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Competitive Edge, Spring 2011

Marathon Checklist

After all the hard work and preparation of training for a marathon, don't make a misstep in the final hours. Follow these tips from exercise physiologist Heather Nettle, MA.

The day before the race
  • Lay out the clothing that you will wear and be sure it is something you have run in before.
  • Check the weather report and plan your clothing appropriately.
  • Don't wear new shoes in the marathon. Wear a pair that you have worn during a few long runs.
  • Be prepared for anything. Fill a gym bag with the essentials: a dry shirt, an extra pair of socks, tissues, extra shoe laces, gloves, hat, Vaseline® (or other lubricant), extra safety pins, blister care products, and whatever else you can’t live without. You can throw your sweats into the bag before starting the race. Most races have a baggage check area.
  • Make sure you have picked up your race number. Don't spend hours on your feet at the race expo. If possible, pick up your number early.
  • Don't eat too late at night and make sure you are well-hydrated.
  • Plan when you will leave, how you will get to the race, and where you will park. You don't want to get lost before the race.
  • If you didn’t tolerate the electrolyte drink that will be used during the race when you were training, plan on another source of calories, such as gel packets or gummy bears. Carry a water bottle or camel back filled with your favorite replacement drink. Friends along the course might be able to restock your supply.
  • Be sure to try your fluid and gel supplements before the event. Even small variations in sugar concentration can upset your stomach during an event.
  • Review the course map; know where water stops, aid stations, and Porta-Johns are located.
  • Check the pollution conditions at the course. If there will be higher levels of polluted conditions, it is best to plan ahead. Minimize your exposure to the pollutants on the way to the race, and find somewhere that is either extremely well ventilated (such as at the waterfront), or indoors as a place to warm up. Areas with tall buildings and heavy traffic can be the worst place to warm up. Pollution will negatively impact performance, and may exacerbate allergies or asthma.
Race day
  • Get up early. Plan on arriving at the start at least an hour before the race. You do not want to feel pressured for time before the race.
  • Take in some calories. Whatever worked before on your long training runs is a good idea. Make sure that you are drinking water, too.
  • While getting dressed, lubricate any areas in which chafing has been a problem. If blisters or hot spots have been a problem, pre-treat the site to guard against developing the problem (Second Skin, moleskin, or whatever worked during training). Don't forget to pin on your number. Tie your ChampionChip to your shoe, if the chip is being used for the race.
  • No matter what the temperature is when you get up, chances are that it will increase during the race. In addition, you will generate a lot of heat while running. At the start of the race, you might wear old clothing that you can discard once you are warmed up. Old socks work well on the hands. Garbage bags do a fine job in inclement weather. If you discard anything, do not throw it in the path of another runner.
  • Arrive at the start planning to find a line at the Porta-Johns. Since you have time to spare, there will be no need to panic.
  • Don't worry about a warm-up run. Walking from the car will loosen you up a little. You might want to do some easy stretching (if you are used to this).
  • Just before heading to the starting line, take off your sweats and check your gym bag. Now head to the start and situate yourself in an appropriate area in the pack. Don't worry about starting too slowly. It will give you a chance to warm up your muscles and save you from the agony of starting out too fast.
  • Make sure you have secured whatever food and/or drink that you are bringing with you.
  • You have worked hard to get here. Enjoy the adventure ahead.
During the race
  • Drink at every water station. Do not wait until you are thirsty — that is too late.
  • Start slowly; a fast start usually spells disaster. You can start running faster later in the race.
  • Finish with a smile on your face. Someone might be taking your picture.
After the race
  • No matter what the result, be proud of yourself.
  • If you are having persistent pain, don't try to "run through it", seek appropriate medical attention.
  • Drink. Even though you drank during the race, you will still be a little dehydrated.
  • Replenish carbohydrates. There is a two-hour window following a hard effort during which carbohydrate absorption may be enhanced. If you can't eat them, then drink them. A little protein mixed in improves recovery. Don’t choose anything extremely high in sugar or fat because it will cause stomach upset.
  • Keep moving. Do lower intensity cardiovascular movements, such as walking, for 60 minutes after the race. This will diminish a lot of the post-race stiffness. Stretch gently.
  • Put ice on anything that is sore. Apply ice for 15 minutes several times over the course of the day.
  • Don't plan on running during the week after the race. Walking, swimming or cycling at an easy pace will work well.
  • You may find that a massage is helpful for post-race stiffness.
  • When you resume running, start easy — 30 minutes three to four times per week and increase gradually from there. Most experts will tell you to avoid speed work for a month after a marathon.
  • Start planning for your next marathon. Review your training — what worked well and what presented a problem. Adjust your training schedule accordingly. Experience is the best teacher.
  • Do not restart your strength training program for two weeks following the event.
  • Allow your body to recover. An extreme athletic event like a marathon is incredibly stressful on the body. The body needs the rest, otherwise problems such as injuries, fatigue, decreases in performance and immune suppression can result.

Heather Nettle, MA, is an exercise physiologist at Cleveland Clinic Sports Health. If you would like to make an appointment with Heather or any of our other exercise physiologists, please call 866.275.7496.

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Ask the Sports Dietitian

Q: I’m considering taking a sports supplement, but I am wondering if they are really necessary?

A: The answer is likely “no.” Sports supplements are not necessary for people who train smart and eat balanced diets. Proper training will ensure your body is adapting to training and a balanced diet should provide you with 100 percent of the nutrients you need to support proper training. But, a daily multivitamin/mineral supplement is not a bad idea if you are looking for an insurance plan to guarantee you meet all of your daily micronutrient needs.

Sports supplements are attractive because they are marketed to athletes with lofty claims such as being able to increase strength, power, or endurance; decrease fatigue; improve recovery; and promote weight loss. While the Food and Drug Administration holds manufacturers accountable for the identity, purity and strength of product ingredients, the law doesn’t require companies to prove their supplements’ safety or effectiveness.

To help you sort through the myriad of sports supplements on the market, let’s break down sports supplements into three categories: “effective as claimed,” “may be effective, but research is inconclusive,” and “avoid due to adverse effects.”

Effective as claimed – According to the American Dietetic Association, the American Society of Sports Medicine, and Dietitians of Canada, only creatine, caffeine and sodium bicarbonate are effective as claimed.

Research shows creatine is effective at increasing lean body mass in athletes who perform repeated bouts of high-intensity exercise for less than 30 seconds (such as sprinters, jumpers, throwers, hurdlers, sprint swimmers, cyclists and weight lifters). Caffeine is effective as a central nervous system stimulant, increasing alertness and decreasing perception of effort. Sodium bicarbonate is touted for its ability to prevent fatigue by neutralizing lactic acid, although a common side effect is nausea and diarrhea.

May be effective, but research is inconclusive – The jury is still out on many popular sports supplements that may be effective, but more research is needed to prove their benefits. These include beta-hydroxy-beta-methylbutyrate (HMB), glutamine and ribose.

Don’t purchase – Avoid using the following sports supplements because they have yet to prove either ability to improve performance and may have adverse health effects: branched chain amino acids, carnitine, chromium, coenzyme Q10, medium chain triglycerides and pyruvate.

Sports supplements are not necessary for those who train and eat smart. But, it is up to you as an athlete and consumer to choose whether or not sports supplements are right for you. Here are some resources to help you in making that choice:

Katherine Mone, MEd, RD, LD, CSSD, is a sports dietitian for Cleveland Clinic Sports Health. She specializes in any type of athletes, diabetes and cardiovascular disease. If you have any questions about sports supplements or want to make an appointment, call 866.275.7496.

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Overuse Injuries: What You Should Know

By Paul M. Saluan, MD

Why are overuse injuries so common? There are many reasons that contribute to this spike in injuries:

  • Specializing in only one sport at an early age
  • Immature bones
  • Insufficient rest after an injury
  • Poor training or conditioning
  • Improper technique

While overuse injuries are seen in many sports, baseball is the sport that classically embodies this overuse phenomenon due to the repetitive nature and tremendous force used in throwing.

Why do overuse injuries happen?

The most overuse injuries from throwing in baseball are seen in children with open growth plates. Growth plates are specific areas at the ends of most bones that contain active cartilage cells, which are responsible for bones growing in length. Torsional stress (stress from twisting or turning), as well as the repetitive nature of practice take their toll on developing shoulders and elbows. The growth plate itself is the weak point of the kinetic chain (the physical sequence of events) used in throwing, with pain being the first evidence of injury to this area.

What specific types of injuries do players suffer?

Commonly seen overuse injuries include:

  • Tendonitis (inflammation of the tendon)
  • Cartilage injury
  • Injury to the growth plate of the arm in younger players
  • Stress fractures
What to do if you suspect an injury

If little leaguers or adolescent athletes develop pain in their shoulders or elbows, it is imperative that they stop play and get some rest to allow for healing. If the pain is persistent, then the family should seek medical attention to assess for more significant injuries, including growth plate injuries or fractures. In some instances, these injuries if left untreated can have a lifelong impact.

Cleveland Clinic has partnered with the American Orthopaedic Society for Sports Medicine on a national multimedia campaign, the “Sports Trauma and Overuse Prevention” (STOP) Program, to help educate athletes, parents and coaches about the dangers of these types of overuse injuries and different ways to avoid these potentially devastating injuries. To learn more, visit

Remember to have your kids play smart and play safe.

Dr. Saluan is a pediatric orthopaedic surgeon at Cleveland Clinic Sports Health. To see him or another sports medicine specialist, call 877.440.TEAM(8326).

Tips for preventing overuse injuries:

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Gym Safety Tip: Using Barbells? A Spotter is a Must!

By: Heather Nettle, MA, Exercise Physiologist

Do not use barbells at home unless you have a spotter. Many people with a hectic schedule feel it is best to make a quick trip into the basement to lift weights.

If that is the case, go for dumbbells, calisthenics, machines, pulleys, balls or bands for resistance training. Lifting heavier free weights, such as barbells, at home without a spotter increases your risk of having a traumatic injury.

In 2009, former University of Southern California football star Stafon Johnson suffered critical injuries when a barbell smashed onto his throat and larynx. At the time, he was doing a routine bench press with a spotter. Experts suggest that had he not had a spotter, the injuries would have been even more life threatening. In this instance, this was a high level athlete doing his regular lifting routine with a spotter. Many people do this at home alone in their basements.

Accidents can happen. Safety precautions should be implemented to prevent potentially tragic outcomes.

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Hip Pain? Understanding Labral Tears

Our understanding of hip pain in athletes has greatly improved over the last 15 years. This new insight has helped doctors evaluate and diagnose more injuries to what’s known as the acetabular (hip) labrum.

Read answers to frequently asked questions about this common cause of hip pain from James Rosneck, MD.

Q: What is your hip labrum?

A: The hip labrum is an “O-ring” of fibrocartilage that lines the edge of the socket portion of the hip (ball and socket) joint. This connective tissue ring provides a fluid seal for the joint, improving its lubrication and overall joint health.

Q: What is a labral tear?

A: The labrum may become injured, torn and painful – as it has pain-sensing nerve fibers. Injury can be due to trauma (such as an accident or sports injury). But, most commonly it occurs over time when the ball portion of the joint rubs abnormally against the socket or doesn’t have the full range of motion, a condition called femoroacetabular impingement (FAI).

Q: What are the symptoms?

A: Patients with labral tears that develop gradually (which is the most common) usually seek medical attention for their hip pain, which is felt deep in the front, side part of the hip. Activities that commonly cause the pain include running, sitting with legs crossed or for prolonged periods of time, getting into a deep squatting position, or even bending over to tie your shoes.

Q: How are labral tears diagnosed?

A: A labral tear is diagnosed by the physician taking a good history of symptoms, doing a thorough physical exam, and imaging of the hip and pelvis. X-rays may be taken to evaluate for any wearing away of the cartilage due to arthritis, or to check for bony impingement (any part of the bone that is preventing normal joint movement). MRI may be used to evaluate your soft tissues and the labrum. The challenge in diagnosing hip pain is the potential for other surrounding structures to be involved. Other conditions that may occur around the hip that must be ruled out when evaluating a patient for a labral tear include arthritis, sports hernia, low back pain/pinched nerve, trochanteric bursitis and hip tendonitis.

Q: What treatments are available?

A: Treating a labral tear may include several different components. First, an initial course of non-steroidal anti-inflammatories, physical therapy and activity modification/rest may be prescribed. If this fails, intra-articular injections with corticosteroids may be used to help ease inflammation for in-season athletes or those with mild arthritis. If conservative management fails, surgery may be needed. Labral tears may be treated with either open or minimally invasive surgical approaches. With arthroscopic (minimally invasive) techniques, in which the surgeon operates through small incisions to either remove or repair the tear and treat any bony impingement, patients can return to their activities or sport of choice over a three- to six-month period of rehabilitation after their surgery. Early outcomes suggest that minimally invasive procedures are just as reliable as open procedures, which involve longer recovery times.

Dr. Rosneck is a sports medicine orthopaedic surgeon with Cleveland Clinic Sports Health, specializing in hip arthroscopy. To make an appointment with Dr. Rosneck or any of our orthopaedic surgeons, call 877.440.TEAM (8326).

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Olivia Warhop of Pepper Pike Receives 2010 Courage Award

Olivia Warhop, of Pepper Pike, Ohio, was 13 years old when an unexplained pain in her leg brought her to doctors who found a mass growing in her tibia, the larger bone of the lower leg.

Doctors in San Francisco, where she was then living with her family, thought the tumor was non-cancerous and Olivia underwent surgery to remove it. She began her recovery as the Warhop family relocated to Cleveland that year. However, when Olivia continued her care at Cleveland Clinic, she learned that the growth was cancerous, and could return.

She was diagnosed with an extremely rare cancer called myofibrosarcoma. After careful consideration and after multiple consultations across the country, she underwent reconstructive surgery and entrusted her care with orthopaedic surgeon and cancer specialist Michael Joyce, MD, and his team to remove and replace a portion of her tibia with a donor bone, plates and screws. The procedure was performed to eliminate the cancer, but would require an intensive rehabilitation program.

Olivia persevered through the difficult diagnosis and multiple steps of treatment. Today, while she continues to recover from her operation, she remains as active as possible, including swimming.

On Feb. 10, 2011, the 8th grader at Hathaway Brown School was presented with the Cleveland Clinic Courage Award at the 2010 Greater Cleveland Sports Awards. This award honors exceptional student athletes who have faced a medical challenge in his or her life and approached the situation with courage and determination to get back to the game. Olivia’s story is an extraordinary example of someone exhibiting perseverance and dedication to overcome the odds of a life-altering situation.

Olivia plans to play soccer and join the swim team as she enters high school at Hathaway Brown in Shaker Heights. The entire clinical team is inspired by Olivia and is pleased to present her with the 2010 Cleveland Clinic Sports Health Courage Award.

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Dr. Bergfeld Receives 2010 Lifetime Achievement Award

John A. Bergfeld, MD, Senior Surgeon and Director of Operating Rooms for Cleveland Clinic, was honored with the 2010 Lifetime Achievement Award at the Greater Cleveland Sports Awards.

Dr. Bergfeld’s tenure includes 34 years as Director of Sports Medicine at Cleveland Clinic, and a combined 48 seasons as head team physician for the Cleveland Browns and Cleveland Cavaliers. He remains active in professional sports as a consultant for the Browns and Cavaliers and also is the team physician for Baldwin-Wallace College. He also developed and continues to host an annual awards ceremony for outstanding teams and athletes in the Cleveland Metropolitan School District.

The Lifetime Achievement Award traditionally honors an individual who has advanced sports in Cleveland through personal or career dedication and achievements.

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