Platelet Rich Plasma (PRP) Injection Therapy: A Musculoskeletal Panacea?

Question: What do rotator cuff tears, plantar fasciitis, Achilles tendon tears, bursitis, and iliotibial (IT) band syndrome have in common?

 Answer: Each of these pathologies may be treated with Platelet Rich Plasma (PRP) injection therapy, a relatively new treatment that practitioners are touting as an effective cure for a wide variety of musculoskeletal injuries. If you suffer from one of these injuries, then you may have heard about PRP from a physician or friend. But what is PRP and how can it help you?

What is it?

Platelet-rich plasma (PRP) is blood serum with a high concentration of platelets. Platelets, which are components of blood, contain growth factors. Since PRP has four times the normal platelet count, it is rich in growth factors, which modulate cellular functions and promote healing processes.

“PRP injection therapy” refers to the injection of enriched plasma into affected tissues.

How is PRP therapy administered?

First, your physician will draw a small amount of blood (30-60 ml). Next, this blood will be spun in a centrifuge to separate platelets from other components. Finally, local anesthetic will be applied and PRP (3-6 cc) will be injected into the injured area. Within ten minutes of the injection, growth factors are secreted and the healing process begins.

The withdrawing of platelet rich plasma for injection/graft

(Steven Sampson, et al. Curr Rev Musculoskelet Med. Curr Rev Musculoskelet Med;1(3-4):165-174.)

Who can PRP help?

PRP works best for people with tendinopathies, which are injuries of tendons. Tendinopathies tend to be over-use injuries involving microtears in a type of connective tissue called collagen. These areas of damage are likely to have poor vascularization, which impedes the healing process. PRP can counteract this lack of blood flow.

PRP has been shown to be effective on:

-         Rotator cuffs

-         Greater trochanter bursitis

-         Hamstrings tendons

-         IT band syndrome

-         Pes anserine tendons

-         Lateral epicondyle

-         Plantar fasciitis

-         Achilles tendons

-         Peroneal tendons

-         Flexor hallucis tendons

-         Posterior tibialis tendons

Do I still need physical therapy?

Following a PRP injection, your physician will likely recommend physical therapy to facilitate your recovery process. Depending on your particular injury and the movement restrictions recommended by your doctor, you might not be able to use your affected limb for a week after injection. You will typically be able to resume normal activities at a reduced level during the second week following treatment, and over the course of the next eight weeks will implement a strength training program, with the goal of regaining full use. Throughout the recovery process, your physician will work with your physical therapist to design a treatment plan that is optimal for you.

Will PRP work for everyone?

If your physician has diagnosed you with a full-thickness tear of a tendon, then PRP might not be the best solution. PRP works by speeding the healing of partially torn tissues, but full tears will not benefit from PRP. PRP works well for tendons, and also ligaments, but its efficacy on the labrum and menisci (cartilage) is unknown. PRP has also been used in wound care for diabetic ulcers, but its effectiveness in this application has yet to be proven.

For more information on PRP and if it is a good treatment option for you see an Orthopedic MD.

After Holiday Nutrition and Exercise – start slow to ensure lasting results

The holidays are over and 2012 is quickly approaching—along with it a new batch of New Year’s resolutions. Many of us will set our sights on weight loss and a healthier lifestyle. Exciting new exercise programs, gym memberships and diets will be initiated, only to be abandoned weeks later when that initial wave of enthusiasm wanes with the difficulty of maintaining lifestyle changes.

“What separates those who are able to make good on their resolutions from the rest of us?”—realistic expectations. Striving for an intense 5 day per week gym routine while on the latest no carb/low carb diet are not only unsustainable habits for the majority, but can often lead to injury, discouragement and the eventual retreat back to old habits. A better approach to your nutrition and exercise goals this year is to start with slow, steady changes and set realistic goals for yourself.

DIET:
In order to lose weight you need to create a negative caloric balance, which means you burn more calories than you take in. You should consult a nutrition expert for more details but you can estimate your daily required calories by multiplying 17 (for men) by your bodyweight in pounds. For women 15 calories per pound of bodyweight is a better estimate. This number can also increase if you are more active, but this is a good baseline estimate. For example, a man who weighs 160 pounds and is participating in light daily activity would start with a diet of about 2700 calories (160 X 17 = 2720).
It has been shown that resistance exercises and a reduction of 500 calories in your daily consumption is a safe way to lose about 1-2 pounds per week in many cases. Losing about 1-2% of your bodyweight is a safe way to slowly burn off your holiday calories and 500 calories is no more than a few cookies.

EXERCISE:
What about exercise? Many exercise experts recommend increasing workout intensity at about 10% per week as you are able to tolerate it. If you normally walk 10 blocks to work, try going a little out of your way and walking the extra block for a total of 11 blocks – a 10% increase. When given a choice between using an elevator or taking the stairs, chose the latter.

SUMMARY:
Small, steady changes are the key to making successful and healthy lifestyle changes in the New Year. Expect the occasional setback—we’re human after all. If you skip the gym for a few days or that chocolate-chip muffin at Starbucks lures you into its dark, delicious corner on a vulnerable Monday morning, don’t let it sabotage the remainder of the week. Focus on the positive changes your new nutrition and exercise habits produce and “stay the path”.

Good luck and Happy New Year from your friends at CPMC Sports Wellness Center!  For more information check out last years blog on making SMART goals.

Safe and Timely Return to Sport for Adolescents

“If you can walk you can run. No one is ever hurt. Hurt is in your mind.” Any guess as to whom this quote belongs to?  None other than the great former Green Bay Packers coach, Vince Lombardi.  Examples of this mentality in sports history are many: Michael Jordan battling the flu in the 1997 NBA Finals; Curt Schilling’s bloody sock in Game 6 of the 2004 AL Championship series; and gymnast Kerri Strug sticking her vault landing on a severely sprained ankle at the 1996 Olympics.  Unfortunately, because of the adulation bestowed upon such performances, playing with pain is a behavior that a lot of young athletes may feel inclined to emulate.

Young athletes should not be encouraged to “play through the pain” because mismanaged injuries can have long term consequences including the development of chronic musculoskeletal dysfunction, impaired sports performance and shortening of athletic careers.  Emphasis instead should be on constructing positive sports experiences and preventing injury.  That being said, pain and injury are common in sport and it’s important to understand how to manage them appropriately.

So how do we know when our young athlete is ready to return to their sport? First, it’s important to determine if the athlete is “hurt” or “injured”. “Hurt” can involve exhaustion, contusions, abrasions, and blisters whereas “injured” may involve fractures, muscle strains, joint sprains, concussions, and overuse injuries. Athletes experiencing the former can usually return to participation with no or very brief downtime, while the latter will require substantially more time away from sport and medical management with rehabilitation. Also important to understand is an athlete’s typical reaction to pain and that some individuals tolerate “hurt” better than others.

A second question to ask is “Where is the athlete within the season?” Injuries occurring during the off-season, pre-season or beginning of the regular season should be rehabilitated to facilitate the athlete returning at full capacity for the end of the season and/or playoffs rather than rushing to get back on the playing field before fully recovered. Injuries occurring during the heart of the competitive season or playoffs may need to stop playing if continued participation is contributing to increased pain.

If your young athlete is experiencing any of the following symptoms, you should consult with a doctor for examination: 1) pain persisting more than 2 weeks despite relative rest, 2) pain getting worse, 3) swelling, 4) impaired or painful range of motion, and 5) a noticeable limp with walking.

Here are some key points to remember when determining when to return a young athlete back to their sport following an injury:

• Understand the individual athlete’s situation and goals
• Determine the severity of the injury
• Evaluate the risks of return to play
• Discuss the risks and benefits with the athlete and parent
• Give the athlete another outlet for physical and mental energy, such as physical therapy or practice modification.

Here at CPMC, we have a great team of physical therapists along with an array of wellness programs that can help your athlete return to his/her beloved sport. Contact us at www.ptsportswellness.com for more information!

On the hot seat: Bikram Yoga

Each week, a new coupon or special deal is offered for Bikram Yoga classes.  But if you’ve never heard of or participated in Bikram Yoga, how do you know if it’s an appropriate form of exercise for you?  Before you pay for that great deal, make sure you know what to expect!

What is Bikram Yoga?

Bikram Yoga is the most popular form of “hot yoga” created by Bikram Choudhury.  Derived from Hatha Yoga  principles, each Bikram Yoga class consists of 26 specific postures and 2 breathing exercises performed in standing, supine (on your back), prone (on your belly), sitting, and kneeling.  All classes are 90 minutes in length and performed in a room set at 105°F (≈ 40.6°C) and 40% humidity.

Why so hot?

Bikram calls his 105°F yoga studios “Torture Chambers”.  His rationale for the “extreme heat” is to “soften [your body], because a warm body is a flexible body. Then you can reshape the body any way you want”.  Also, he writes, “When you sweat, impurities are flushed out of the body through the skin”.

Research

In general, yoga’s most common benefits include improved strength, flexibility, posture, breathing, concentration, and mood.  Unfortunately, there is only one research article supporting Bikram Yoga’s affects at improving balance and leg strength in young adults.  The majority of research on yoga practice has been conducted by and published in Indian journals, particularly yoga specialty journals.   As the West further embraces yoga, however, research from the U.S. and England has emerged, but additional high-quality randomized control trials are needed to confirm and further illuminate its effects.  With increased popularity of alternative medicine, you can expect to see future research on yoga and its benefits.

Controversy

Despite the potential benefits of yoga, there are several aspects of Bikram Yoga that are controversial:

Bikram Principles & Theories	Controversy
ONLY Bikram’s 26 postures and 2 breathing exercises are performed through each class.	Performing the same exact exercises over an extended period of time does not provide the variability and progressive strengthening most people need.   The body adapts to exercise and needs to be constantly challenged in order to continue to develop and evolve.
Teachers to teach from the podium at the FRONT of the room.	Can the Bikram yoga instructor see that each student is performing the yoga posture correctly and safely if they never move from their podium?  This principle is especially controversial given that each Bikram studio must be a minimum of 3000 square feet – that’s 2/3 of a basketball court!  That does not provide for a very intimate setting.
NO PHYSICAL, HANDS ON CORRECTIONS or adjustments of students.	Each individual has a different body type with strengths and weaknesses unique to them.  Can Bikram yoga students perform and maintain these postures safely without cues provided by their teacher?
When you sweat, impurities are flushed out of the body through the skin.	Sweating is the body’s way to regulate temperature.  Sweat consists of mostly water with trace (0.2-1%) minerals, lactate, and urea.  Toxins or impurities are filtered through the kidneys and intestines and exit the body as urine and feces.  Perspiration, although imperative to our health, have no part in excreting toxins or impurities.

Bikram Yoga and your health

We can all agree that exercise is an important aspect of health and wellness, but it’s always important to check with your doctor before starting a new exercise regimen.  Because of the extreme heat, Bikram yoga may increase the likelihood of heat stroke in children and the elderly.  It may also cause a sudden increase in blood pressure which may be dangerous for those with heart conditions.  It is not recommended for women who are pregnant.  Even in young and healthy individuals, the risk of dehydration when performing “hot yoga” is much higher, thus drinking plenty of water is imperative to avoid dizziness, fainting, and heat stroke.

The most important thing to remember when experimenting with any form of exercise, including yoga, is that it should be fun and safe.  So if you love the heat, bring your water bottle and a towel, and we’ll meet you on your yoga mat!

References

Bikram’s Yoga College of India: http://www.bikramyoga.com/

Hart CE, Tracy BL.  Yoga as steadiness training: effects on motor variability in young adults.  J Strength Cond Res. 2008 Sep;22(5):1659-69.

A Yoga Heat Wave.  American Fitness. 2003 Nov/Dec;21(6): 32-35.

Strength Training for Throwing Athletes – Part 2

Are you an injured or at risk throwing athlete?  Welcome back for the second half our our blog on how to prevent a throwing related injury.

See an explanation of The Throwers 10 and the first 3 exercises on our last blog.

This week we will present the second half of our series focusing on upper body strengthening to help prevent injuries and improve performance for all you throwing athletes.  Check out the video below for demonstration of the following exercises.

4: Scaption with Internal Rotation – great to strengthen one of the 4 rotator cuff muscles, but it is now recommended that you perform this exercise with your thumb up (external rotation) to prevent unnecessary stress to the muscle.

5: Prone Horizontal Abduction – a great exercise to work on stabilization of the scapula.

6: Lower trap press ups  - one of the only exercises that targets the lower part of the shoulder blade and is crucial to developing a stable shoulder.

7: Prone rowing – keep your shoulder down and back, be cautious not to hike your shoulder blade up towards your ear.

8: Pushups – Great as an advanced exercises but I would add a “plus” to this exercise as this has been shown to increase activation of the lower and outside part of the shoulder girdle.

9: Biceps curls and Triceps press

10: Wrist Flexion, Ext, Supination and Prontation

If you have further questions you should seek further consultation from a qualified professional.  Check back every two weeks for more blogs written by your CPMC Sports Wellness Physical Therapists.  In the next couple of months we will discuss popular health and fitness related topics including:  PRP, Bikram Yoga and CrossFit.

Strength Training for Throwing Athletes – Part I

What a great World Series this year!  Time for the rest, recovery and rehab for our favorite big leaguers.  Regardless what level you participate at, throwing places high amounts of stress on the shoulder and arm and can quickly lead to injury.   In fact, nearly 60% of young pitchers sustain injuries to their arm, and 15% of college baseball pitchers with current shoulder pain report prior episodes of arm pain in their youth (JOSPT May 20011).  These statistics demonstrate the importance of prevention through instruction on proper throwing mechanics and appropriate strength training.

Traditionally, athletes in throwing sports have been taught to complete a group of  exercises which strengthen the muscles required for throwing. Half of this “Thrower’s 10” is demonstrated in the video below.  Be sure to check back in two weeks for the second half. Additionally, here are a few other tips to help keep you pain-free and out on the field:

• Be sure to include an appropriate warm-up before all games and practices.
• If you’re a pitcher, practice from a mound whenever possible to simulate game situations. When a mound is not available, use short distance (120- 180 feet) throws to warm-up instead of long toss. (JOSPT May 20011).  Long toss produces more strain on the elbow and shoulder due to mechanical differences and is not a safe way to warm-up (JOSPT May 20011).
• 60% of your throwing power is generated from the muscles of the legs and core. Check out our previous articles for exercises to develop improved strength in these areas.
• Instruction in proper throwing mechanics should be sought only from a trained professional, coach or trainer.

The Classic “Throwers 10”

1: D2 Flexion/Extension

2: External Rotation and Internal Rotation at 0 and 90 degrees

3: Shoulder abduction to 90 deg

4: Scaption with Internal Rotation

5: Prone Horizontal Abduction

6: Lower trap press ups

7: Prone rowing

8: Pushups

9: Biceps curls and Triceps press

10: Wrist Flexion, Ext, Supination and Prontation

Week 1:

This week we start with the first half of our series focusing on upper body strengthening to help prevent injuries and improve performance for all you throwing athletes.  Check out the video below.

1: D2 Flexion/Extension   Great exercises in the later stages of recovery from injury and include strengthening of most major muscle groups in the body.  Remember to point the thumb up as you go up and down.  The shoulder should stay close the body and come closer to your face rather than further away

2: External Rotation and Internal Rotation at 0 and 90 degrees.  Theses should be emphasized, as the rotator cuff is very important for stability and control of the shoulder during throwing mechanics.  New research has shown that External Rotation strength is very important to prevent shoulder pain.

3: Shoulder abduction to 90 deg  No need to complete as this strengthens similar muscles as other exercises in the progression with more stress to structures of the shoulder

The attached videos will help guide you to the correct performance of these exercises.  If you have further questions you should seek further consultation from a qualified professional.  Check back for the second half of our Throwers 10 series in two weeks.

How to Avoid Shoulder Pain at the Gym

There are a lot of ways to injure the shoulder—don’t let your workouts be one of them.  If you’re already having pain (or would like to avoid it), the following tips will help you keep those shoulders safe in the gym.

1. Avoid all behind the neck exercises.  Although behind the neck shoulder presses, lat pull downs and back squats might evoke fond memories of your first foray into strength training (myself included), they’re also a recipe for shoulder disaster.  That’s the bad news.  The good news? All of these exercises have alternatives which keep the hands and weight in front of the face and are just as effective at targeting the intended muscles.
2. Keep those elbows close.  Flaring your elbows out to the side during bench presses, push-ups and overhead presses places the shoulder joints in an incredibly vulnerable position. Perform those same exercises with the elbows in closer to the body and you’ll drastically reduce your risk of shoulder injury.     
3. Don’t lose sight of your hands.  When performing chest presses and flyes, don’t let your hands disappear from your peripheral vision.  This will keep the elbows from dropping behind the plane of the shoulders which can produce excessive strain on joint structures.
4. Take a look at your push to pull ratio.  If your routine emphasizes pushing (bench press, shoulder press, flyes) over pulling (rows, etc.), you’re asking for trouble.  Much of our daily life already encourages excessive recruitment of muscles on the front of our shoulders (seated computer work, driving, lifting/carrying tasks). Reinforcing this imbalance in the gym is a surefire way to end up with unhappy shoulders.  Aim for 3 sets of pulling movements for every 1 set of pushing movements at the gym.  Can’t think of many pulling exercises?  Look here  (video for I’s, T’s, W’s and Y’s).
5. Don’t neglect the rotator cuff.  These (Shoulder ER and IR) simple exercises should be part of your regular workout routine—not just when you’re already hurting.
6. No dips or upright rows.  Although frequently staples of strength and bodybuilding routines, dips (both on a bench or in the parallel bars) and upright rowing place unnecessary strain on the shoulder joints.  Avoid these exercises—your shoulders will thank you.

For more advise on safe shoulder exercises visit a physical therapist.  If you have pain or limited shoulder function visit your doctor.  Check back in two weeks for our two part series on shoulder training for the overhead athelete. 

References:

Upper Extremity Weight-Training Modifications for the Injured Athlete : A Clinical Perspective. Martin Fees, Tony Decker, Lynn Snyder-Mackler and Michael J. Axe Am J Sports Med 1998 26: 732

Refueling with Chocolate Milk

Remember the days of little league baseball when your post-game snack game consisted of a sandwich (white bread, no crust), Capri-Sun and some cookies?  Most of us have probably abandoned those early favorites and turned instead to water, sports drinks, granola/energy bars, or even possibly the  occasional adult beverage to refuel after exercise or sports activities.  All of these refreshments have one thing in common—they’re all forms of post exercise nutrition.  Turns out what fuel you give your body after exercise is just as important as what you consume prior. In fact, proper post exercise nutrition helps to reduce the risk of injury, improve your performance during the next game or workout, and boost your health and well-being.

In addition to water, athletes need:

•    Protein to help build muscle, reduce muscle breakdown and work with carbohydrates to restore muscle glycogen
•    Carbohydrates to restore muscle glycogen
•    Fluids and Electrolytes to help replenish what’s lost in sweat (sodium, calcium, potassium, and magnesium) and to help rehydrate the body
•    Vitamins and Minerals to contribute to overall health and nutrition

So, you may now be wondering “What do I have in my refrigerator that has all that?” The answer might surprise you—chocolate milk! Athletes such as Michael Phelps drew attention to this at the 2004 Olympics when cameras spotted him chugging Carnation chocolate drinks following his swimming events. Studies now show that chocolate milk aids the body, particularly the muscles, in recovering from bouts of exercise. A recent study published in the Journal of Sport Nutrition and Exercise Metabolism, found that chocolate milk has double the carbohydrate and protein content compared to plain milk, water, and most sports drinks—a perfect recipe for replenishing tired muscles.  Its high water content replaces fluids lost as sweat, preventing dehydration. Plus it packs a nutritional bonus of calcium, and includes just a little sodium and sugar—additives that help recovering athletes retain water and regain energy.  It appears the delicious verdict is in. Chocolate milk is an optimal post exercise drink to promote muscle recovery and fluid restoration following intense exercise.  Need more incentive? It’s also cheaper (and better tasting) than most sports drinks you’ll find in the market.  Not only is chocolate milk good for your health, but chocolate packs good nutrition.
To read about other studies on chocolate milk as nature’s recovery drink, go check out refuelwithchocolatemilk.  If you’re looking for an excuse to drink more chocolate milk, visit our Sports Wellness Center website and sign up for one of our fitness classes.

Wrist Pain with a New Baby

Congrats!!! The little one is finally here!

As a new mom, you’re busy settling into the routine of motherhood. The last thing you need slowing you down is wrist pain! Luckily, there are some easy tricks and tips that can help you feel better and prevent further injury to your body.

After childbirth, hormone levels are fluctuating, pressure in your body changes from a significant loss of fluid, and you’re likely tired—all the time. This can be a tricky combination, particularly when you’re now having to lift a squirmy, fragile baby throughout the day. Additionally, repetitive movements throughout the day (breast or bottle feeding, lifting/lowering your baby, carrying car seats and diaper bags), create the perfect recipe for “repetitive stress” injuries of the muscles and nerves surrounding the forearms and wrists.

Fortunately, there are some simple ways to protect you from pain, or to decrease pain if it’s already started.

While feeding baby:

• Use a nursing pillow (i.e. Boppy, My Brest Friend [www.boppy.com, www.mybrestfriend.com). This will help support the weight of baby so your hands don’t have to!
• Allow yourself to recline back, and support the weight of baby on your body, rather than in your arms
• Use arm rests or pillows under your elbows for support
• Keep your fingers/hands relaxed and shoulders back. You can even think about tightening your abs – this not only helps tighten up that baby belly, but it provides more support to your spine which in turn helps to support your neck/shoulders/arms.
• If bottle feeding, be sure to keep your wrist in a neutral position (knuckles in line with forearm) – try holding the bottle from underneath rather than over the top and keep your elbows tucked in.baby

When lifting/carrying baby:

• Get in the habit of tightening your abs and pulling your shoulders back, this gives you a stronger core and makes it easier for your arms and hands to do their job efficiently
• Get close to your baby. The more you have to reach with your arms, the more stress you place on your wrists, elbows, and shoulders.
• Train yourself early on to carry baby on both sides, or in the middle using both arms. Holding your baby too much on just one side places increased stress that side.
• If you’ll be needing to hold your baby for more than a couple of minutes, use a baby carrier (i.e. Ergo, Baby Bjorn, Moby Wrap) to help distribute the weight from your arms to your trunk.

Here are some great exercises to help prevent overuse:

Wrist flexor/extensor stretches: Start with right arm stretched out in front of you, palm down. Grasp fingers of right hand with left hand. Keeping right elbow straight gently pull fingers down towards the floor until you feel a comfortable stretch in the forearm. Hold for 15-20 seconds, then relax. Repeat with palm turned up towards the ceiling.

Plank: Get on the floor on your hands and knees. Tighten your abdominal muscles (think about pulling the belly button up towards your spine). Extend one leg back, then the other, until you are in a pushup position. Hold for 2-3 deep breaths, up to 1 minute as tolerated.

Exercises to do with your Newborn

Baby Kisses (pushup): With baby lying on the floor, get into pushup position, either on your knees or toes. Bend elbows to lower yourself towards the floor, giving baby a kiss when you get to the bottom. Be sure to keep your abs tight and your spine straight and long!

Baby press (chest press): Lie on your back, with baby on your chest/stomach. Holding baby around the ribs, under the arms, press the baby up towards the ceiling, then lower back down for a kiss. Repeat 5-10 times as baby allows!

Baby reach arms and legs (bird dog): Start on hands and knees. Tighten abdominals. Reach right arm forward and left leg backward. Hold for a breath, then switch arm/leg. You can hold a rattle or baby’s favorite toy in each hand to keep baby interested. Wiggling the fingers works too!

If you have ongoing pain, numbness or any other symptoms see your doctor for apropriate care. Physical Therapy may be warrented. Go to Sports Wellness Center for more information and subscribe to our bi-monthly blog for ongoing fitness and wellness tips.

Hyponatremia: The Athlete’s Drinking Problem

With the arrival of warm summer days, many of us are hitting the roads and trails to train for and participate in endurance events. Hot temperatures + exercise = sweat, and the need to hydrate to maintain performance becomes increasingly important.  Gone, however, are the days of worrying only about drinking enough; we now know that athletes must be aware of the risks of overhydration. When it comes to exercise, excessive drinking can be a dangerous thing.

Case in point: Cynthia Lucero and the 2002 Boston Marathon. With finish temperatures forecast in the 70’s—hot for marathoning–Cynthia made sure to hydrate before the race. She consumed large quantities of Gatorade during the first twenty miles and looked strong at the base of Heartbreak Hill before passing out near Cleveland Circle. Transported to a hospital in a coma, Cynthia Lucero died on April 18, 2002 at the age of 28.   Doctors determined the cause of death was swelling of her brain, brought on by excessive hydration.

Excessive hydration can lead to a condition called hyponatremia.  This occurs when water intake is sufficient to dilute the normal concentration of sodium in extra-cellular fluid within the body. Research with endurance athletes during intense exercise has also demonstrated inappropriate secretion of arginine vasopressin, the body’s main antidiuretic hormone.  This combination of dysfunctional hormone release with excessive, voluntary fluid intake can lead to the development of hyponatremia. Early signs of hyponatremia are nausea, vomiting and headache. Later signs include confusion, disorientation, seizures and coma. The most severe effects are pulmonary and cerebral edema, or swelling of the lungs and brain, both potentially fatal conditions.

Although death from hyponatremia is relatively rare, exercise-associated hyponatremia (EAH) has recently emerged as the most common life-threatening complication in endurance sports participants.”    To make matters even more worrisome, there is no easy, one-size-fits-all solution for the problem of how much to drink. Each athlete is different, and current research recommends that every athlete develop an individual hydration strategy optimized to their own physiology and activity. Factors to consider include sweat rate and electrolyte losses (which in turn are influenced by, among others, body weight, genetics and metabolism); temperature; humidity; clothing; and the type of activity.

Here are some general guidelines to keep in mind:

•    Start your workout at normal body water and electrolyte levels. Consuming food or beverages containing sodium may be helpful in stimulating thirst and helping your body retain fluids.

•    Any fluid intake in excess of the amount that the body can naturally excrete through sweat and urine, about 800 to 1000 mL per hour, places you at risk of hyponatremia.

•    Beverages containing electrolytes and carbohydrates may be more effective than water alone.

•    The consensus recommendation is to drink ad libidum during exercise.  In other words, drink when you’re thirsty.

For more tips on managing your fluid intake check out this article at Runners World.

Finally, dehydration is still the more common foe, so do make sure to hydrate adequately during exercise. Get outside and have fun, but remember: Hydration in moderation.

For more tips on safe training for running check out CPMC Running Clinic at the Sports Wellness Center.  More articles related to training for running and running injuries can be found on the running tab.

References

1.  Boston Globe

2.  Rogers, IR, Hew-Butler, T. 2009. “Exercise-Associated Hyponatremia: Overzealous Fluid Consumption.” Wilderness and Environmental Medicine, 20: 139-143.

3.  ACSM press release of February 8, 2007. “Exercise and fluid replacement position stand now available: American College of Sports Medicine releases new, revised hydration recommendations.” Accessed June 17, 2011 at ASCM.com.

4.  Rogers and Hew-Butler (2009).

5.  ACSM press release (2007).