Injury Prevention for the Figure Skater

1. Injury Prevention for the Figure Skater Jake Veigel, MD jveigel@cayugamed.org www.cayugamed.org/sportsmedicine

2. Objectives To become familiar with basic injury prevention practices and strategies that work Warm-up Strength and conditioning Rest, recovery, training, and monitoring Nutrition and hydration

3. Top 5 Myths of Injury Prevention Injuries just happen and are not preventable Stretching prevents injuries Males athletes sustain more injuries than female athletes Protective equipment only makes athletes more aggressive Braces work

4. Prior Injury Stress fractures Knee injuries Ankle sprains Low back injuries Shoulder disorders Concussion Heat illness Dehydration What is the Greatest Predictor of Injury???

5. Exposure Practice time Games played Duration of season Lack of off-Season Years participated Age of the athlete What is the Second Greatest Predictor of Injury???

6. What Types of Injuries Are Preventable??? • Acute Injuries • Contusions • Sprains • Strains • Fractures • Dislocations • Trauma • Concussions • Overuse Injuries • Tendonitis • Bursitis • Stress Fractures • Overuse Joint Pain

7. Mechanical stress beyond strength of tissues Improper technique shifts or creates high loads on structures not meant to carry these loads Training errors (on or off the ice) Inappropriate nutrition Injury Causes

9. Strength Imbalances

10. Active warm-up Increase heart rate, blood flow, muscle temperature, and breathing rate Improves performance Active Warm-up

11. Athletes that use active warm-ups have decreases in injury rates Warm up activities that practice coordination and control are effective in decreasing acute injuries, overuse injuries and injury severity (over 1800 adolescent soccer players). Active Warm-up Soligard et al British Medical Journal 2008, 2009

12. Includes Jogging, jump rope, side steps, carioca, bench stepping Dynamic stretching Hops , jumps, leaps, skips Balance activities (one legged standing) Active Warm-up (off-ice)

13. Children can participate in strength training safely, program must be designed for their age and maturity level The program should be simple to understand and primarily consist of multi-joint exercises The program should be a balanced full body workout The youth must be properly supervised at all times The youth must be able to follow directions and obey rules Safety is above all else (i.e. proper spotting, maintained equipment and facility, etc.) Strength and Conditioning

14. General Guidelines are: 2 to 3 times per week Moderate loads only with higher reps (13-15) Typically 1 to 3 sets, though very little information specific to children is available Focus on whole body, particularly at young age and skaters new to strength training Always include a warm up Strength and Conditioning Vaughn & Micheli. Phys Med Rehabil Clin N Am. 2008.

15. Include aerobic(20+ minutes 70 to 90% max HR), anaerobic(high intensity intervals with rest periods), and flexibility as part of a total program Strength and Conditioning

16. Basic nutrition is needed for growth and development Keeps bones strong Provides fuel for brain Provides energy for muscles and allows muscle growth Skaters have additional nutritional needs Nutrition

17. Weak bones Inadequate growth of muscles, bones Poor strength Fatigue and inattention Mistakes, poor technique, poor performance and susceptibility to injury Inadequate Nutrition

18. At least 2,000 calories Teenage Athletes need 2200 to 6000 depending on sport and gender 55-60% should be carbohydrates (1100 calories) Whole grains Vegetables Fruits Beans Nutrition Hoch et al (2008) Nutritional Requirements for the Child and Teenage Athlete, Phys Med Rehab Clin N am

19. 12 to 15% of calories should be protein (240-300 calories) 2g/kg/day for active children Lean meat, beans, nuts, whole grains Too much protein: Tends to compromise carb intake Can lead to dehydration, weight gain, stress on kidneys and liver Protein intake after intense exercise improves muscle repair Peanut butter, cheese, yogurt Add carbs (cheese and crackers, yogurt and granola) to refuel and repair Nutrition

20. 20 to 25% of athlete’s diet should be fat Fats contain essential vitamins and are necessary for menstrual function Fats are major energy source for light and moderate intensity exercise Fat

21. Low glycemic index foods are best several hours before intense training Whole grains, apples, vegetables High glycemic index are great right after and up to 2 hours after intense training Raisins, bananas, pasta, sports drink, white bread Chocolate milk Eat to Train

22. Proper nutrient intake from foods is essential for active children Calcium is needed for bone health and muscle contractions Suggested 1300 mg per day (about 4 /12 cups of milk or 6.5 ox cheese) Need vitamin D to absorb Only 13.5% of girls get enough calcium per day Nutrition for Adolescents

23. Ironnecessary for oxygen delivery to muscles by blood Suggested 8 mg day for girls and boy, 11-15 for adolescents Eat lean red meet or dark poultry, leafy greens, beans Avoid caffeine, drink OJ Insufficient iron increase risk for anemia which can result in poor performance during exercise Iron

24. Vitamin D is needed for bone health and the immune and cardiovascular systems Obtained from fish, eggs, fortified milk, sunlight (UV radiation) Athletes who train indoors and live in northern climates are at risk for vitamin D insufficiency Vitamin D

25. Fluids & Electrolytes Athletes rarely drink enough to balance sweat loss Dehydration decreases aerobic capacity and mental performance Recommendations for fluids are: Drink fluids and be well hydrated 24 hours before exercise 14 to 20 oz about 2 to 3 hours before exercise Drink 6 to 12 oz at 15 to 20 minute intervals during exercise Children are more at risk for dehydration than adults Fluid

26. Be pro-active not reactive Focus on balance, agility, and jumping exercises for conditioning Incorporate balance, agility, jumping exercises as key parts of each warm-up Follow-rules and support safe sport practices Utilize appropriate safety equipment Keys to Success

27. All athletes would incorporate dynamic warm up routines Athletes would institute year round balance, agility, plyometrics, and functional strength training An off-season for young athletes Safe rules need to be enforced/supported All athletes would get enough sleep All athletes would get appropriate nutrition Dr. Veigel’s Wish List