Integrative Sports Medicine
Integrative sports medicine is a holistic approach to preventing illness and injuries in athletes while optimizing their performance through nutrition, manual therapies and corrective exercise.
In general, athletes seek care for three reasons:
1. Managing acute and chronic injuries
2. Performance enhancement
3. Injury prevention
A holistic approach takes into consideration nutritional, structural and psychological factors.
Nutrition can be used to promote injury healing by reducing inflammation and providing the nutrients that are necessary for repair and optimum immune function. It can also be used for performance enhancement and injury prevention.
Those athletes who are adequately nourished will have optimum energy supply and will be less likely to fatigue during an event.
Fatigue is often a factor in the breakdown of an athlete’s form and technique, which could predispose them to an injury.
Nutrition for inflammation and immune function
Playing a sport or performing any kind of exercise can create inflammation as well as suppress the immune system.
It is common for athletes who train hard and are inadequately nourished to become susceptible to infections.
A well nourished athlete is one who consumes adequate amounts of the macronutrients (carbohydrates, proteins and fats), micronutrients (vitamins and minerals), phytonutrients (colorful fruits and vegetables) and is adequately hydrated (usually half their weight in ounces as a minimum).
Carbohydrate recommendations for athletes differ from the general public and can also vary based on the type of sport (i.e. aerobic vs anaerobic).
In general, I favor the majority of carbohydrates coming from low glycemic plant sources such as dark green leafy vegetables, sweet potatoes, apples, berries, pomegranates and other fruits and vegetables. Because of the energy demands of endurance events, I recommend cycling in quinoa, lentils and legumes for endurance athletes.
For athletes whose sport or training is greater than an hour, a higher glycemic source, such as an energy bar or PB & J sandwich, is often necessary to avoid fatigue and catabolism (muscle breakdown).
Carbohydrates are the main nutrients that supply energy. They are essential for performance and recovery.
Protein recommendations are poorly understood by most, given the amount of misinformation that is perpetuated by the media.
The minimum amount of protein for the general public is 0.8g/kg body weight. Depending on the type and intensity of activity, it would not be unreasonable for an athlete to consume 1 – 2 grams of protein per kg of body weight (1 kg = 2.2 lbs).
The type of protein is also important.
There are complete and incomplete forms of protein. Complete proteins, such as those coming from animals, contain all the essential amino acids (essential amino acids are the building blocks of proteins that need to be consumed from food because the body does not manufacture them).
I recommend eating a variety of wild seafood as well as locally sourced, pasture raised animals that consume a diet that is vegetable-based (rather than grain-based).
Incomplete proteins come from plant sources, many of which are higher in carbohydrates (e.g. legumes and grains, although soy and quinoa are two plant sources that have a complete protein profile). It is possible to make complete proteins by combining two compatible incomplete proteins (brown rice and beans, for example).
Protein is essential for cellular repair, immune function and muscle development/retention.
A protein supplement can be an effective way for an athlete to recover after training for an event.
I like grass-fed whey protein as part of a smoothie, as it contains the Branch Chain Amino Acids (Leucine, Isoleucine and Valine), which are essential for repair. However, if someone has a sensitivity to whey, other plant-based options exist, such as hemp, soy (which I don’t usually recommend), rice, pea and my latest favorite, pumpkin seed protein.
There are a number of different kinds of fats:
1. Saturated (e.g. animal products and coconut oil)
2. Monounsaturated (e.g. olive oil, avocados)
3. Polyunsaturated – e.g. Omega 6 (Sunflower, safflower, corn) and Omega 3 (flax, hemp, walnut, cold water fish)
4. Partially hydrogenated (e.g. margarine) – These have been proven to adversely affect health and should be eliminated
A balance of saturated, monounsaturated and polyunsaturated fats is the key to limiting and reducing inflammation.
A diet high in saturated and polyunsaturated (omega 6) favors inflammation and will adversely affect injury and repair and could predispose one to having an exaggerated inflammatory response to an injury.
The best way to get fats is through the diet. I recommend using olive oil for salads and low heat cooking and using coconut, avocado, walnut or almond oils that have been refined for medium to high heat cooking (check the label for temperature recommendations).
Eating raw nuts, avocados and cold water wild fish is also a good way to get healthy fats along with other nutrients.
Peanuts (not really nuts), are a good source of protein, but have a mixed inflammatory profile.
I generally reserve supplementing fat in the form of fish oil, MCT or other fat supplements for specific health conditions.
Micronutrients and phytonutrients come from whole foods. Eating a plant based diet with healthy fats and animal products as mentioned above supplies most of what we need.
I often recommend a multi-vitamin/mineral as well as a back-up. This ensures adequate intake of the antioxidants that are needed for repair.
I discourage using vitamin waters and juices for several reasons:
1. Negative effects on dental health
2. They often also have preservatives and artificial chemicals
3. Juices are mostly sugar
4. You get the extra electrolytes you need by drinking coconut water (not from concentrate)
What about supplements?
Here are few of my favorite:
1. Creatine Monohydrate- anaerobic performance, lean body mass
2. Whey protein- repair
3. Curcumin for inflammation- acute injury
4. Bromelain for inflammation- acute injury
5. Caffeine- performance enhancement
6. Glutamine- immune function
Yes, there are a number of other choices, but it comes down to how much you want to spend, the cost-benefit ratio and whether or not you should put the money towards better quality foods.
The hallmark of an injury or a muscle that is weak is suboptimal length. This can lead to joint dysfunction and compensatory movements.
The key (this is important) to correcting biomechanical dysfunction, treating injuries and enhancing performance is correctly assessing the entire body and then treating the primary and secondary issues.
I consistently see people who have seen a lot of great providers for numerous therapies (e.g. chiropractic, massage, acupuncture, PT, injections), but with temporary relief because the underlying cause has not been addressed.
There are a number of techniques that are effective to prevent injuries and enhance performance:
1. Soft tissue techniques – Dry needling and deep myofascial therapy
2. Joint techniques – Mobilization (chiropractic) and mobilization with movement (Mulligan technique)
3. Nervous system – Re-educate through corrective exercise
There has been a lot in the news lately about dry needling.
Depending on the state, naturopathic physicians, chiropractors, physical therapists and even medical doctors are learning and performing this technique.
Because it works fast, is easy to do and is a cost-effective modality.
Dry needling can reset a muscle that is overactive or underactive in a matter of seconds.
If the involved muscle is pulling on its anatomical attachments and causing a tendonitis, the pain and inflammation can quickly resolve.
If the involved muscle is limiting range of motion or is weak, then flexibility and strength can often instantly be restored.
How does this work?
The mechanical stimulation of the muscle produces a local twitch or rapid depolarization of muscle fibers. This results in a dramatic reduction of muscle activity, resulting in relaxation and decrease in pain and dysfunction.
The decrease in pain is related to the removal of muscular compression on joint, nerve and vascular tissue.
Dry needling also stimulates release of endogenous opioids, your body’s natural pain killers, and initiates a new healing process secondary to the stimulation of platelet derived growth factors.
In my opinion, dry needling should be considered as a mainstream, first line for acute and chronic injuries by athletes and coaches (please pass this on to the Seahawks, Huskies, Sounders and Storm 🙂
Soft tissue mobilization induces a local inflammatory response, which augments the production of fibroblasts. This, in turn, will promote the healing process.
Myofascial release is different than massage. It does not require any lubricant and often involves deep, but tolerable gliding pressure around the injured areas from various angles and in different positions.
There are many components to sports psychology. For the purpose of this blog, I will focus on the adverse effects of stress.
Stress activates the sympathetic aspect of the autonomic nervous system, which inhibits blood flow to muscles, nerves and connective tissue resulting in inflammation, pain, injury and a reduction in performance.
Athletes who are under stress, either self-inflicted, from a coach or from other factors, are encouraged to identify the trigger, journal and confront the stressor under safe circumstances.
There are a number of excellent counseling techniques, such as cognitive behavioral therapy, Thought Field Therapy and EMDR.
While conventional approaches can quickly cover up the pain, injuries often linger for weeks and in many cases heal incompletely, resulting in chronic issues.
Integrative approaches to sports injuries, injury prevention and performance enhancement are based on holistic nutritional recommendations and techniques that augment the body’s capacity to heal, can result in fewer injuries and allow a faster return to play.