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Pediatric Sports Medicine: Essentials for Office Evaluation
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Thanks to CHOC Children's Hospital for filming my January, 2016 Grand Rounds presentation on Top Sports Nutritional Topics in Adolescent Athletes.
Topics include:
When making sports nutrition recommendations, I tend to favor the collateral benefits, lower costs, and the "knowing what you are getting", of whole food sources rather than individual vitamin or nutrient preparations.
I was energized to share the podium at the 2015 CHOC Children's RD's in Practice: Pediatric Sports Nutrition Conference with some truly amazing colleagues, and in reviewing their handouts, I found some new whole food thoughts that I felt needed to be shared.
I want to give full credit to both Shondra and Jessica Brown of CHOC Children's Sports Nutrition Program for organizing the conference, and to Becci Twombley, RD, CSSD who presented on the following important food sources for young athletes:
In appreciation of CHOC Children's Hospital inviting me to speak on Top Sports Nutrition Concerns Seen in Adolescent Sports Medicine first at their RDs in Practice – Pediatric Sports Nutrition conference and following up with a Pediatric Grand Rounds on the same subject, figured I would compile a list of past blog posts that will form the backbone of those presentations.
Dealing with double-day practice sessions, multi-event competitions over a weekend, or a quick turn-around from an evening event to the next morning practice?
What are some sensible tips for young athletes to replenish energy, reduce post-exercise soreness, and be best prepared for that next practice or game?
1) Get that post work-out protein
Protein is the building block of muscle tissue, and the first 30 minutes after exercise is an ideal time for protein intake to allow muscle repair and growth. A good rough suggestion is 30 grams of protein mixed in with some carbohydrate to increase the protein absorption. Good tasting, easily accessible and rather inexpensive suggestions include a glass of chocolate milk, a container of Greek yogurt, or a large serving of peanut butter.
Click here for more info on the virtues of chocolate milk
2) Don't miss out on necessary fluids
Being under-hydrated after exercise can be a major set-up for poor performance in the next workout or game. Ideally, any fluid losses from exercise should be fully replaced, and one easy way to monitor is to do pre and post-exercise weights. Young athletes should return to their pre-practice weight before the next exercise session.
For suggestions on fluid choice (water vs. sports drinks), click here.
3) Berries and Cherries can attack muscle soreness
Either immediate or delayed post-exercise soreness can put a damper on future sport activity. Good studies have shown that berries, cherries and even tart cherry juice have natural anti-inflammatory properties that can reduce muscle soreness with far fewer potential side-effects than both over-the-counter and prescription anti-inflammatory medications. Not only do those fruits taste much better than medications, they also provide important fluid and salt sources.
For more on tart cherry juice, click here
4) Best time to stretch is after activity
Many of us adult-types were taught that stretching before exercise was best. That though is definitely old-school and been replaced with recommendations for after exercise, when the muscles are warmed up and more able to benefit from stretching. Now, probably the last thing anyone wants to do after a hard game or practice is to take the time to stretch, but those valuable efforts that take only a few minutes can prepare muscles to better handle upcoming demands.
5) Ice Bath Challenge?
Many athletes seek out a cold water tub for their lower legs or even their entire body (below the head) to reduce soreness and help foster elimination of muscle waste products after exercise. The evidence in support of ice baths is mixed- so probably a situation where some athletes will find benefit, while others will not.
Do you have any other recommendations for assisting in post-workout recovery to better prepare for the next practice or game?
Looking for an inexpensive post-exercise or post-game snack that aids in muscle recovery, delivers several key nutritional components, tastes pretty good, and will make both young athletes and their parents happy with your choice?
Look no further than chocolate milk.
Now, some might say that I have an inherent bias towards chocolate milk due to my medical school and residency years in the dairy state of Wisconsin followed by work in California (another prime milk producing region).
However, when one looks at the science, chocolate milk carries a fair amount of support.
What's even more exciting is that not only does one get the benefits of post-exercise carbohydrate (this is one form of carbohydrate intake that can be endorsed even by a low carb diet advocate such as me) and protein, but let's not fail to mention other essential nutrients found in chocolate milk:
So when it comes time for your post-game snack duty, or if looking for a favorable post-exercise recovery beverage, again, look no further than chocolate milk and don't forget to take in a few final key thoughts:
There is no magic age at which a child can begin weight training. Readiness for weight training depends on the willingness of the child to lift weights, follow directions, and maintain the program for several months to see results. Remember, this is for the child, not for an adult or coach.
Weight training should supplement regular sport activity. It is not acceptable to have weight training injuries keep an athlete away from his/her sport. I recommend qualified supervision by a performance or physical trainer who routinely works with children and adolescents. The focus should be on appropriate-sized equipment, meticulous weight lifting technique, starting with low weights/high repetitions, and working multiple body parts. In appropriate program, a child will often lift weights 2 or 3 days a week with at least 48 hours of rest between sessions.
The physical results, such as muscle enlargement and weight gain, depend on the gender and developmental stage of the child. Routine weight training can make a child somewhat stronger by increasing nerve and muscle communication. However, if the child is looking for larger and more bulked muscles, then they must wait until after their growth spurt. Androgens are a particular hormone, produced more in boys than girls, which produce muscle and strength gains. Since androgens increase late in puberty right after the growth spurt (age 11-12 in girls, age 13-14 in boys) lifting before this time will not result in massive muscle bulking or extreme strength gains.
Does this mean one should not lift before the growth spurt? No, but just place the emphasis on good technique and reduce the expectations for big-time muscle gain. Remember, due to lower androgen production than boys, girls will have less increase in muscle mass.
Is weight training safe for children?
Studies have shown that a properly designed and supervised resistance training program can be safe for children and young adults. Contrary to popular belief, weight training at a young age does not stunt growth as long as proper techniques are utilized. There are reports of overuse injuries with back strains the most common but at no greater frequency than what is seen on the athletic field. Again, placing the emphasis on a properly designed and supervised resistance training program will help reduce injuries and maximize enjoyment.
Click here to learn about:Proper post-lifting recovery, focusing on nutrition and sleep, can greatly enhance the results and safety of a weight training program.
Does weight training work?
Both published studies and personal experience have shown impressive strength, speed, and endurance gains with an appropriate weight training program. There is no good scientific data to show that this directly translates to better on-field performance, but it does contribute to overall athletic ability. The athlete needs to be aware that he/she must stay with the program or risk losing the gains.
To produce optimal results, recommend starting a program during break periods between sport seasons and not initially scheduling weight training sessions on same days as practices or games. Once the athlete is more comfortable with the demands of weight training, can incorporate lifting sessions with regular training and competition activities.
Can weight training reduce injuries?
High school-based studies indicate a resistance training program could decrease the number and severity of injuries, and also reduce the rehabilitation time once an injury has occurred. These benefits may be due to stronger supporting joint structures, muscle absorbing more energy before tiring out, and greater muscle balance around a specific joint.
Can weight training help with weight loss or weight control in children?
Weight training programs that feature higher repetitions, lower weights and limited rest between sets have been shown to contribute to both weight loss and weight control in children. Appropriate professional supervision in designing such a program can be of significant help.
For centuries, athletes have searched for any substance or technique that could enhance exercise and allow for more effective weight gain/loss or increases in strength and endurance. Many available performance enhancing products may report claims of potential amazing efficacy but use of them can be clouded by concerns over true scientific support, side effects, and financial cost.
Here are 5 sensible tips to guide you on nutrition and recovery with your exercise program:
1. The Importance of Sleep
Can’t begin to tell you how sleep deprivation can derail even the best constructed exercise program, as skeletal muscle needs adequate recovery time to rebuild damaged fibers and to increase the working capabilities of contractile units. Multiple studies support the efficacy of a minimum of 8-9 hours of sleep a day to foster such recovery. Insufficient sleep can also reduce mental alertness on the job or at school and has also been associated with statistically higher risk of illness or injury. Establish a regular bedtime and not allow deviation of more than ½ hour and also encourage daytime naps of under one hour per day which have been shown to be restorative, add to the cumulative daily sleep amount, and not adversely affect nighttime sleep patterns.
· TIP TO ASSIST WITH SLEEP: Stop any type of screen device use no later than one hour before bedtime, and do not have screen devices in the sleep area, as use right before bedtime or alerts/temptation to check during sleep have been associated with reduced amount and quality of sleep.
2. The Timing and Amount of Protein
Protein is the building block of skeletal muscle and is needed to assist in that reparative and rebuilding process after exercise. Good data suggests that the best time for workout-related protein intake is within 30 minutes after completing exercise. A post workout protein amount of 25-30 grams along with a total daily intake of 0.5-0.7 mg protein/pound of body weight are both solid recommendations. I have always favored dairy or meat/bean/egg sources of protein as readily available products that confer well-absorbed collateral benefits of calcium, Vitamin D, and iron. Amino Acids are the building blocks of proteins, and intake of specific individual amino acids has been touted for both weight loss and strength building. However, there is a lack of rigorous support for high amounts of individual amino acids, so stick with whole food protein sources.
· TIP TO ASSIST WITH PROTEIN INTAKE: 8-12 ounces of chocolate milk within 30 minutes of exercise is a sensible recovery drink that has a ratio of carbohydrate to protein that allows enhanced transport of protein to recovering muscles. Other good post workout food-based protein sources include Greek yogurt and peanut butter.
3. What About Creatine?
Creatine is a natural substance that assists with regeneration of short-acting energy sources that fuel contraction in working skeletal muscle. Increased amounts of creatine in working muscles can potentially contribute to more intense workouts and also assist in muscle recovery after workouts. Powdered and liquid creatine supplement products have been studied, with trials that include higher loading doses for the first few days, followed by lower daily maintenance doses and other regimens that include medium daily doses without any higher loading amount. Positive results have included increased speed and ability to complete multiple short-burst activities such as 80-100 yard sprints. Possible side-effects include water retention, bloating, muscle cramping, and potential kidney injury (currently only reported with individuals that had pre-existing kidney concerns). Anecdotally, many athletes using creatine have reported enhanced recovery with increased ability to work harder in subsequent workouts, and documented strength increases support increased muscle size not being simply due to water retention, but to increased contractile abilities. Take note that many United States-based sports medicine advisory organizations do not endorse creatine supplementation in children under 18 years of age.
· TIPS ON CREATINE USE: Creatine monohydrate in either liquid or powder format has been the best studied form of creatine. If using any supplement, ensure that you are getting exactly what is on the container and not any additional substances (see below). Reductions in creatine dose have been shown to assist with bloating, cramping or extreme water retention. Good food sources of creatine include wild game meats or wild-caught fish which also have those collateral benefits of protein, calcium and iron. Domestic meats and fish (especially free-range meats) still have reasonable amounts of creatine.
4. Are Pre-Workout Supplements Safe and Efficacious?
Advertised preworkout supplements or “energy drinks” report to enhance athletic performance and routinely contain multiple components such as caffeine and taurine. While a few small studies support the performance enhancement of stand-alone agents, published data on combination products is scant, inconclusive, or confusing. Safety concerns exist with use of products that have cross reactivity of multiple agents or larger than studied amounts of a certain product.
· TIPS ON PREWORKOUT SUPPLEMENTS: Read labels! If using any preworkout supplement in addition to usual daily caffeinated beverage of choice, you might be getting an enormous caffeine load with possible dangers that outweigh possible benefits to your workout.
5. What’s the Lowdown on other Supplements?
Use of a vast array of pre and post-workout supplement products has been touted to enhance athletic performance and exercise capabilities. Many of these products will work- no doubt about it, - however the gross majority of products do not have any rigorous practical scientific result to support clams and there is a tangible risk of adverse consequences from both known and potentially unreported elements in supplement products. What is on the label of many products is not the same as what is in the actual container. Personal experience along with results found by national sport organizations have found a significant number of supplements that have additional, unreported elements that are potentially dangerous and might be banned for sporting competition. While most of you are not subject to drug testing for performance-enhancing agents, suffering real and possibly long-term health consequences is not worth the short-term gains in strength and endurance.
