The purpose of this study was to document eating strategies employed by runners during a 160-km race, and to identify eating patterns that predispose the runner to disturbed mental or gastrointestinal functioning. We monitored intake in 19 volunteers during the 12 hours pre-race. Intake was determined by interview with runners approximately every 12 km throughout the race. The mean finish time was 24.3 hours, with 4 runners not completing the race. Body mass decreased during the race, 75.9 ± 2.3 kg to 74.4 ± 2.2 kg (p < .001). Runners ingested 2643 kcals during the 12 hours prerace (68% carbohydrate) and 3.8 L of fluid. During the race 6047 kcal, 18 L of fluid, and 12 g of sodium were consumed. Gastrointestinal distress (GI) was experienced by half of the participants, but was unrelated to food or fluid intake. Upper GI symptoms were more prevalent than lower and occurred mainly after 88 km. Runners with GI distress tended to complete fewer training miles (p = .10) and to do shorter training runs (p = .08). Half of the volunteers reported mental status changes (MSC), such as confusion or dizziness. Runners with MSC had greater intake of total calories, carbohydrate, and fluid (p < .05) than runners without MSC. They also completed shorter training runs (p = .03). Caloric and moisture intake for all runners far exceeded intakes described previously. Although intake did not match energy expenditure, it may represent the upper limit for absorption during exercise, and very high food and/or fluid intake appears to lead to perturbed mental status.
Beth Glace, Christine Murphy, and Malachy McHugh
Timothy F. Tyler, Anthony Cuoco, Aaron K. Schachter, Gregory C. Thomas, and Malachy P. McHugh
Scapular strengthening is thought to be an important component of the rehabilitation of patients with internal impingement.
To determine the effect of scapular-retractor-muscle fatigue on internal- and external-rotation-torque production in patients with internal impingement.
Case control study.
15 patients and 18 healthy subjects.
A scapular-retractor-fatigue protocol.
Main Outcome Measure:
Shoulder-rotation- torque production.
After the scapular-retractor-fatigue protocol external- rotation strength was reduced in patients (involved 25%, noninvolved 19%; P < .001).
Fatigue in the scapular retractors resulted in lower shoulder-rotation-torque production. These findings emphasize the importance of the scapular retractors for proper function of the shoulder rotators with the arm in an abducted position in patients with internal impingement.
Timothy F. Tyler, Brandon M. Schmitt, Stephen J. Nicholas, and Malachy P. McHugh
Hamstring-strain injuries have a high recurrence rate.
To determine if a protocol emphasizing eccentric strength training with the hamstrings in a lengthened position resulted in a low recurrence rate.
Longitudinal cohort study.
Sports-medicine physical therapy clinic.
Fifty athletes with hamstring-strain injury (age 36 ± 16 y; 30 men, 20 women; 3 G1, 43 G2, 4 G3; 25 recurrent injuries) followed a 3-phase rehabilitation protocol emphasizing eccentric strengthening with the hamstrings in a lengthened position.
Main Outcome Measures:
Injury recurrence; isometric hamstring strength at 80°, 60°, 40°, and 20° knee flexion in sitting with the thigh flexed to 40° above the horizontal and the seat back at 90° to the horizontal (strength tested before return to sport).
Four of the 50 athletes sustained reinjuries between 3 and 12 mo after return to sport (8% recurrence rate). The other 42 athletes had not sustained a reinjury at an average of 24 ± 12 mo after return to sport. Eight noncompliant athletes did not complete the rehabilitation and returned to sport before initiating eccentric strengthening in the lengthened state. All 4 reinjuries occurred in these noncompliant athletes. At time of return to sport, compliant athletes had full restoration of strength while noncompliant athletes had significant hamstring weakness, which was progressively worse at longer muscle lengths (compliance × side × angle P = .006; involved vs noninvolved at 20°, compliant 7% stronger, noncompliant 43% weaker).
Compliance with rehabilitation emphasizing eccentric strengthening with the hamstrings in a lengthened position resulted in no reinjuries.
Tom Clifford, Will Abbott, Susan Y. Kwiecien, Glyn Howatson, and Malachy P. McHugh
Purpose : To examine whether donning lower-body garments fitted with cooled phase change material (PCM) would enhance recovery after a soccer match. Methods : In a randomized, crossover design, 11 elite soccer players from the reserve squad of a team in the second-highest league in England wore PCM cooled to 15°C (PCMcold) or left at ambient temperature (PCMamb; sham control) for 3 h after a soccer match. To assess recovery, countermovement jump height, maximal isometric voluntary contraction (MIVC), muscle soreness, and the adapted Brief Assessment of Mood Questionnaire (BAM+) were measured before 12, 36, and 60 h after each match. A belief questionnaire was completed preintervention and postintervention to determine the perceived effectiveness of each garment. Results : Results are comparisons between the 2 conditions at each time point postmatch. MIVC at 36 h postmatch was greater with PCMcold versus PCMwarm (P = .01; ES = 1.59; 95% CI, 3.9–17.1%). MIVC also tended to be higher at 60 h postmatch (P = .05; ES = 0.85; 95% CI, −0.4% to 11.1%). Muscle soreness was 26.5% lower in PCMcold versus PCMwarm at 36 h (P = .02; ES = 1.7; 95% CI, −50.4 to −16.1 mm) and 24.3% lower at 60 h (P = .04; ES = 1.1; 95% CI, −26.9 to −0.874 mm). There were no between-conditions differences in postmatch countermovement jump height or BAM+ (P > .05). The belief questionnaire revealed that players felt the PCMcold was more effective than the PCMamb after the intervention (P = .004). Conclusions : PCM cooling garments provide a practical means of delivering prolonged postexercise cooling and thereby accelerate recovery in elite soccer players.
Susan Y. Kwiecien, Malachy P. McHugh, Stuart Goodall, Kirsty M. Hicks, Angus M. Hunter, and Glyn Howatson
Purpose: To evaluate the effectiveness between cold-water immersion (CWI) and phase-change-material (PCM) cooling on intramuscular, core, and skin-temperature and cardiovascular responses. Methods: In a randomized, crossover design, 11 men completed 15 min of 15°C CWI to the umbilicus and 2-h recovery or 3 h of 15°C PCM covering the quadriceps and 1 h of recovery, separated by 24 h. Vastus lateralis intramuscular temperature at 1 and 3 cm, core and skin temperature, heart-rate variability, and thermal comfort were recorded at baseline and 15-min intervals throughout treatment and recovery. Results: Intramuscular temperature decreased (P < .001) during and after both treatments. A faster initial effect was observed from 15 min of CWI (Δ: 4.3°C [1.7°C] 1 cm; 5.5°C [2.1°C] 3 cm; P = .01). However, over time (2 h 15 min), greater effects were observed from prolonged PCM treatment (Δ: 4.2°C [1.9°C] 1 cm; 2.2°C [2.2°C] 3 cm; treatment × time, P = .0001). During the first hour of recovery from both treatments, intramuscular temperature was higher from CWI at 1 cm (P = .013) but not 3 cm. Core temperature deceased 0.25° (0.32°) from CWI (P = .001) and 0.28°C (0.27°C) from PCM (P = .0001), whereas heart-rate variability increased during both treatments (P = .001), with no differences between treatments. Conclusions: The magnitude of temperature reduction from CWI was comparable with PCM, but intramuscular temperature was decreased for longer during PCM. PCM cooling packs offer an alternative for delivering prolonged cooling whenever application of CWI is impractical while also exerting a central effect on core temperature and heart rate.
Malachy P. McHugh, Tom Clifford, Will Abbott, Susan Y. Kwiecien, Ian J. Kremenic, Joseph J. DeVita, and Glyn Howatson
Purpose: To assess the utility of an inertial sensor for assessing recovery in professional soccer players. Methods: In a randomized, crossover design, 11 professional soccer players wore shorts fitted with phase change material (PCM) cooling packs or uncooled packs (control) for 3 h after a 90-min match. Countermovement jump (CMJ) performance was assessed simultaneously with an inertial sensor and an optoelectric system: prematch and 12, 36, and 60 h postmatch. Inertial sensor metrics were flight height, jump height, low force, countermovement distance, force at low point, rate of eccentric force development, peak propulsive force, maximum power, and peak landing force. The only optoelectric metric was flight height. CMJ decrements and the effect of PCM cooling were assessed with repeated-measures analysis of variance. Jump heights were also compared between devices. Results: For the inertial sensor data, there were decrements in CMJ height on the days after matches (88% [10%] of baseline at 36 h, P = .012, effect size = 1.2, for control condition) and accelerated recovery with PCM cooling (105% [15%] of baseline at 36 h, P = .018 vs control, effect size = 1.1). Flight heights were strongly correlated between devices (r = .905, P < .001), but inertial sensor values were 1.8 [1.8] cm lower (P = .008). Low force during countermovement was increased (P = .031) and landing force was decreased (P = .043) after matches, but neither was affected by the PCM cooling intervention. Other CMJ metrics were unchanged after matches. Conclusions: This small portable inertial sensor provides a practical means of assessing recovery in soccer players.