INJURIES & NUTRITION

See also WarmupsConditioning.doc.

Table of Contents

INJURIES..............................................................................................................2Treatment of Injuries..........................................................................................2Ice or Heat?.......................................................................................................4Heat Exhaustion / Heat Stroke...........................................................................5Foot Blisters.......................................................................................................7Returning to Play from a Leg or Foot Injury.......................................................9Sore Heels – Sever’s Syndrome......................................................................10Heel Pains........................................................................................................11Sore Ankles......................................................................................................12Taping Ankles..................................................................................................15Injury Prevention: The Ankle in Soccer............................................................16Exercises to Prevent Ankle Sprains.................................................................17Calf Tightness..................................................................................................17Sore Knees......................................................................................................22Osgood-Schlatters...........................................................................................23Muscle Pull and Appropriate Stretch................................................................27Cramps and Stiches.........................................................................................29Pains in the Side (Side Stitches)......................................................................32Side Stitch........................................................................................................34Swallowing Air?................................................................................................35Checking for Concussions...............................................................................36References on Concussions............................................................................37Heading Injuries...............................................................................................38Heading Injuries...............................................................................................43Purposeful Heading Not Injurious....................................................................46

DIET AND NUTRITION.......................................................................................48Diet...................................................................................................................48Nutrition - a Basic Handout..............................................................................53Nutrition for Sport.............................................................................................54Eating Before Competing.................................................................................55Eating for Peak Performance...........................................................................58Power Foods for the Busy Athlete....................................................................60Nutrition for Soccer Players.............................................................................61Fast Food’s Best Bets......................................................................................63Carbohydrates for the Traveling Athlete..........................................................65

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Nutrition and Soccer Games, Tournaments and Practices..............................69Tournament Nutrition.......................................................................................71Nutrition – Multiple Games with Minimal Rest and Recovery...........................72Helping Athletes Survive Two-A-Day Practices...............................................76Hydration..........................................................................................................77Overhydration..................................................................................................79Exercise and Heat............................................................................................81

INJURIES

Treatment of Injuries-----Original Message-----From: Martin A. CluderayIs there a site anywhere which gives clear, straightforward info on the treatment of injuries which might typically occur in a game or training session? E.g. distinguishing between injuries that can be treated on the pitch, and ones that require the player to come off / whether to apply a hot spray or a cold one / treatment of injuries between games

Date: Sun, 6 Sep 1998From: David GrahamThe LOTG web site has a guide to common injuries which can be downloaded athttp://www.ucs.mun.ca/~dgraham/lotg/dl/injury.rtf

Date: Sun, 6 Sep 1998From: Bryan L. Pinn"Complete Guide to Sports Injuries", H. Winter Griffith, MD., 1986, published by The Body Press, Division of HPBooks Inc., PO Box 5367, Tucson, Arizona 85703. Ref. # ISBN 0-89586-379-0.This 530-page super paperback is the best I've seen. It's ALWAYS in my bag.

Date: Mon, 7 Sep 1998From: Gary RueI wholeheartedly recommend the taking of a first aid course if at all possible. If you can find a "qualified" parent on your team, ask them to assist you when you have an injury.

Even if you think you know what the injury is and how to "fix" it, you could be opening yourself up for trouble. You do NOT want to offer any medical advice or seem too knowledgeable in this area when dealing with injuries. You should always recommend the player seek professional medical help when in doubt.

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Here is site I have come across that seem to have good information on injuries.http://www.ccsd.k12.wy.us/CCHS_web/sptmed/fstaider.htm

In general, here are some general guidelines when dealing with an injured player that is in pain, but conscious:

* WALK to the player; most players need a short time period to get over the initial shock of the injury; a coach that shows TOO much concern may cause the player to think something is REALLY wrong

* ask him what happened, and where his problem is (pain, dizziness, etc.); don't touch the player until you have collected your facts

* check out all areas to make sure the player does not have other injuries; for instance, he may have hit his head hard enough not to notice his sprained ankle

* if the player can walk off, let him do so, else give him assistance; don't carry a player off, unless the injury is obviously debilitating

* do not move a player until you feel the player can move, regardless of what the referee says; if you have any doubt, get professional help immediately and remain with the player until help arrives

* if the player suffered a head injury that causes any dizziness, blurred vision and especially unconsciousness, get the player to a medical facility as soon as possible and have the player obtain written permission from a medical professional before returning to play

* once a player has made it to the sideline, then reassess the situation; if the player can move without pain, then he should be able to go back in

* normally, if the player suffered a contusion (blow to the body), apply ice for 20 minutes

* if the player suffered a strain or sprain, apply compression (e.g., ace bandage) and ice, elevating the area above the heart; note, don't remove the shoe if the shoe help to keep the area from swelling until other compression is applied; professional assistance should be sought to ensure nothing is broken

* if the player appears to have a broken bone, he should not be moved until help arrives

* if a player is bleeding, stop the bleeding immediately via compression to the area and get professional assistance as soon as possible

Always err to the side of safety when dealing with an injured player.

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Date: Mon, 7 Sep 1998From: Bryan L. PinnGary's common-sense "rules" should be a hand-out to every coach! I would add two further points.

* Insist that other players stay well back from the injured player. You don't need a gathering of "vultures" as you care for the player, and I've had a youngster stepped on when a shoving match developed after the original foul that broke his leg.

* If you suspect a serious neck/back injury, immobilize the head IMMEDIATELY, call for an ambulance and refuse to move the player (no matter what the ref says) until qualified people arrive. As the instructor in a recent course stated, moving a neck-injured player improperly can turn a paraplegic into a quadraplegic. Horrible image, but it CAN happen.

Every team should have someone present who can deal competently with scrapes, cuts, bruises, sprains, insect bites/stings, sunburn, heat exhaustion, nosebleed, and on-site first-aid for fractures. But Gary's point on medical knowledge is absolutely key. "A little knowledge can be a very dangerous thing." Err on the side of caution!

Ice or Heat?> After an initial muscle injury is treated with ice on/off for the first> 24 hours, should heat be applied next (if muscle is still sore)? Or> will it make it worse? I thought ice is always best, and don't remember> if/when heat should be applied.

Date: Tue, 15 Sep 1998From: John PeacheyThe Acronym is RICE: Rest Ice Compression Elevation. Use RICE until bleeding stops.Bleeding = swelling. Heat increases bleeding. So no heat on sprains or strains for IMO 3 days. At initial injury it's a good idea to apply ice with an ace bandage or cling wrap around the ice. Follow with ice 20 - 30 mins every four hours. Wear an ace bandage between ice treatments. This helps minimize that initial rush of bleeding/swelling which is what you want : it reduces returntime.

An excellent method to help return to activity is contrast baths. Prepare one bucket 1/2 ice & 1/2 water. Another bucket as warm as you can stand. Have massage ice ready (best way to do this is to freeze water in a disposable cup -

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then tear the cup off the ice). Alternate affected area between baths to expand/reduce coagulated internal blood mass.

Alternate 30 secs each bath several times. Massage internal mass in a circular motion occassionally moving towards body (as opposed to down leg for instance). This may be painful. This process works very well but is not to be done until injury stops actively bleeding/swelling. Takes 2 or 3 treatments.Removing the internal mass of blood reduces pain, increases range of motion.

Date: Wed, 16 Sep 1998From: Dirk GaddTreating muscle injuries is a tricky process at the best of times. The "general rule of thumb' is to apply ice for the first 24 - 48 hrs. and should be repeated AT LEAST hourly for 15 mins.

The most important point to remember: NEVER USE MASSAGE OIL, HEAT, SPA BATHS OR ENTHUSIASTIC STRETCHING in the early stages of injury, (i.e. 48 hrs) as this promotes blood flow, which can prolong the recovery period. If the injury does not progress over a 48 hr period the athlete should be referred to a sports doctor or physiotherapist.

The (general) immediate injury management process should be :R - Rest - immediatelyI - Ice - as soon as possible C - Compression - not too tight - helps minimize bleeding, provides supportE - Elevation - helps drain fluid away from the injury - restricts blood flowR - referral - qualified personnel always know best

Heat Exhaustion / Heat StrokeHeat exhaustion is generally caused by loss of body fluids and important salts. Symptoms include: Headache, nausea, fatigue, dizziness, actively sweating, cool skin, pale. The person suffering from heat exhaustion may faint. Typical recommended treatment is: get in cool place, increase fluids, cool by placing cold wet towels on victim or by fanning the victim. Get the temperature down. If heat exhaustion is untreated it can lead to heat stroke.

Heat stroke is a failure of the body's heat controlling mechanism. This is an immediate medical emergency so call 911. Symptoms include: headache, flushed skin (contrast with heat exhaustion where skin is pale), dry skin (contrast with heat exhaustion where the skin is wet), warm skin, and rapid, bounding pulse. The victim is likely to be incoherent, disoriented, confused, and may be unconscious. Core temperature is over 105. Treatment is required immediately:

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Get victim into a cool place, remove most of clothes, apply cool wet towels, fan to increase air flow, and get to medical attention.

The general guidelines are in most first aid books. However, I suggest that everyone of us should check with medical authorities to see what the most recent recommended first aid is. Check to find the recommended method for getting the core temperature down as rapidly as possible.

The best way to deal with heat problems is to avoid them. Make sure that your players take in lots of fluid. When possible, keep them in the shade when they're not playing. Try to keep them as cool as possible. Those spray bottles with battery operated fans are a lot more effective than I ever thought.

I've posted some information on this on my web site: http://www.ntrnet.net/~less/u18You can also find information at: http://www.umr.edu/~umrshs/selfcare/heat.html

Two items in the news point to the urgency for dealing with this topic. First, here in NC last week a young HS football player, practicing when the temperatures were in the 70's and the humidity was high, suffered from heat exhaustion and later died. Second, the number of people who are treated in ER's for heat exhaustion or heat stroke who later die is fairly high. So it's really important to prevent these problems and to rapidly and properly treat them if they do happen. The usual disclaimer. I'm not an MD and this information is offered for your education. Seek medical advise for the proper treatment.

Date: Sat, 5 Jun 1999From: Les SparksYou need to be prepared to deal with hot weather to assure the safety of your players (heat can kill) and to allow them to play their best. The team should provide things that allow the players to stay as cool as possible and lots of fluid. I know many teams and coaches feel that these are the responsibility of the players, but if you want to get the best out of the team, the team needs to take responsibility.

Useful things for keeping the players cool:Shade (not always possible and in many places impossible)An ice chest full of wash cloths or small towels immersed in ice water. These can be applied on the back of the neck, over the head, or anywhere else.Water that the players can pour over their heads. Great way to cool off.The spray bottles that have built in fans are pretty effective way to coolof.

If any of your players show signs of heat related problem, get them out of the game at once--even if you have to play short handed. Evaluate the player to

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determine if the problem is heat exhaustion or heat stroke. Heat exhaustion: wet skin, heat stroke (usually) dry skin.

Heat stroke is a medical emergency and is life threatening. Call for medical attention at once. Get the player into the shade and start cooling measures.Symptoms: high body temperature, hot dry skin, weakness and rapid pulse and breathing. Sometimes unconsciousness or convulsions. I've read recent literature showing that even if good medical care, permanent health damage or death can occur due to heat stroke. Don't take a chance.

Have high powered sun screen for your players. Make them use it.

For fluids to drink. You need to provide each player with her/his own personal bottle, paper cup, or whatever. I know of several teams where sickness was passed from one player to the another from drinking out of common squirt bottles.You need to make sure that all your players are fully hydrated before the game. If you're at a tournament, you can make them drink a bottle of sports drink (or water) before leaving for the field.Have the drink more before the game starts. If you send in a substitute, have her/him drink something before entering the game. Just sitting in the hot sun can dehydrate a player.At half time drink some more.At the end of the game drink more and keep drinking until the next game of the day.Players will drink more if the drinks are cool or cold and taste good.

Poor performance in the second game of the day is often due to dehydration and not lack of fitness.

As an aside, you may want to suggest that the parents and other fans that go with you take care to ensure that they (the parents) don't suffer from the heat.

Sports drink or water is something you'll need to decide for yourself. I am reviewing much of the current literature on the subject and will post it on my site in the next few days.http://www.ntrnet.net/~less/u18

Foot BlistersDate: Thu, 30 Jul 1998From: Chris Mohr The imminent start of fall practices in many areas, after a summer layoff, means: a) a lot of players are buying new soccer cleats; b) and practicing in hot, steamy weather; c) and developing bad BLISTERS on their feet.

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My younger daughter is at soccer camp at N.C. State University this week, wearing her nice new soccer cleats. When she took them off at the end of the first day's play wearing them, she had bad blisters on both heels, making us skeptical whether we could fix up the situation enough to let her continue the rest of camp. The next morning, the trainer at the camp applied a product called "second skin" to each heel, which is a clear small gel pad that feels like, well...skin, and is held on by a covering bandage. The fact that one of the camp coaches (an ex-college soccer player at NCSU) was next in line to get *her* heel blister fixed in the same fashion by the trainer, and swore by the treatment from experience, gave me added confidence in leaving my daughter there to give it a go playing that day.

It worked! Though the blister had been too painful that morning to bear touching, my daughter reported she was able to play the whole day long without any pain, and by this morning the healing process was obviously healthily underway. There have been discussions before on this list about care of blisters, with other solutions mentioned, but I could not remember whether the "second skin" product had come up. For many purposes (perhaps not all), this appears to be a better solution than "moleskin".

From: Bruce BrownleeAssuming that you have purchased correctly sized shoes and that the shoes have been softened with mink oil and stretched a bit with a wooden shoe tree, there is one more powerful tool that you can use to prevent blisters so that treatment does not become a requirement.

1) On the bare foot, apply baby powder liberally on all surfaces. The regular Johnson & Johnson kind, not cornstarch.2) Put on the first sock. Apply powder all over the heel and other parts of the sock, on the outside. Rub the powder into the sock.3) Pour about a tablespoon of baby powder into the shoe. Shake it around inside the boot, rub it into the heel, pour out the extra.4) Put the shoe on.

Unless the players are ankle deep in water, baby powder does a marvelous job of reducing friction and preventing blisters. It smells nice, is easy to apply, and the container does not weigh much so kids can keep it in their bag.

From: Gary RueWe do two things to help reduce our blister problem at the high school. First, we train half of our practice in flats, tennis shoes, etc. We do that for two reasons, one is the blister problem and the other is I want them to get use to making cuts, etc. without the help of cleats.

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Secondly, for players with new shoes, we ask them to put Vaseline on their feet to reduce the possibility. The Vaseline should go between their toes as well, because a rub can occur there as well.

From: Bob SefczekSecond skin is a very useful product amd is advocated by multiple sports (ice skating, hockey, etc. anything with tight shoes). It is different from moleskin in that it is applied directly to the blister area (moleskin is supposed to be cut out like a donut so the boot doesn't touch the area). I have run into a couple of situations, however, when the second skin wore through or moved but the player was aware very quickly:-) Remember to keep the area very clean (as well as the second skin). As I recall it is relatively expensive per use making the the other suggestions (proper size boots, baby powder, vaseline, etc.) for PREVENTION of the problem the way to go.

From: Joseph CohenThe current URL for this article is: http://www.physsportsmed.com/issues/1997/12dec/blisters.htm

Returning to Play from a Leg or Foot InjuryDate: Fri, 11 Sep 1998From: Gary Rue

Below is information I have collected from a couple of sources on how to test players to see if they are fit to play after a leg or foot injury. Some of these things can and should be done on the sideline during a game. Each activity is timed and/or counted for the non-injured leg first. The injured leg is deemed to be healthy enough if it can reach 85% of the time or reps of the uninjured appendage.

Balance: single leg volley kick; 30 reps or loss of balance

Strength:* vertical jump test #1 - standing on one leg, maximum leap and land; compare height of jump* vertical jump test #2 - standing on one leg, jump a consecutive series of 10 jumps on one leg; time jumps and compare

Propriceptors:* single hop for distance (twice)* timed hop for 7 yards* cross over hop - hop over a line up and wide as far as possible, then back, then back again (player must maintain balance)

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Coach looks for signs of injury in:* straight ahead running* backward running* side shuffles* Cariocas* figure 8's* zig-zags with 45-60 degree cuts* shuttle runs

Coach looks for signs of injury in functional test with ball; various methods of passing (all parts of foot) and shooting. Distances should cover 5 yards progressing to 30.

Sore Heels – Sever’s SyndromeDate: Fri, 1 Oct 1999From: Noel WilliamsSever's syndrome is one of the most common growth linked injuries suffered by Australian Soccer players in the 10-14 age bracket. The symptoms are sore heels; it can become very painful and debilitating. A Podiatrist who is used to Soccer players will diagnose it quickly and help players to reduce it or alleviate it entirely. My layman's understanding is that the calf muscle and the bones in the leg have trouble keeping up with each other. In heavy growth times young players aggravate this condition through constant pounding and turning during training and games.

Two podiatrists have told me it can be dealt with by a more thorough stretch of the calf and related muscles. The simple calf stretch is NOT enough for a junior player; seniors can get away with it - kids can't.

Once WARM a senior starts to stretch a calf by standing with feet together:

1. Place Left foot approx half a stride straight out2. Ensure the extended L knee is over the L toes3. Keep the front L and back R toes pointed straight ahead (parallel)4. Tense the calf in the back R leg (hold for 10-15, don't bounce)5 Switch legs and repeat.

All juniors should do this 5 step stretch. But there's more...

Junior players MUST do more than this because their muscles are not appropriately formed for the stresses they endure. There is a muscle that runs up the back of the 10-14 Yr olds heel that is NOT stretched by the standard calf

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stretch above. This is the muscle that causes the Sever's syndrome (believe your kids it's very painful).

In ADDITION to the senior or standard stretch, the following stretch should be added for juniors in the 10-14 Yr bracket.

Once WARM, stand with feet together

1. Place Left foot approx half a stride straight out2. Ensure the extended L knee is over the L toes3. Keep the front L and back R toes pointed straight ahead (parallel). (change technique here)4. Don't tense the back R leg. Bend the R knee; drop your butt a little.5. Refocus the tension to the back R heel.

** By dropping the butt and bending the R knee you focus the stretch on muscle that runs up the back of the heel (this is the one causing the pain). All juniors 10-14 yrs should do these stretches prior to and after every training session and game. Any kid suffering SEVER'S SYNDROME should do these stretches before every meal... 3 TIMES A DAY ! Parent's - if they don't warm up and stretch, they don't eat.

A kid who's got it can be right to play in a week or two if they stretch.

Heel PainsDate: Tue, 10 Apr 2001From: Ash ClementsMy 11 year old son is getting bad pains at the very bottom of his heels. Some folk say that this is some growing pains associated with the development of upper thigh muscles..I don't know. What I have learnt though is to make him stretch the heels before games and do some other rotating movements....seems to work well although I still give him anti-inflammatory pills before games.

Can someone tell me exactly what this problem is? I've heard other young players get this problem as well..even myself way back in the dark ages can remember something of this nature happening to myself.

Date: Mon, 9 Apr 2001From: Brandon MacyBeing a podiatrist in addition to a soccer coach, in that age group and activity, it sounds like it could be a growth plate inflammation. At the back of the heel, there's a growth plate which is subject to both pounding and torque from the achilles tendon in physically active kids. At one time it was entirely the domain of 9-12 year old boys, but is now also seen in the 8-12 year old girls.

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It is called calcaneal apophysitis or Sever's Disease. Milder cases can respond relatively quickly to the use of a good heel cup. More severe cases can sometime require casting for the short term. Over the long haul , it will eventually go away as the growth plate closes with physical maturity.

I recommend a visit to your local podiatrist or orthopedist to make sure that this is what it is. Treating it early in the process can minimze the disability.

Date: Mon, 9 Apr 2001From: Jim O'BrienAshley,Here is a link: http://www.heelspurs.com/_intro.html

A number of players in our area have experienced heel pain and advised it is Plantar Fasciitis or an inflammation of the fibrous material between the growth plate and the heel. Whatever it is...its very painful for them. They have been advised to reduce/eliminate training for a while (couple weeks), stretching, heel cups available at most drug stores, a change of shoes (bladed cleats instead of rounded studs...supposedly it spreads the force over a wider area of the heel???) and a reduction of running on hard surfaces has eliminated most of the problems.

Date: Sat, 14 Apr 2001From: Mike C.A few years ago a girl (U12) on my team was experiencing the same symptoms. She was a tough kid, but would ask to come out of games because of the pain. Her parents took her to a doctor who showed her some stretches. The worked pretty well and she was able to play pain free. Eventually, the pain stopped altogether. If I remember correctly, the doctor told her parents that heel pan in adolescents is common.

Basically, she was told to stretch her foot by placing her foot against a poll or wall so that the heel was on the ground and her toes were raised so that the ball of her foot pressed against the wall, and then the press her knee forward. Teammates would also help her by pressing her foot back (toes toward the shin) while she rested on the ground holding her leg straight.

Sore AnklesDate: Saturday, October 17, 1998

Three girls (U12) on my team complain that their ankles hurt them. Almost every game at least one of the three ask to come out due to ankle pain. They come out

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rest and then go back in, but they are playing with discomfort. We practice about six hours a week.

Are there any stretches or strengthening exercises I do with them? Two of the players have been to doctors and were told that they were ok physically and that sore ankles come with soccer .

From: David Teetz1. Walk on toes.2. Walk on heels3. Walk on outside of feet so that heels are pointing in4. Walk on inside of feet so that the heels are pointing out.Do each walk for the 50 yards.One more exercise. This one primarily works the calves, but provide secondary strengthening to the ankles.Do simple heel raises. Pair the players up according to height. They hold shoulders for support. Simply lift the heels off the ground as high as possible, then return to the ground. Don't let the heels touch the ground though.These can be done three ways without an props: Toes straight ahead, toes pointing in and toes pointing out. Each works different angles of the muscles. Start with about 15 reps for each.

Date: Mon, 19 Oct 1998From: SamWhile not always the cause, I have found that too often the kids are playing in cleats designed for soft turf when they are playing on hard packed ground. For most recreation soccer players, they will only own one pair of cleats. I have been preaching for years that my players get turf cleats. These are the best single pair of cleats a player can own.

I saw the same problem when my girls team was U-12. I took all of their cleats home one night, and using an electic filet knife, I cut their cleats down by 1/2 to 2/3. The ankle problems went away.

The high studs on the cleats they were wearing was causing their ankles to roll slightly. Imagine playing with the high cleats on astro turf. That is what it is like when your team is playing on packed ground.

Date: Mon, 19 Oct 1998From: Robert Wing Jr.I've had the same problem with jr. high boys. I believe the typical hard ground in late summer, coupled with players wearing spikes for the first time in a year is the major reason for the problem. I spend quite a bit of time, the first few weeks,

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working on ankle and leg strengthening exercises. Slowly the complaining has stopped so I assume the pain has stopped.

Date: Tue, 20 Oct 1998From: David GagnerThis thread is dead on for one of my teams problems this year. I have had at least six of sixteen players with ankle or foot problems. One is in a cast for a stress fracture while the other five, along with most of the team have switched to turf shoes. The difference has been tremendous. While most of the girls now have two shoes they wear the turfs nearly all the time and have had no problems to report since. The one girl has played 4 of our 16 games this season and the doctors are still not sure when she can come back.

We play in the Washington, DC metro area and the fields this year, up until the last two weeks, have been rock hard. Many facilities had been shut down. The adult league teams I play for play only on dirt fields. Considering the conditions, I have a beautiful pair of Puma King screw-on cleats and they are used maybe twice a year.

BOTTOM LINE: The effect of the field conditions can be tragic to the development of your players. Make sure that the equipment they wear is good for their health and conducive to strong play. We are the coaches and considering that the majority of the parents would put football or baseball cleats on their children, and think they are the same, we must explain the proper equipment.

Sore AnklesFrom a local sports doc who deals primarily with boxers and distance runners:

Have the girls stand up, feet together, hands at their sides. Have them pick up one foot and bend the leg backward at the knee till lower leg gets to right angle with ground and just try to balance. They will do this easily and look at you as if you are crazy. Then say "close your eyes". They will start fighting for balance, using the muscles in their ankle, almost immediately. Weakest ankle is the one that makes them tip over the fastest. This is simple, and "works" all of the little muscles in the ankles as they try to adjust.

Also, one ball for two players. players stand on opposite sides of the ball facing each other, ball between them. Hold each other's right hand. Simultaneously place right foot against ball, heel down, toe up, and lean forward (same as placing against wall or tree, hand hold is for balance.)

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Taping AnklesDate: Sat, 3 Oct 1998From: Gary Rue

<Disclaimer: I am not trained in the following area; however, I have discussed the following with people who have been trained. Unfortunately, I have heard several different opinions over the years and I offer the following from my personal observations and experiences. I welcome anyone else to submit their views or procedures on this subject, especially if they have a background in this area.>

When taping a player's ankles, be sure to provide support for the proper area. For instance, if the weak area is on the side of the foot, the taping should prevent the foot from turning to the side. This is done with the use of side stirrups. If the Achilles Tendon is the problem, then the stirrups should be run along the back of the ankle to prevent the tendon from over-stitching.

A stirrup is a long strip of tape that runs from the one side of the leg (in the case of the side stirrup), above the ankle, across the bottom of the heel to the opposite side of the leg. In the case of the Achilles Tendon, it runs from the back of the leg, above the ankle, to the bottom of the foot.

The process I use to tape an ankle is as follows:

1. Pre-wrap the foot and ankle (I am unsure of the formal name of the material I call "pre-wrap")2. With standard athletic tape (1.5 inch), wrap overlapping strips around the leg above the ankle and around the middle of the foot to help stabilize the pre-wrap and to give connecting places for the stirrups.3. Be sure the Achilles Tendon is stretched by pulling the foot back towards the shin (a towel pulling against the ball of the foot works well). This is to make sure the tendon is expanded enough to keep the tape from being too tight.4. Run the stirrups; overlap three strips, pulling them tight 5. Lock in the stirrups with tape around the lower leg; it is recommended to run short strips that only overlap about an inch on the back of the leg. One long strip continuously wrapped may not allow enough expansion room for the tendons.6. Run a couple of figure eights from the back of the leg, around one side the ankle, across the top of the foot, underneath the foot over top the foot, around the other side of the ankle and overlapping about an inch on the back of the leg.7. Run a couple of lower leg locking strips (see #5) for good measure.

The ankle should be stable, with enough flexibility for the foot to move without the pain of tape constriction.

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Injury Prevention: The Ankle in SoccerDate: Tue, 15 Dec 1998From: James J. Bjaloncik

Another interesting article in the latest issue of Penn State Sports Medicine Newsletter (Vol.7, No.4, December 1998, pg.4-5)

SOCCER: THE ANKLE

Regardless of the age, gender, or ability level being studied, all of the data indicate that your next soccer injury will be an ankle sprain. Knees are second and injuries to the upper leg are third. Given the nature of the game, none of this should be a surprise. Here are some other facts about soccer injuries:

* The incidence of injury increases with age.* Players who have sustained previous injuries may be more likely become injured again.* Most studies show that women sustain injuries more frequently than men.* Soccer injuries are more likely to occur on artificial playing fields than on natural surfaces.* Most injured players can return to play in less than a week.

When an ankle is sprained, the ligaments that hold the ankle joint together are stretched, torn or completely severed. In most cases, the player rolls the ankle over and to the outside. It's called an inversion sprain.

FIRST AID: Once it happens, the rest, ice, compression and elevation (RICE) protocol is still the basis for treatment for sprains. Stay off the leg at least 24-48 hours or until you or a sports medicine physician determines the severity of the injury. If the pain, swelling and disability are mild, you can treat it yourself. Apply ice, keep the ankle higher than your waist, and wrap it tightly enough to prevent further swelling without restricting ciculation. If the symptoms are more severe (tearing or popping sound, serious swelling, tenderness, bruising and continued loss of function), get to a doctor.

PREVENTION: Most ankle sprains are unavoidable accidents, but there are some things you can do to protect yourself. Begin with a strength and stretching program for the structures that surround and support the ankle. The Achilles tendon is particularly vulnerable and should be as flexible as possible, accoarding to Lyle J. Micheli, author of "The Sports Medicine Bible" and a member of [this] Newsletter's Editorial Board. The Achilles stretch and exercises peformed with rubber bands or tubes for ankle inversion and eversion are illustrated [in this article - are also illustrated in most sports exercise and training books jjb].

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Exercises to Prevent Ankle SprainsDate: Fri, 27 Apr 2001From: ront

>So far this season (three games) for our BU16 club team, we have had four>kids out with sprained ankles. Are there any exercises one can do to make>sprained ankles less likely? Should everyone wear an ankle brace? (If this>continues, we may not be able to field a team.)>mark

Hi Mark. I do NOT believe that all should wear brace for couple of reasons. might end up actually WEAKENING the ankle and they are uncomfortable.

Strengthening? just a few. stand straight, hands by sides, lift one foot by bending the knee backward and balance on just the one foot. (ok all stand up and try it!). Now close your eyes (picking yourselves off of the floor now??). this will strengthen all of the little muscles in the ankle.

Get a bath towel toss it on the floor in front of you, sit down and take off shoes. put foot on one end of towel and begin to gather the towel in towards by flexing your toes only (you will feel this one up through the ankle in short order).

Put half dozen 16 oz paper cups upside down on floor in a line about 4" apart. stand in front of them and bend one foot at knee and balance on other. lower yourself by bending the knee till you can pick up a cup, stand by straightening knee, then repeat.

Sit with your leg straight out in front of you and write the alphabet with your toes by flexing foot at the ankle.

Sit in a desk chair or secretarial chair or on a stool with wheels. hold onto the sides. pull yourself forward across the room using one foot only. then push self backward using same foot.

Calf TightnessDate: Thu, 24 Feb 2000From: Tim HiddemenIf its hot where you are, it may be dehydration. The gastrocs tend to cramp when you are dehydrated.

I've dealt with this on a personal level. In the past two years I have developed tearing in the gastroc muscles of both legs, and its no fun. When running distance make sure the ladies run heel-toe, and do not run on their toes or the balls of their feet.

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On the other hand, as with any muscle, you can tear the tissues if you do not warm it up properly. For me, at 35, this meant a good hour of jogging, stretching and light kicking before I would do any sprinting in a game. Unlike some muscles, its difficult or impossible to play through pain in the gastroc. You need it for any cuttting or sharp acceleration or deceleration. Make sure they stretch their calves thoroughly, but even more important make sure that there is some acticvity prior to stretching that begins the warming up process. Its essential to get the blood circulating through the muscles before stretching. Stretching cold muscles can actually cause micro-tearing of the tissues.

Finally, if there is evidence of a tear, desist from stretching. Stretching a torn muscle widens the tears. Use ice at first to decrease swelling, and to cut down on blood flow throught the injured muscle. The flow of blood can widen tears as well. After the tears have healed the following is useful. When I was rehabbing my gastrocs they told me to soak in a hot bathtub and massage the muscles as hard as I could, and then after the bath to rub oil into the skin. This is to break up any scar tissue on the muscle. They told me that this would feel good that night and hurt like a bitch the next day when I exercised, and they were right! but it worked.

(Note: never massage muscles or apply heat to fresh injuries as this will increase blood flow and widen tearing.)

Date: Thu, 24 Feb 2000From: D HarrisDavid, When talking about calf tightness it's worth remembering that there are about 7 key muscles in this area used to a greater or lesser extent during football-style activities. The two major ones are the soleus and the gastrocnemius. The stretch often seen in soccer training manuals and recommended by Richard Brown in his list response (foot flat on floor, lean into a resistance) is valid, but only really stretches the Gastrocnemius (the upper part of the calf. It is important to gently stretch as many of the muscles in th calf area as possible as they feature in many of the soccer related activities. A good stretch for the soleus (the lower part of the calf as part of a stretching routine is as follows:

- Place both feet parallel to one another, with one about 25 centimetres in front of the other.

- Gently bend both knees and slowly "sit down" towards the floor.

- You should feel a stretch through the lower part of the back calf

- Hold for 10-12 seconds

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- Ease up to standing again and change legs

- Repeat as needed.

I tend to get our guys doing this about three times on each leg to ensure the muscle is completely ready to go before any exercise.

One thing that many coaches forget is that the majority of muscles in the body work in what are known as antagonistic pairs i.e. one contracts while the other relaxes. Most people know the obvious ones i.e. quads/hamstrings, biceps/triceps but few realize the pairing nature of the calf. While stretching the calf, many athletes and coaches neglect to stretch the shins (a contributory factor to "shin splint" problems suffered by many top level athletes including Andy Cole at Man Utd.)This can lead to an imbalance in the pairing which is likely to cause problems during exercise.

A basic stretch for the shins is as follows.

- In the changing rooms before a game, get each player to remove their boots.

- Fold a towel up into quarters and place it on the ground ( to protect the feet/toes)

- place the toes of one foot on the towel

- slowly push your knee forward

- you should feel that through the shins

- Hold for 10-12 secs, ease out and change.

There are infinite reasons as to why some of your players are suffering from calf trouble, too numerous to go into now - drop me a line if you want more info.

Here at Loughborough Uni in the UK we are pioneering some new stretching techniques that are certainly helping our athletes to improve their general and specific flexibility - an exciting area to be working in!

Date: Thu, 24 Feb 2000From: Rich KenzieI have just gone through knee surgery (torn meniscus) and have to keep my leg straight when walking, thus resulting in VERY tight calfs. The PT has given me a couple of exercises to do that really help.

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1) lay flat on your back, "push" the back of your knee to the ground so it is as flat as possible to the ground. Then simply do an ankle flex, where you take your foot and pump it up and down, while keeping your leg as straight as possible. Do this 20 times with 3 reps. On the 3rd rep hold the foot straight up for a count of 5, then release. Works great!

2) stand on a stair with your toes and ball of your feet. Your arch and heel will be "hanging" over the stair. Lift your body up and down. Again same reps as before.

This has worked wonders for my calf.

ALSO: One of the BIGGEST problems with calf tightening is a lack of calcium. If a player has repeated cramping and tightness, calcium supplements should do the trick. Check this with the family doctor first, but I am sure they would agree.

Date: Thu, 24 Feb 2000From: Jim TurpinDavid,

You have received good advice already about the warm up and stretching and I do not feel the need to go further on that.

However it is possible that a few, or maybe many, of the sore calves are due to something else. When I used to play on a hard surface, no matter how I warmed up or stretched, if I played in "molded" cleats I would develop pain in the lower calf and sometimes down the achilles all the way to the heel.

A sports doctor that examined me found that my Achilles and lower calf would inflame doe to the uneven support the molded cleats provided on hard ground. She recommended that on hard ground I play in turf style shoes. I used the kind with a lot of small, closely packed cleats. After I began wearing these shoes the pain went away and, as a side benefit, on hard or sandy surfaces I slipped less.

Be sure that the calf tightness is really that and be sure that the shoes age providing correct support to the foot.

I have had several players that went to this kind of shoe for most surfaces and the number of complaints of calf pain has decreased. A shoe change does NOT replace proper warm-up or stretching but it can prevent pain that is caused by poor stability.

Date: Thu, 24 Feb 2000From: Gary Rue

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It is with caution that I step into the magical and mysterious world of stretching. Dan makes some excellent comments and I for one would welcome any more info on what he discovers with his stretching studies.

However, on "shin splints" I have found the cure (and prevention) not to be in the stretching, but the strengthening. I also suggest that to stretch the shin area, one must point the foot and toe. When the foot is brought back where the toes are closer to the shin, this is promoting a constricting action (there is a medical term that I can't recall) of the main muscle group.

My best results have come when the foot is pulled back (using the shin muscle group) or by squeezing the toes under the foot, etc. Raising the foot with a small weight near the toes also helps strengthen this area.

I know that this may be all semantically b.s., but my brain is at such a precarious balance, that I can't afford to "stretch" or "strengthen" it to any great degree :-)

From: D Harris> Gary Rue wrote: My best results have come when the foot is pulled back (using the shin muscle group) or by squeezing the toes under the foot, etc. Raising the foot with a small weight near the toes also helps strengthen this area.

Gary, Seems my inability to master the English language has dropped me in it again! My suggestion for a shin stretch was based completely upon your statement above. The toes and foot DO need to be pointed and DO need to be pointing away from the shin - I obviously didn't explain it properly! In reality what the athlete is trying to do is to push the top of their foot and their knee towards the floor - the only direction a stretch for the shin can be obtained in.

Date: Fri, 25 Feb 2000From: Nick GuothJust another stretch for the lower calf area, which has already been described as very important and on many occasions overlooked. The one already described to us has IMO a slight problem in that the person needs to concentrate on two things. One is the stretch and the second is balancing, alike a standing quadracep stretch.

What we do is to half-kneel down so that the point of the knee is right next to the toe of the second foot. The heel of the second foot is tight on the ground and you lean forward with your chest onto the knee of this second foot, the one you are stretching.

And of course, as always, never push a stretch too far.

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Date: Thu, 24 Feb 2000From: Dennis MuellerIn my former life as a boys HS track coach and serious long distance runner, I can tell you that stretching both the upper and lower calf are needed to help prevent (or heal) a variety of problems with the lower leg and foot.

More than one HS boy with pain in the lower calf (actually, I would describe it more as pain around the upper end of the achilles tendon) was able to return to competitive running in about a week after following a simple routine of icing, twice a-day stretching and jogging limited by pain (very short jog at first and gradually increased duration of jog until pain returns or 4 miles).

In my personal case, these calf stretches help ease the pain and prevent serious inflammations of my chronic plantar fasciatas (sore arch, lower heel pain for those with a medical dictionary).

Sore KneesDate: Fri, 5 Feb 1999From: Dave WeissigSubject: Child knee injuries> And, if it is just growing pains, start him on stretching twice per day -> and get him to ice the knee before/after exercise. The doc may want to> give him some anti-inflammatories, but his age requires that you be> careful on what you use (as things like aspirin can lead to Reyes> syndrome if he gets the flu while taking it).

Please don't let a player (child especially) ice their soreness or joints BEFORE exercise or activity. This can lead to more serious injury to soft tissue.

Date: Fri, 5 Feb 1999From: Gary RueDave makes a good point, you should not ice muscles and joints prior to training. Warm-ups are there to warm players up. If a player must ice before warm-up to reduce swelling, then that player should not be practicing--in my opinion.

But on the other hand...injury rehabilitation is different from training. If the injured area is not 85% or still tends to swell after exercise, the following procedure should be considered:

* ice massage the injured area for 15 minutes to reduce the chance of swelling from the exercise* gradually stretch and do range of motion exercises (light weight resisted exercises can be used as the injured area is ready to accept it)

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* ice massage the injured area for 15 minutes to stop swelling that the light exercise may have stimulated.

Exercise is important to rehabilitation, even when there is some swelling, but it must be the correct exercise and it must progress at the speed the injury allows.

If a player has as much as 85% of his flexibility and strength returned and has very little or preferably no swelling, the player should be able to return to practice--again don't forego a physician's opinion on this.

In this situation, a player may want to ice prior to training. However, the player should always follow the icing with slow stretching and range of motion exercises should be done to "re-warm" the area before heavier exercise.

The above apply to those during game injuries where the ice is slapped on for a few minutes and then the player is ready to go back to war. Be sure they warm-up the area before putting them in.

From: Connie T. MatthiesHi, Dave:You suggested no icing before activity, as could lead to more severe injuries. Might be true if a muscle tear was in progress.

However, for Osgood-Schlatter type knee pain (on the attached on the quad just below the front of the knee), it works wonders - and was recommended by the top sports doc at our most high-respected Ortho group.

Just goes to show, however, that it is always a good idea to talk with the docs beforehand, as the treatment obviously will vary with the injury - and some treatments which are fine for certain problems might not be a good idea for others.

Osgood-Schlatters>I've got a son a U13 player, who in the course of the last year will occasionaly complain of pain just below the right and left knees after participation in a sports activity. The sports medicine doctor at our HMO believes this to be Osgood Schlatters condition, and recommends stretching and ice. I am wondering if anyone out there has encountered this with their players and if they have any advice.

From: Connie T. Matthies My son had a horrid time with Osgood-Schlatters, so I will give you the benefit of our experience (and many hours/$$ at the orthos).

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Essentially, what happens is that the bones in growing kids actually grow ahead of the muscles, which puts a great deal of tension on the muscles and ligaments until they get stretched and grow as well. Because of the strength of the large muscle in the front of the thigh, as well as the relatively small attachment just below the knee, this area tends to get very inflamed if you are using the leg for lots of vigorous forward motion (like kicking or running or climbing stairs). The inflammation can get so bad if ignored that some kids have to go into casts, and even can pull bone away (like a bad ligament tear). So, what the sports docs said to do was as follows. Rest the joint until it is pain-free, using ice massages and anti-inflammatories (ibuprofen worked fine for my kiddo, who grew 6 inches one year). A nifty thing which the docs suggested was to freeze ice in styrofoam coffee cups, then tear out the bottom, which gave you a neat holder to hang onto the ice while you massaged the inflamed area. Once pain-free, you then start on a regime of stretching both before and after any exercise. These will be the normal stretches for the front of the thigh, as well as for the hamstrings. Basically, just standard runner stretches. Alex also took ibuprofen regularly, including about 2 hours before a game and then when we got home. Interestingly, he was told to ice the knee before exercise, as well as when he got home. When he did not do this, he felt that the knee did not work as well. Once we got started on this regular stretching about 3 times per day, as well as the ibus and the ice, his legs calmed down quite a bit and the problem gradually went away as his growing slowed. However, don't ignore it and don't just try to run through it. The pain is telling him something, which is that his muscles and ligaments are putting too much stress on the bone because they are too tight. He needs to work on getting them loose, which also will help to avoidinjury.

From: John W.I have dealt with this condition in many players. I am a varsity High School coach for soccer and basketball and this condition can hinder players in both sports. The stretching and ice are crucial...especially immediately after activity it is important to ice for 15-20 min's. The other thing I would recommend is to tightly place athletic tape around the leg where the kneecap's ligament/tendon joins the top of the shin. (the tibial tibialis) there will probably be a bump in the bone there. This is 2-3 inches below the bottom of the kneecap. The thought is that this is caused by the rapid growth in the child and the tendon/ligament is pulling away from the bone. This tightly wrapped tape seems to help support the tissue where it joins with the bone and has helped some of my younger players tremendously. Good luck.

Date: Mon, 19 Jan 98From: Dennis Mueller

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I think the doctor gave sound advice. All the kids I've known with it simply outgrew the problem in 6 months to 2 years. Conservative treatment and avoiding stress on the joints is probably best. It is hard to keep 12 to 14 year-olds resting for that long, but you don't want to risk making a long-term chronic problem. A condition that mimics this is patellar-femur syndrom. This pain just below the kneecap and is supposedly caused by a muscle imbalance with the medial (inside) of the quadracep being weaker that the larger quad muscles anc this causes the patella to slide out of its natural groove and eventually produce pain. The cure for this is strengenthening excercises. Foot pronation, asd, for girls, wider hips, can cause a torque in the knee that causes pain. (This, I think is the symptom relieved with the band worn below the kneecap). These three things are hard to tell apart and a good sports doctor should be consulted. Askthe doctor for a plan for recovery and prevention.

Date: Mon, 7 Sep 1998From: Bryan L. Pinn>...one of my players has Osgood Schlatter.. we try to treat him as well>as we can with our (little) experience. Furthermore, I (as a player)>have sprained the cross bands (I don't know the English name for sure)>in my knee. Are there tips for a succesful come-back in that book?

I had Osgood-Schlatter Disease in my mid teens. Damn painful! I'll type in the pertinent page from the Guide. In your own case, sounds like you've strained the cruciate ligaments. Get thee hence to a physio!!!

(From "Complete Guide to Sports Injuries", H. Winter Griffith M.D.)OSGOOD-SCHLATTER DISEASE (Osteochondrosis)GENERAL INFORMATIONDEFINITION"Growing pain" at the knee, a temporary condition affecting adolescents who exercise vigorously. The powerful quadriceps muscles of the thigh attach to the lower leg bone (tibia) at a growth zone, a relatively vulnerable area of bone. Pain, tenderness and swelling occur at this point with repeated stress. Both knees may be affected. (Paul... "temporary" was 2 full years for one fine young player I coached.The more bow-legged a player, the more susceptible they seem to be.)SIGNS & SYMPTOMS* Pain following extended period of vigorous exercise in an adolescent. In more severe cases, pain occurs during less vigorous activity, especially straightening the leg against force, as in stair-climbing, jumping, deep knee-bends, weight-lifting. * A slightly swollen, warm, tender bump below the knee. CAUSES & RISK FACTORS* Repeated, zealous conditioning routines: e.g running, jumping, jogging.* Overweight.

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HOW TO PREVENT* Help an overweight child or adolescent to lose weight.* Encourage exercising moderately; avoid extremes.

WHAT TO EXPECTDIAGNOSTIC MEASURES* Observation of symptoms.* Medical history and physical exam by doctor.* X-Ray of knee.SURGERYNecessary only in severe cases, in which a bone fragment forms and remains painful after growth has ceased.NORMAL COURSE OF ILLNESS* Mild cases can be "lived with" successfully with reduction of activity level.* Moderate to severe cases may require significant reduction in activity and immobilization for 4 to 8 months.* No permanent defects are expected.POSSIBLE COMPLICATIONS* Bone infection.* Development of bone fragment (ossicle) below affected knee.* Recurrance of condition in adulthood.

HOW TO TREAT(NOTE: Follow your doctor's instructions. These instructions are supplemental.)MEDICAL TREATMENTUnneccessary for mild cases. For moderate/severe cases, knee may be immobilized with a cast.HOME TREATMENT* Use heat to relieve pain. Warm compresses, heating pads, warm whirlpool baths and heat lamps are effective.* Wear a kneepad below the knee during exercise.* Apply ice to the affected area immediately before and after exercise (if doctor has cleared you for increased activity.)* Avoid kneeling.MEDICATION* For minor discomfort, you may use non-prescription drugs such as aspirin or ibuprofen.* Your doctor may prescribe corticosteroid injections of other treatment fails. Injections may weaken tendons. Avoid them if possible to allow condition to heal with rest & simpler treatment.ACTIVITYIf pain is incapacitating, resting the leg is the most important treatment. this is done with:* Crutches* Leg cast or splint* Elastic knee brace that prevents knee bending fully.

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* During treatment, don't participate in sports that cause pain. Condition is normally temporary. Normal activity can be resumed when inflammation subsides. Mild to moderate activity up to the point of pain can sometimes be pursued during treatment. Ask your doctor.CALL YOUR DOCTOR IF:* You have symptoms* If symptoms don't improve in 4 weeks despite treatment* If pain increases duriung treatment.* If temperature rises to 101F (38.3C)

Paul... the book has two full pages on sprained leg ligaments, so I'm not going to type them here. I strongly recommend that you see a sports-medicine therapist. Even a mild ligament sprain needs 2 to 6 weeks of healing time. I'll just give you one of Doc Griffiths' paragraphs on this. "POSSIBLE COMPLICATIONS: * Prolonged healing time if usual activities are resumed too soon.* Proneness to repeated injury. * Inflammation at the ligament's attachment to the bone (periostisis). * Prolonged disability.

Muscle Pull and Appropriate StretchDate: Tue, 28 Mar 2000From: Ed LeahyWhat you are describing sounds like either a strain of the quadracep or a groin pull (the popular myth about groin pulls is that they only involve the muscles on the inside of the leg; not so). Warming up is important, but cooling down is even more important (though it's hard to sell this to young players). A good quad stretch is to balance on one foot, bending the other knee, reaching down and grabbing the foot with your hand and pulling with gentle force. Hold the stretch for the count of 10, then do with other leg. Do three sets.

A good stretch to prevent groin pulls is to stand with one foot pointing straight ahead and the other pointing away at a 90 degree angle (sort of like a fencing stance). Then, with hand on hip, lean gently toward the foot pointed away from the body. Hold for a count of 10. Do three sets.

These are from my experience as a marathon runner. What I also found was that strengthening one set of muscles sometimes cause an imbalance, especially in the area between the knee and the hip. Therefore, when strengthening adductors (groin muscles) and quads, I also made certain I did a hamstring stretch. A good one for soccer players is to stand with feet crossed, then lean down as if to touch the toes. Hold the stretch for a count of 10, do three sets. If bleachers are available, another good ham stretch is to lift one leg and rest it on the bleacher so that it is almost straight out away from the body. Lean forward and touch your

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toes with the fingers on that side (i.e. right hand to right foot, left hand to left foot). Hold for count of 10, and do three sets.

These are all preventive measures. Since the player is already hurting, I suggest ice immediately after a workout/practice/game, and light work while the area is still inflamed. DO NOT TRY TO PLAY THROUGH IT. I once decided to run through achilles tendonitis. I did permanent damage and can no longer run.

Date: Tue, 28 Mar 2000From: Tim Hiddemen I have heard this muscle called the lifter and the hip flexor, though I am not sure of these are accurate. It takes a while to heal as I found out through personal experience. The best cure is RICE with emphasis on the Rest part. To prevent this injury I do know a good stretch. When i was in high school we called it the standing hurdler. While standing, place one foot as far forward as comfortable, foot flat on the ground, with the knee bent as close to 90 degrees as possible. The other leg should be extended behind the body with the toe on the ground, heel up. Place the hands behinds the head and arch the back. You should feel the stretch in the muscle at the top inside of the leg. It is the muscle that you use when you flex the knee and lift your foot. Mine is sore right now <grin> because I neglect my stretching. it can be a challenge to maintain your balance while doing this stretch!

At 35, overweight and out of shape I need at least 60 minutes of jogging and stretching and light kicking to be able to play 80 minutes. I emphasize stretching and warm up with my team to try and prevent injury.

Date: Wed, 29 Mar 2000From: D HarrisSounds like Tim Crawford is describing the muscle known as the SARTORIUS. Originates at the front point of the ilium (pelvis area) and runs down across the quadriceps into a point on the inside of the tibia (just below the knee).

Interestingly enough, this muscle is particulary sensitive to adrenal exhaustion which can often manifest itself as low blood sugar, low resistance to infections and asthma - vitamin C can help.

Personally, the problem described by Gary Rue would seem to be with the Psoas or Iliacus - more commonly grouped together under the title ILIOPSOAS. This is the main hip flexor and low back stabilizer and works to flex the thigh.

Most of the stetches and suggestions mentioned by the list seem sensible enough, BUT in the case of repetitive problems with the same area it is always far better to get the advice of a qualified professional whether it be a doctor,

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physio etc. By experimenting and trying a DIY job you're only setting yourself up for problems - let the pro's take care of it, that's what they're there for!

From: Bill AndrewsMay be hip flex muscle? I had a similar player develop the same type of injury. The doctor gave my player an exercise for pre-game, pre-workout as follows;

1) Feet together, lean forward, use a fence or solid object, swing the leg in a pendulum arch, side to side as high as possible. First one leg then the other.

2) Standing sideways, swing the leg in a pendulum motion front to back as high as possible.

At a pre-game warm of an MLS game, I notice Tony Meola warming us this way using the goal post. Several years later, I purchased a video from Vern Gambetta this warm up for the hip flexor was also demonstrated as a pre-warmup.

Cramps and StichesDate: Mon, 19 Jan 98From: Dan Becque

Tim Fleury wrote:A couple of my U-10 players frequently complain about getting cramps just below the rib cage during the games. When I ran track (many years ago) my caoch claimed that it was from improper stretching. My assistant coach claims that it is from improper breathing. Has anyone researched this area?----------------------------------I've not done research, but when I run, I get these cramps when I'm not properly hydrated. I seem not to have the problem when I've consumed a lot of water throughout the day leading up to the run. So, for me anyway, it has nothing to do with stretching or breathing.---------------------------My understanding of these cramps is that they are spasms of the diaphram. The diaphram is a highly aerobic muscle that controls the ventilation of the lungs. Just like the skeletal muscles that are involved in locomotion and playing the game, the diaphram must adapt to the stresses of training. The stress on the diaphram is the increase in ventilation that is neccessary when aerobic exercise in undertaken. Sometimes these spasms can be brought on by repeated sprinting which causes very high ventilation rates because of the bicarbonate buffering of hydrogen ions generated from intense muscular contractions. Most times as the individual's aerobic fitness increases these cramps go away because the diaphram adapts to the increased demands placed upon it. The hard part for a

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coach is when a player doesn't come consistently to enough practices to gain in aerobic fitness.

These cramps can also occur when you fill the stomach. The stomach is above the diaphram and when filled it will apply an added stress to the muscle. The key to staying hydrated and avoiding cramps is to promote rapid emptying of the stomach. Water uptake occurs only in the small intestine. Three things influence the emptying of the stomach: volume, concentration and temperature of the contents. The bottom line for hydration is to drink cool, plain water in 250 ml (approx 8oz) drinks at regular intervals. Lightly sweetened and flavored non-carbonated beverages (Koolaid, Gatorade ) are preferred during exercise and are consumed in greater quantities than are water, carbonated soft drinks and fruit drinks. Soft drinks and fruit drinks are also too concentrated and impede stomach emptying.

Dan BecqueAssociate Professor, Exercise PhysiologyDepartment of Physical EducationSouthern Illinois University at Carbondale

Date: Mon, 19 Jan 98From: Gary RueTim, the web site Les referred to is excellent, as well as Dan's post. Though there can be several things that can cause this, I like to focus on the breathing early in the season during training. We seem to rarely have cramp attacks.

During warm-up and cool down stretching, I ask the players to breathe into their stomachs (that is, their stomach should expand versus the chest). As the air is released, the stretched muscle always seems to relax a little bit more. A lot of yoga (of which I have very little knowledge) is based on breathing. During cool down relaxation, I stress this breathing with the players and ask them to practice at home when they are watching TV, etc. <It seems every thing is life requirespractice, even breathing.>

If a player does experience cramps during play, he is to "rub the cramp out" by massaging the cramp area, start belly breathing and to hydrate.

Date: Mon, 19 Jan 98From: Mark A. MorinFrom the Sport Science mailing list posted by Will Hopkins (will.hopkins@stonebow.otago.ac.nz (Will Hopkins)) about July of this year.

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>In a paper currently under re-review by MSSE (Investigation of the side pain "stitch" induced by running after fluid ingestion) Brian T. Plunkett and William G. Hopkins make the following conclusion:On the basis of these findings, we present the following advice to athletes wishing to avoid stitch or reduce its severity.* Don't exercise straight after a meal or large drink. Our stitch-prone athletes experienced little or no stitch when they ran with empty stomachs, but stitch was still well developed an hour after drinking a liter of water or Coke. It would therefore be advisable to wait 2-3 hours before exercising after a meal or large drink.* If you drink during exercise, take small amounts frequently rather than a single large drink. This practice will reduce the mass of fluid in the stomach.* Sports drinks with composition similar to Exceed may be less likely to cause stitch than water or "pop" drinks. This advice may be more important for avoiding stitch in exercise lasting several hours in the heat, when you need to consume and absorb several liters of fluid.* When you get stitch, bend forward and tighten the abdominal muscles, or breathe with more air in the lungs at the beginning and end of each breath, or breathe out through pursed lips. These three maneuvers worked in our study; combining them might be even more effective.* If you experience stitch frequently, try wearing a light wide belt around your waist that you can tighten when necessary. We used a rather heavy leather weights belt, but a light wide cloth belt with a Velcro fastener should be equally effective against stitch without weighing you down.But note also this comment from our Discussion:A reviewer of this paper remarked that there are at least two forms of "stitches": "minor annoyance[s], associated with recent consumption of food and drink, and very painful, incapacitating stitches, which never seem to be related to food or fluid intake [and are] always on the right side." S/he went on to suggest that "the latter type are often associated with missing meals or being dehydrated from inadequate fluid intake in the previous 24 hours or acutely from fluid loss during a prolonged race." If these observations are valid, then clearly our study addresses only stitch of the "minor annoyance" variety.

----------------------------------------------About two years ago, my (then) 12-year was in the same boat at school - and I was summoned to come and see him. From his signs (doubled over, extreme pain in the lower abdomen, etc) I immediately suspected an appendicitis - so I rushed to the local ER. To shorten a long story, it turned out that he was 'slightly' impacted. He had been very active that week (sports-wise), hadn't been drinking enough water but apparently had had too much of the caffeinated sodas. One of the main sources of water for a water-stressed body is the bowl - and if you don't have enough roughage in your diet (which he apparently didn't - gotta love pre-teens!) to keep things moving - you can dry things out pretty badly and wind up in a nasty way. A mild laxative, extra water and a good lecture about the importance of staying hydrated and laying off the sodas as well as a little extra

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bulk in his diet did the trick and he's never had a problem since. So there may be a realistic explanation as to why your player recovered so quickly -- but there's no way it was a groin pull - so I'd make sure his folks aren't playing amateur physician with him.

Pains in the Side (Side Stitches)-----Original Message-----From: Tim HiddemenAt 01:58 PM 11/25/99 EST, you wrote:>Can someone PLEASE tell me what is the exact cause of those annoying pains in the sides that some people suffer from while running? I have heard several different explanations but would like to know the honest to goodness truth!

I was always taught that it was a cramp in the muscles of the lower torso. If this explanation is true then these muscles undergo a strain as they seek to balance the body when running. as with any muscle cramp, hydration and stretching prior to exertion, but after getting the blood flowing through the muscles will help. If you eat heavily, blood flow is diverted from the muscles to the stomach to aid in digestion, thus making cramping worse. My coaches always said that if you get a stitch while running and run through it that you are improving conditioning. I always tried and it never affected me adversely. I also was taught to fold my hands behind my head while running, or hold the arms at the sides without swinging them. It may have been a psychological effect like a placebo, but it often reduced the pain. I tell my players to try this and have seen varying levels of success. I tended to get stitches more at the beginning of swimming season, or when I was swimming year round when I switched from a 1 practice a day to a harder two practice a day routine and found that they went away after my conditioning improved. Hope this helps.

Date: Thu, 25 Nov 1999From: Gary RueI think it was "The Runners Book" by Jimmy Fixx that recommended the following for side stitches: bend over and rub the stitch out.

One key reason for side stitches seems to be improper breathing. Diaphragmic (or belly) breathing is the recommended breathing technique. The best way I can describe this technique is that the stomach expands when air is taken in. If "belly" breathing is not being performed, the chest expands and the stomach is tightened. Pursing the lips to slow the exhales also helps, though I can remember all the technical and medical reasons for any of this.

I can only attest that the above seems to work for me and all that I have coached.

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Date: Thu, 25 Nov 1999From: Mark A. MorinI received this on a now-defunct sports science list a couple of years agoand it seems to me like he knows.

>Date: Thu, 17 Jul 1997>In a paper currently under re-review by MSSE (Investigation of the side pain "stitch" induced by running after fluid ingestion) Brian T. Plunkett and William G. Hopkins make the following conclusion:

On the basis of these findings, we present the following advice to athletes wishing to avoid stitch or reduce its severity.

* Don't exercise straight after a meal or large drink. Our stitch-prone athletes experienced little or no stitch when they ran with empty stomachs, but stitch was still well developed an hour after drinking a liter of water or Coke. It would therefore be advisable to wait 2-3 hours before exercising after a meal or large drink.

* If you drink during exercise, take small amounts frequently rather than a single large drink. This practice will reduce the mass of fluid in the stomach.

* Sports drinks with composition similar to Exceed may be less likely to cause stitch than water or "pop" drinks. This advice may be more important for avoiding stitch in exercise lasting several hours in the heat, when you need to consume and absorb several liters of fluid.

* When you get stitch, bend forward and tighten the abdominal muscles, or breathe with more air in the lungs at the beginning and end of each breath, or breathe out through pursed lips. These three maneuvers worked in our study; combining them might be even more effective.

* If you experience stitch frequently, try wearing a light wide belt around your waist that you can tighten when necessary. We used a rather heavy leather weights belt, but a light wide cloth belt with a Velcro fastener should be equally effective against stitch without weighing you down.

But note also this comment from our Discussion:

A reviewer of this paper remarked that there are at least two forms of "stitches": "minor annoyance[s], associated with recent consumption of food and drink, and very painful, incapacitating stitches, which never seem to be related to food or fluid intake [and are] always on the right side." S/he went on to suggest that "the latter type are often associated with missing meals or being dehydrated from inadequate fluid intake in the previous 24 hours or acutely from fluid loss during a

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prolonged race." If these observations are valid, then clearly our study addresses only stitch of the "minor annoyance" variety.

Date: Thu, 25 Nov 1999From: Michael MurphyRaise the arm that is on the same side as the pain, bend it at the elbow and rest it on the top of your head. You can continue running and the pain will go away. A cross country coach told me about this cure for side stitches about 30 yrs ago. I don't know why it works but it does!

Date: Fri, 26 Nov 1999From: Kenneth DodsonSomething I was taught by a coach at a training session many years ago that seems to work is similar to Gary's. I have the player put their stiffened fingers on the side where the pain is and push in hard is if they were trying to stab their fingers through the pain. As they push in they are to blow all the air out of their lungs. Try to get a nice slow exhale that they really concentrate on getting all the air out. I have them do it 2 or 3 times. I don't know whether this is strictly a placebo affect or what but they all say "cool, it quit hurting." and then take off again. I have done it with 8 year olds and 18 year olds and they all think it works.

Side StitchDate: Mon, 15 Apr 2002From: Wayne Mery

Robert C. Christensen wrote:> Ashley,> A side stitch is believed to be caused by a cramp in the diaphragm. So it> is essentially a muscle cramp.

Cramping is a limited description. At least for some people, it is more of a 'pulling' or 'tugging' action going on inside your gut.

Here are a few explanations that are close to my knowledge as a runner.The first, Dr Pribut, is one of my favorite resources.His treatment is also what I have used effectively for years.

http://www.drpribut.com/sports/spthrowup.htm http://www.makeithappen.com/wis/readings/sidest.html http://www.drmirkin.com/fitness/8128.htm http://mn.essortment.com/sidestitchinr_prt.htm

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Yes, the problem can be exacerbated or caused by too much weight in the stomach. You may of course find several sources and websites that are way off the mark. Beware what you read.

From: Bob ChristensenProper hydration is critical to help prevent cramps. Make sure that the player does not drink carbonated beverages before a match, as I have seen this aggravate side-stitches. An old runners trick is to interlock your fingers behind your head while continuing to run through the cramp. This does help. I think that it helps stretch the diaphragm or supporting muscles somehow. It may also help you determine when it is appropriate to sub him out. But be careful that your substitutions do not interfere with that player developing his own sense of pace in a match and being able to work at an appropriate pace. This is perhaps the most serious down-side to the unlimited substitution rules common in youth soccer: The young players never do learn how to properly pace themselves, and mete out effort when it is most likely to be most effective.

Swallowing Air?Date: Tue, 10 Jul 2001From: Shelborne FungI have an U14 player who says he gets a gaseous, bloated feeling in his stomach during and immediately after practices. His only liquids are water and gatorade; no sodas or fruit juices or drinks before, during, or immediately after. I'm not clear on what foods he has before practice, but it doesn't sound like anything out of the ordinary, a slice of pizza or a hamburger about two hours before practice. Practices are a good workout but they are not a source of tension, i.e. it's not like the team is playing in a big game. He says it does not happen to him outside of practices. Is it possible that following periods of intense activity, when the player is trying to catch his breath but the body also has a swallowing reflex, that this player swallows air, and if so, can that cause the gaseous feeling in his stomach? Also, is there a "cure" or a way to prevent this?

Date: Tue, 10 Jul 2001From: John ZiperskiI am not a physician, but I can relay a similar situation/condition that I have. After much in the way of tests (the whole kaboodle!) they diagnosed me with ³nervous bowel syndrome² basically it occurs, or is noticed during stressful situations, or after adrenaline wears off after competition. I still get it, except I have found it more controllable through the management of my stress, and knowing what it does to my body. It is terribly real for the victim, and sometimes can range from slight discomfort to strong pains. I noticed them mostly in tournament situations where stress rolled like a roller coaster. Try having him concentrate on controlling

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his stress, continue drinking correctly, and eat less acidic fluids such as OJ or fruit drinks.

From: Ted GoeltzJohn's reply is on or at least close to the mark. My daughter had similar problems. Her problem turned out to be related to 'yeast'. Eliminating the pizza and hamburger buns (and in her case bagels before a match) helped a lot. This condition is referred to as Candida Albicans and you can get more information on it at health food stores. By building up the 'good" bacteria in your stomach (acidfadopholus sp?) it will allow digestion to occur properly and keep gas and bloating to a minimum. Try yogurt (with those active cultures), some fruit, cheese, etc. a couple of hours before a practice.

Checking for ConcussionsDate: Tue, 15 Dec 1998From: Connie T. MatthiesHere is something which I posted about one year ago, which mentioned a Wall Street Journal in Sept. of 1997 on insuring that players who have taken a hard hit are able to return to the field. This is very important, because of what is known as "second-impact" injuries. If the brain has started to swell slightly, and has sustained some blood vessel damage, even a slight second impact can result in a massive stroke or other complications which can result in death and/or serious longterm disability.

The advice is:

1. If the player loses consciousness, even briefly, they should be sent to the hospital for an evaluation.

2. If the player is merely woozy after a hard hit, then the player should sit out for awhile. During that time, you need to do the following tests:

a. Exercise test - If they cannot do 5 pushups without feeling woozy, then they are out for the game.

b. Immediate past memory - Ask them to describe what just occurred in the game before the hit. If they don't remember, they flunk.

c. Current thinking - Ask them to count backwards by 7s (with smaller ones, maybe something easier). If they cannot, they flunk.

d. Ability to retain new memories - Ask them to remember 3 random words (e.g., apple, car, Cleveland). If they cannot, they flunk.

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This is important info. Each year, several players in various sports die after second-impact concussions. The second-impact doesn't have to be the same day, or even the same week. Apparently, as long as the player is unable to perform each of these types of tests, there is still some brain injury which needs healing.

Watch out carefully for nausea, dizziness, headaches, confusion, or vision changes. Make sure that the kiddo stays out until all of these symptoms have passed AND they can pass the above tests.

I intend to copy this article and put it with my coaching materials - just to give parents and players if they push to return too soon. Hope everyone finds this as valuable as I did.

Date: Sun, 20 Dec 1998From: Les SparksI was glad to see Connie Matthies' post on concussions. It gave me the kick in the pants needed to pull information on concussions together for my goal keepers. In pulling information together I found that soccer has the same incidence of concussion as football (0.25 per 1,000 for men and 0.24 per 1,000 for women). The American Acadamy of Neurology (AAN) has established guidelines for dealing with concussions. These guidelines are endorsed by numerous sports organizations but USSF is not listed as one of them. AAN's tests which appear to be the ones Connie posted were established to allow coaches to grade the concussion level. Because soccer is listed as one of the top 3 sports in incidence of concussions (ice hocky first with 0.29/1000, American football with 0.25/1000, Men's soccer 0.25/1000, and women's soccer 0.24/1000), I think all coaches should become familar with the AAN guidelines and tests.

I plan to post the information I have dug up on concussions on my web site for the Carolina United U18 Ladies (Navy) at http://www.ntrnet.net/~less/u18/

I also suggest that coaches check out the AAN site http://www.aan.com/public/concussion/concussion.htm.

References on ConcussionsDate: Tue, 15 Dec 1998From: Mark A. MorinI repost some information sources regarding concussions because of the recent discussion of head injuries. In addition, "Revised Concussion Recommendations: A New Standard?" in the March 1997 issue at the

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http://www.physsportsmed.com/ gives a summary of MDs' responses to some of the below articles.

Concussions are not an injury to fool around with. Guidelines are becoming more and more strict as to the advisability to go back to playing after getting your "bell rung." There are a few very good articles on the topic on the web.

For a basic outline of what is going on with concussion, go to the Cramer First Aider page (http://www.ccsd.k12.wy.us/CCHS_web/sptmed/fstaider.htm) for:

Managing ConcussionsSource: Sideline View, September 1991

For a more through coverage regarding problems with mental processes after concussions look to the Physicians and Sportsmedicine page (http://www.physsportsmed.com/) for:

Managing Successive Minor Head Injuries: Which Tests Guide Return to Play?Margot Putukian, MD; Ruben J. Echemendia, PhDTHE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 11 - NOVEMBER 96

In a series of two articles covering different reasons not to allow athletes to participate in sporting activity, the second (same website) has a good coverage of concussions:

Contraindications to Athletic Participation: Cardiac, Respiratory, and Central Nervous System ConditionsJames L. Moeller, MDTHE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 8 - AUGUST 96

And for the man-o-man bring along to your doctor coverage, see:

Guidelines for Managing Concussion in Sports: A Persistent HeadacheRobert Roos, M.D.THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 10 - OCTOBER 96

Heading InjuriesDate: Mon, 14 Dec 1998From: James J. BjaloncikFrom the latest issue of the Penn State Sports Medicine Newsletter (Vol.7, No.4, December 1998, page 2)

SOCCER: HEADING AND BRAIN INJURIES

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Various investigators have suggested that directing a soccer ball with the head may be related to headaches, neck pain, dizziness, abnormal EEGs, impairment to thinking, personality change and brain atrophy.

Michael J. Askens, Ph.D. and Robert C. Schwartz, M.S., writing in "The Physician and Sportsmedicine", state that concerns about the practice of heading are warranted. However, the question of whether heading the ball causes brain damage "remains elusive". Studies indicating heading and brain injury relationships have been limited by the number of subjects, statistically insignificant differences between control and experimental groups, or other flaws in research design. Generally, no studies have shown neurological or psychological differences between soccer players and other athletes, but differences have been reported between soccer players and nonathletes.

PRECAUTIONSUntil more conclusive evidence is produced, the authors recommend these four precautions:

Players, coaches, parents, referees and health professionals should be educated to increase awareness of the potential of brain injury.

Correct heading technique should be emphasized.

Rules stipulating the distance from the ball on restarts should be strictly enforced.

Physicians should consider the possibility of concussions during sideline evaluations and when receiving calls about head injuries from parents or players.

Date: Sun, 14 Feb 1999From: Dan GrunfeldReceived this from a concerned parent. Article appears on page 90, Better Homes and Gardens, March, 1999:

"Parents often tell their kids to "use their heads." When it comes to soccer, that might not be such good advice. A study of 53 Dutch professional soccer players found that hitting the ball with your head too many times may impair memory and recognition skills. And while very few studies have been done on kids, Dr. Lyle Micheli, of the sports medicine department at Children's Hospital in Boston, believes that no one under age 12 should "head" a soccer ball. Before that age, children's muscles aren't fully developed. He compares the impact of a soccer ball to taking a punch in the face in a boxing ring.To be safe, Dr. Micheli suggests letting some air out of heavier soccer balls for less impact. Or ask the coach about using a size 4 ball. It's lighter than the

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professional size 5 ball used by most American kids. European kids play with the smallest and lightest ball - a size 3 - and don't move up to a size 5 until they're 18."

Date: Mon, 15 Feb 1999From: Mark A. MorinA commentary titled, ["Heading the Ball in Soccer: What's the Risk of Brain Injury?" Michael J. Asken, PhD; Robert C. Schwartz, MD, THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 11 - NOVEMBER 98], can be found at:http://www.physsportsmed.com/issues/1998/11nov/asken.htm

It is a review of the literature and describes the concerns and problems associated with the heading of the ball. It seems well-balanced regarding risk/reward decisions of kids heading the ball. No matter how we soccer boosters want to frame the question, it is clearly reasonable to have some concerns over the process of flinging our heads into oncoming balls. (Insert obvious joke(s) here.) The doctors ended the paper with:----------------------------------------Therefore, while heading a soccer ball has not been proved hazardous, caution is warranted until more definitive evidence becomes available. Given the present knowledge, four steps seem appropriate.

First, education should be enhanced to increase awareness of the potential for injury from heading a soccer ball. This information needs to be imparted to coaches, parents, and referees, as well as healthcare professionals.

Second, correct heading technique must be emphasized and promoted. While some accidental injuries, such as those from goalpost collisions, may be unavoidable, proper technique for preventing injury can be used consistently.

Third, rules that protect players should be enforced by referees and supported by coaches, parents, and fans. For example, referees should ensure that defenders maintain the full required distance from the ball on restarts and should not allow encroachment, which decreases defenders' distance from the ball and increases impact.

Fourth, physicians should continue to appreciate the potential for brain injury from heading. Appropriate sideline evaluation of athletes for concussion should be part of care. Additionally, calls from parents or players about symptoms after a game or injury should be addressed and evaluated, and, when appropriate, concussion should be part of the differential diagnosis.

Finally, still needed are controlled prospective studies with an emphasis on the clinical significance of any positive findings.-------------------------------

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The paper is very interesting and well worth your time. Even if you come to different conclusions, you will learn something in the process. (I liked the physics of heading section.)

Date: Thu, 14 Oct 1999From: James J. BjaloncikGood evening fellow soccer coaches - The following has appeared in the latest issue of the "Georgia Tech Sports Medicine and Performance Newsletter" (Vol.8, No.1, p.4, 1999)

SOCCER: HEADING ISSUE WILL NOT GO AWAY (PART 1)

There are still more questions than answers regarding the debate over possible long-term consequences of heading a soccer ball.

An article written by two physicians in a recent issue of THE PHYSICIAN AND SPORTSMEDICINE acknowledged that concerns about the practice of heading are warranted. Previous studies suggested that heading may have been related to headaches, neck pain, dizziness, abnormal EEGs, mental impairment, personality change, lower verbal scores and brain atrophy.

A more recent study, presented at an August meeting of the American Psychological Association, compared the mental performances of 32 college and professional soccer players with a group of swimmers. The investigators found that the soccer players scored lower on 5 of the 11 tests than the swimmers.

In a September, 1999 issue of the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, a group of researchers in the Netherlands reported on a study of 33 soccer players and 27 control subjects. Their findings suggest that participation in amateur soccer may be associated with mild chronic traumatic brain injury (CTBI). They found evidence of diminished ability on tests of memory and planning among soccer players when compared to those who did not play soccer.

Before you draw any conclusions, there are limitations to every research effort, including those on soccer. The number of subjects and how they are selected, the type of ball-head contact, and the speed of the ball affect the outcomes of these studies. None of them took into account other collisions during games and practices that may have occurred. In addition, there have been studies that did not find a link between heading and head injuries or brain damage.

Soccer coaches and officials have been quick to defend the practice of heading and can provide plenty of anecdotal evidence showing no apparent effect of heading on the brain. It is fair to say that, as a group, they are defensive on the

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subject. It is also important to note that the kinds of injuries that may be possible are not likely to be seen in the short term nor observed by non-scientific methods.

Nationally recognized authorities on children and sports medicine have gone on record expressing their concerns. NEWSLETTER Editorial Board member Lyle J. Micheli, M.D., Boston Children's Hospital, has been quoted as saying, "Until further studies clarify the risks, there should be a yellow warning light signal going out". Benjamin Kibler, M.D., a Lexington, KY orthopedic surgeon, says that studies showing brain damage risk have been flawed, but the issue has "some merit".

In the meantime, Micheli and others have suggested some safety precautions for young soccer players. Micheli recommends that heading not be taught until the age of 12, when coordination and neck strength have been developed sufficiently to learn the correct technique for heading.

Additional measures include the following: 1) Players, coaches, parents, referees and health professionals should be educated on the potential for injury; 2) Correct heading technique should be emphasized; 3) Rules stipulating the distance from the ball on restarts should be strictly enforced; 4) Players should use balls appropriate in size and weight for their ages; and 5) Physicians should consider the possibility of concussions when evaluating soccer-related head injuries.

Date: Mon, 18 Oct 1999From: Dennis MuellerI think that it is clear that not enough research has been done to make a definitive statement concerning chronic damage or lack of it due to heading a soccer ball. There is as yet NO clear evidence either way. However, there is a clear causal agent and there is what appears to be a reasonable theory (yet unproven) that repeated minor trauma can cause chronic damage.

There were similar epidemiological studies involving high power lines and cancer. These studies have been generally discarded as the result of poorly designed studies and in at least one case of fabrication of data. So far as I can tell the only impact was economic due to the unfounded fear.

When the studies about cigarettes, came out in the fifties, they were supported by all scientists who were knowledgeable in the field, save those employed by tobacco companies.

A major difference between the power lines issue and that of heading is that there is a clear mechanism to initiate damage in heading, while for for power lines, the mechanism was murky at best. The two issues are similar in that the

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"dose" for heading is hard to quantify (the dose for power lines was basically unidentified and not quantified) and any expected effects are small. If the effects were not small, it would seem that soccer playing countries would be experiencing significant problems compared to non-soccer countries. (Compare USA - England in the years 1920-1980 for example.)

A conservative approach is to fund a major study and in the meantime, encourage your players to play the ball on the ground.

A more aggressive approach would be to ban heading outside the penalty area, thereby eliminating the heading that occurs after every goal kick and keeper punt. This would not change the nature of the game too much. (An even more aggressive approach would be to ban heading altogether, but this would need some thought to avoid changing the game unnecessarily). Then wait on the results of the research. This may take years since we are looking for subtle effects and will have continue poor dose measurements (at least until we outfit players heads with accelerometers and continue to monitor them for years for possible effects).

There is clearly no proof either way, but it is not an unreasonable postulate that heading may cause later brain damage.

It is clear in the case of boxers that such damage can occur, but the "dose" is much larger for boxers. You would get a much smaller "dose" by shaking your head, and as the parent of any small child can tell you, having small children affects your mental facilities ;.). Seriously, the issue must either involve a threshold effect or any trauma to the head, no matter how small must result in some permanent damage, no matter how small.

I will take the conservative approach until such time as interim research results give reason to change my position and to attack the proposed problem with a more aggressive solution.

Heading InjuriesDate: Thu, 1 Oct 1998From: Jonathan Utley

The press reports summarized in postings on this thread lumped heading with other contact injuries. The following study suggests that it is not heading the ball that is the danger but two players knocking heads while attempting to head that is the source of brain damage (not to mention diving into a goal post.)

The following report originally appeared in US Youth Soccer, Fall, 1995. I found it about a year ago at the Fairmount Soccer Association web site:

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http://www.libertynet.org/~fsa/head.html#SAFE

Extract from report follows: In a study from UCLA to be published in the American Journal of Sports Medicine, five prominent physicians (Jordan, Green, Galanty, Mandelbaum and Jabour) confirmed the results of Swedish researchers Eriksson and Haglund, who found minimal radiographic or neuropsychiatric abnormalities in soccer players when compared to amateur boxers or track athletes. The study found no evidence of a "dose response" to heading. In the soccer player group, head injury symptoms or MRI findings did not correlate with age, years of play, exposure index to headers, or number of headers per practice orgame. The U.S. doctors studied 20 active U.S. National Team soccer players. These players who were playing for an average of 17 years were compared to 20 elite track athletes. Both groups completed a head injury symptom questionnaire and underwent magnetic resonance imagining of the brain (MRI). In addition, the soccer players were segregated by position, teams, numbers of headers, and years of soccer experience. Both groups were also questioned regarding alcohol intake and incidence of acute head trauma. This study also tested the hypothesis that the amount of brain damage is directly proportional to the absolute number of headers. The study created an "exposure index" to assess if more heading created more objective damage. If heading a soccer ball truly causes brain injury, then those players with the greatest number of headers in their careers would be at greatest risk. There was no evidence of any such injury being caused. The UCLA physicians did find head injury symptoms in both soccer players and track athletes. These symptoms did correlate with previous acute head trauma from collisions with other athletes, objects such as goal posts, and with the ground. The UCLA physicians concluded that repetitive heading does not cause chronic brain damage. If brain injury occurs, it is more likely related to acute injury from contact, and not from heading..... The Sports Medicine Committee of US Soccer also studied this subject, and presented results at the "Sports Medicine of Soccer" symposium in conjunction with World Cup '94. These findings confirm and support the research and findings of the UCLA physicians.

Date: Thu, 1 Oct 1998From: George GehrigA few cites to recent articles published in the medical literature:

TITLE: Medicolegal aspects of athletic head injury.AUTHOR: Davis PM; McKelvey MK

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ABSTRACT: This article reviews the legal aspects of head injuries resulting from a variety of athletic activities, focusing primarily on head and brain injuries resulting from the playing of football, boxing, horseback riding, winter sports (hockey and skiing), and soccer. Part 1 give a general overview of the occurrence of head injuries in athletics and the potenti al for litigation. Part 2 reviews the history of and increase in sports injury litigation, as well as resulting changes in the law. In Part 3, the current status of athletic head injury litigation, the parties involved, types of claims brought, and viable defenses are discussed. Finally, Part 4 reviews different ways to reduce athletic head injury litigation through better equipment design and adequate warning and instructions for users and coaches.SOURCE: Clin Sports Med 1998 Jan;17(1):71-82

TITLE: Common soccer injuries. Diagnosis, treatment and rehabilitation.AUTHOR: Tucker AMABSTRACT: Soccer is a game with worldwide appeal. Increasing numbers of participants are members of all age groups and skill levels. The game presents to the sports medicine practitioner a wide variety of musculoskeletal and medical problems. Soccer injuries increase in frequency as the age of participant increases, with a low incidence of injury in preadolescent players. Musculoskeletal injuries most commonly affect the lower extremities and include contusions, acute and chronic musculotendinous strains, and ligamentous injuries to the knee and ankle. Most injuries are minor and respond to analgesics, therapy modalities and exercise therapy. Groin pain is a common problem and particularly prevalent among soccer players owing to the game's specific stresses. Other less common but important injuries include facial trauma, mild brain injury (concussion) and heat-related injury. Team physicians, athletic trainers and physical therapists need to possess a basic understanding of the most common injuries and problems in order to maximise safe participation for their athletes.SOURCE: Sports Med 1997 Jan;23(1):21-32

TITLE: Acute and chronic brain injury in United States National Team soccer players [see comments] [published erratum appears in Am J Sports Med 1996 Jul-Aug;24(4):563]ABSTRACT: We designed a study to determine whether chronic encephalopathy occurs in elite, active soccer players resulting from repetitive heading of the soccer ball. Studies have suggested that the cumulative effects of heading a ball can cause a chronic brain syndrome similar to dementia pugilistica, which is seen in professional boxers. Twenty of 25 members of the U.S. Men's National Soccer Team training camp (average age, 24.9; average years of soccer, 17.7), who completed a questionnaire on head injury symptoms and had magnetic resonance imaging of the brain, were compared with 20 age-matched male elite track athletes. The soccer players were surveyed about playing position, teams, number of headers, acute head injuries, and years of playing experience. An exposure index to headers was developed to assess a dose-response effect of

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chronic heading. The soccer and track groups were questioned regarding alcohol use and history of acute head traumas. Questionnaire analysis and magnetic resonance imaging demonstrated no statistical differences between the two groups. Among the soccer players, symptoms and magnetic resonance imaging findings did not correlate with age, years of play, exposure index results, or number of headers. However, reported head injury symptoms, especially in soccer players, correlated with histories of prior acute head injuries (r = 0.63). These findings suggest that any evidence of encephalopathy in soccer players relates more to acute head injuries received playing soccer than from repetitive heading.SOURCE: Am J Sports Med 1996 Mar-Apr;24(2):205-10

Purposeful Heading Not InjuriousDate: Sat, 5 May 2001From: Brian DougherWell it looks like the Experts are on our side. Heading is safe to children.

http://dsc.discovery.com/news/reu/20010430/soccer.html

Soccer Easy on the Brain

May 3 - The next time you rise above the defense to score a winning goal at a soccer match, celebrate carefree - players do not increase their chances of brain injury while heading the ball, according to research published on Thursday.

Heading - striking the ball with the forehead to direct it - is safe when the player is prepared for it, said Dr. Donald Kirkendall, a clinical assistant professor of orthopedics at the University of North Carolina at Chapel Hill School of Medicine.

Soccer moms should only really worry if little Johnny or Joanne is involvedin a head collision, he added.

"In purposeful heading, where you're actually trying to head the ball and actually do head the ball, the impact is spread out over the whole body because your head is fixed to your body by a tensed neck," said Kirkendall, the lead author of a study in the journal Sports Medicine.

"People ask the question, 'Can heading a ball cause a head injury?' In purposeful heading, we don't see that. In accidental ball contacts, yes, it is possible."

That's an important distinction, Kirkendall said. Accidental heading can lead to injuries because the neck and body are not braced for the impact of the ball.

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"The whole idea that kids are taught is to tighten up the neck. What that does is it makes you a whole lot bigger than the ball. As a result, the impact is spread out over such a large area that it's a fairly small impact."

In reviewing more than 50 studies on heading, head injury and cognitive function dating as far back as 1943 and throughout the United States and Europe, Kirkendall learned that injuries, such as concussions, may occur some time after a person heads a ball. But those types of maladies may be related to other events, drug or alcohol problems or learning disabilities, and are not caused simply by heading the ball.

"The most common method by which someone injures their head in a game is from contact with another player ... as well as head to ground ... and then a very rare occurrence is a head to a goal post," Kirkendall said.

For example, a player may head a ball and then bang into another player and fall to the ground. The resulting headache or concussion is from the impact of the fall, not from heading the ball, Kirkendall said.

Encouraging referees to whistle for potentially dangerous play that could cause a head collision and encouraging players to keep the ball on the ground are two ways that the use of heading can be decreased, said Jim Moorhouse, a spokesman for the U.S. Soccer Federation in Chicago.

Common heading injuries are lacerations to the face or nose that result from using poor technique, colliding with something or skidding on the ground, Kirkendall said. A player usually heads the ball betwe*en six and 10 times per game.

Proper heading technique is for the ball to make contact with the forehead, near the hairline area.

"It's much more enjoyable if the game's played on the ground, I think," Kirkendall said. "But (heading the ball) is a part of the game. ... It's trained and practiced and there's certain tactical things around using the ball with your head."

"The bottom line is that purposeful heading does not seem to be a factor in the cognitive problems that have been published ... people having problems with memory and things like that," Kirkendall said. "Purposeful heading is not the issue, it's the head injuries, the concussions. That seems to be the factor that contributes to the problems people see later on."

DIET AND NUTRITION

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Diet Playing four to six games over three days creates significant demands on the body. There are two dietary areas that need particular attention - hydration and carbohydrates. Recent studies have shown a SIGNIFICANT improvement in aerobic and anaerobic performance when soccer players diet and drinking prepares them for matches. The following is summary information for young athletes from several national and international sports medicine institutes. Following these guidelines will not guarantee success. But, when two teams of equal ability play, and one is better prepared physically, the better prepared team will usually win.

BEFORE GAME Breakfast Suggestions - Bagel, fruit, cereals (low in sugar), yogurt and fruit juices. Lunch Suggestions - Pasta, breads, rice, vegetables, chicken, fruit, water.

GAME TIME 1 Hour Before Kickoff - Approx. 12 ounces of your favorite sport drink such as Gatorade. Halftime - Sport drink and fruit. This may also be supplemented with power bars and power gels. Within 30 minutes After Game - Sport drink and fruit. This may also be supplemented with power bar, power gels and other healthy snacks.

FLUID REPLACEMENT Fluid replacement is a key component in a winning sports nutrition plan. During training and competition, loss through sweat evaporation can lead to dehydration and a decrease in performance. Thirst is not a good indicator of dehydration. Athletes can be dehydrated and not feel thirsty. It is important to encourage athletes to drink fluids before, during, and after practice and competition. When fluid levels are adequate, the urine will be pale yellow in color-the color of freshly squeezed lemon juice.Bottom line - If you are not using the bathroom between matches, you are not drinking enough fluids. Water, juice and sports drinks are good choices for replacing fluids.

GENERAL DIET There is no one perfect food or supplement that can supply the 40-plus nutrients the body needs for top performance. The best way for young athletes to get the right balance of these nutrients is to eat a variety of food types that are high in carbohydrate and low in fat. The daily game plan for a balanced diet includes the types and amounts of foods listed in the Food Guide Pyramid and outlined in the accompanying chart.

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NO. OF SERVINGS & FOOD TYPES ONE SERVING EQUIVALENTS

3 to 5 servings of vegetables 1/2 cup

2 to 4 servings of fruit 1/2 cup or 1 piece

6 to 11 servings of bread, 1 slice of bread or 1/2 cup cereal, rice or pasta

3 servings of low-fat milk, 1 cup or 1 slice yogurt or cheese

2 to 3 servings of meat, Piece of meat the size of a poultry, fish or cooked dry deck of cards or cup of cooked beans or peas beans/peas or 2 Tbs. of peanut

butter

Now, for older players (U16 and above) in a hard tournament with a lot of minutes playing time, there may be some benefit to planning carbohydrate (CHO) intake. For younger players, such effort is of little benefit. The idea of "carbo loading" is a fairly specific methodology of diet and exercise designed to increase glycogen in the muscles. A meal heavy in CHO a few days before an event will not be physiologically effective.

When thinking about CHO, "Glycemic Index" is a more modern model. In the '80s, scientists tried to classify the true effects of CHO-rich foods. Some foods had a high glycemic index meaning the blood sugar would rise rapidly, causing a "spike." (Sometimes dropping rapidly thereafter--depending on the person.) Where foods with a low glycemic index will cause the blood sugar to rise more slowly over a longer period of time.

From the sportscience site (www.sportsci.org): "Generally, nutritionists now divide foods into those that have a high GI (bread, potatoes, breakfast cereal, glucose-based sports drinks), a moderate GI (sugar, soft drinks, tropical fruit) or a low GI (dairy foods, lentils, legumes, oats, cold climate fruits such as apples)."

"1. The glycemic index may be useful in sport and deserves further attention. However, it is not intended to provide a single way to rank the virtues of carbohydrate foods. There are many other features of foods which may be of value to the athlete, such as nutritional value or practicality. Sometimes foods need to be chosen because they are tasty, portable, cheap, easy to prepare and unlikely to cause stomach upsets. These issue are specific to the individual and the exercise situation. In other words, foods must always be chosen to fit the "Big Picture" and not one single issue. In the case of food eaten before or during

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exercise, the athlete should practice any strategies in training so that they can be assessed and fine-tuned.

2. Despite early speculation, there is insufficient evidence to support the statement that all athletes will benefit from eating low GI carbohydrate meals prior to prolonged exercise. The idea is that a more sustained glucose response might sustain fuel and performance. In fact, in sports events where carbohydrate stores can become depleted, the typical way to sustain the carbohydrate supply during exercise is to consume carbohydrate during the event. The athlete should let practical issues and individual experience guide the choice of a pre-event meal. You may happen to like a carbohydrate food that is low GI (e.g. pasta), or you may find that your choices tend to foods with a high glycemic index such as rice, breakfast cereal, toast. Both choices can work.

3. For specific individuals or during unique training situations, a low GI pre-event meal may be of particular benefit. Some athletes show an exaggerated and negative response when they eat carbohydrate foods in the hour before exercise. About 5% of the population experience a rebound hypoglycemia or blood sugar drop - and they feel terrible. Why this response occurs in some people is unknown. During unusual endurance sessions such as open water swimming where practical difficulties prevent the athlete from consuming carbohydrate during the session, the pre-event meal may have greater bearing on metabolism and fuel availability during the event, and a low GI carbohydrate meal may sustain blood glucose, and performance.

4. Athletes performing prolonged exercise should consume carbohydrate during the event to supply additional fuel and thereby enhance their performance. Which carbohydrate drink or food to consume depends generally on their previous experience, the logistics of the event, gastrointestinal comfort and the need for fluid replacement. A carbohydrate source of moderate to high GI appears to be sensible - such as a glucose-based sports drink. However, practical issues and individual tastes are more important than GI when choosing a carbohydrate source for prolonged exercise situations.

5. Moderate and high GI carbohydrate foods appear to enhance glycogen recovery after exercise compared with low GI foods. The reason for this is not clear. The most important point, however, in post exercise refueling is to eat enough total carbohydrate. We give recommendations to athletes about how much carbohydrate they should consume immediately after exercise and throughout the day to meet their refueling needs. Foods must be available and appetizing to the athlete so that these recommendations can be met. It is OK to let some favorite low GI carbohydrate foods contribute to total fuel intake - especially if these are foods that are handy and easy to eat. However, it makes sense to focus on carbohydrate foods and drinks with a moderate to high GI for glycogen recovery. The overall message: choose what is practical."

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Brand Miller, J., Foster-Powell, K., & Colagiuri, S.(1996). The G.I.Factor: The Glycaemic Index Solution. Sydney, Australia: Hodder and Stoughton.==============================================Playing several games in one day or a weekend creates significant demands on the body. There are two dietary areas that need particular attention - hydration and carbohydrates. Recent studies have shown a SIGNIFICANT improvement in aerobic and anaerobic performance when soccer players diet and drinking prepares them for matches. The following is summary information for young athletes from several national and international sports medicine institutes.

Following these guidelines will not guarantee success. But, when two teams of equal ability play, and one is better prepared physically, the better prepared team will usually win.

BEFORE GAME

Breakfast Suggestions - Bagel, fruit, cereals (low in sugar),yogurt and fruit juices.

Lunch Suggestions - Pasta, breads, rice, vegetables, chicken,fruit, water.

GAME TIME

1 Hour Before Kickoff - Approx. 12 ounces of your favorite sportdrink such as Gatorade.

Halftime - Sport drink. This may also be supplemented with power gels.

Within 30 minutes After Game - Sport drink and fruit. This may alsobe supplemented with power bar, power gels and other healthysnacks.

IF A PLAYER HAS NOT USED SPORT DRINKS, POWER GELS AND POWER BARS IN THE PAST, USE WITH CAUTION BEFORE GAMES TO ELIMINATE THE POSSIBILITY OF UPSET STOMACHS. YOU MAY WANT TO CONSIDER STARTING WITH WATERED DOWN SPORT DRINKS AND TRY THE FULL STRENGTH DRINKS, GELS AND POWER BARS DURING PRACTICE AND AFTER GAMES TO DETERMINE INDIVIDUAL TOLERANCE AND DISLIKES.

FLUID REPLACEMENT Fluid replacement is a key component in a winning sports nutrition plan. During training and competition, loss through sweat evaporation can lead to dehydration and a decrease in performance. Thirst is not a good indicator of dehydration. Athletes can be dehydrated and not feel thirsty. It is important to encourage athletes to drink fluids before, during, and after practice and

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competition. When fluid levels are adequate, the urine will be pale yellow in color-the color of freshly squeezed lemon juice. Bottom line - If you are not using the bathroom between matches, you are not drinking enough fluids. Water, juice and sports drinks are good choices for replacing fluids. As the weekend progresses and a player is feeling particularly tired, GNC Ultra Fuel (a sport drink) may be helpful. Ultra Fuel is Gatorade times 5.

GENERAL DIET There is no one perfect food or supplement that can supply the 40-plus nutrients the body needs for top performance. The best way for young athletes to get the right balance of these nutrients is to eat a variety of food types that are high in carbohydrate and low in fat. The daily game plan for a balanced diet includes the types and amounts of foods listed in the Food Guide Pyramid and outlined in the accompanying chart.

NO. OF SERVINGS & FOOD TYPES ONE SERVING EQUIVALENTS

3 to 5 servings of vegetables 1/2 cup

2 to 4 servings of fruit 1/2 cup or 1 piece

6 to 11 servings of bread, 1 slice of bread or 1/2 cup cereal, rice or pasta

3 servings of low-fat milk, 1 cup or 1 slice yogurt or cheese

2 to 3 servings of meat, Piece of meat thesize of a poultry, fish or cooked dry deck of cards or cup of cooked beans or peas beans/peas or 2Tbs. of peanut butter

Tournament schedules make it very difficult to eat at regular times. Eat many small meals from the above food groups throughout the weekend to keep your "fuel tank" full.

Scott Zettlemoyer

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Nutrition - a Basic HandoutDate: Mon, 9 Nov 1998From: Mourad FaridOver the last couple of years there have been periodic discussions regarding the proper nutrition needs for players. What follows is a short handout that I have used in the past in conjunction with meetings that I have held with youth players and their parents on that very subject.

NUTRITIONThe competitive Edge

EAT:High carbohydrate (CHO) foods

WHY ?High Energy Foods that are digested quicklyEXAMPLES - Bread, Cereals, Crackers, Rolls, Pasta (all kinds), Rice, Muffins, Bagels, Fruit, Vegetables., low fat Yogurt, etc…

AVOID:High fat foods high in calories - Slows down digestionEXAMPLES - Butter, Margarine, Mayonnaise, Nuts, Seeds, Salad Dressings, Cream Cheese, Fried Foods, Sauces, Gravies

CUT DOWN ON:High Protein foods - High in fatEXAMPLES - Meat, Fish, Poultry, Cheese, Milk (Unless Skim), Nuts, Seeds, etc….

WATER:VERY IMPORTANT NUTRIENT – “DEHYDRATION” (Loss of too much water) is the most common nutrition problem among athletes. Bring water to all practices and games. Drink BEFORE practices and games – Drink DURING practices and games – Drink AFTER practices and games (After strenuous exercise, drink beyond thirst.)

PRE-GAME MEALS:Eat your pre-game meal at least (2 – 3 ) hours before practice or game time. This allows for good absorption. REMEMBER – No fats or Oils and avoid DEHYDRATION.

Date: Tue, 10 Nov 1998From: Larry Schuster

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It's obviously unrealistic to expect players to rise at 5 to eat. There are two things that can be done. Whenever we have this problem, I advise my players to have a large meal for dinner and a substantial snack around bedtime the night before. When they do get up, which will be between 6 - 6:30 A.M. (am I dreaming?), they can try a liquid breakfast if they have done it before without problems. They should eat nothing within an hour before the game, but should drink plenty of water. I don't think the season will have much to do with the eating part, but they may become less dehydrated in a fall game than in a summer game. Overall, I've found that, during tournaments especially, you should ignore large mealtimes and simply have them snacking anytime there's sufficient time between games.

Date: Wed, 11 Nov 1998From: Mourad Farid 1. I thought that Larry Schuster's comments in reply were very appropriate. One needs to recognize as well that like most guidelines or ROT'S ( Rules of Thumb), it's impossible to cover off all eventualities. having said that, a couple of thoughts spring to mind (a) I presume you are talking about young kids, given that, provided they stick to the guidelines with respect to the types of foods ingested and provided as well that the quantity if food is not excessive, it shouldn't make much difference. (b) with a little creativity on the part of parents, they could probably safely eat smaller quantities of good food that should carry them through until after the first game.

2. Some examples of a quick breakfast that's still nutritious:

- A bagel and a banana with a glass of skim milk- A bowl of (basic) cereal with skim milk and an orange- A couple of muffins, no butter- A small bowl of porridge

AVOID - Bacon & Eggs, Pancakes with heavy syrup, etc....

The other thing that can be done is as suggested in Larry's post a big time meal the night before and a late snack.

Nutrition for SportDate: Sat, 30 Jan 1999From: Dan BecqueSomebody recently wrote asking about nutrition for sport. There are many well done studies that have looked at nutrition before, during and after sport performance. The short answer is carbos, carbos, carbos. Without a doubt, performance drops as blood glucose (simple carbo) and muscle glycogen (stored carbos) drop with exercise. Also, the harder you work, the faster you use it up.

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The athlete with more carbos stored in his/her muscles and with access to carbos while exercising will be able to do more work and will perform better. What should you do?

Ask the parents to feed your players a high carbo meal on Thursday and Friday night before the tournament. The morning before the first game, get another high carbo meal. It's okay to get some fat too but stay away from donuts and other extra high fat foods. Pancakes, waffles and most ready to eat cereals are pretty good. Some of it is individual and you have to find something that agrees with you. Try to eat at least 2 hours before the match. When you arrive at the pitch, get warmed up and then start drinking fluids with 8% carbo 30 min before the game. Gatorade, Allsport and Koolaide all are about 8%. Research has shown that 8% solutions are a good balance between fluid replacement needs and carbo needs. One word of advice, the type of carbo is important. Fructose, fruit sugar, does not reach the exercising muscles and increase performance. You need a balance of fructose and glucose. Check the label. Drink early and keep drinking. When the match is over its important to load up again because this is when you replentish your stores the fastest. Start eating and drinking carbos as soon as possible. After exercise you don't need as much fluid so you can encourage your athletes to get more concentrated forms of carbos, i.e. bagels, bread, and more concentrated drinks like Gatorload and Ultra Fuel. Again you need alot of carbs. Keep them away from McDonalds, Burger King, Wendys,

Eating Before Competing Nancy Clark, MS, RD THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 9 - SEPTEMBER 98 Many casual exercisers and competitive athletes believe they should avoid food for several hours before they exercise or compete. Others wonder if they should snack, perhaps on an energy bar before a soccer game. And a few are so nervous that even the thought of food is nauseating. Whatever your concerns, experimenting with some of the following preactivity strategies and finding what works best for you can give you top energy and performance.

Is it bad to eat before exercising or competing? Doesn't the food just sit undigested? As long as your activity is moderate (at a pace you can maintain for more than 30 minutes), your body can digest food during exercise. Preactivity eating can help you significantly by supplying energy for sustained exercise and preventing the lightheadedness, fatigue, and indecisiveness that can result from low blood sugar. The food you eat 5 minutes to 4 hours before activity helps fuel your muscles and brain, and it can help you perform better. For a few people whose activity is moderately paced, eating causes gastric upset or intestinal problems. If you have these difficulties, you simply have to learn from experience the preexercise eating plan that works best for you. With intense activities like

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rowing, sprinting, or speed skating, blood flow is diverted from the stomach to the working muscles. If you'll be exercising or competing intensely, you'll probably want to allow about 4 hours between eating and the event. That's the time needed for a typical meal to empty from the stomach. Otherwise, you may have discomfort or even nausea.

What can I do before a 10 am soccer game? Carbohydrates are very important for maintaining normal blood sugar (the fuel used by the brain) and glycogen (the fuel used by the muscles). Because your blood sugar drops as you sleep, you need to replenish the depleted stores or your morning performance could suffer. Plan to eat a carbohydrate-based breakfast between 6 am and 8 am; then, if you're still tired, go back to bed. Cereal, bread, fruit, and fruit juice are excellent choices that may help you concentrate better and respond more quickly during that morning soccer game. Or, be sure to eat extra food the day before: Have an extra-big dinner that's low in fat and a substantial bedtime meal or snack. You'll have a better chance of maintaining a high energy level the next morning.

I get so nervous before a competition that I can't even think about eating. What can I do? Plan to eat several hours before activity, and eat familiar foods that won't cause a surprise stomach upset. Many athletes like oatmeal or other hot or cold cereals with low-fat milk. Other soothing, carbohydrate-rich choices are bagels with a little light cream cheese, yogurt, pancakes, or French toast. If the thought of solid food turns your stomach, you may prefer a meal replacement drink. Any fuel is better than none, so try to consume at least 300 to 500 calories.

I'm so hungry in the afternoon that I buy a candy bar for quick energy before working out. Does sugar hurt sports performance? Research suggests that candy doesn't hurt most people's sports performance. In one study, reported in the March 1987 Journal of Applied Physiology, athletes who ate a big breakfast 4 hours before and a candy bar 5 minutes before hard exercise improved 20% during the exercise test compared with when they ate nothing. The results of the study also suggest that just candy and no breakfast before exercise improved performance 10% in comparison with eating nothing. Some people are sensitive to preexercise sugar, however, and have a rebound blood-sugar low that makes them feel weak. Hence, the safest bet is to eat the candy within 5 to 10 minutes of starting activity. This span is too short for the body to respond. (Or, eat the candy more than 45 minutes before exercise to allow insulin levels to drop.) Candy is better than nothing, but it's not premium fuel. It's better to eat a more wholesome snack like cereal, a banana or apple, yogurt, or pretzels and juice. The urge for a quick energy fix is a sign you've eaten too little food earlier in the day. To prevent cravings, eat a hearty breakfast and lunch.

When we travel to a 7 pm event, I often miss dinner. Any suggestions?

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Traveling athletes commonly struggle to fuel properly. Sometimes they simply run out of time. Or they get to the event and expect food to be provided--and find nothing left, or nothing appealing or appropriate. Your responsibility is to fuel yourself well throughout game day. That means, for example, getting up early enough to have a hearty pancake breakfast, eating a double serving of pasta or two big sandwiches at lunch, drinking water throughout the day for extra fluids, and making time for a pregame dinner. The key: Plan ahead. The best pregame meals are carbohydrate-based: for example, spaghetti and tomato sauce (a little lean meat in the sauce is fine); or potatoes or rice, vegetables, and dinner rolls with a small serving of chicken or other protein-rich food (see "Timing Your Preactivity Meals," below). As with any pregame meal, choose foods that you know will settle comfortably and digest easily. Be sure to limit fried and high-fat foods like burgers, fried chicken, french fries, and nachos. These and similar fast foods take a long time to digest. Too many athletes--most of whom know they should have a carbohydrate-rich pregame dinner--fail to plan meals into their schedule. If this sounds familiar, pack emergency food in your gym bag (see "Packable Snacks," below). Snacks are better than nothing, but a good meal helps mentally, if not physically. Rather than regret improper eating, make time to eat well--perhaps even planning a mandatory team dinner--so you'll have energy to enhance your sports performance.

Timing Your Preactivity Meals The rule of thumb for eating before exercise is to allow 4 hours for a big meal (about 1,200 calories), 2 hours for a light meal (about 600 calories), and an hour or less for a snack (about 300 calories). Sample carbohydrate-rich menus:

Large Meal Light Meal Snack 2 large bagels 2 c spaghetti 1 medium banana 2 tbsp peanut butter 1/2 c tomato sauce 1 pkg instant oatmeal 2 tbsp jam 8 oz low-fat milk 8 oz low-fat milk 8 oz fruit yogurt 16 oz orange juice

Packable Snacks So you won't go hungry if you're traveling to a night game, stash 1,000 calories of tried-and-true food in your gym bag. (Never try new foods before an important event.) You might even pack extra snacks for underfed teammates. On game day you can add perishable items such as yogurt, bagels, apples or other fresh fruit, or even a sandwich or two. Some possibilities: Granola bars or energy bars (about 200 calories each) Trail mix (about 200 calories per 1/2 cup) Toaster pastries (about 200 calories each) Dried fruit (150 calories per 1.5-ounce box of raisins) Animal crackers (about 140 calories per 12 pieces) Juice boxes (100 to 150 calories per 8 ounces)

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Remember, you, your physician, and your nutritionist need to work together to discuss nutrition concerns. The above information is not intended as a substitute for appropriate medical treatment.

Ms Clark is director of Nutrition Services at SportsMedicine Brookline in the Boston area. She is a fellow of the American College of Sports Medicine, a fellow of the American Dietetic Association, and a member of its practice group, Sports, Cardiovascular, and Wellness Nutritionists (SCAN). Copyright (C) 1998. The McGraw-Hill Companies. All Rights Reserved

Eating for Peak Performance Susan M. Kleiner, PhD, RD THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 10 - OCTOBER 97 Nutrition plays a critical role in athletic performance, but many active people do not eat a diet that helps them do their best. Without a basic understanding of nutrition, popping a pill seems easier than planning a menu. In reality, there is no pill, potion, or powder that can enhance your performance like the right foods and fluids.

The Energy Diet To have enough energy you need to consume enough energy. Getting adequate calories is one of the keys to an ergogenic, or performance-enhancing, diet. With too few calories you will feel tired and weak, and you will be more prone to injuries. The ergogenic diet is based on the US Department of Agriculture's widely published food guide pyramid, which includes five basic groups: grains, fruits, vegetables, dairy foods, and protein-rich foods. Sugars and fats provide extra calories after the needs for foods from the other groups have been met. By eating adequate calories from a variety of foods, you will satisfy your need for macronutrients (carbohydrate, protein, fat) and micronutrients (vitamins, minerals). Carbohydrates. A high-carbohydrate diet increases stores of glycogen, the energy for muscles, and improves overall athletic performance. The bulk of the day's calories--60% to 70%--should come from carbohydrates such as bread, cereal, grains, pasta, vegetables, and fruit. Different carbohydrate foods can affect your energy level in different ways. Digestion rates are expressed as a "glycemic index." Foods with a high glycemic index release energy into the bloodstream rapidly, while foods with a moderate or low glycemic index release their energy more slowly. (However, beware of the old idea that simple sugars are always digested rapidly and cause wide swings in blood sugar, and that all complex carbohydrates like bread are digested more slowly and don't cause blood sugar fluctuations. This turned out to be wrong, as the table shows.) If you exercise for longer than an hour, you can begin to deplete your muscles of glycogen. By consuming 30 to 75

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grams per hour of high-glycemic-index carbohydrate in liquid or solid form when you exercise, you can minimize this effect. After a long workout or competition, your depleted muscle glycogen stores must be replenished, especially if you will be exercising again within the next 8 hours. Eat at least 50 grams of high-glycemic-index carbohydrate just after exercise, and consume a total of at least 100 grams of high-glycemic-index carbohydrate in the first 4 hours afterward. Moderate-glycemic-index foods may be added for the next 18 to 20 hours, with a goal of consuming at least 600 grams of carbohydrate during the 24 hours after an intense workout or competition.

Fat. Fat is definitely an important energy source, particularly for athletes involved in prolonged, low-intensity activity. (For high-intensity, short-term activity, carbohydrate is the primary fuel source.) About 20% of the calories in a performance-enhancing diet should come from fat (1), most of it unsaturated fat like vegetable and fish oils.

Protein. Protein plays a minor role in energy production, contributing only 5% to 10% of the energy used during prolonged exercise. Although the current recommended dietary allowance for protein is about 0.4 grams per pound of body weight per day, most active people need slightly more. And athletes involved in heavy resistance exercise or prolonged endurance events may require 0.7 to 0.9 grams per pound per day. Even this amount is relatively easy to eat, since 3 ounces of fish or chicken, 1 1/2 cups of tofu, or 1 1/2 cups of garbanzo beans contain 20 to 24 grams of protein.

Vitamins and minerals. They don't contribute energy themselves, but vitamins and minerals are integral to food metabolism and energy production. Iron and calcium are the minerals most commonly deficient in athletes, and strict vegetarians may be deficient in vitamin B12. By consuming adequate calories and following the food guide pyramid plan, your needs for all the important micronutrients can be met. Hydro Power Water is the ultimate ergogenic aid--but because the body has a poor thirst mechanism, you must drink before you feel thirsty. Once you are thirsty you are already slightly dehydrated, and your performance will be diminished. To stay well hydrated, you need to drink about a quart of caffeine-free, nonalcoholic fluids for every 1,000 calories of food you eat, assuming you maintain your weight. To ensure that you are well hydrated before you exercise, drink 2 cups of water or sports drink 2 hours beforehand. To avoid dehydration during exercise, begin drinking early and at regular intervals. For exercise lasting an hour or less, 4 to 6 ounces of cool water every 15 to 20 minutes provides optimal fluid replacement. During exercise that lasts longer than 60 minutes, carbohydrate-electrolyte beverages containing 5% to 8% carbohydrate should be drunk at the same rate

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to replace fluid and spare muscle glycogen. Also, consuming sports drinks during intense activities such as soccer or basketball may enhance performance. After exercise, replace every pound lost during exercise with at least 2 cups of fluid.

The Ergogenic Future The search for energy-giving food substances is widening. Alongside old standards like caffeine and herbal stimulants stand newly researched substances like capsaicin, the active ingredient in hot red chili peppers. One study showed that runners who ate a breakfast laced with 10 grams (about 1/3 of an ounce) of dried hot red pepper powder burned carbohydrates faster, both at rest and during exercise (2). These results are preliminary and tentative, but they raise the question whether designer ergogenic foods may be in our future. Until then, you'll find the staples of your ergogenic diet in the food aisles of your local supermarket.

References 1. Dimeff RJ: Sports nutrition, in Johnson RJ, Lombardo JA (eds): Current Review of Sports Medicine. Philadelphia, Current Medicine Inc, 1994, vol 15, pp 201-221 2. Lim K, Yoshioka M, Kikuzato S, et al: Dietary red pepper ingestion increases carbohydrate oxidation at rest and during exercise in runners. Med Sci Sports Exerc 1997;29(3):355-361

Remember: you, your physician, and your nutritionist need to work together to discuss nutrition concerns. The above information is not intended as a substitute for appropriate medical treatment. Dr Kleiner is a private nutrition consultant to athletes in the Seattle area. She is a member of the American College of Sports Medicine; a member of the American Dietetic Association and its practice group, Sports and Cardiovascular Nutritionists (SCAN); and a fellow of the American College of Nutrition. Copyright (C) 1997. The McGraw-Hill Companies. All Rights Reserved

Power Foods for the Busy AthleteDate: Wed, 16 Feb 2000From: Brian DougherThis came from a seminar put on by a Doctorate Candidate from University of Rhode Island that I attended about eating right as a college athlete. There is a neat one about eating while on the road that I will try next. It will be mostly for the USA coaches and potentially Canadian coaches if you have these restaurants. I will have send out more of the hand-outs a bit at a time.

Power Foods for the Busy AthletesFast Food On-the-Go...To Go!

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Developed by:Kathy Andersen, MS, RDDayle Hayes, MS, RD

* At Home 1. Stock up on bread, bagels, English Muffins, pita bread, and low-fat fillings such as fruit spreads or lean deli meats for a handy sandwich on the run 2. Toss up a pasta salad ahead of time and store in the fridge for a quick after-school snack 3. Keep crackers and low-fat cheese ready for quick snacks 4. Use the microwave to zap a pizza; melt mozzarella cheese on a flour tortilla and roll with salsa; nuke some water for instant soup; or bake a potato

* In your Locker 1. Pack your favorite dry cereal for munching between classes or before practices 2. Store some nuts and seeds like peanuts, pistachios, almonds, sunflower seeds, or pumpkin seeds 3. Crunch on Teddy Grahams, ginger snaps, fruit newtons, and low-fat crackers 4. Munch a muffin - corn, bran, blueberry

* In your Gym Bag 1. Hit the trail with your favorite mix cereals with raisins, dried fruits, nuts, and cinnamon 2. Load up on fresh fruits - apples, oranges, bananas (nature's original fast food) 3. Gulp 100% fruit juice for thirst quencher 4. Pack peanut butter and jelly sandwiches for after practice snacks

* On the Team Bus 1. Pack plenty of dried fruit - raisins, apples, apricots, peaches – for concentrated carbohydrates 2. Pop up some corn before hitting the road - eat it plain or sprinkle with spices such as chili powder, garlic powder, onion powder, or soy sauce 3. Fill coolers with plenty of fruit juice, sport drinks, skim or low-fat milk, and water 4. Fuel up with carbohydrates like baked tortilla chips, pretzels, bagel, flavored saltines, rice cakes, vanilla wafers, and reduced-fat crackers

Nutrition for Soccer PlayersDate: Sat, 7 Sep 2002From: Mark A. Morin

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Dan Nabben gave great advice for the majority of players we coach: "The deal with drinking is very simple. When your body heats up, it uses water to cool off. Therefore the best way to replace this lost water can only be with water."

However, some modern research tends towards the superiority of some drinks other than pure water for older players who are exercising for over sixty minutes. In "Optimal Muscle Recovery", Edmund R. Burke, PhD has "Restore Fluid and Electrolytes" as the first pillar of his R^4 system. Under a section on rehydration, he points out that thirst is dependent on two factors: the body's blood volume and the concentration of salts, or electrolytes, in the blood.

When we lose fluids during exercise through sweating, our blood volume decreases. One result is a corresponding increase in the concentration of electrolyte in the blood--which stimulates thirst. He says, "when you drink plain water, you usually satisfy your thirst before you have actually consumed enough liquid to return blood volume and electrolyte concentrationsto pre-exercise levels." (For very long term exercise bouts [>4 hours] he mentions problems of water intoxication from just drinking water.)

"Recent research has shown that (your) body absorbs more fluid when electrolytes such as sodium are added to water." One study had people get mildly dehydrated. "Each volunteer then drank either water or a water and sodium solution to replenish fluids. During the three-hour rehydration period, subjects who drank water alone restored 68 percent of the fluid they lost, while subjects who drank the sodium solution replaced 82 percent of their lost fluids."

He said, "Subjects who drank plain water satisfied their thirst quickly for two reasons. First, water intake caused blood volume to increase, which eliminated the volume-dependent element of thirst. Second, plain water diluted sodium in the blood, resulting in a decrease in sodium concentration within 15 minutes. In this case, the body 'shuts off' thirst to keep sodium concentrations within healthy limits. Thus, the dilution of sodium eliminated the salt-dependent element of the thirst drive." When sodium was added, the salt-dependent factor of the thirst drive was maintained--motivating the subjects to drink more.

His recommendation was 75 milligrams of sodium for every 8 ounces of fluid. He says this will add to the "flavor of the product" and encourage players to drink more as well. Although he doesn't give specific recommendations here (that's what the rest of the book is for), he wrote that according to the "American College of Sports Medicine consensus conference, carbohydrate should be an ingredient in rehydration drinks in addition to electrolytes. Research has shown that carbohydrate and sodium work together to increase water absorption in the intestinal wall. Carbohydrate's component glucose molecules stimulate sodium absorption, and sodium, in turn, is necessary forglucose absorption. When these two substances are absorbed by theintestines, they tend to pull water with them, thus facilitating the absorption of water from the intestines into the bloodstream."

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His bottom line:"--Water is a good source of replenishment for exercise lasting less than one hour. However, sports beverages, which are formulated to encourage continued consumption, and to replace carbohydrate and some protein, aremore effective fluid replacements.

--Drink up to 12 ounces of a sports drink fifteen minutes before exercise or competition. This drink should provide sufficient amounts of electrolytes, as shown below. Continue to replenish fluids by drinking 4 to 8 ounces ofyour sports drink every ten to fifteen minutes during your event or training session."Sodium 75-250 mgChloride 45-75 mgPotassium 200-330 mgMagnesium 100-400 mg

Fast Food’s Best BetsPosted Wed, 29 Mar 2000 from an earlier article

Nutrition for athletes: Fast Foods Best Bets

By Nancy Clark, MS RD

Fast foods are her to stay, and thankfully many of today's quick service restuarants offer some healthy, low fat options. Athletes can actually choose a decent sport diet at most places if they make wise choices.

It also is important to have on hand foods with supplemental carbohydrates, such as apples, oranges, pretzels, fig cookies, bagels, pitas, crackers, raisins, dried fruits, juice boxes, sports bars, or granola bars. That way, an athlete who succumbs to the fast and fatty options at least is able to add on the carbohydrates the muscles need for energy.

The best bets for fast-foods-that-fuel include the following options at quick-service restuarants:

Best Fast Food Breakfast Bet: McDonald's offers a tasty sports breakfast; pancake/syrup, orange juice and milk. Hot cocoa is an appealing choice for higher carbohydrates than coffee. Or choose cold cereal, juice and a muffin or englich muffin with jelly.

Best Bagel Breakfast Bet: Find a deli or bagel with whole-grain bagels, fresh fruit, juice and yogurt. A little low-fat cream cheese and and/or jam can complete the meal.

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Best Hotel Breakfast Bet: Save yourself time, money and temptations by bringing your own cereal, dried fruit and spoon. Either pack powdered milk or buy a half-pint of milk at the corner store. Use water glass or the milk carton for the cereal bowl.

Best Sandwich Bet: Seek out a deli that offers a sandwich with more bread than filling. For example, a large submarine roll provides far more carbohydrates than a small pita. "Hold the mayo" and add moistness with lite salad dressings (if available), mustard or ketchup, tomatoes and lettuces. The best meat fillings are turkey, ham and roast beef.

Best Soup Bet: Hearty bean soups, including minestrone, lentil and split pea soups, accompanied by crackers or crusty rolls, provide a satisfying carbohydrate-rich low-fat meal. Chili, if not glistening with a layer of grease, also can be a good choice. For example, a Wendy's large chili with eight saltine crackers provides about 400 calories, of which only 25 percent are from fat. Ideally, meals should be less than 30 percent.

Best Chicken Sandwich Bet: Grilled Chicken sandwiches are fine, except for the special sauces. The 29 grams of fat in the Burger King BK Broiler makes it almost as fatty as a double cheeseburger. Request no mayo or wipe it off.

Best Burger Bet: If there is no eatery that offers more than just burgers and fries, then make the best of a bad situation. With an order for a burger, request an extra roll or extra bread. Squeeze the grease into the first roll, and then replace it with a fat-free one. Boost carbohydrates with fluids such as juice, soft drinks and low-fat shakes. Enjoy the high carbohydrate snacks (pretzels, fig bars) for dessert. Athletes with big appetites should order two small burgers (each with a roll) rather than a double burger with one roll. It is better to get more carbohydrates with two rolls while paying a similiar price.

Best Red Meat Bet: Better than burgers, satisfy a craving for meat with a lean roast beef sandwich. At only 260 calories, a Roy Rogers Roast Beef Sandwich (4 grams of fat) is preferable to the 260 calorie McDonald's hamburger (10 grams of fat)

Best Salad Bar Bet: At a salad bar, be generous with colourful vegetables, chick peas, kidney beans, pasta salads and hearty breads, and carefully choose lite dressings. Beware of Caesar salads, For example, Boston Market's Chicken Caesar Salad with 4 tablespoons of dressing totals 670 calories, of which 2/3 are from fat (47 grams). A chicken breast (without skin) corn bread, steamed vegetables, and dill potatoes totals only 15 grams of fat and 570 calories.

Best Baked Potato Meal Bet: The helpful hint is to order two potatoes, one plain and one with toppings. For example, at Wendy's by splitting the broccoli and

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cheese topping (14 grams of fat) between two spuds, an athlete has a hearty 770 calorie carbohydrate-based meals that fuels the muscles. For added protein, drink a glass of low-fat milk.

Best Pizza Bet: Order a pizza that is thick with extra crust rather than cheese. The more dough, the more muscle fuel. For example, one slice of Pizza Hut's Pan Pizza (260 calories) has 10 more grams of carbohydrates than does a slice of its Thin 'n Crispy variety (200 calories). Pile on vegetables for a vitamin boost. Blot off any grease with a napkin.

Best Chicken Dinner Bet: Roasted, rotisserie or grilled chicken meals are generally preferable to fried chicken meals. No matter the manner of preparation, it is important to abstain from eating the skin. By removing the skin and wing from Kentucky Fried Chicken Rotisserie Gold Quarter breast, you remove 13 grams of fat and 115 calories. If fried chicken is the only option, order the larger pieces, peel off the skin and eat just the meat. For carbohydrates, order extra rolls, corn on the cob, potatoes or baked beans; include nutrient-rich carrots, squash, spinach or broccoli. Although the vegetables are sometimes buttery, the extra fat from the butter can be balanced by eating lower fat foods at other meals.

Best Dessert Bet: Low-fat frozen yogurt is fun, refreshing and carbohydrate rich. Frozen yogurt may be a best bet for dessert, but do not think of it as a meal replacer. Regular yogurt has far more nutritional value.

Carbohydrates for the Traveling Athlete

"Carbs to Go: Tips for the Traveling Athlete" by Nancy Clark, M.S., R.D. SportsMedicine Systems, Inc. who also authored the Sports Nutrition Guidebook.

CARBS "TO GO" - TIPS FOR THE TRAVELING ATHLETE

Athletes who travel have an added challenge - finding adequate carbohydrate-rich meals/snacks in restaurants, delis, and fast-food places. Although a high carbohydrate sports-diet is important during training and before competition, all too often when you're traveling, you succumb to convenience, and dine on whatever is easiest at that moment.

Here are a few tips for eating on the road.

BREAKFAST:

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1) In a restaurant, order pancakes, French toast, whole wheat toast, bagels, bran or corn muffins. Add jelly, jam or syrup for extra carbohydrates, but "hold the butter" (or request it be served on the side). 2) Order a LARGE orange juice for extra Vitamin C and potassium. This can compensate for a potential lack of fruits or vegetables at other meals. 3) You may want to save time and money by packing along your own cereal, raisins and spoon (A water glass can double as a cereal bowl). Either bring powdered milk or buy a half-pint of low-fat milk at a local convince store.

LUNCH: 1) Find a deli/restaurant that offers wholesome breads and request a sandwich that emphasizes the bread rather than the filling. "Hold the mayo" and instead use mustard or ketchup, sliced tomatoes and lettuce for moistness. Add more carbs with yogurt for desert, juice, fruit or fig newtons (brought from home). At fast-food restaurants, the burgers, fried fish and French fries have a very high fat content. You'll get more carbs by sticking to the baked potato, chili, thick-crustpizza or salad bar. Request extra bread or rolls. 3) At a salad bar, generously pile on the chick peas, three-bean salad, toasted croutons. Carve off a slab of bread but don't "fat-load" on salad dressings and mayonnaise-smothered pasta and potato salads. 4) Baked potatoes are a super choice if you request them plain rather than drenched with butter, sour cream and cheese toppings. For moistness, try mashing the potato with milk (special request) rather than butter. 5) Hearty soups (i.e. split pea, minestrone, lentil, vegetable, noodle) accompanied by crackers, bread, plain bagel, English muffin or corn muffin provide a satisfying carbohydrate-rich, lowfat meal. 6) Although soft drinks are carbohydrate-rich, fruit juices are preferable sources of carbs, Vitamin C and potassium.

DINNER: 1) Patronize the restaurants that offer wholesome carbohydrates (pasta, baked potatoes, rice, steamed vegetables, salad bars, homemade breads, fruit, juice); broiled foods and lowfat options. 2) Request THICK-CRUST pizza (with veggie toppings) rather than thin crust with pepperoni or sausage. 3) Enjoy the bread/rolls either plain or with jelly (special request). Replace the butter calories with another slice of bread, a second potato, soup and crackers, juice or sherbert - all carbohydrate-rich choices. 4) When ordering salads, always request the dressing be served "on the side". Otherwise, you can get as many as 400 calories of oil/mayonnaise - fatty foods that fill your stomach but leave your muscles unfueled.

SNACKS/MUNCHIES: 1) Pack your own goodies grab-bag. Some suggestions include - whole grain bagels, muffins, rols, crackers, pretzels, fig newtons, oatmeal raisin cookies, granola, raisins or dried fruit, etc.

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2) Buy wholesome snacks at the convenience store - small packets of trail mix, raisins or dried fruit, yogurt, V-8 juice or fruit juice, a hot pretzel, cup of soup or hot cocoa.

In addition, Kristine L. Clark (no relation?), Ph.D., R.D., member of the editorial board of the Penn State Sports Medicine Newsletter, states the following (Vol.5, No.7, March, 1997):

On pre-game eating: Athletes make the mistake of not consuming enough fluids. That is always an issue. Also, they should eat a balanced meal about four hours before competition and a pre-game snack an hour before game time.

On after-game eating: Don't wait too long after a game to eat. Take in carbohydrate-rich foods within two hours after intense exercise. It doesn't matter whether you take in solids or liquids. After exercise, you can eat almost anything you want. Sports drinks and juices are beneficial for rehydration as well as providing carbohydrates.

FOODS HIGHEST IN CARBOHYDRATES

For health and performance reasons, you should try to choose wholesome, carbohydrate-rich foods for both your daily training diet and for pre-competition meals. Here are some suggestions:

Spaghetti, Macaroni, Noodles - Top the pasta with tomato sauce to add more carbohydrates. If you choose an oil, meat, butter or cheese sauce, you may end up "fat-loading" rather than carbohydrate-loading.

Rice - Steamed or boiled rice is preferable to Chinese fried rice which is saturated with oil and fat-calories. When possible, choose brown rice; it has more wholesome nutrition than white rice.

Potato, Sweet potato, Yams - Limit the fatty french fries but enjoy potatoes that are baked, boiled or mashed. Add moistness to a baked potato by mashing it with milk or topping it with plain yogurt in place of sour cream, butter or gravy.

Stuffing - A tasty, carbohydrate-rich change from pasta and potato. Plus, the bags of pre-seasoned stuffing are very quick and easy to prepare; just add hot water (along with apples and raisins if desired).

Cous-cous, Millet, Bulgar, Kasha - Wholesome alternatives to the standard dinner starches. A creative addition to meals, casseroles.

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Dried beans, Lentils, Peas - Chili with beans, split pea soup, lentlls, baked beans, limas,other beans and legumes are excellent sources of both carbohydrate and protein. Caution - large portions may lead to digestive problems!

Breads, Rolls, Bagels, Tortillas - Try to choose dark, hefty products made from whole wheat flour, oatmeal and other whole grains, in order to get more fiber and nutritional value than offered by the refined, white breads. Add butter sparingly (if at all) so that you fill up on bread (carbohydates) and not the butter (fat).

Pretzels, Popcorn (unbuttered), Crackers - Those low-fat snacks are preferable to greasy potato and corn chips. Stoned wheat crackers, Rye crisp and other wholesome, low-fat brands are preferable to Ritz, Wheat thins, Triscuits and other crackers that contain a lot of oil and leave you with greasy finger tips. When making popcon, use an air-popper or else pop the kenels in very little oil. Commercially baged popcorn or the brands designed for microwave ovens generally contain at least half the calories from fat. Even the "lite" brands can be deceptively high in fat, relatively low in carbohydrate.

Hot Cereal - Unrefined cereals, such as oatmeal, Wheatena and Maltex offer wholesome goodness. Cream of wheat, although refined, offers lots of iron (Note: much more important for female athletes as opposed to male athletes, too much iron is detrimental to most males). You might want to either mix the brands (i.e. Wheatena and Cream of wheat) or alternate cereals during the week in order to boost your iron intake. Add raisins, banana, dried fruit and brown sugar or maple syrup for extras carbohydrates. Oat bran is a hot cereal that's particlularly in that it lowers blood cholesterol and helps protect against heartdisease.

Cold Cereal - Rather than puffed or flake-type brands, choose the dense cereals such as Grape-nuts, muesli, Wheat Chex, raisin bran or bran flakes. The fiber-rich brands can help protect against constipation. Serve cereal with bananas, raisins and other fruits. Drink orange juice to enhance the absorption of iron from the iron-enhanced brands (raisin bran, Wheat Chex, Wheaties, etc.).

Muffins, Corn bread, Banana bread - For extra carbohydrate and less fat, spread with jam or honey rather than butter or margarine.

Pancakes, Waffles, French toast - Top with aditional carbohydrates such as maple syrup, bluebery sauce, honey, applesauce or jam - but use butter/margarine sparingly.

Fruit - Dense fruits such as banana, pineapple, raisins, dates, apricots and other dried fruits ofer much more carbohydrate than watery fruit (such as grapes, plums and peaches). Don't try to carbo-load on too much fruit - you may end up with diarrhea!

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Juice - Apple, pineapple, cranberry, cran-raspberry, grape, apricot nectar and other fruit nectars ofer more carbohydrates than orange, grapefruit and tomato juice. You can increase the carbohydrate value of frozen orange juice by simply diluting it with less water than the directions suggest. Fruit smoothies (made by mixing fruit and juice in the blender) are excellent, carbohydrate-rich drinks.

Desserts - Although many desserts such as cheesecake, ice cream and rich cookies are made with lots of cream, buter and shortening (and thereby offer primarily fat-calories), you can carbo-load on lower-fat (and more nutritious) alternatives such as apple crisp, blueberry cobbler, brown-rice pudding, date squares, fig newtons and oatmeal raisin cookies.

Ice Milk, Sherbert, Sorbet, Juice bars - These are lower fat alternatives to ice cream. If you must have ice cream, remember that the less expensive brands have more carbohydrates than the more expensive (i.e. fatier) gourmet varieties.

Nutrition and Soccer Games, Tournaments and PracticesDate: Wed, 10 Feb 1999From: Phillip Blansett

Recently someone asked about guidelines for game days and tournament days.

I'm sharing some material below that is written by Barbara Day, M.S., R.D., C.N., and can be found in its entirity in Soccer magazine's Jay/June 1996 issue beginning on page 14.

Before that, however, a note about my research on calories burned at practice. The average 2 hour intense practice burns 2,000 calories! If an average youth burns an average 3000 calories a day, and eats an average 3000 calories a day .... and then goes to practice and burns an additional 2000 calories at practice, he has a deficit of 2000 calories for that day.

Research shows that if calories are replaced within 30 minutes of practice ending, they are stored as muscle and not as fat. Beyond that they are passed through the body as waste or are stored as fat.

Barbara Day says:

... eating a series of small meals or snacks rather than three normal meals may be necessary for maintaining optimal energy levels... the big meal may have to wait until the end of the day when the games are completed...

...The amount and type of food eaten are primary considerations...

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Soccer players need at least four hours to digest a large meal containing 700-1000 calories...

Three hours are needed to digest a smaller meal of 500-700 calories.

Small snacks of fewer than 300 calories can be digested in less than one hour depending on the type of snack with those high in carbohydrates and low in fat digesting most easily and quickly.

LIQUID MEALS SUCH AS ENSURE of 300-500 calories digest in one to two hours and are helpful for players who are nervous or anxious about tournament competition or who have sensitive stomachs, however some players report that too much liquid sloshes around in their stomach making them nauseous.

She further advises that for morning games soccer players should eat a hearty, high-carbohydrate dinner and a bedtime snack the night before the event. Breakfast could be a bowl of cereal (NOT high fiber cereals) with skim or low fat milk, toast or English muffin with jelly, fruit juice and hot chocolate, keeping calories under 300 and eating foods high in carbohydrates. Breakfast should be eaten 2 hours before the game, or at 6am for an 8am game.

For afternoon games she suggests players eat a carbohydrate-rich dinner and a bedtime snack the night before. A carbohydrate-rich breakfast of no more than 500 calories followed FOUR HOURS LATER by a light lunch of less than 300 calories eaten 2 hours before the game.

For evening games, players should eat a carbohydrate-rich breakfast and lunch followed by a light snack of fewer than 300 calories. Breakfast and lunch should be planned four hours apart (9am and 1pm for example).

The light snack could be served at 5:30pm before the 730 match, eating the snack 2 hours before the match.

In all cases, drinking lots of fluids.

Now for all day competition, use 300 or 500 calorie meals depending on when the first and second games occur. That is, if the first match is at 10am, eat 300 calories by 8am if the next game is at 2pm eat another 300 calorie meal by noon. But if the second game isn't until 4pm, then a 500 calorie meal could be eaten immediately after the first game.

She suggests weighing each player first thing in the morning on tournament days and at the end of the day to determine dehydration. For each pound of weight lost during the day the player should drink 16 oz (2 cups) of fluid to prevent further dehydration.

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Tournament NutritionDate: Wed, 11 Aug 1999From: Connie T. MatthiesTell your parents to start hydration and carbo loading the day before (so, no pop or caffeine of any type; tons of water and sports drinks; and lots of carbos, such as pasta, pizza, baked/mashed potatoes, etc.). Have them get the kids up around 6am to eat a breakfast of oatmeal or other "stick to the ribs" cereal, along with melons (high in potassium) and more sports drink). Tuck them back in to snooze, then get them up again around 7:30am and force diluted sports drinks/water into them from then on. You want them all to want badly to hit the potty just before game time (good sign of good hydration).

During the game, watch for overly-flushed faces or very pale faces. If someone is NOT sweating, get them into the shade very quickly and send somebody to the First Aid tent (as the child may be suffering from heat stroke - which is life-threatening). Also watch for nausea and light-headedness (the first signs of heat-related problems), and pull those kids into the shade to get them cooled off. Consider bringing along a garden sprayer filled with ice/water, to use to spray down the kids and keep them cool. At every chance, make sure that the kids take in tons of liquids.

After your first game, get in the shade (but stay outside so that they don't get shocks to their systems from air conditioning). Give them mixed fruits (melons/grapes/etc.), along with sports drinks. Some may want more food (although lots of kids don't have much appetite when hot). Give graham crackers to the hungry ones, up to 1 hour before game time (then it is just sports drinks). Make absolutely certain that every child consumes at least one full quart of diluted sports drink (50/50 with water) - unless really small, most should have more than this.

Repeat the above during/after your 2nd game (but eliminate the graham crackers - not enough digestion time).

After your last game, be sure to tell the parents that the critical muscle recovery time is 2-3 hours after exercise, and the kids should be drinking sports drinks and doing carbo loading during this time. Push the parents and kids to order pizza or pasta, and chow down within the next 2 hours or so. The kids probably will be pooped, and the parents may be tempted to let them nap (rather than eat). However, from a muscle recovery standpoint, they need to get those carbos into their systems early (even a little snack will be better than nothing). Once again, the parents need to be sure that the kids avoid all pop/caffeine, and just drink water or sports drinks.

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Some other tips - bring plenty of towels/blankets to sit on (the kids will be dripping wet); bring extra socks/underwear/shorts/shirts (and shoes, if you have them); bring sandals to wear between games to let the socks/shoes dry out; and beg/borrow as many big water jugs as you can (you will be amazed at the amount of water which kids will go through on a hot day). If you have an energetic bunch of team moms, they can even prefill some ziploc sandwich bags with water - so that you can toss these out to the kids at any stoppage.

Locate a place where you can refill your water jugs between games (lots of convenience stores are very nice about letting you use their faucets if you buy ice and other supplies from them) - and also locate shady areas near the fields where you can sit between games (these will fill up early - so you may want to put down blankets to stake your claim to some of the shade). If no shade is available, ask if anybody on the team has a canopy shelter. If not, buy one (they usually cost around $15 at Walmart). If you want to splurge, there are high-end canopies for around $100-150 from Academy sports and other places which have built-in legs/supports.

Hope this helps - as diet is going to be less important than hydration and shade,

Nutrition – Multiple Games with Minimal Rest and RecoveryDate: Wed, 19 Jan 2000From: Gary Rue

Recovery...Multiple Games with Minimal Rest and Recovery

By Dr. Don Kirkendall

I know Cam Rast, assistant coach with the University of Santa Clara. A good guy, an upcoming star in the coaching ranks and I was pulling for them when they made the final four of college soccer.

However, after their four-overtime win over UConn, I told my wife that their chances were slim, that they would have a hard time recovering before the semifinal. Like last year when the UNC women went four OTs in the semifinal, their fate was sealed as much by the semifinal OT win as much as their final opponent.

But then, Indiana went four OTs to defeat UCLA, so, in a sense, the two finalists would be playing on a "level field" as both had gone equally long to mach the final. However, practically everyone knew that the quality of play wouldn't match the semi's because both teams would tire as the game wore on, players would be going down with cramps, and play would be very spread out due to fatigue.

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The schedule called for another running game in less than 48 hours and begs the question about how does one prepare for another contest with so little time to recover. I have written in the past that one of the impressive features of the well-trained soccer player is their ability to perform one high intensity run and recover quickly to do it repeatedly. This aspect of recovery involves other aspects of training and nutrition.

Fatigue

Probably the first thing to consider is this concept of fatigue. For the exercising athlete, the best definition of fatigue is "the failure to maintain an expected power output." You want to run fast and far, but you cannot.

The reasons why a player cannot muster the speed or distance are complicated. Virtually every step in the process of muscle contraction has been studied from the brain down to the cross bridges in the muscle and every step can be a culprit for fatigue.

In soccer, the primary factor in fatigue has been linked to a lack of fuel for the exercising muscle. This fuel is glycogen - the muscle's storage form of glucose. Multiple studies have shown that as muscle glycogen levels decrease, the volume and intensity of running in soccer decreases.

Muscle Glycogen

The goal is make sure that the muscle is adequately filled with glycogen. Training and appropriate nutrition can ensure adequate stores of glycogen. While the trained athlete should have more muscle glycogen than non-athletes, early studies from Sweden have shown that the glycogen levels of the typical professional soccer player was hardly any different than their spectators.

This was a result of their training/ game schedule and improper food choices. It typically takes about 24-48 hours after exercise to refill the muscle with glycogen, assuming die proper food choices.

In addition, the timing of food in- take is critical. The muscle is most receptive to storing glycogen when it is most "hungry" for carbohydrate - right after exercise. Muscle stores more glycogen faster in the first two hours after exhausting exercise. Wait later and the rate of replenishment slows.

So, the questions are what to eat, how much to eat, and when to eat. The foods to choose are those high in carbohydrate. The body really does not care what form is ingested because it will all be broken down to glucose anyway.

Post Game

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On the side of the field or in the locker room is where preparation far the next game begins. Starchy foods, candy, carbohydrate replacement drinks (not sodas), fruit drinks, dried fruits mm all - choices. A good recipe I heard once was Chex Mix minus the oil and baking. Just mix up the ingredients and let players eat it by the handful after the game.

Candy is good, but the best choice is what might he called "clear candy" (like Skittles, jelly beans, Gummi-candy) - you get die idea. These have less fat than chocolate candy, but even candy bars are OK.

Carbohydrate replacement drinks (different from fluid replacement drinks; Gatorade and GatorLode are not the same thing).

Do not pass up this incredibly important time period. The stage for the next game is set in the locker room after the first game.

Post Game Meals

After leaving the locker room, a meal is usually consumed and the choice of foods is critical. Your parents may like Dr. Atkins, but you should not follow those guidelines. Choose foods high in carbohydrate and low in fat. That means stay away from red meat and fried foods and heed for the pasta, baked potatoes, sweet potatoes, corn, carrots, bread (especially daily cornbread, bagels, muffins) with jellies/jams, rice, fruits, desserts (like fruit pies, ice cream).

Your coach may be paying for it, but that does not mean you choose the prime rib or the 8 oz. burgers, your calories need to be carbohydrates. Subsequent meals should also follow similar logic.

After meals, snacks should again focus on carbohydrates. That Chex Mix, fruit, clear candy, ice cream and milkshakes (fast food chain note: if the sign says "shake" it doesn't have enough milk to be called a milkshake. Search out hand-dipped milkshakes instead).

The research generally suggests that an athlete by to eat 450-600 grams of carbohydrate in 24 hours. The typical person today eats about half that, so to eat that much carbohydrate requires some thought.

Cramps

You no doubt saw a number of players with cramps in both the semi- finals and finals. The actual mechanism of a cramp is a tough thing to define. Again, any step in the process of muscle contraction can be blamed for a cramp.

What is known is that many steps require the movement of the electrolytes sodium, potassium and chloride across cell membranes for proper function.

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These membranes include neurons, muscle cells, and membranes within the cells. These movements are based on concentration differences across membranes, and concentration is the number of particles in water.

Thus, we hear the frequent call that the cure for cramps is drinking water with electrolytes. While l am skeptical that a person with cramps can make them go away by drinking a fluid/ electrolyte drink, I do think that you can make yourself more resistant to cramping with adequate water/electrolyte intake.

We have all heard everybody is supposed to drink eight 8 oz. glasses of water a day. Athletes sweat, so they need to ingest even more water. The best way to know how much to take in is to weigh before and after play. The replacement formula is 1.5-2 pints/pound of weight lost.

This usually cannot be done in one sitting, so spread it out - add this to the normal half gallon of daily water intake. You usually get enough electrolytes in food and you might naturally add some salt to your menu, but a commercial fluid/electrolyte drink can also be useful. While I have no data to support this, a player who enters the next game weighing less than they did for the first game could be at risk for developing cramps.

To Summarize

Make sure you go into the first game with full glycogen stores, are fully hydrated, and weigh in. After the first game, weigh again, Start eating lots of carbohydrates in the first 2 hours and figure out how much extra fluid you need. The remaining meals should be predominately carbohydrates--so choose foods wisely. You probably will not be training much, so you do not need to be concerned about exercise draining your fuel stores.

Date: Fri, 21 Jan 2000From: Dennis MuellerAs a once-upon-a-time serious distance runner, I can echo Gary's advice.

Energy stores (carbohydrates) are important in any athletic event of a significant duration. (Probably essential for anything equivalent to a 5k and up run, a full 90 minute soccer match is about a 10k for a midfielder and probably a 5k even for a relatively lazy forward. When the distance climbs to about 20 miles carbo reserves will be exhausted and most athletes are reduced to a shuffle.) Most soccer players ingest enough food to make this not too much of an issue, except when multiple competitions are closely spaced.

Cramps are most often related to fluid loss or electrolyte imbalance. Your stomach can absorb only about 8 oz of water per hour, but you can sweat over 6 pints in that same hour. Avoiding fluid loss while competing in

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warm weather is impossible; fluids must be ingested in quantity for about 24 hours before the event (clear pee is a good sign). A good booster is to ingest 16 oz of water just before competition and 8 oz every 1/2 hour, so you can repay at least a small amount of the fluid loss while competing. (Some individuals do not tolerate anything in their stomach while exercising vigorously; this needs to be tried in practices both to see how well it is tolerated and to "train" the system to handle a "sloshing" stomach.) Electrolytes are a bit more tricky. Personally, I found that using a daily multiple vitamin with minerals was much more effective than any of the commercial electrolyte drinks taken on the day of competition. (Most of the potassium can come from the high carbo-food, calcium from milk, most others can be supplemented with a pill.)

Helping Athletes Survive Two-A-Day PracticesDate: Wed, 29 Mar 2000From: Brian Dougher

---STAY COOL---1. Get in shape and acclimate2. Know the warning signs of dehydration and heat illnesses3. Don't rely on thirst to drink4. Drink on schedule5. Favor sports drinks6. Monitor body weight7. Watch urine color and volume8. Shun alcohol and caffeine9. Key on meals10. Stay cool when you can

From: Eichner, E.R. (1998). Treatment of Suspected Heat Illness. Int. J.Sports Med. 19:S150-S153

---STAY HEALTHY---1. Minimize the stresses of life2. Eat a well balanced diet3. Avoid overtraining4. Sleep well5. Avoid rapid weight loss6. Avoid sick people and large crowds7. Keep hands away from nose and mouth8. Get a flu shot9. Key on meals10. Stay hydrated and ingest carbohydrates during exercise

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From: Niemen, D.C. (1998). Immunity in Athletes: Current Issues. SportsScience Exchange 11(2):1-6.

---STAY HYDRATED---1. Drink throughout the day (water, sport drinks, fruit juice,non-caffeinated soft drinks)2. Drink at least 16 oz. two hours before a practice or game (to allow timeto urinate)3. Drink another 8 oz. 15 minutes before exercise (to help assure immediatehydration)4. Drink to fully replace sweat loss during exercise (at least 4-8 oz. every15 minutes)5. Drink 24 oz. for every 1 lb of weight deficit after exercise.

From: American College of Sports Medicine (1996). Exercise and FluidReplacement. Med. Sci. Sports Exercise 28(1):i-iiv.

HydrationDate: Fri, 11 Jun 1999From: Shaun GreenThis information is taken from our PREMIER CD, hope this helps.------------------------------------------------------------

WHAT YOU NEED TO KNOW ABOUT FLUID

Don’t wait until you’re thirsty. Drink fluids before, during, and after exercise toreplace fluids lost as sweat.

At one time athletes mistakenly thought it was a good idea to limit their water intake. We now know that this is very dangerous.

What does Water do for you ?

Water is an important nutrient for athletes. Water makes up 60 percent of your total body weight and 70 percent of your muscles. Without enough water, you can’t work at your top level of performance. And you may even harm yourself. Water cools your body. As you exercise, your body temperature increased (even when it’s cold outside). As your temperature increases, you sweat. When the sweat evaporates from your skin, your body cools down.

What Happens Without Water ?

Dehydration. If you start exercising without having enough water in your body,

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or if you sweat during practice and do not replace the water lost, you may become dehydrated. You can become dehydrated even when you lose just a few pounds as sweat. Once you become dehydrated, you can no longer sweat and get rid of the heat that builds up in your body.

Dehydration can be dangerous. The first symptoms of dehydration include thirst,chills, clammy skin, throbbing heart beat, and nausea. When you become more dehydrated, you may develop a headache, cramps, shortness of breath, dizziness, and/or dryness in the mouth.

At the most serious level of dehydration, you can experience hallucinations, deafness, visual problems, swollen tongue, and/or kidney failure.

How can you avoid Dehydration?

· Drink plenty of cool fluids before, during, and after practice and competition. Even if you don’t feel thirsty:- Drink 1 to 1 1/2 cups of cool fluid 15 minutes before competition or practice.- Drink 1/2 cup of fluid every 10-15 minutes during the event.

· Don’t rely on thirst alone as a guide to how much water your body needs. Weigh yourself before and after exercising. For every pound lost as sweat, drink two cups of fluid.

· Avoid salt tablets. Too much salt increases your body’s water needs. Salt tablets can also irritate your stomach and cause nausea.

· Avoid working out in plastic or rubber suits. They can cause serious dehydration, limit your performance, and lead to heat exhaustion and heat stroke.

What happens if your sweat doesn't evaporate?

For your body to cool down, two things must occur. You must sweat. And the sweat must evaporate from your skin. If the sweat doesn’t evaporate quickly enough to cool your body down, you can become overheated. This can happen when the weather is hot and humid or when you are wearing heavy gear. You can avoid problems by following these tips when exercising during hot, humid weather:

· Exercise at the coolest time of the day--early morning or late evening. Avoid the middle of the day when the temperature is usually the highest. If you must practice then, build up your tolerance to heat by working out for a short time each day. Gradually increase the length of each workout.· Wear the lightest clothing and equipment you can. Mesh jerseys, lightweight shorts, and low-cut socks allow more sweat to evaporate than sweat suits and heavy gear.

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· Drink plenty of water before, during, and after practice and competition.

When you exercise in cold weather, your body still sweats. To keep warm and still allow the sweat to evaporate, wear several layers of loose clothing. Layers of clothing will trap the warmth from your body while absorbing your sweat.

Date: Fri, 11 Jun 1999 13:31:16 -0500From: Michele Freeman <ssdmrf@TTUHSC.EDU>Subject: Re: Prep: Hydration

These are some recommendations for hydration from a Sports Medicine physician that we use during the hot months:

Fluid Loading: Two days before the tournament, have your child drink at least 8 oz (1 cup) of water or sports drink every 1 to 1.5 hours while awake. This causes a total saturation of all the soft tissues of the body and significantly reduces the chances of dehydration. Do not allow the child to have any caffeine, as it has a diuretic effect (causes water loss) and will defeat the purpose.

On the day of the tournament, encourage frequent consumption of sports drinks. After 20 minutes of exercise, the body begins to lose essential elements and minerals that cannot be replaced by plain water. Also, make sure the drinks are cold, as the body absorbs cold fluid five times faster than room-temperature or hot fluids.

OverhydrationDate: Mon, 29 Jul 2002From: S. Fung

I don't imagine that overhydration is a problem that many of us will encounter, although with today's heightened awareness of the problems of dehydration, there's a danger a well-meaning coach could go too far the other way. Here's a cautionary note taken from www.mercola.com.

****************************************************************************A new review of three deaths of US military recruits highlights the dangers of drinking too much water.

The military has traditionally focused on the dangers associated with heat illness, which has killed a number of healthy, young enrollees. However, pushing the need to drink water too far can also have deadly consequences.

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The risk has always been not drinking enough. And then people who aren't medically attuned get overzealous, inducing recruits to drink amounts of water that endanger their health.

In September 1999, a 19-year-old Air Force recruit collapsed during a 5.8-mile walk, with a body temperature of 108 degrees Fahrenheit. Doctors concluded he had died of both heat stroke and low blood sodium levels as a result of overhydration.

During January 2000, a 20-year-old trainee in the Army drank around 12 quarts of water during a 2- to 4-hour period while trying to produce a urine specimen for a drug test. She then experienced fecal incontinence, lost consciousness and became confused, then died from swelling in the brain and lungs as a result of low blood sodium.

In March 2001, a 19-year-old Marine died from drinking too much water after a 26-mile march, during which he carried a pack and gear weighing more than 90 pounds. Although he appeared fine during the beginning stages of the 8-hour walk, towards the end he began vomiting and appeared overly tired.

He was then sent to the hospital, where he fell into a coma, developed brain swelling and died the next day. It is unclear how much water he drank during the march, but Marines were given a "constant emphasis" on drinking water before and during the activity.

Drinking too much water is dangerous because the body cannot excrete that much fluid. Excess water then goes to the bowel, which pulls salt into it from the body, diluting the concentration of salt in the tissues.

Changing the concentration of salt, in turn, causes a shifting of fluids within the body, which can then induce a swelling in the brain. The swollen organ will then press against the bones of the skull, and become damaged.

Previous cases of water toxicity have been noted in athletes who consume excessive amounts in order to avoid heat stroke. In addition, certain psychiatric patients may drink too much water in an attempt to wash away their sins, or flush out poisons they believe have entered their bodies.

In 1998, the Army released fluid replacement guidelines, which recommend a certain intake of water but limit it to 1 to 1-1/2 quarts per hour and 12 quarts per day.

Military Medicine May 2002;167:432-434

----------------------------------------------------------------------------DR. MERCOLA'S COMMENT:

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Although water is the best liquid you can drink, and I recommend drinking only water, you can overdo it. There is a difference between optimizing and overdoing. As this study shows, drinking too much water can decrease the sodium in your blood to extremely dangerous levels.

Depending on your size, a body can process slightly more than a glass of water per hour. Keep a water bottle with you during the day to confirm precisely how much water you have consumed. The general rule is one quart of water for every fifty pounds of body weight. Drinking enough water is one of the most simple, basic, and important health steps you can take.

****************************************************************************

Exercise and Heat----- Original Message -----From: Heidi Andres> I agree with pre-event hydration! The girls on our team (U13, competitive)> who stay hydrated all the time are the ones who perform consistantly well.> I also advise drinking cool (or tepid?) water rather than cold water.

Date: Sun, 2 Jul 2000From: James J. BjaloncikGood evening Heidi: Having picked up on this thread from the posts by you and Paul, I've dug around in my archives of sports medicine and athletic training for some info. First of all, all my sources indicate that "cold" water is absorbed much more rapidly by the body than "cool" or "tepid" water, consequently it is recommended more so than the other two. (i.e. one source is "Nutrition for Fitness and Sport" by Melvin H. Williams, Old Dominion U., 3rd edition, chapter 8, page 202).

> But what IS hot anyway? It's probably a matter of what you're acclimated to.

That is true, as the body tends to take 7-14 days to adjust itself to an increase in environmental heat (plasma volume expands thus increasing the total blood volume, allowing the heart to pump more blood per beat and reducing stress on the heart; more blood flows to skin and muscle, allowing more oxygen to be delivered and skin cooling to increase). Athletes living in areas of the country that are fairly warm throughout the year are undoubtedly more acclimatized to their environment than others that train in cooler areas of the country that then have to travel to the warmer areas for competition. For instance, someone from Florida that is training for a marathon run in their home state are far more acclimated to the environment than someone from Michigan who is training up there for the same run. (Makes sense).

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However, even in acclimatized athletes, In "Sports Fitness and Training" (Mangi, Jokl and Dayton, c. 1987, Pantheon Books) indicates that there are still serious guidelines to follow while training in high heat and humidity. They establish a "Low Risk" zone running on a graph from 75F and 45% humidity to 70F and 100% humidity, a "Moderate Risk" zone above the line indicated above up to a line from 92F and 40% humidity to 80F and 100% humidity, a "High Risk" zone above the Moderate Risk zone up to a line from 100F and 40% humidity to 90F and 100% humidity. Above that last line is the "Very High Risk" zone, where ALL athletic endeavor should be postponed or cancelled.

Their guidelines for hydration:

1) Drink 6-8 ounces water before and every 15 minutes during hot weather exercise. Stop and rest during these breaks to allow the body to lose heat.

2) Wear light-colored, loose-fitting, mesh-type fabrics.

3) Drink at least an extra quart of fluid a day during hot weather.

4) Replace electrolytes after competition with fruit juice or sportsade drinks. The old idea of consuming salt tablets has been discarded!

5) Weigh yourself each morning - if you lose more than 1% of your body weight, drink extra fluid and avoid exercise until that weight is regained.

6) Never try to perform at maximum effort during hot weather. If you feel weak, dizzy or nauseated, STOP!

Hi Paul: Unfortunately, the above-mentioned authors don't give specifics regarding aspects of training in the different risk areas. The general notion of lots of cold water breaks, frequent rest periods, and suggestions of holding practices in either the early morning or later evening period are listed.

In a book I received from the N.E. Ohio Sports Medicine Institute a few years ago (at a coaches clinic), sports physiologist Conrad Earnest lists the following:

TEMP HUMIDITY PROCEDURE

80-90 F Under 70% Key eye on those athletes who tend towards obesity

80-90 F Over 70% Athletes should take a 10-minuterest period every

90-100 F Under 70% hour and t-shirts should bechanged when wet. All

athletes should be

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under constant supervision.90-100 F Over 70% Under these conditions it would be

well to suspend practice.Over 100F Any

These guidelines were established for pre-season practice for "pointy football". However, since our high school soccer kids are also enduring 2- and 3-a-days at that same time, the guidelines are still pretty appropriate.

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