Sports Health Tips

Ask the Jock Doc

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Nutrition / Medications

Eating Disorders

My friend and I are on the cross country team, and I think she has an eating disorder. She says that she’s a vegetarian, but she eats next to nothing and drinks only water all day. Even though she had a stress fracture last year she’s running again this season. What should I do?

Unfortunately, an athlete with an eating disorder is likely to deny or be secretive about it. Some athletes begin restricting calories out of a sincere desire to be healthier, but get sucked into an obsessive pattern of food restriction and fear of getting fat. Their list of “bad/fattening foods” gets longer and longer, they may train excessively to “purge” extra calories, and excessively criticize their body.

A vegetarian diet can be a healthy choice if an athlete knows how to ensure that he/she takes in adequate calories, protein, calcium and other nutrients.

Steps For Helping A Loved One

Although your friend may not initially be receptive to your concerns, if there is a problem, you could be that first step in helping her tackle it.

If you suspect that your friend has an eating disorder:

  1. Talk to your athletic trainer, team physician or coach.
  2. Approach your friend with a genuine concern about her health, now and in the future.
  3. Ask if she would be open to seeing a sports nutritionist or sports psychologist to improve her training diet.
  4. Put her in the healthiest frame of mind around her body and competition.
  5. Come with helpful resources.

UC San Diego has an Eating Disorders Program for adolescents and adults:
Phone: (855) 824-3050

Another helpful website:

What are the effects of an eating disorder on an athlete's body?

A constant energy deficit can have serious negative health consequences. When the body doesn’t have enough energy to sustain itself, it begins shutting down certain body processes.

The body needs energy (calories) and key nutrients for:

  • Training and recovery
  • Muscle repair
  • Heat regulation
  • Bone metabolism: Athletes can start losing bone at the very time in their lives when they’re normally building critical bone mass for the future. An athlete may experience stress fractures or injuries that are slow to heal.
  • Reproductive function: In females, one of the things that can become abnormal is the menstrual cycle. An athlete with an energy deficit created by an eating disorder may start to experience irregular periods or lose her period altogether.

According to Amy Leu, DO, it is no longer considered "normal" for female athletes to have menstrual irregularities. Sometimes irregular periods are an early sign of an athlete moving into the energy deficient state. If evaluated and addressed early, devastating complications can be avoided, including stress fractures and impact on return-to-play.

Eating disorders and severe body image issues are at the extreme end of a syndrome called the female athlete triad. Watch video on female athlete triad:

Men can also get caught up in excessive body criticism, overtraining, under-eating and abuse of muscle-building supplements, referred to as the Adonis Complex.

Where can I get support for an eating disorder or body image issue?

Health care professionals that can help you work through eating disorders and an unhealthy body image include:

  • A primary care physician
  • Athletic trainer
  • Sports nutritionist
  • Sports psychologist

Performance-Enhancing Drugs (PEDs)

My son is a high school athlete and wants every advantage going into a competition. I’m sure that it’s tempting to think about using performing-enhancing drugs (PEDs) because the kids talk about them. What are the risks vs. the benefits of PEDs?

It’s important to stay educated about the substances you put in your body. Whether it’s an energy drink, water, food, or PED, we need to know what’s good for us and what’s bad. PEDs are defined as any substance taken to perform better athletically. Even though that extra edge may sound tempting, the use of PEDs is very risky for health and doesn’t yield definitive results. One PED we typically hear about, and often of interest to teenage boys, is anabolic steroids.

There are many irreversible risks to taking anabolic steroids including:

  • Enlarged heart
  • Stunted growth
  • Balding
  • Increased risk of injury to tendons, ligaments, and muscles
  • Accelerated puberty changes and abnormal sexual development
  • Increased emotional changes like anger and depression, even suicidal thoughts
  • Atrophy (shrinking) of the testicles
  • Abnormal breast development in men

The best way to maximize your athletic performance is through hard work, practice and healthy eating. Learn more about the negative effects of PEDs and many other substances, and how to support an athlete in making healthy choices:

What was the original purpose of PEDs?

Many PEDs were originally created to treat certain medical conditions and illnesses under the guidance of a physician. Unfortunately, some athletes now use them to gain an edge over the competition by taking these substances at significantly higher doses than have ever been shown to be safe in the human body.

What's the impact of PEDs on the female body?

Adolescent girls in particular may suffer from:

  • Severe acne
  • Excessive body and facial hair
  • Deepened voice
  • Permanent enlargement of the clitoris
  • Disruption of the menstrual cycle
  • Permanent infertility

Anti-Inflammatory Medications (NSAIDS)

Before working out, I’ll sometimes pop a couple ibuprofen to prevent pain or inflammation. Is there any reason NOT to do this?

Combining non-steroidal anti-inflammatory medication (NSAIDS) such as ibuprofen with vigorous exercise can be dangerous. During exercise, blood flow to the gut decreases so that blood can be redistributed to the working muscles. This causes a temporary loss of gut function and small intestinal injury. Studies have shown that when NSAIDS are taken before exercise, it aggravates these gastrointestinal effects, even in healthy individuals.

Chronic use of NSAIDS has been associated with:

  • Ulceration
  • Impaired kidney function
  • Bleeding
  • Perforation
  • Stomach pain
  • Heartburn
  • Indigestion
  • Nausea
  • Life-threatening hyponatremia due to increased fluid retention

What if I'm in pain after a workout? Can I take ibuprofen then?

In general it's safe to take ibuprofen after exercise as needed. Just make sure it’s not taken on an empty stomach and limit to the lowest dose needed.

If you constantly experience significant joint or muscle pain during or after exercise, it may be time to assess your workout and/or visit a sports medicine specialist.

3 tips to help you soothe workout pain naturally:

    1. If your knees bother you after running 60 minutes, but not after 40, stick with a shorter jog. Cross-training is a way to develop/maintain cardiovascular conditioning while decreasing repetitive stress on specific muscles and joints. Check your shoes: it may be time for a new pair.
    2. If your knees bother you during squats, try not going down as far, using lighter weights, or using a sled and not the floor.
    3. If you just can’t find a Plan B that works, see a sports medicine specialist who can help you figure out a safe and effective treatment plan.

    Weight Loss

    I’m a junior in the middle of wrestling season. We try to compete as lean as possible to gain an advantage over opponents in our same weight class. I’ll do whatever it takes to win, but I feel pretty weak after fasting and working out hard to sweat my weight down. Any suggestions?

    Athletes in weight class sports such as wrestling, boxing, judo and lightweight rowing need to “make weight” every week for competition. This can unfortunately lead to dangerous weight-cutting practices that have a negative effect on performance.

    Negative performance risks associated with fast weight loss:

    • Continuous or last-minute fasting depletes muscle glucose (ready stores of energy) so your muscles tire out faster.
    • Dehydration (loss of greater than 2 percent body weight through fluid depletion) can decrease an athlete’s stamina, affect balance control, reduce your ability to handle the heat, and impair decision-making on the mat.

    Various sports organizations have tried to eliminate the motivation for crazy weight-loss practices by instituting policies to identify the lowest safe weight and body fat level for each athlete before the seasons starts.

    In California, high school wrestlers must undergo a pre-season test to establish a safe margin of body fat. The established margins are:

    • 7 percent for high school males
    • 12 percent for high school and college females
    • 5 percent for college males

    These numbers aren’t to be used as goals, but rather as guidelines to prevent excessive weight loss.

    How can I lose weight in a safe, healthy way?

    If an athlete and coach believe he/she will wrestle better at a lower weight, the athlete should begin several weeks before the season starts. It’s recommended that athletes attempting to lose weight set a goal of losing no more than .5 to 2 pounds per week through a balanced reduction in calories coupled with aerobic exercise/strength training.

    Small dietary changes can help you lose weight include:

    • Eat more whole grain and high fiber foods (helps you feel full).
    • Eat smaller but more frequent meals over the course of a day.
    • Cut back on junk food – usually high in calories, sugar and fat. Instead choose healthier foods such as pretzels, nuts, bagels, fruits, veggies, graham crackers, peanut butter, low-fat milk, pudding or yogurt, lean meats, chicken, tuna, spaghetti, waffles, rice and cereals.
    • Reduce your plate size so it looks like you’ve got more food.
    • Have a water bottle with you during the day so you remember to keep hydrated. If your urine is dark in color and there’s not much of it, you’re dehydrated and won’t be able to train as effectively. Beverages may include water, fruit smoothies, sports drinks, herbal teas, soda and milk. Just be aware that some beverages are loaded with sugar and calories, so read the label.

    If you have an athletic trainer or sports nutritionist who works at your school, check with them for individualized recommendations regarding fluids, carbs and proteins. There’s no scientific evidence that protein supplements are necessary to build muscle in athletes who eat a well-balanced diet. And weight loss supplements can be a minefield, with harmful ingredients and also cause positive drug tests.

    Any advice on what to eat or not eat after a weigh-in?

    After a weigh-in, it’s important to drink fluids and take in some carbohydrate and protein. Eat a bigger meal if you've got a couple hours before your first match. Light sandwiches, fruit, energy bars, sports drinks/water between matches can help you keep your energy up.

    Replenishment of energy stores immediately after training or a match is important for optimal performance in the next round. Muscle re-synthesis seems to occur most rapidly within the first 30 minutes after exercise.

    GREAT TIP: Rehydrate and ingest carbohydrate and protein foods within 30-60 minutes after exercise to maximize muscle recovery.

    Post-Workout Foods

    Since beer has carbohydrates in it, can having a few brews after a game or competition help with muscle recovery?

    A 12-ounce beer has only 14 grams of carbohydrates. Compare this with 40 grams of carbohydrates in a can of soda, 34 grams in 8-ounce lemonade, or 38 grams in a cup of grape juice. You’ll see that beer isn’t such a good recovery beverage.

    Although alcohol contains carbohydrates, it actually interferes with glucose metabolism and will ultimately impair your body’s ability to replenish muscle glycogen stores. Drinking a lot of beer can cause you NOT to eat enough carbohydrate and protein, further reducing the amount of protein and carbohydrates available to aid in muscle recovery. This is because carbonation and fluid volume make you feel full.

    In addition, alcohol:

    • Is a diuretic (causes your body to lose fluid at a time when it’s critical to rehydrate).
    • “Goes to your head” faster when taken on an empty stomach because it's absorbed quickly from the stomach into your bloodstream.
    • Affects your judgment, motor skills, coordination and reaction time.
    • Interferes with normal sleep quality, disrupting REM sleep and affecting your ability to think or train properly the next day.

    What should I eat or drink after a game?

    Remember the three Rs: Refuel, Rehydrate and Rest.

    You should drink at least 20 ounces of fluid for every pound of weight lost during exercise. Choose non-alcoholic beverages (e.g., soda pop, seltzer) and high-carb foods that you enjoy (e.g., pizza), with some protein for muscle repair. Chocolate milk is a great recovery beverage with carbs, protein and fluid all in one package!


    My kids and I often skip breakfast, but we get plenty of exercise during the day. What’s the real deal on breakfast – is it really that important?

    Actually, breakfast is an important start to the day for young and adult athletes.

    Breakfast helps:

    • Rev up your metabolism.
    • Improve concentration and problem-solving skills, important for keeping your focus on important work projects (or for kids on schoolwork).
    • Reduce cravings to overeat later in the day and can set the foundation for fueling your afternoon workouts.

    What are some examples of healthy and nourishing breakfasts?

    You don’t have to eat a monster breakfast, but include some carbohydrates to build muscle glycogen stores (energy for training), and protein to aid in muscle recovery. Here are some examples of nutrient-rich breakfasts:

    • Whole grain toast w/ 1 teaspoon peanut butter, ½ sliced banana and 1 glass non-fat milk
    • Microwave a breakfast burrito (beans & cheese/beans & rice), and a 6-ounce orange juice.
    • 1 toaster waffle, ½ cup cottage cheese, 1 cup blueberries, 12 walnuts
    • ¾ cup whole grain or bran type cereal, 1 cup milk, 1 orange
    • 2 eggs scrambled with 1-ounce low-fat cheese, 1 slice whole grain toast with 1 teaspoon butter, ½ grapefruit
    • 1 cup non-fat yogurt, ¼ cup Grape-nuts, 1 ½ cup strawberries, 12 almonds

    Adjust these based on your food preferences and caloric needs.

    For example, pick a different fruit or add more – double the serving size if you need the calories!


    I’ve read that eating smaller, more frequent meals provides better energy and weight control than eating three big meals a day. So where does snacking fit in?

    One great way to get all the nutrients you need, keep your energy up and maintain a healthy weight is to snack, but also reduce portion sizes during your regular meals. Learn to anticipate your daily hunger patterns and plan on snacking. For example, if you’re hungry every day in the afternoon, plan to eat a mid-afternoon snack at school and then you’ll have energy for after-school practice and won’t be starving by dinner.

    What are some examples of crunchy health snacks?

    These healthy suggestions can help satisfy those crunchy cravings:

    • Multi Grain Cheerios or other crunchy cereal
    • Baked chips (try with bean dip)
    • Baby carrots
    • Crisp, juicy apple or Japanese pear
    • Trail mix with granola, nuts and dried fruit
    • Almonds, walnuts, sunflower or pumpkin seeds
    • Graham or animal crackers (have with a small carton of low-fat milk)
    • Air-popped popcorn
    • Jicama or celery (try with salsa or hummus)

    What are some examples of rich and creamy snacks that are good for me?

    Treat yourself to these creamy and delicious health snacks:

    • Small fruit smoothie
    • Apple sauce with cinnamon
    • Low-fat yogurt (Greek or other varieties)
    • Tomato basil soup
    • Frozen banana
    • 1 tablespoon of peanut butter
    • Chocolate milk (made with 1 percent milk)
    • Baked sweet potato (try seasoning with nutmeg)
    • Sorbet bar, pudding pop or fudgsicle
    • Pudding snack (chocolate, vanilla, rice or tapioca)

    I have a sweet tooth. What snacks would you recommend?

    To satisfy your sweet cravings, try some of these healthy alternatives:

    • Mandarin or satsuma oranges
    • Strawberries dipped in chocolate
    • Two Fig Newtons (available in other flavors like apple and strawberry)
    • Five vanilla wafers or two small cookies
    • Instant oatmeal with brown sugar, nuts and low-fat milk
    • Raisins, prunes or dried cranberries
    • Kettle corn
    • Frozen fruit bar
    • Fresh red or yellow bell pepper
    • 15 jellybeans

    What are some examples of salty health snacks?

    When you feel like something salty, try eating:

    • Pretzels
    • Pickles
    • One small slice of pizza with mushrooms and peppers
    • Whole-grain crackers with string cheese
    • Sun-dried tomatoes
    • Tortilla chips with salsa
    • Lightly salted almonds or other nuts
    • Fresh tomatoes with crumbled low-fat feta cheese
    • Baked potato
    • Sliced cucumber, salted


    ACL Injury

    I hear that ACL injuries are common in basketball, skiing and other sports. What exactly is the ACL and how can you injure it?

    The ACL (anterior cruciate ligament) in your knee helps to stabilize the knee during cutting and stopping maneuvers. Complete ruptures have a significant impact on an athlete's ability to continue in sports or physical activity. You may frequently hear about ACL injuries occurring in basketball, soccer, skiing and other sports that involve rapid acceleration and changes of direction.

    According to Amy Leu, DO, some ACL ruptures or complete tears occur in contact settings. However, roughly 2/3 of ACL tears occur when an athlete is landing from a jump, cutting, pivoting, accelerating or decelerating.

    Are there any good ACL injury prevention programs out there? I want to play hard, yet stay healthy.

    According to the National Athletic Trainers Association, an ACL injury prevention program should include:

    • Stretching
    • Warm up
    • Balance
    • Strengthening
    • Plyometrics
    • Quality technique correction (particularly during cutting, landing and sport-specific agility movements)

    The Journal of Arthroscopy identified 3 ACL prevention programs that successfully reduced injury when their programs were implemented.

    These are:

    1. PEPProgram (Prevent Injury, Enhance Performance), developed by the Santa Monica Orthopedic and Sports Medicine Research Foundation 
    2. Sportsmetrics, developed by Dr. Frank Noyes at the Cincinnati Sports Medicine Research and Education Foundation
    3. KIPP (Knee Injury Prevention Program)

    Other helpful programs:
    FIFAA 11+
    PEAK Control Program

    Preventing injuries is an important goal for all organizations that support sports. However, when you’re moving fast and playing hard, it’s inevitable that some sports injuries will occur. Since an ACL injury tends to be one of the more devastating injuries in sport, it makes sense to develop a training regimen that puts you in the strongest position possible to prevent one in the first place.

    Are ACL tears more common in men or women?

    It’s well known that non-contact ACL tears are 2-6 times more common in females than males. This may be due to a number of factors, including lack of muscular strength and control to keep the knee in ideal alignment and absorb the landing (not stiff-legged).

    What’s the best way to prevent an ACL injury?

    Current research tells us that one of the best ways to prevent ACL injury is to pay close attention to each athlete’s biomechanics.

    “Of all the many biomechanical variables that can contribute to an ACL injury, landing technique has the most predictive value,” says athletic trainer Kevin Messey, ATC. “At UC San Diego Sports Medicine, I work with athletes of all ages to identify specific errors in landing and athletic movement that contribute to ACL injury. I then use evidence-based techniques to correct those errors and return my athletes to play in a safer condition that ultimately improves their performance.”

    Attention to form and detail are crucial for successful implementation of injury prevention. This means an athlete must work on skills that put his/her body in the best possible alignment until the those positions and movements become second nature.

    Bone Strength

    I’ve heard that once you reach age 30 it doesn’t matter if you’re active, you won’t gain any more bone. Is this true?

    Bone is a living tissue and is constantly renewing itself through specialized cells that build new bone and others that break down old bone.

    Most individuals achieve peak bone mass by age 30, and then experience gradual losses over many decades. The rate of loss accelerates for women during the 5 years after menopause. Bones are most responsive to biomechanical stress during the growing years, building in size and density more than at any other time in our lives.

    How can I help my kids build bone strength?

    Weight-bearing exercise and strength-training exercise both provide bone-stimulating mechanical stress. Weight-bearing exercise is any activity where you are supporting your body weight through your feet/legs.

    According to clinical exercise physiologist, Robyn Stuhr, certain characteristics of exercise are associated with a greater bone response.

    These include:

    • Higher loads or intensities
    • Faster speed of force application
    • Changes of direction/different loading angles
    • Adequate rest intervals

    There are many fun activities that contribute to bone strength:

    • Soccer
    • Basketball
    • Wrestling
    • Tennis
    • Gymnastics
    • Jump rope
    • Various forms of dance

    While sports and dance are great for all of us, they're especially important for adolescents and kids. Research has shown that children and adolescents hold onto the extra bone mass they’ve acquired well beyond the actual intervention. It’s different for adults – if adults don’t use it, they lose it, just like many other aspects of fitness.

    So encourage your kids to get off the couch and step away from the computer to play whatever sports or recreational activities they enjoy!

    If I’m over 30 and have already reached my peak bone mass, do I need to exercise as much?

    Exercise still has a positive role to play. Bone-loading activities can help you protect the bone you have or slow the rate of loss.

    You don’t have to run for 30-60 minutes to reap the benefits. Animal research has shown that high-intensity intervals done over a short time period are more beneficial to bone than a long period of constant-intensity loading. Bone becomes “de-sensitized” after a certain period and won’t achieve additional benefit.

    While swimming and cycling are great for cardiovascular fitness, weight control and muscle endurance, they are NOT weight-bearing forms of exercise. Elite cyclists, like those who ride in the Tour de France, have been shown to actually have lower bone density than other athletes, which makes them more susceptible to fracture. Their low bone density may be due to the fact that they spend many hours training on the bike (an unloaded environment) and don’t replace the calcium lost in sweat.

    If you participate in swimming or cycling, make sure that you balance out your exercise schedule with some “land-based” options and strength-training.

    Is strength training good for bones?

    Strength training is terrific for bones and muscles. It’s great for adults who have orthopedic conditions that limit their ability to perform high-intensity weight-bearing exercise.

    Since bone’s adaptation to mechanical stress is site-specific, put together a program that involves the entire body. The use of free weights can be a great choice as it requires more balancing and stabilizing around the spine.

    Whatever bone-loading activities you choose, remember that something is better than nothing. And if you love it, you’ll do it!

    Muscle Strength

    No matter how hard I try, I can't lift as much weight as my teammate, who's the same size as me and doing the same program. Why is this?

    There are several factors that influence muscle strength:

    • Muscle size: Size of a muscle determines how much force it can generate. An athlete with larger muscles will generally have greater strength.
    • Limb length: The amount of torque (rotary force) required to lift a weight is related to limb length. An athlete with longer limbs is typically at a mechanical disadvantage when lifting weights. However, longer limbs are an advantage when blocking a pass on the football field or shooting a basketball over a defender.
    • Tendon insertion location: Every muscle attaches to your bones through tendons that insert somewhere on the bone, and these points aren’t the same for everyone. Tendon insertions changes the length of the lever arm and influences torque. 
    • Individual genetic differences in hormones and body type.

    How can I maximize my personal strength potential?

    First, stop comparing yourself to everyone else in the weight room. Focus on maximizing your personal potential for strength and power by working with the coach and your athletic trainer. Remember that many other factors influence sports performance, including:

    1. Skill development through practice
    2. Good nutrition
    3. Mental skills training
    4. Adequate recovery
    5. Heart! As Albert Einstein said, “Not everything that counts can be counted. Not everything that can be counted counts.”

    NCAA Safety Guidelines

    My son will get started soon with football practice and two-a-days. Someone told me there are new NCAA safety guidelines for football. What should I know?

    The National Collegiate Athletic Association (NCAA), the College Athletic Trainers Society, and the American College of Sports Medicine (ACSM) have collaborated to develop new athlete safety guidelines in three areas:

    1. Concussion
    2. Football practice
    3. Independent medical care

    See complete guidelines on the NCAA website Division I area

    Concussions can occur in a variety of athletic situations. To get on top of early identification, monitoring and treatment of sports head injuries, UC San Diego Health Sports Medicine has assembled a multidisciplinary team of experts to provide comprehensive concussion evaluations and treatment. See our Concussion Clinic.


    I’ve heard that you should stretch after exercise, not before. What’s the latest on stretching?

    There is no scientific proof that stretching before exercise prevents injury during that specific workout. However, stretching in general can increase range of motion, promote smooth and efficient movement and may reduce the risk of injury during exercise, particularly in sports that require extreme flexibility or explosive movements.

    There is some evidence that static stretching (long, slow stretching) immediately before exercise may temporarily decrease the muscle’s ability to generate force or power.

    When is the best time to stretch?

    Ideally stretching is done when your muscles are warm, for example, after a workout. But you can also stretch any time during the day: while watching TV, waiting for a ride, during a break at work. Put the muscle into a position of tension (not pain) and hold for 15 to 60 seconds. Repeat four times.

    What is dynamic stretching?

    “Dynamic stretching” is appropriate for sports that involve ballistic (bouncing) movements. For example, if you play tennis, jog for 5 to 10 minutes. Then do some hurdle walks, trunk rotations and swing your racquet easily to simulate all your strokes (forehand, backhand, overhead/serve), gradually increasing the arc of movement. Move onto the court and perform your strokes at half speed. Build up to hitting the ball with full speed and intensity. After your match or practice, stretch the muscles you use in tennis (e.g., calves, hamstrings, groin, trunk).

    If you experience muscle soreness after a hard workout or competition, stretching doesn’t help get rid of the discomfort any sooner. But it won’t hurt either.

    Skin Care

    What kind of sunscreen should I use, and how often should I reapply?

    Since sunscreen can wear off, it’s important to reapply every three hours. If you’re an athlete, this might mean reapplying at halftime or between matches. If you’re out surfing or swimming, have sunscreen on hand when you get out of the water. Choose a cream, lotion or gel with at least SPF 30 to receive adequate protection.

    You may have heard concerns that using sunscreen will compromise your Vitamin D status, but studies haven’t shown this to be true.

    What are the chances of getting skin cancer?

    One out of five Americans will develop skin cancer during their lifetime. Your risk increases with a higher lifetime history of sun exposure. If you want beautiful, wrinkle-free skin, along with a healthy body, early sun protection is critical.

    I play beach volleyball and try to remember to put on sunscreen before I get started. But it ends up looking chalky or stinging my eyes. Is there anything new for sun protection?

    Since the new FDA guidelines were released in 2012, a different labeling system is required for sunscreens. However, most consumers don’t understand that SPF (Sun Protection Factor) ratings only apply to ultraviolet B (UVB) rays which cause sunburn. Ultraviolet A (UVA) rays penetrate the skin more deeply and are associated with skin cancer and aging/wrinkling. To provide protection from UVA rays, a sunscreen must also state that it is “broad spectrum.” There is currently no rating system for the amount of protection from UVA rays other than the overall term “broad spectrum.”

    New technology using nanoparticles prevents active sunscreen ingredients from leaving a white residue on your skin, providing more even coverage and better UV protection. Oxybenzone is one of the few ingredients in sunscreens that provides both UVA and UVB protection. It was approved by the FDA in 1978 and there is no evidence showing negative health effects.

    In a recent consumer reports review of sunscreens, SPF and broad spectrum product claims weren’t always accurate, and this was particularly true for sunscreens labeled “natural.” To ensure that you’re protected, remember to re-apply every two hours when you’re out in the sun. In addition, a rashguard or even a long sleeve t-shirt provides a physical sun barrier. (However, if the t-shirt gets wet, sun protection is lowered significantly). Specialized clothing manufactured with a certain weave, thread count and/or anti-UV protectants is sold with a UPF rating (Ultraviolet Protection Factor). The UPF number represents a certain level of protection. For example, UPF 40 blocks about 97% of UV rays.

    It takes about 15 minutes for the skin to absorb sunscreen and provide protection. So apply at least 15 minutes before you head out into the sun. Most people put on less than half the amount needed for adequate sun protection, so be generous. It’s important to apply sunscreen regularly, even on cloudy days, since we’re still exposed to harmful UV rays.

    To avoid eye stinging, try products made specifically for the face or sensitive skin. If you sweat a lot, a headband can absorb sweat and sunscreen instead of letting it roll into your eyes. And while you’re on the sidelines, a broad-brimmed hat will provide extra protection for your skin and neck.

    Our active Southern California lifestyles mean lots of sun exposure. Unfortunately unprotected skin looks older faster - with more wrinkles, spots and sagging. Not to mention a greater risk of skin cancer. Sun protection is a MUST. The bottom line? When purchasing a sunscreen look for the following:

    • SPF 30 or higher (SPF 30 blocks 97% of UVB rays)
    • Broad Spectrum
    • Water resistant

    To see how well you’re protecting your skin, take the Suntelligence Survey as part of the Play Sun Smart program developed by the American Academy of Dermatology with Major League Baseball. Go to

    Warm Up/Cool Down

    I’m a soccer player and would like some advice about how to warm up before my game or practice.

    “Gone are the days when standing around in a circle and holding a stretch for 15 to 30 seconds (static stretching) is considered warm-up,” says Alan Shahtaji, DO, team physician for the U.S. Soccer Federation.

    “What’s most important is to get your muscles warm and ready for the explosive activity that will be needed in the match. There are a variety of ways to accomplish this and your coach may have a routine for the team to follow.”

    This will likely include:

    • Some cardiovascular warm-up (running around the field).
    • Dynamic stretching and drills, starting at half-speed and working up to full-speed. Even if you’re not starting the game, it’s important to do a similar warm-up on the sidelines prior to going into the match.

    Dr. Shahtaji recommends a warm-up and conditioning program from FIFA (Federation of International Football Associations) that can be found on the following website:

    How important is the cool-down period?

    The post-match or post-practice cool-down period is just as important as the warm-up. 

    "Our strength and conditioning coach has certain players sit in an ice bath for several minutes," says Dr. Shahtaji."This may not be possible, but applying an ice pack to sore or injured areas for 10 to 20 minutes is also helpful. The time to do static stretching is after you are done playing and before icing. Sometimes the whole team will do this together if it’s practical; it’s a nice way to wind down after the competition.”

    Stretch the muscles that you particularly use in soccer (calves, hamstrings, quads, buttocks) or muscles that you know are tight. An evaluation by an athletic trainer can help you assess personal deficits of flexibility and strength to design a personalized program.


    Everybody talks about strengthening the core. What is the core exactly?

    The core is a group of muscles in the center of your body, from the diaphragm to the pelvic floor, particularly the deep abdominals and back extensors/rotators. A strong core is an important link between your legs and arms, helping to transmit power and prevent injury during athletic movements such as a volleyball smash or soccer kick.

    What are some exercises that can help strengthen the core?

    Contrary to popular belief, crunches and sit-ups aren’t the best exercises for the core. The best way to train your core muscles is by activating them through a “bracing” maneuver. Bracing involves tightening the muscles in your stomach and low back as if you were preparing to absorb a punch to the abdomen and a shove in the back at the same time.

    Here are some examples of core exercises, from basic to advanced:

    1. Plank: Assume a push-up position, but with your forearms on the floor. Keep your body perfectly straight by performing abdominal bracing. Hold 30 secs. A side plank can be performed to improve hip stability.
    2. Bridging with a stability ball: Lie on your back with your knees bent and both feet on the stability ball. Perform abdominal bracing, contract your glutes and lift your hips off the floor.
    3. Cable diagonal pattern: Using a cable machine or resistance band, perform a diagonal motion across the body from high-to-low or low-to-high. As you move, keep your ab and back muscles contracted and strong.
    4. Lunge twist: Perform abdominal bracing. Then step forward into a lunge position while turning your torso toward the side of your rear leg. Return to the start position. Hold a medicine ball in front of your chest for a greater challenge.

    Remember that the most important part of these exercises is what you cannot see: contracting your core muscles to provide a stable axis for movement. Whenever you move your arms or legs away from the body, bear down to stay strong in your body’s center.

    A physical therapist or trainer can teach you how to engage and strengthen these muscles through progressively challenging exercises.


    I started surfing this summer and LOVE it! Is there anything I need to know to stay safe out there?

    For many beach-goers, summertime means shredding waves. More than 17 million Americans are active surfers, including 1 million in California alone. The benefits for the body and mind are unquestionable, yet there are inherent risks associated with the sport.

    “The most common injuries are bruises and cuts often caused by contact with the surfer’s own board,” says Ken Taylor, MD, medical director for the International Surfing Association. Surfers are also at increased risk for sunburns and developing skin cancer.

    Dr. Taylor recommends the following safety precautions:

    • Helmets
    • Protective eye-wear
    • Rubber guards for the board's fins and nose 
    • Using sunscreen with both UVA and UVB protection (at least SPF 30) and reapplying as needed
    • Wearing protective clothing such as rash guards or wetsuits and limiting sun exposure
      between 10 a.m. and 4 p.m.
    • Making sure weather and water conditions are safe
      (ask a lifeguard about rip currents, stingrays and other hazards prior to paddling out)


    I've heard using a surf leash can be dangerous. Should I use mine?

    "The use of a surfboard leash for protection is recommended but occasionally this strategy can backfire," says Dr. Taylor. "Leashes keep the board near the surfer providing a flotation device in case of an accident. They also reduce the number of accidents caused by runaway boards hitting other surfers. Leashes, however, make it more likely for a loose board to recoil back at the surfer and cause serious injuries, such as eye damage. It’s important to always stay focused, and protect your head with your arms every time when surfacing from a wipe-out.”

    Dr. Taylor, who provides medical coverage at the World Surfing Games held in exotic locations such as Tahiti, Portugal and Costa Rica says shark attacks are extremely rare. “Stingray injuries, while extremely painful are much more common and in most cases can be initially treated with hot water to inactivate the nerve toxin. Shuffling the feet while walking through shallow water can prevent stings, because bottom-dwelling fish scatter when they are alerted to human presence.”


    Head Injuries

    When I was out surfing the other day, my board hit me in the head. Afterward, I felt a little nauseous. Could it be a concussion?

    There’s a lot of discussion about concussions right now, and for good reason. You’ve probably noticed that much of the talk is related to football, but all athletes (surfers, skateboarders, soccer players, skiers, etc.) are vulnerable.

    Identifying and treating a concussion properly can make the difference in a speedy return to activity.
    See how our team handles sports concussions in the clinic.

    According to Alan Shahtaji, DO, while concussions can occur from a direct blow to the head they are usually a result of a collision where your body stops or changes direction suddenly. This can cause a whiplash effect that can injure the brain.

    The brain is suspended in cerebral spinal fluid within the skull. When the head moves abruptly in a different direction, the brain slams against the inside of the skull, causing injury to the brain tissue.

    Do you have to have a loss of consciousness or memory loss to have a concussion?

    While loss of consciousness can occur, most athletes who get a concussion do not black out.

    Can you try to “wait out” a concussion?

    If you think you have a concussion, seek help right away. Delaying proper care can result in prolonged symptoms or even second impact syndrome.

    It’s best to see medical professionals trained in evaluating and treating concussions (e.g., sports physicians, certified athletic trainers).

    Our Sports Concussion Clinic is specifically geared toward the evaluation and care of sports concussions. We provide a comprehensive evaluation that helps rule out deficits in brain function such as:

    • Orientation
    • Concentration
    • Memory
    • Balance
    • Ocular function
    • Vestibular function
    • Cognition

    We work with other specialists in neurology, psychology, physical medicine and rehabilitation.

    My son is a sophomore and wants to play on the varsity soccer team. He had a concussion last year and I’m concerned about him getting another one. Should I talk to him about wearing protective headgear?

    Most concussions in soccer actually result from contact with an opponent (for example, an elbow hitting your head) or when your head hits the ground. Dr. Shahtaji suggests instead making sure he has proper form when heading the ball: "keep your eyes open, contact the ball with your forehead and use your neck muscles.”

    According to Dr. Shahtaji, there is not enough evidence that headgear in soccer prevents concussions. However, he does say that a past concussion increases risk for future concussions. Seeing a sports medicine physician who can review your history can be extremely beneficial for both kids and their parents. It's vital that your child is well educated on concussion symptoms so they know when to seek the attention of their coach or athletic trainer during a practice or game.

    What are the signs and symptoms of a concussion?

    Concussion symptoms may include:

    • Blurry vision or double vision
    • Headache
    • Difficulty concentrating or memory problems
    • Nausea or vomiting
    • Balance problems
    • Mood changes (e.g., irritability)

    Dr. Shahtaji cautions, “NEVER go back into a game or practice if you have had a concussion. If in doubt, sit it out! Remember, the rest of your life is more important than any game.”

    The Center for Disease Control (CDC) has a “Heads Up” program promoting recognition of concussions in sports:

    Should I be worried about soccer-related head injuries? What can I do to prevent concussions?

    Soccer is a contact sport and has an inherent risk of head injury, but FIFA (the international governing body for soccer) statistics show that only one concussion occurs per 10,000 exposure hours in youth soccer. In the World Cup, the average is one concussion every 20 matches. Once players get to the collegiate level, the mechanism for concussion almost exclusively results from head-to-head or extremity-to-head contact. Thus, one of the ways to reduce head injuries has been the implementation and enforcement of rule changes to penalize players leading with the elbows and raising their arms while going for a header.

    For younger ages, concussions are more likely to result from intentionally heading the ball. Some of the soccer head gear that has been worn in the past has not been shown to prevent concussions so U.S. Soccer recommends no heading for kids younger than age 10. When kids are ready, the emphasis should be on teaching proper form, strengthening the neck muscles and working on nerf ball heading. Do not force headers for players who are not ready.

    There are a variety of signs and symptoms that can suggest a concussion and the CDC has some great information for the parent or coach to help identify a concussion. According to Dr. Shahtaji, once a player sustains a suspected head injury, the most important thing is to get a proper evaluation and "when in doubt, sit it out!" A second head injury before the brain has recovered can lead to prolonged recovery and complications and there have been reports of catastrophic brain injury.

    At our Sports Concussion Clinic, we do a comprehensive evaluation and coordinate a safe and appropriate plan for an athlete to return to learn (RTL) and return to play (RTP). We also have a team of consultants who specialize in concussion rehabilitation, should the athlete not recover in the expected seven to 10 days for adults or two to four weeks for children.

    Wrist Injuries

    I was playing beach volleyball and dove for a ball. When I landed my wrist bent back. It’s sore now when I try to do stuff like push-ups or try to grip and turn things. Any ideas?

    Most falls on an outstretched wrist will be a simple wrist sprain and usually get better on their own, although this can take as long as three months or longer.

    Hand surgeon, Matt Meunier, MD, says, “Less frequently you can have a strain of one of the tendons on the pinky side of your wrist, which may be painful in the manner you described. You may also have injured a ligament between two of the little bones in your wrist (the scapho-lunate ligament), or one that supports the pinky side of your wrist (the triangulofibrocatilagenous complex).” What a mouthful!

    To determine the exact type and severity of the injury, a physical exam by a qualified hand surgeon is recommended. Most times treatment is non-surgical, including bracing and special exercises for the hand. The first step is to figure out what happened and then start your treatment plan.

    How can I stay fit while my wrist is healing?

    While your wrist is healing, keep fit by running, indoor cycling (don’t support your weight on the handlebars) or performing strength training exercises for your core and lower extremities. You’ll be back in action before you know it!

    Ankle Injuries

    I recently sprained my ankle and was told to just “walk it off.” Does this really help my ankle sprain?

    That’s a great question! The quick answer is NO.

    Athletic trainer, Kevin Messey, says the best thing you can do is stop playing and use the tried and true RICE formula: Rest-Ice-Compression-Elevation. "RICE reduces pain and helps prevent further injury to the tissues by minimizing inflammation and swelling. This shortens your recovery time, allowing you to return to play more quickly,” says Kevin.

    What should I do for mild ankle pain?

    If your pain is mild and you can walk on it with minimal discomfort, you should see your sports medicine provider within a few days for an evaluation. Don’t play on it until you are evaluated.

    What should I do for moderate to severe ankle pain?

    If the pain is moderate to severe, stay off that foot and immediately go to your doctor or an emergency room for evaluation. When you sprain your ankle it’s common to damage the ligaments on the outside of the ankle that provide stability. It’s important to have your ankle evaluated by a sports medicine specialist to rule out more severe injuries.

    How common are ankle sprains?

    Ankle sprains are the most common orthopedic pathology, accounting for 30 percent of sports injuries. "The highest number of sprains occurs in our high school athletes, particularly those involved in basketball, football, and soccer. Recovery from an ankle sprain will vary, but on average it will take eight days for an athlete to return to sport,” says Kevin Messey.

    How long does it take to recover from an ankle sprain?

    Keep in mind that even though you may be back playing, your ankle is still healing and will continue to heal for months. During this recovery time it’s important to protect your ankle with a brace while you play. You should continue to work on balance, proprioception, strength and power until your ankle is 100 percent.

    At UC San Diego Health, athletes of all ages receive a guided program of hops and balance exercises to keep their ankle strong and prevent recurrence.

    I sprained my ankle playing basketball and I’m a little nervous about getting back on the court. How do I know that I’m ready to play and won’t re-injure it?

    Return-to-play decisions should be made with the advice of your sports medicine doctor, physical therapist or athletic trainer. However, in general, you should NOT return to play until:

    • You have complete range of motion in your ankle (in and out, up and down, side to side).
    • You have full weight bearing, good balance and strength in the muscles around your ankle.
    • You can run pain-free.
    • Your ankle doesn’t hurt or swell up during exercise or daily activity.

    What are some basic strengthening exercises for a sprained ankle?

    Your physical therapist or trainer can guide you through the rehabilitation process by first helping you to regain your range of motion and then gradually introducing strength exercises. For example, begin by making gentle circles and tracing the alphabet with your foot several times a day.

    Basic strengthening may include:

    • Calf raises
    • Moving your ankle in and out using an elastic band
    • Functional strength exercises with lateral movements (e.g., side slides and patterns)
    • Balance challenges (e.g., single leg stance on the ground)

    These exercises will give you the necessary strength and confidence to return to the basketball court and step into a game.

    What's the most common risk factor for a sprained ankle?

    The most common risk factor for an ankle sprain is a previous ankle sprain, so it’s important to get appropriate rehab before you return to sports to avoid a repeat injury. It’s a good idea to wear an ankle brace once you’ve had an ankle sprain to provide support and stability while your ankle adjusts to the stresses of sport activity (the lace-up models tend to be more supportive than the elastic ones).

    Knee Injuries

    I run a lot for conditioning and been feeling pain on the outside of my right knee. I've been told that it’s IT band syndrome (ITBS). What exactly is ITBS and how can I get rid of it?

    ITBS is common in runners, cyclists and other athletes. The iliotibial band is a thick, fibrous band of connective tissue that runs all the way from the hip, down the outside of the leg, to the knee. Pain can happen anywhere along this pathway, but often occurs at the outside of the knee.

    Jeff Chen, MD, MHS, says that knee pain is likely caused by excessive friction during repetitive knee flexion /extension. With each repetition the lower end of the ITB slides over the outside bone at the knee, causing inflammation, thickening, and swelling.

    ITB pain may appear after:

    • Running downhill
    • Lengthening your running stride
    • Sitting for long periods with the knee in a flexed position.

    Some risk factors include:

    • ITB tightness
    • High mileage running
    • Leg length discrepancy
    • Muscular weakness or imbalance (particularly hip abductor weakness at the buttock)

    How can I accelerate recovery from ITBS?

    Tips that can help accelerate recovery:

    • Temporarily take a break from running, cycling or any activities that bring on knee pain
    • Ice the area for 20-30 minutes every four hours for a few days
    • Take anti-inflammatory medications (as directed by a doctor)
    • Self-myofascial release of the ITB prior to stretching (helps relax overactive tissue)
    • Targeted stretching of the ITB
    Self-myofascial release
    Lie on your side on a foam roll at the hip. Roll down the outside of the leg until you come to a spot where you feel pain/tension. Stay on that spot for 30-40 seconds to allow the ITB to release.

    Stretching your ITB
    Stand upright and cross your left “good leg” in front of your right “bad leg.” Shift your right hip out to the side while reaching your right hand over your head and towards the left. Once you can perform this stretch without pain, work on strengthening your gluteus medius (buttocks muscle) as well as core stabilization.

    I've been doing strength training for ITBS for a few weeks now. When can I start running again?

    “Once strengthening exercises can be done without pain, you can gradually return to running,” says Dr. Chen. “Begin each workout with a quarter mile warm-up and stretches. Start back with low mileage every other day, and increase mileage gradually over the next 4-6 weeks. If you have any pain, decrease the mileage or stop running for a few days until the pain has resolved. If you are running on a track, make sure that you reverse directions each workout. Cross-training with other activities such as swimming is ideal for healing.”

    When I play basketball I typically get pain in the front of my knee. The pain kind of goes away once I’m warmed up. But it comes back the more I play and especially when I have to jump and land a lot. What is this?

    Athletes who jump and land frequently can develop “jumper’s knee” which is also called patellar tendinitis. In fact, 30 to 45 percent of elite basketball players experience this problem.

    The patellar tendon lies at the front of your knee and feels like a thick cord traveling from your kneecap (patella) to your shin bone (tibia). Jumper’s knee is a repetitive condition that occurs due to excessive force on that tendon. An athlete will experience pain directly on the tendon and occasionally notices mild swelling. The pain usually happens during the act of landing from a jump, but sometimes occurs with jumping up too. Most athletes notice that the tendon is sore at the beginning of practice but goes away after they warm up. However, this pain usually comes back during exercise when the activity reaches a certain duration and/or intensity.

    Sometimes patellar tendinitis can become chronic, so listen to your body and address the pain early to avoid a long term problem.

    What’s the best treatment for jumper’s knee?

    Kevin Messey says that the best treatment for jumper’s knee is to temporarily modify activity until your knee feels better. This means less jumping and more horizontal training. This can be tough in the middle of the season, but there are many skills you can work on to keep sharp such as:

    • Running through plays
    • Free throws
    • Defensive drills
    • Ball handling
    • Practicing your skills away from the ball

    A good rule of thumb is to stay away from activities that cause pain.

    How long can it take to recover from jumper’s knee, and what can I do to accelerate the process?

    Recovery may take as little as 2 weeks or up to 6 months. Ice may also be helpful when the tendon is sore immediately after activity.

    Athletic trainer, Kevin Messey, says,“In addition, you can use a patellar tendon strap to wrap around your knee putting pressure over the patellar tendon. This alters the line of pull of the tendon and can temporarily relieve pain while you play.”

    To reduce the stress on the tendon, Kevin recommends using a foam roller before and after activity to stretch:

    • Calves
    • Hamstrings
    • Quadriceps
    • Hip flexors

    Also consider seeking treatment from a qualified healthcare professional, like a physical therapist or athletic trainer to recover faster. They will design a rehabilitation routine for you to reduce your pain and increase your function. They can also evaluate your jumping and landing mechanics to prevent jumper’s knee from coming back.

    How can I prevent jumper’s knee?

    Prevent jumper’s knee by maintaining a healthy level of conditioning in the off-season. This allows you to resume high levels of activity in pre-season without developing jumper’s knee, which is when it usually starts.

    As you train, be sure to slowly increase the volume and intensity of your training over many weeks. A good rule of thumb is to increase your training by 10 percent each week.

    In addition, stretch your hamstrings and quadriceps regularly and work on eccentric strengthening of your quadriceps using a single-leg squat technique. An athletic trainer can show you how to do this properly.

    There are many conditions of the knee that cause pain at the front of the knee. It’s always best to seek the opinion of a sports medicine specialist to get an accurate diagnosis.

    Hamstring Injuries

    I’m a runner and have a nagging hamstring strain that won’t seem to go away. I’ve tried resting it for a few weeks, stretching, even had some physical therapy, but it still lingers. What else can I do?

    Hamstring injuries occur frequently in runners with tight hamstrings or muscle imbalance. Initial treatment should include:

    • A defined period of rest
    • Mild stretching
    • Strengthening
    • Local modalities (e.g., ice) 
    • Soft tissue massage (when area is no longer painful to the touch)

    Despite early treatment, some hamstring injuries develop into more chronic injuries that not only last beyond three weeks, but become more difficult to treat.

    Why do some athletes get chronic hamstring injuries?

    Most athletes understand that a period of rest is required, but many return to activity too early and develop chronic injuries. “You’ve been working with a physical therapist and stretching, but one component that many athletes forget is strengthening” says Dustyn Severns. “Many hamstring injuries occur because the hamstring muscles are not nearly as strong as the large quadriceps muscle group.”

    How can I tell if my hamstrings are ready to start running/jogging again?

    Dustyn Severns suggests using the following guidelines to determine when you can return to activities such as jogging/running:

    1. When you have no pain with stretching, strengthening or general conditioning activities.
    2. Hamstring flexibility should be equal between the injured and uninjured side.
    3. Hamstring strength should be equal between the injured and injured side.
    4. Hamstring strength in general should be at least 50 to 70 percent of quadriceps strength.

    What are some hamstring exercises that can help prevent re-injury?

    Starting with light weights, gradually increase your resistance using both concentric and eccentric contractions. When you can perform therapeutic hamstring exercises without pain, begin high intensity eccentric hamstring exercises to promote tissue remodeling and prevent re-injury.

    Some exercises that can help prevent re-injury include:

    An athletic trainer can help you put together an effective re-conditioning program. Remember to ice after exercise and do a proper warm up prior to stretching or strengthening.

    Most importantly: be patient! Make sure that you are meeting the strength and flexibility goals as you go. As athletes, we all want to get back to our sport as soon as possible. But with hamstring injuries, getting back out there too soon can turn a month of recovery into six months or more! To avoid re-injury, continue your strengthening and stretching program even after you return to activity.

    Neck Injuries

    I've been having pain in the back of my neck while swimming longer freestyle workouts. What's causing the pain?

    There can be many different reasons for pain in the back of the neck. Pain can be from bones, muscles, ligaments, facet joints, intervertebral discs or nerves. The most typical neck pain while swimming is myofascial, involving the muscles and soft tissues. Fortunately, this type of pain can be improved with proper stretching and positioning.

    When should I warm up my neck in order to prevent pain?

    “Decreasing neck pain starts before exercising,” says Dr. Chen, who was a former competitive swimmer.

    For warming up the neck, Dr. Chen recommends:

    • Using some heat on the back of the neck for 10-15 minutes prior to stretching.
    • Adding passive stretching by using a little pressure from your hand to help increase the stretch.
    • Moving chin down and up, side to side, and look over shoulder.

    How can I minimize neck pain while swimming?

    “Focusing on a neutral and symmetric body position can often minimize pain during swimming,” says Dr. Chen. “Anything that causes you to turn the neck too far in any direction can worsen the pain, whether it is to the side, or extending too far back.”

    His suggestion: Ask someone to take a video of you while swimming, shooting from the end of the pool as well as the side. This will give you an idea as to whether you are turning your head too high to one side to breathe, or extending your neck back too much in order to look towards the wall.

    Tips on maintaining a neutral body position:

    • Keep your head and neck in a straight line, while focusing on the bottom of the pool, instead of looking up towards the end.
    • Practice your flip turns using landmarks on the bottom of the pool, or by counting strokes going into the turn so that your neck position remains neutral.
    • If you only breathe on one side, try breathing on both sides to keep the body in a more neutral position. If you cannot breathe on both sides, try rolling the torso a little more while breathing, to decrease the amount of movement in the neck.

    What are some post-workout tricks for a stiff, sore neck?

    After workouts, cool down with the same stretches as those prior to your workout. At this point if your neck is still sore, you can ice it for 15-20 minutes, use some anti-inflammatory pain relievers and then rest.

    If your neck pain continues to bother you, or if you start to experience radiating pain down the arms, tingling or weakness in the hands, see a doctor for a medical evaluation.



    I'm tired of getting blisters during soccer practice. Any advice?

    Friction blisters on the feet are common in athletics, but the right pair of socks (and properly fitting shoes) can go a long way in preventing them.

    Did you know?
    The sole of your foot has more sweat glands than any other area on your body. Moisture on the skin causes increased friction between your skin and sock. Cotton socks retain moisture and increase the co-efficient of friction between the sock and the foot. This transmits mechanical stress to the skin and can promote blister formation.

    Technical athletic socks are currently made with fabrics designed to absorb or wick moisture away from the skin.

    Look for synthetic fibers or blends such as:

    • Coolmax
    • Drymax
    • Acrylic
    • Nylon

    Some socks utilize two thin fabric layers so that friction is transferred to the second layer of sock instead of the skin.

    Anatomical toe socks (gloves for the feet) may help reduce blisters between the toes. However two layers of fabric do spread the toes apart and may feel uncomfortable.

    I've heard that the right sock can enhance performance. What factors should I keep in mind when sock shopping?

    Here are some things to consider:

    • Look for socks with flat knit toe seams.
    • A vector heel design can help to anchor the sock to the back of your foot.
    • Many socks have cushioned pads strategically placed in certain areas of the foot (ball of the foot, heel or toes) to provide cushioning and minimize shearing forces. 
    • Make sure that your socks are the right size for your foot and the right thickness for your shoe.
    • Wear the socks you intend to use for the sport.

    Are thicker socks better?

    Thickness and cuff height of socks is often a personal preference, or dictated by the sport. Whichever you choose, the right fit and fabric will go a long way towards comfort and blister prevention. Athletes who are well hydrated have healthier skin and are less likely to develop blisters. So drink plenty of fluids before, during and after training. Be sweet to your feet!


    What’s the scoop on minimalist shoes?

    Minimalist shoes are meant to simulate “going barefoot” while providing a protective wrap around the foot. Research is inconclusive regarding whether minimalist shoes have an effect (either way) on injury risk or performance.

    Some data suggest that barefoot running shortens stride length and promotes a more natural forefoot/midfoot strike, which can reduce vertical impact forces, improve running economy, and minimize abnormal torque at the knee, hip, and foot.

    Drawbacks to switching to minimalist shoes:

    • New type of foot strike changes gait biomechanics and alters the loading pattern on the body, which can be difficult to get used to.
    • Switching to minimalist shoes too quickly may initially cause pain.
    • They don't provide the amount of support some people need.

    I'm thinking about using minimalist shoes for running. Any advice?

    Prior to running in minimalist shoes, follow these steps:

    1. Begin by walking barefoot more often around your house, and even on the sand at the beach.
    2. Perform strengthening exercises for the intrinsic muscles of the feet (e.g., toe towel grabs, heel walking and calf raises).
    3. Maintain a good stretching routine for the calves and Achilles.
    4. Start walking 5-10 minutes in your minimalist shoes, gradually building up to 30 minutes.
    5. Then add 1 minute of running for every 10 minutes of walking. Each week increase your running intervals by one minute (8:2, 7:3, etc). Once you’re up to 30 minutes of running, increase weekly mileage by 10 percent per week.
    6. If you’re concerned about losing aerobic conditioning during this transitional period, cross-train with cycling or swimming.

    If you have questions about minimalist shoes or want to know if barefoot running is a good idea for you and your feet, find a sports medicine specialist who can evaluate you and discuss your options.


    Is there a helmet that can protect me against having a concussion?

    No. Helmets can protect against a fractured skull, facial lacerations, dental trauma, and injuries to the ears. But no helmet has been shown to reliably prevent a concussion. Mouth guards do nothing to prevent concussions either.

    Douglas Chang, MD, PhD, says that helmets:

    • Give players a false sense of protection.
    • Can be used as a weapon, causing players to expose themselves to more head trauma.
    • Have a weight and mass that must be born by the neck.
    • Can unpredictably increase rotational forces of the head, like a bobble-head doll (these rotational forces which are thought to be the most injurious to the head).

    Some athletes will sustain a big blow to the head and be unaffected. Other athletes will experience a seemingly trivial hit, and have lingering effects that last for weeks. Part of the issue is that we don’t know how much trauma was actually delivered to the brain in a given situation.

    What factors increase the probability of getting a concussion that a helmet can't help?

    Factors that increase risk of a concussion:

    • Gender - Females seem to have a higher number of concussions than males. Males tend to experience problems with memory, orientation and cognition while females report symptoms like drowsiness and sensitivity to noise.
    • Genetics - Some individuals are very sensitive to injury because they carry a particular type of gene responsible for the health of neurons in the brain (E4 variant of the APOE gene).

    While none of these factors are addressed by helmet technology, some commercial vendors have endorsed “hit meters” such as chin straps that light up when it is shaken vigorously. These are not widely used as some believe the hit meter actually serves as a target that opposing players may delight in triggering, increasing the rates of concussions.

    Are sports organizations making any attempt to reduce the number of head injuries, for example by making better helmets?

    Sports organizations have addressed head injuries by adding rules that discourage improper helmet use. For example, the NFL stopped “spear” tackling, helmet-to-helmet tackles on defenseless players, and shortened kickoffs to reduce the number of high velocity collisions. Changes to the NFL kickoff rules led to a 43 percent reduction in concussions from 2010 to 2011, reversing a multi-year trend of more head injuries.

    The key to concussion prevention is to provide an environment of healthy competition, and to broaden public awareness of the problem so that players, parents, coaches and trainers can be alert for the signs and symptoms of a concussion when it occurs. How best to manage a concussion, once identified, is currently the topic of much research.



    I heard one of the players for the Tampa Bay Buccaneers was diagnosed with an MRSA infection. It kept him out of competition and some other teammates also got MRSA. I think he even needed surgery. What is MRSA?

    MRSA is methicillin-resistant Staphylococcus aureus. This is a type of bacteria that can be difficult to treat and eradicate because it’s resistant to certain antibiotics. It used to only occur in very sick or hospitalized people, but it’s recently become more common among healthy people, including athletes.

    According to Dr. Shahtaji, MRSA can cause a skin infection or a small pocket of infection underneath the skin (abscess). He advises that you have red areas and anything that looks like an infected pimple or reddened hair follicle evaluated right away by your athletic trainer or sports medicine physician. When the infection is diagnosed early, it’s much easier to treat – either with an antibiotic or a procedure to drain the infection. Surgery is rarely needed.

    How can I avoid an MSRA infection?

    “Athletes can transmit the infection to each other so we recommend not sharing towels, clothing, athletic equipment or toiletries, such as razors. If an athlete has an open wound or any suspected skin infections, he or she should avoid using hot tubs, pools and ice baths," says Dr. Shahtaji, who is also a U.S. Soccer Federation physician. He has treated a number of athletes with MRSA including high school wrestlers, collegiate soccer players and volleyball players.

    There are different rules for different sports, but most require adequate treatment and coverage of any wounds. In wrestling, regulations require that before returning to the mat, athletes who’ve been diagnosed with MRSA have:

    • A three-day course of antibiotics
    • No new lesions for 48 hours before a meet
    • No active lesions

    The best treatment is always prevention. Here are a few tips from the Center for Disease Control and Prevention (CDC) for avoiding infections:

    Sedentary Lifestyle

    I do a high-intense workout three to four times a week for an hour each time. Is this enough to combat the effects of sitting for eight hours or longer, five days a week?

    There is clear scientific evidence that regular moderate-to-vigorous exercise is associated with a myriad of health and fitness benefits, and a longer, more vibrant life. However, if you spend the rest of your time sitting, four hours of Crossfit or another intense workout each week may not be enough.  

    Scientists are studying the effects of long periods of sedentary behavior (sitting) on overall health and weight, independent of whether someone works out or not. 

    Questions they’re addressing:

    1. Can we impact the epidemic of chronic disease in this country by getting people to simply move around more over the course of a day? 
    2. Do regular workouts offset the negative effects of a whole day of sitting? 

    Findings from recent studies:

    A study by Katzmarzyk, in the journal “Medicine and Science in Sports and Exercise” found that sedentary people who reported standing “almost all of the time” had a 33 percent lower risk of mortality over a 12-year period compared to those who sat most of the day. 

    An Australian study with 222,000 adults reported that individuals who sat less than 4 hours/day lowered their mortality risk by 15 percent when compared with people who sat 8 or more hours/day. 

    Matthews and colleagues (American Journal of Clinical Nutrition, 2012) found that individuals who watched seven or more hours of television/day had higher mortality rates, and this increase was not fully mitigated by regular exercise.

    What negative effect(s) does prolonged sitting have on the body, and what are some things I can do to prevent it?

    Prolonged sitting has shown to have a negative effect on metabolic function and carbohydrate metabolism.

    Frequent bouts of activity help drive down insulin and triglycerides over and over again over the course of a day, which helps you maintain a healthy metabolic profile.

    Things you can do throughout the day:

    1. Stand up and take frequent breaks. 
    2. Walk to your colleague’s office instead of picking up the phone. 
    3. When you’re on the phone, stand, don’t sit. 
    4. Talk to your boss about getting a standing desk or treadmill desk. Both set-ups will allow you to get your work done and off your bum!