Injury Prevention for the Figure Skater

Jake Veigel, MDjveigel@cayugamed.org

www.cayugamed.org/sportsmedicine

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

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

What is the Greatest Predictor of Injury???

• Prior Injury– Stress fractures– Knee injuries– Ankle sprains– Low back injuries– Shoulder disorders– Concussion– Heat illness– Dehydration

What is the Second Greatest Predictor of Injury???

• Exposure– Practice time– Games played– Duration of season– Lack of off-Season– Years participated– Age of the athlete

What Types of Injuries Are Preventable???

• Overuse Injuries– Tendonitis– Bursitis– Stress Fractures– Overuse Joint Pain

• Acute Injuries– Contusions– Sprains– Strains– Fractures– Dislocations– Trauma– Concussions

Injury Causes• 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

Time

Stress

Adaptation

Maladaptation

Individual StressLimit

Strength Imbalances

Active Warm-up

• Active warm-up– Increase heart rate,

blood flow, muscle temperature, and breathing rate

– Improves performance

Active Warm-up• 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).

Soligard et al British Medical Journal 2008, 2009

Active Warm-up (off-ice)• Includes

– Jogging, jump rope, side steps, carioca, bench stepping– Dynamic stretching– Hops , jumps, leaps, skips – Balance activities (one legged standing)

Strength and Conditioning

• 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

• 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

Vaughn & Micheli. Phys Med Rehabil Clin N Am. 2008.

Strength and Conditioning

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

Nutrition• 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

Inadequate Nutrition

• Weak bones• Inadequate growth of

muscles, bones• Poor strength• Fatigue and inattention

– Mistakes, poor technique, poor performance and susceptibility to injury

Nutrition• 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

Hoch et al (2008) Nutritional Requirements for the Child and Teenage Athlete, Phys Med Rehab Clin N am

Nutrition

• 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

Fat• 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

Eat to Train• 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

Nutrition for Adolescents

• 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

Iron

• Iron necessary 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

Vitamin D

• 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

Fluid• 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

Keys to Success

• 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

Dr. Veigel’s Wish List

• 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