Integrative Approaches to Performance Enhancement


Whether you’re a professional athlete or avid recreational sports enthusiast, preventing injuries and having that competitive edge are two things that athletes strive for.

Many of my patients want to know what they eat or do for performance enhancement.

There numerous training styles, formulas and nutritional supplements claiming to offer athletes the winning edge. Some work, while many do not.

This week’s blog outlines an evidence based performance enhancement and injury prevention approach used by the Phoenix Sun’s that has been proven to work.


Starting with an assessment is essential as it helps to identify postural distortion patterns (movement impairments) that affect the Kinetic Chain (Human Movement System).

An assessment helps to evaluate:

  1.  Length tension relationships in myofascial structures (i.e. the resting length of soft tissues for optimal force production)
  2. Joint function (i.e. optimal movement of joints, which can also affect muscle strength)
  3. Nervous system function (i.e. the proper timing and coordination of  movements around joints)

Optimum function of the of the neuro-musculo-skeletal system results in optimum neuromuscular efficiency– the ability of the Human Movement System to produce force concentrically, reduce force eccentrically and dynamically stabilize isometrically in all planes of motion.

Athletes who demonstrate optimum neuromuscular efficiency perform better and have fewer injuries.

The Overhead Squat Assessment is an evidenced based tool that can identify dysfunctional movement patterns:

The Overhead Squat:

Stand facing a full-length mirror with your feet shoulder-width apart and pointed straight ahead and your arms raised overhead. Squat three times. Hold the pose at the lowest point in your third squat and take note of your body position at the checkpoints. Perform the movement again and have someone watch from the side and behind.

Common movement distortions include:

1. Feet turn out or flatten

2. Heels rise

3. Knees moves in or out

4. Shoulders elevate and/or arms fall forward

5. Low back shifts to one side, arches, rounds or there is excessive forward lean of the torso

Because of the interrelationship of the Kinetic chain (Human Movement System), distorted movements at one anatomical area will affect the entire chain. For example, lack of mobility at the ankle joint will result in compensation at the knees. Because the knees require stability, this could result in knee pain and dysfunction. The knees will compensate to allow more movement e.g. turn in or out, placing abnormal tension on muscles that attach to the pelvis and lumbar spine. The lumbar spine will compensate by an increase in the lordotic curve, causing an anterior pelvic tilt. This results in tension on the latissimus dorsi muscle which connects the low back to the shoulder. A tight latissimus dorsi muscle will alter the alignment and motion in the shoulder, potentially leading to shoulder pain and forward head carriage. At the top end of the chain, forward head carriage can lead to neck pain, headaches and other chronic painful conditions in the upper extremities.

The Overhead Squat Assessment gives us clues as to where to look. This assessment should be followed up with:

  1. Range of motions testing
  2. Manual Muscles testing

Once overactive and underactive muscles as well as joint dysfunction are identified, then a specific corrective plan can be created for the athlete consisting of:

  1. Inhibiting tight muscles with manual therapies and self myofascial release
  2. Lengthening muscles with stretching
  3. Activating weak muscles with manual therapies and corrective exercises
  4. Integrating dynamic movement to reeducate efficient movements of the entire Kinetic Chain  with functional exercises
  5. Optimum Performance Training (OPT) consisting of 3 blocks:
    1. Stability
    2. Strength
    3. Power

Integrating: flexibility, core, balance, reactive training, speed, agility, quickness, resistance and cardiorespiratory exercises


*Performing Self-Myofascial Release with a Foam Roller is an extremely effective warm up tool prior to an event as well as recovery after an event to reduce post-exercise soreness.

What about eating for performance?

The Basics:

Carbohydrates, proteins and fats provide the energy necessary to maintain body functions at rest and during activity as well as provide energy for recovery and repair.

Carbohydrates primarily come from vegetables, fruits, legumes and grains. Carbohydrates can be classified according to how they affect one’s blood sugar. A high glycemic carbohydrate (e.g. refined cereal, Gatorade) will lead to a rapid increase in blood sugar whereas a low glycemic carbohydrate (e.g. nuts, legumes, sweet potatoes, oats) has more of a stabilizing effect on blood sugar. Carbohydrates are responsible for energy, fat metabolism and sparing muscle protein. The type of carbohydrates an athlete should consume depends on the energy requirement of the sport (i.e. aerobic or anaerobic).

Protein is found both in animals, grains and plants. Animal proteins are classified as being “complete” and as such are optimal in terms of repair and recovery. Protein functions as part of our immune system, hormones and fuel when muscle glycogen (carbohydrate) is depleted. Protein is especially important for repair as well as stabilizing blood sugar levels. It is not a preferred source of energy.

Fats or lipids, are found in both and animals and plants. They are classified according to their chemical make-up or degree of saturation. Fat is the most energy dense nutrient. It is an ideal fuel source for lower intensity or endurance activities. Other functions include: nerve transmission, vitamin transport and organ cushioning. Research shows that optimum health can be achieved by a diet higher in omega 3 fats e.g. cold water fish and monounsaturated fats such as olive oil. I recommend using extra virgin olive oil for salad dressing and low heat cooking and walnut, almond or coconut oil for moderate heat cooking. Avoiding Trans fats and partially hydrogenated oils is important for general health. In my observation, many popular snacks contain a combination of these bad fats, sugar and artificial ingredients, which are poor choices for recovery and repair and are major causes of obesity and other chronic health conditions.

In general, it is recommended that athletes consume approximately 55% carbohydrates, 30% fat and 15% protein of their total caloric intake (not including physique athletes, who require a different combination in order to achieve that defined look).

The healthy plate is a good guideline for major meals:


1.    Emphasize whole foods (preferably local, seasonal and if possible organic)

2.     Pre-exercise nutrition should be 4-6 hours before practice/game and should consist primarily of low glycemic sources. If a game is in the early morning, then dinner the prior night should meet these criteria. Pre-exercise nutrition is important for maximizing glycogen (carbohydrate) storage in muscle. An additional snack is recommended 30-60 minutes prior to the practice/game

3.     Moderate-high glycemic foods should be consumed every 20 minutes during exercise to reduce muscle protein breakdown.

4.     Moderate-high glycemic foods are also the foods of choice after exercise and should be consumed within 30 minutes after a practice/game in order to minimize muscle catabolism (breakdown) and maintain anabolic state. This helps to support recovery and immune function

5.     A post exercise meal 1-2 hours after practice/game should consist primarily of low glycemic sources

6.     Stay hydrated throughout the day and especially before/during/after games and practices. For activities under 90 minutes, water is the best choice. Vitamin drinks and other colorful concoctions are superfluous and in my opinion not healthy due to the artificial ingredients. Coconut water is a healthy option for electrolyte replacement and hydration

7.     Sleep 8-9 hours per night


Example of Pre-exercise meal:

*Dinner the night before- enriched Barilla pasta with turkey meat sauce a mixed salad. Oatmeal/Berry crisp for desert

*Breakfast that morning- Oatmeal with nuts, raisins, berries and cinnamon. Smoothie (Unsweetened Almond milk/whey protein-15g/1/2 banana/1 tbsp almond butter/1/2 cup berries)

Example of Pre-exercise snack:

*Nut butter and honey on multi-grain bread or sliced apple

*Smoothie (see above)

*Cheese and high fiber crackers

Example of what to eat during a practice/game:

*Blend 8 oz orange juice or dark apple juice with ½ banana 1 scoop whey protein and water (16 oz total). This should be consumed during breaks and at half time. This should not replace water

*Coconut water

Example of immediate post-exercise nutrition:

*Nut butter and honey or mozzarella cheese sandwich on high fiber bread e.g. Dave’s killer bread and a piece of fruit.

Example of post exercise meal:

*Brown rice, beans, chicken, guacamole and salsa

*Pasta with meat sauce and a salad

*Tuna or turkey sandwich with veggies and 1 fruit


The above recommendations do not take into consideration food sensitivities or intolerances that are unique to each athlete, nor are they recommended for physique oriented athletes who require a different percentage of carbohydrates, proteins and fats (see prior paleo post).


About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin