR (resting metabolic rate)
- Initial exercise prescription and counseling session with a medical professional
- Three monthly evaluations and counseling sessions with a medical professional
- Follow-up V02
- Follow-up RMR
- Updated written exercise prescription
Our experience in this new field of bio-monitoring sports medicine has led to an improved understanding by the athlete on what bodily and data cues to recognize during training and competition in order to avoid catastrophic or even minor injuries. This has led athletes in our program to enjoy prolonged athletic careers, to enjoy time in sports activities throughout their lifetime and to improve performance to their maximum gifted abilities with less risk.
Ultimately, the coaching staff, training staff and parental involvement will lead to a total reduction in sports-related injuries in future years as bio-monitoring during sports is more widely accepted as the standard, and it becomes not only affordable, but necessary, to decrease health-care costs to families of the athletes who are currently being injured at an unacceptable rate.
About the Author: Dr. Barry Henry is a board-certified sports medicine subspecialist and orthopedic surgeon in Lafayette, Louisiana. He earned his medical degree at LSU School of Medicine in New Orleans, and he is one of eight orthopedic surgeons in Louisiana to hold sports medicine certification.