Posts in athletes
High Intensity Interval Training Improves Endurance Performance

Among Boulder endurance athletes many training variables are utilized to promote beneficial adaptations within our bodies.  These adaptations to the cardiovascular and musculoskeletal systems lead to improved future performances in practice and competitions.  One training variable includes interval training where athletes complete portions of endurance exercise at a high intensity followed by a recovery period.  As these intervals are completed, athletes are able to train at this intensity for a longer cumulative duration (multiple intervals) than if they tried to complete the same intensity and duration over a single bout.  High intensity interval training (HIIT) programs, where the intervals are held close to maximum efforts followed by recovery periods, are gaining momentum among endurance athletes.

A recent article in the Journal of Strength and Conditioning research examined the impact of HIIT programs among triathletes (Garcia-Pinillos et al. 2016).  Athletes were timed on a sprint triathlon before being divided into two groups: one continued their current triathlon training and the second continued their training except substituted their run training for HIIT.  Athletes in this group completed 3-4 sessions of HIIT/week consisting of 100m and 400m distances, as well as, 30-120 second run intervals over 5 weeks.  At the end of the 5 weeks all athletes were tested again on their sprint triathlon performance. 

The authors reported improved run and swim performance after the HIIT leading to faster times among the trained group.  This study adds evidence to support the use of high intensity, low volume interval training among endurance athletes. 

Compression Garment's Impact on Running Recovery and Performance

Compression garments including shorts, tights, and socks have gained in popularity among both amateur and professional runners.  Manufacturers and athletes claim improved circulation, recovery, and performance can be found using these products either during or after a run.  As with many products in health, fitness, and performance these claims should be taken with a grain of salt until supported by research institutions.

A recent article in the journal Sports Medicine evaluated the available evidence on the psychological, physiological, and performance effects of compression garments (socks, calf sleeves, shorts, and tights) in runners (Engel et al. 2016).  The authors found moderate beneficial effects for delayed onset muscle pain/soreness and delayed muscle fatigue in athletes wearing compression garments during run.  Additionally, smaller beneficial effects were noted for improvements in running economy and time to exhaustion suggestion these garments may slightly improve performance.  Important to note is the lack of significant effects on sprint, middle, or long distance timed runs or physiologic variables such as cardiac output, blood lactate levels, or body temperature were noted in the review.  

In short, compression garments seem to have their greatest impact on perceived muscle pain/soreness and recovery, but performance effects are small.  

Increased Achilles Tendon Loading In Treadmill Running

The treadmill remains a necessary evil when completing run training allowing athletes to escape inclement weather to complete their workouts.  Thankfully, in Boulder we have few inclement days as we move through the Spring and Summer months allowing athletes to train outside.  Prior research has noted significant bio-mechanical differences in treadmill vs. ground running including athletes adopting a shorter stride length on the treadmill.  This reduction in stride length is accompanied by an increased in step frequency to maintain a given speed.  These changes will impact the rate and magnitude of loading across the leg during landing.  Recently, a Physical Therapy article examined the biomechanical impact of treadmill and over ground running on the knee and ankle structures. 

Willy and colleagues studied 18 healthy runners (9 female) who were running at least 10 km per week over the last 6 months and were free of injury over the previous 3 months (JOSPT. 2016).  Runners were analyzed in a Physical Therapy biomechanics laboratory while running on a treadmill and overground both at a previously self selected gait speed.  

Similar to prior research, runners selected a shorter stride length when using the treadmill compared to level ground.  The authors did not find differences in knee mechanics or loading between the two conditions.  Conversely, the authors noted greater achilles tendon loading and calf muscle contraction during treadmill running.  They attributed these changes to increased peak tendon forces during the treadmill run.  

This article was performed in healthy individuals but may have implications for those returning to running from achilles injury or those using the treadmill for the majority of their training runs.  


ACL Reconstruction in Older Athletes

ACL injuries are on the rise across the United States as more individuals participate in athletic activities.  As described in prior posts, the majority of these ligament injuries do not involve contact but rather occur with deceleration and directional changes in sports.   Athletes with decreased strength, balance, and coordination are unable to dissipate forces placing greater loads on their knee ligaments.  One segment of the population at risk of ligamentous injury due to these factors includes “weekend warrior” athletes over the age of 40. 

The necessity of repairing a torn ACL injury in these older athletes is debatable with many patients able to return to activity, albeit often at a lower level, with conservative treatments alone.  A recent review article examined the outcomes associated with ACL repair among athletes >40 years old.  Mall and colleagues analyzed the results of 452 patients (average age 48) who underwent ACL repair (Sports Health. 2016).  The authors reported few complications and a low failure rate among this population along with A or B outcomes in >80% of patients. 

The results of this review suggest ACL repair combined with post operative Physical Therapy is a safe and effective alternative for patients with ACL tears. 


Risk Factors for Ankle Sprain

Ankle sprains are one of the most common sports and orthopedic injuries encountered in Physical Therapy.  In previous blog posts we described the effectiveness of Physical Therapy treatments over other treatments including rest, ice, compression, and elevation (R.I.C.E.).  In addition, we have good evidence supporting the use of Physical Therapy clinical testing to determine which sprains are most likely to develop into chronic symptoms.  A recent review article highlighted the modifiable risk factors, which make patients more likely to sustain a first ankle sprain. 

Authors in the journal Sports Health (Kobayashi et al. 2016) reviewed 8 published articles to determine the ability of risk factors to predict a future ankle sprain.  The authors reported patients have a greater risk of ankle injury with increased weight, weakness in the leg and ankle musculature and limited balance ability.   Recreational and professional athletes are advised to work with a local Physical Therapist to identify and treat these impairments to reduce their risk of future injury.

Predicting Lasting Symptoms After An Initial Ankle Sprain

Ankle sprains are one of the most common orthopedic injuries we see in our Boulder Physical Therapy practice.  These injuries create local pain, swelling, loss of motion, weakness, and balance difficulties.  In past years these injuries were treated with R.I.C.E. (rest, ice, compression, and elevation), but more recent research has demonstrated improved outcomes and faster recovery with a more active approach.  Athletes treated with manual therapy and exercise by a Physical Therapist demonstrate superior outcomes than those treated with R.I.C.E.  The greatest limitation of the R.I.C.E. and wait and see approach involves prolonging treatment which may lead to lasting chronic symptoms throughout the lower extremity.  

A recent article in the American Journal of Sports Medicine attempted to identify predictors of chronic symptoms and balance difficulties among athletes after an ankle sprain (Doherty et al. 2016).  The authors followed 82 patients who sustained a first time ankle sprain.  The athletes were examined at 3 times points: 2 weeks, 6 months, and 12 months post injury.  At 12 months patients with lasting, chronic symptoms were identified and their data was analyzed to determine if prior clinical data could predict their lack of recovery.  The authors noted patients who were unable to complete landing and jumping tasks at 2 weeks post injury and/or were unable to demonstrate balance in multiple planes of movement demonstrated the greatest risk of lasting pain and symptoms.  

Individuals who sustain an ankle sprain are advised to contact their local Physical Therapist as soon as possible to accelerate recovery and prevent chronic symptoms.