Ask the Jock Doc is brought to you by the sports medicine experts at UC San Diego Health System – Sports Medicine. Let us help you get back on track. Call 858.657.8200. For answers to your sports injury or performance questions email jockdoc@spotlightsportsmag.com.

Q.

I’m on the varsity football team at my high school. I got hit in the head during a tackle and the referee took me out and didn’t let me play the rest of the game. He said something about a concussion.  I didn’t black out and it was frustrating that he wouldn’t let me play. Why would he say that I had a concussion and why wouldn’t he let me play?

A concussion is when either a direct or an indirect impact to the head that leads to a temporary disruption of brain function. This means that when you got hit in the head your brain got “jolted” and the brain cells were “shaken up” a bit; they needed time to recover in order to return back to normal. Although many people associate a concussion with blacking out or loss of consciousness, many concussions don’t involve blacking out or losing consciousness.

Natalie Voskanian, MD, sports medicine doctor at UC San Diego Health System says, “Symptoms from a concussion can vary. The concussed athlete often ‘just doesn’t feel right’. He/she may not be able to think clearly (‘feel foggy’) or might get easily confused. There might be balance issues, memory loss, difficulty concentrating, feeling extra tired, being moody, feeling anxious or depressed. There may be ringing in the ears, nausea, dizziness, blurry vision, headache, or extra sensitivity to light or noise. The symptoms can last hours, days, or sometimes even weeks.”

A concussion is a serious injury that is commonly seen in contact sports.  Advances in science have changed our understanding of concussions and the way that we treat them. It’s critical that any athlete who gets hit in the head and then feels “out of it”, or has any signs suggestive of concussion, speak to the athletic trainer, team physician, referee, or coach ASAP and get out of the game to be evaluated. This is because playing with a concussion can lead to serious consequences and long-term problems such as chronic fatigue, headaches, poor concentration, depression, and memory issues.  In other words the symptoms may never go away if you don’t give your brain a chance to recover.

The treatment of a concussion is a period of rest from sports, as well as from all stressful mental and physical activities.  Only return to exercise when you feel completely back to normal. This may take days, a week, or sometimes longer. Rarely a head injury can result in bleeding in the brain, which is even more serious than a concussion, and can be deadly. So it’s important that if you have any type of head injury, or if you get a severe headache from a sports injury, you get evaluated ASAP by a medical professional.  Don’t play through it! Your life and brain off the field are just as important as your life on the field.

Q.

I’m going into my senior year in high school and my last year on the varsity football team. I’m able to power clean 225 and squat 330. However, during one weightlifting session I might’ve done something wrong and pinched a nerve. It’s been about a month and it’s getting worse to the point that I can’t really practice or play without pain.  Any ideas before I decide to see a chiropractor?”

This kind of traumatic episode, resulting in prolonged (e.g. one month) symptoms that significantly limit your performance and get progressively worse, should be evaluated by a medical doctor.

Doug Chang, MD, PhD, a spine specialist at UC San Diego Sports Medicine says “The problem sounds more significant than a simple “strained muscle” in your back. It could be a vertebral disk herniation in the spine, a tear/rupture of the hamstring or gluteal muscles, or even a fracture of parts of the vertebral bones (e.g. spinous process, transverse process, pars interarticularis).  The first step in getting better is getting the right diagnosis, which will guide your treatment and rehabilitation.”

“Once certain medical conditions are ruled out, you’ll be able to safely work with a physical therapist, athletic trainer, chiropractor or coach to gradually resume activity,” Dr. Chang adds.  Proper static and dynamic posture can help you position the spine to best handle loads that are placed upon it.  Learning to engage your core musculature to support the spine during movement is an important part of any program for back pain.   A visit to the doctor is the first step on your road to recovery.

Q. My feet get pretty sore during practice and games. Could it be my shoes that are wrong for me or maybe something bigger?

There are many reasons for your feet to get sore during practice and games. Was there any history of trauma? “Some sprains/strains take much longer to get better than others. In particular, high ankle sprains, lisfranc sprains, and turf toe injuries are the most notorious. These typically require more prolonged periods of rest and physical therapy/rehabilitation.” says Bat Smith, MD, foot/ankle orthopedic surgeon at UC San Diego Sports Medicine.

If there is no history of trauma, it’s important to note where the pain and discomfort is. Is it in the ankle, hindfoot, midfoot, forefoot, or arch? There are many potential causes of the pain depending on the location. While this can be partially related to shoe wear, it’s important to rule out more significant causes of pain that can become a much bigger problem if left untreated.

The type of sport is also important in looking into the cause of pain. Endurance sports tend to be associated more with stress fractures, most notably in the navicular, metatarsals, and calcaneus. Dr. Smith strongly recommends identifying and treating stress fractures early to prevent them from getting worse and potentially moving out of alignment, which would require surgical treatment. “These typically can be ruled-out with a history/physical exam along with x-rays and sometimes an MRI.”

If there is no underlying structural cause for the pain, then a change in shoe wear is the right place to start. Plantar arch pain can be treated well with appropriate shoes and arch support orthotics.

Q. Does milk do anything for me as an athlete? I drink non-fat milk so that I don’t get the fat and calories in whole milk, but does it have less calcium than regular milk?

During adolescence your body is building bone more rapidly than at any other time in your life. What you eat and do for activity play a critical role in how much bone you accumulate and how strong your bones are – now and for the rest of your life! It’s a window of opportunity that, once missed, is gone forever. The good news is that you’re an athlete. Participating in high-impact sports, particularly with changes of direction (such as soccer, basketball or volleyball) definitely helps build strong bones. As an athlete, you also require calcium for bone remodeling, protein for muscle repair/recovery, vitamin D for optimal functioning of many body systems, and carbohydrates for energy. Dairy products provide one of the most complete sources of all those nutrients.

Non-fat dairy products have just as much calcium, vitamin D and protein as regular dairy products. If you’re watching your weight, this allows you to get the nutritional benefits without the extra calories.

In your age group (9-18 years), you should be consuming 1,300 mgs of calcium/day or 4 calcium equivalent foods. A calcium equivalent is a food containing about 300 mg of calcium. Examples include:

• 1 cup of milk or yogurt or 1 1/2 cups of frozen yogurt
• 1 slice of low-fat cheese (1.5 oz) or 2 slices of cheese pizza
• 3/4 cup of almonds
• 3 cups of cooked broccoli

Foods that don’t normally have calcium can be “fortified”, such as soy milk, cereal or orange juice. Calcium supplements can also help you bridge the gap between what you take in and what your body needs. But real food provides many other nutrients that help with calcium absorption and overall health, so don’t be afraid to break out the “moo”!

Q. Why do muscle cramps occur in sports and how can I prevent them from happening?

Muscle cramps are common in sports. They occur most commonly in the calf and thigh muscles. During a cramp, the muscle contracts suddenly and forcefully (also known as a spasm). It can be very painful and may cause the athlete to fall to the ground in the middle of play. Muscle cramps usually occur during activities that are intense and involve explosive leg movements, such as in sports with a lot of running, sprinting, jumping, or pivoting.

According to UCSD sports medicine doctor Natalie Voskanian, MD, “A variety of factors are believed to cause muscle cramping. Muscle cramps occur more often in fatigued muscles that have not been sufficiently conditioned or trained. Deficiencies in electrolytes, particularly sodium, can cause muscle cramps. Dehydration can also lead to cramping by reducing the amount of blood flow to the muscles. The risk for muscle cramps is particularly increased during warm weather because higher sweat rates decrease blood flow and increase sodium losses, particularly in “salty sweaters”.

There are several things that can be done to treat a muscle cramp when it occurs.

• Stretch the muscle continuously in order to get the muscle fibers to stop contracting/spasming.
• Manual massage can also be used to relax the tightened muscle.
• Rehydrate with a sports drink and add extra sodium ( ¼ tsp salt to 2 cups of sports drink)

To prevent muscle cramps, stay hydrated by drinking plenty of fluids throughout the day. During activity, choose sports drinks. Consume a balanced diet with some salty foods – to prevent sodium depletion. Increase your muscle stamina through endurance and sport-specific training, lengthening the time it takes before the muscle gets fatigued.