Whether you’re still making necessary travel to the office each day or sidelined to home, with or without much work to do, there’s no denying that life for most of us has drastically changed in the last few weeks. For this reason it’s especially important to establish structure again, giving a sense of purpose to time that may otherwise easily drift into a blur.  By the way, today is Tuesday, in case you weren’t sure. 

While we have still remained open on abbreviated hours here for post-operative/emergent patients and staying in touch remotely with others, we are all taking a proactive approach to using extra time in clinic and at home to discuss treatment techniques, hone our manual skills, and get creative with new exercises. 

Since pools are no longer available, and the lakes are still a little cold for even the most neoprene-equipped among us, many triathletes and swimmers are wondering what to do.  I have always been a fan of resistance tubing for swim specific strengthening and now I am using it regularly to make the most of these days on dry land. Having a set time to work out, along with my usual walk/runs with my dog in the morning and afternoon, is helping me maintain normalcy and focus before winding down with a good meal and checking in with friends and family in the evenings. 

Below are two articles and a video, ranging from practical to perhaps a little off the wall, that might just provide a little spark of motivation to stay in control of life during uncertainty.

How to set a routine, stay productive and be active during the coronavirus

My Coronavirus Routine: A Neighborhood Primal Scream

Man runs marathon on his balcony during lockdown

Aaron Bachman is a Physical Therapist Assistant, endurance coach, and former elite triathlete.  As a PTA, Aaron also offers sports massage and running gait analysis services. Read Aaron’s bio here.

As a healthcare clinic…we remain open and dedicated to our community

At all times our TEAM is vigilant to the health of our athletes and patients. We are trained in universal precautions in order to prevent the transfer of viral and bacterial infections. We have staff that follow the protocols and policies in place for the routine cleaning of patient-use equipment, hand washing techniques/use of hand sanitizers, and educating our community on best-practices.

With that being said, we are open and treating our patients. We are complaint with the State of Michigan / Governor Whitmer’s Executive Order 2020-07 [LINK] in asking triage questions to best reduce the spread of COVID19 and other Influenza Viruses. We remain vigilant with the care of our patients, and are up to date on the current state in our community. As Executive Orders change, we will continue to adopt the new orders and educate our staff, patients and community.

What can you do???

Educate yourself. We have included some links below and a podcast that may help to inform and decrease over-reaction and fear.

Limit your exposure. Wash your hands. Minimize contact. Keep your hands out of your eyes, nose and mouth, as this is a doorway for virus and bacteria to enter your body. Review the CDC recommendations.

HOW LONG WILL THIS continue?

We honestly have no idea. The landscape is changing daily, if not hourly. We are working diligently to stay abreast of the most recent recommendations and information.

What if i have to cancel…or what if i still need PT treatment?

We are working hard with requests for rescheduling. Our staff is staying flexible with getting our patients in based on their needs and schedules. If you cannot make your scheduled appointments, we are asking that you contact our clinic to cancel and make arrangements for rescheduling your appointment.

If you cannot make it into the clinic but still have questions for our Team, we will work hard to answer your concerns by phone or email.

More to come….

Please stay tuned, reach out with questions, and most of all: take care of yourself and loved ones, and stay healthy and positive.

There is a lot of discussion in the news lately about Relative Energy Deficiency in Sport (RED-S) and it is a topic that we at Adams Sports Medicine and Physical Therapy talk a lot about. Dr. Hannah DePaul and Dr. Katie Noble spend time educating high school cross country and track teams about how to be healthy and fast. We respect and admire Mary Cain and other women who have come forward with their personal struggles with RED-S. RED-S has dangerous, long-term consequences to the health of both female and male athletes. As Mary Cain highlights, in order to navigate the complexities of sport, body image and self-worth – the support and guidance an athlete has is critical to avoid the disorder. 

So what is RED-S? It’s having an inadequate amount of energy to support bodily functions for optimal health and performance, which can lead to serious health and performance consequences (see diagram below).¹ When runners don’t eat or recover enough to support training, an energy deficit is created. When this energy deficit persists, an athlete will experience decreased performance, strength, and endurance and has increased risk of depression and physical injury. In a culture that often glamorizes #norestdays, young athletes need to be protected from developing habits that feed this disorder.

For women, RED-S can lead to menstrual dysfunction, which weakens bones and can lead to fractures. This is especially concerning in young athletes, as teens are developing peak bone mass that they will rely on for the rest of their lives. Periods are a barometer of overall health and if it’s lost, an athlete should seek medical help. Losing a period from training is never normal. For men, low testosterone can lead to thinning bones. While the signs of low testosterone aren’t as obvious as a lost menstrual cycle, knowing the risk factors for RED-S can help male athletes stay ahead of it. 

Historically, the culture of distance running has included a “thinner is faster” ideal. Research now proves that this thinking is dangerous to health and performance. A recent study found that male runners who responded “yes” to the statement “being thinner means being faster” were more likely to have low bone mineral density and an increased risk of fractures.² A runner’s thoughts and beliefs about body image has real effects on physical health. There is no truth that the lightest runner is the best runner. The best runner is well-supported, well-rested, well-fueled, and wisely trained. 

Nutrition and sleep also play a huge role in preventing RED-S. A study found that women who consumed less than 800 mg of calcium per day had nearly 6x the rate of stress fracture than women who consumed more than 1500 mg of calcium.²   It’s shown that sleep deprivation can lead to bone loss.³ 

RED-S isn’t just a physical health issue, it’s a cultural problem with sport. The culture of a sport and team can bring out the best in a runner or can be toxic to well-being. Breakthrough performances elevate sport and inspire humanity. The future of the sport lies within young athletes. Coaches, health care providers, parents, and everyone within an athlete’s support system has a responsibility to foster performance without sacrificing an athlete’s long-term physical and mental health. 

1. De Souza MJ, Nattiv A, Joy E, et al. Br J Sports Med 2014;48:289.
2. Tenforde, Adam & Fredericson, Michael & Sayres, Lauren & Cutti, Phil & Sainani, Kristin. (2015). Identifying Sex-Specific Risk Factors for Low Bone Mineral Density in Adolescent Runners. The American journal of sports medicine. 43. 10.1177/0363546515572142. 
3. Tenforde AS, Sayres LC, Sainani KL, Fredericson M. Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: a review of the literature.” PM R. 2010;2(10):945-949. Article Summary on PubMed. (http://www.ncbi.nlm.nih.gov/pubmed/20970764)
4. Ben-Sasson, et al. Extended duration of vertical position might impair bone metabolism. Eur J Clin Invest, 1994

Healthy bones are the foundation to healthy running. Bones are strong, sturdy, and designed to tolerate a great amount of stress. In fact, bones get stronger from weight bearing. This is good news for runners, who put cumulative stress through their bones with each foot fall.

However, bones have their limits and require proper care. Here are key things all runners should know about their bone health.

Energy availability is a pillar of bone health. Energy availability (EA) is a measure of energy burned versus energy replenished per day. You have to eat enough calories to not only support the miles you put in, but to support your brain and bodily functions. If EA is chronically low from underfueling or overtraining, your body will start to drain your bones to get the nutrients it needs to keep you alive and moving. If you’re underfueling or overtraining, bones become weaker. EA can be quantified with this calculator (www.femaleathletetriad.org/calculators). Daily EA should be around 45 kcal/kg FFM/day and athletes should be eating a MINIMUM of 30 kcal/FFM/day for optimal bone health. Along with weaker bones, low EA can lead to fatigue, decreased performance, and increased risk of injury.

Sleep is by far the most important aspect of recovery an athlete can utilize, as lack of sleep is associated with weakened bones. Sleep deprivation can have significant negative effects on performance in endurance tasks and may also influence learning, memory, pain perception, cognition, immunity and inflammation. In a study of military recruits who were purposefully sleep deprived, it was found that they had a 5% reduction in bone mineral density in just seven days.¹ Sleep is the time your body takes to replenish and repair tissue that was stressed during the day. If your sleep is disturbed, your bones are at a greater risk of injury.

Nutrition is about quality and quantity. Runners need to eat enough food each day. (Remember EA?). Some runners find benefit in an individualized consultation with a registered dietician. (We can recommend some good ones!) Specifically, all runners should pay attention to daily calcium intake. Calcium is a major building block that keeps bones strong. Recent studies show that women who consumed less than 800 mg of calcium per day had nearly 6 times the rate of stress fracture than women who consumed more than 1500 mg of calcium.² Furthermore, fracture risk in runners is decreased by 62% for every additional cup of skim milk consumed per day.² Calcium’s best friend, Vitamin D, is responsible for calcium absorption. The worse a runner’s vitamin D intake, the longer it takes to recover from stress fracture.³ Thus, increasing daily calcium and vitamin D is a simple way to reduce fracture risk.

Listen up, ladies. Your menstrual cycle is a vital sign. That’s right: put it right up there with heart rate and blood pressure. A healthy, regular cycle is the cardinal sign that you are maintaining an appropriate EA, getting adequate nutrition, and protecting your bones. Female runners who have stopped menstruating are at a 4.5-fold increased risk of injury compared to regularly menstruating women.⁴ This is because monthly estrogen spikes with each cycle help protect bones against break down. Your period is a monthly signal of your health. If your periods become irregular or stop, talk to your healthcare provider for strategies to regain your cycle.

When it comes to bone health, prevention of fractures is best. If a fracture does happen, the road to recovery doesn’t have to be so bumpy when you’re armed with the right information to help prevent future bone health issues. Most importantly, the road ahead has the potential to be better than before. If you have questions about bone health or would like to be evaluated for a bone stress injury, don’t hesitate to reach out to our therapists.

1. Ben-Sasson, et al. Extended duration of vertical position might impair bone metabolism. Eur J Clin Invest, 1994
2. Nieves et al. Nutritional Factors That Influence Change in Bone Density and Stress Fracture Risk Among Young Female Cross-Country Runners
3. Serum Vitamin D Levels Are Inversely Associated With Time Lost to Bone Stress Injury in a Cohort of NCAA Division I Distance Runners
4. Heikura I. 2018