Dr. Dimitri Thomas

School is back and that means it’s time for youth sports. It’s a time of year we sports doctors enjoy as it gives us the chance to help those patients we really enjoy helping – healthy athletes that just want to compete. Successful competition doesn’t just mean rigorous practices and training sessions; it also requires a great deal of preparation to help make safe competition more likely.

As someone that participated in high school and college level sports in Texas, I can tell you the heat and humidity in Eastern North Carolina is no joke. One of the most important aspects of healthy participation in sports is adequate hydration. This does not mean sodas; oftentimes, this will be detrimental to an athletes’ health and will actually DEHYDRATE them. Water is the main thing that should be ingested; sports drinks themselves are full of sugar and unnecessary. It is a highly unusual scenario in which an athlete exerts and sweats so much that their body chemistry is altered enough to the point of requiring electrolyte replenishment via a sports drink. Water is the key drink, and this should be done often. It is not a sign of toughness to restrict water intake, or a sign of weakness to need water. Water breaks should be taken often and frequently. Athletes should drink water whenever possible and not just when thirsty; sometimes, if one waits until they are very thirsty, they may have entered the initial stages of heat exhaustion which can lead to heat stroke. Players, and coaches especially, should not let it get to this stage. Avoidance of athletic activity outdoors at the hottest points of the day should avoided if possible.

Similarly, nutrition is extremely important. Meals should NOT be skipped. Athletes are burning calories and these must be appropriately replaced with a BALANCED diet. Empty calories such as sodas and candy are not adequate and not healthy; in fact they are detrimental to performance. Appropriate food intake needs to be constant, and not just on the day of competition or the day leading up to it. Everyday adequate nutrition needs to be achieved to keep the body in optimal operating condition. Fresh fruits and vegetables are vital, as well as enough healthy proteins especially when weight training is a significant part of the training regimen. Fish such as salmon are an extremely good source of protein and provide a high content of omega acids essential for brain health as well. Without adequate protein intake, muscle cannot be built or maintained. Without enough calories, energy levels cannot be maintained.

Cramps are related to nutrition. When I was at Missouri taking part in the care of an SEC football team, the training staff always used to say cramps are a product of poor preparation and are the only injury that is totally preventable. They did not feel too sorry for those athletes that cramped although they obviously would tend to them with the utmost care. Before every football game, the training staff to include the doctors would drink a shot of pickle juice prior to running on the field to the sidelines as an acknowledgment of the need for proper hydration and electrolyte balance. An appropriate diet, when eaten consistently, combined with adequate hydration, should provide the correct electrolyte balance to prevent cramps. Once cramps are present gentle and gradual stretching of the affected muscles should take place. Additionally, electrolyte supplementation is then needed. Sports drinks can be useful in this situation. Other options include pickle juice and even packets of mustard and ketchup. However, the goal should be PREVENTION of cramps.

Another way to prevent injuries is with appropriate warming up. Muscles need time to stretch and elongate before engaging in explosive activities; this is known as introducing “creep” into the muscles and tendons. Weight training should be built up to; if one has not trained regularly with weights or has taken some time off from weight training, it needs to be gradually introduced (or reintroduced). Form should always be emphasized overweight; ego lifting will only lead to injuries. When doing activities such as heavy squats or leg presses, knee wraps can be very helpful for reducing discomfort and protecting the joint. If wraps are used, I recommend the direction of the wrap to move the kneecap to the center of the body; that is, the wrap should come from behind the knee, around the side, and taking the kneecap medially. This helps ensure appropriate tracking of the kneecap as the tendency is for the kneecap to want to slide to the outside, especially in those individuals without adequate quadricep mass. With weight training, adequate protein intake should be a priority otherwise muscle gains will not occur.

One specific injury that should be discussed is the torn ACL (anterior cruciate ligament). Most athletes have heard of this. It is not an uncommon occurrence in young athletes for myriad reasons, but especially in young females. Younger athletes do not always have the same level of muscle and body control that older athletes do; this can leave them susceptible to injury. Pre-practice and pre-game warm up routines dedicated to appropriate landing and body biomechanics have shown great success at reducing ACL injuries. However, upon cessation of these quick pre-activity exercises, the injury rate returns to baseline. Female athletes, especially in sports such as volleyball, basketball, and soccer, should have these exercises incorporated into their routines before every game and practice session. Prevention is always the best course of action.

Despite the best preparation, injuries can and will happen. In this case, trained medical help should be sought. Sports are an excellent way to have fun and stay healthy by staying fit. Hopefully, the things mentioned above can help guide people towards strategies for staying healthy and safe while enjoying these activities. Before engaging in any diet or specific training plan, make sure you consult with your own trained medical provider so that you can make sure each plan is tailored to your specific needs.

About Dr. Dimitri Thomas: Dr. Thomas is an Orthopedic Surgeon specializing in Sports Medicine at UNC Orthopedics and Sports Medicine at Lenoir in Kinston. He completed medical school at University of Texas Southwestern, residency at William Beaumont Army Medical Center and sports medicine fellowship at University of Missouri. Dr. Thomas is a former U.S. Army Major and served for 13 years.