Nutrition For The Female Athlete: To Win And Avoid Injuries


Poor or sub-optimum nutrition is more common in female athletes than in male athletes. Proper diet is of the utmost importance in order for active individuals to maintain adequate energy during intense bouts of exercise/activity and for recovery afterwards. In our sports injury practice, we often see female athletes with exercise related injuries in which inadequate nutrition may play a factor in the development or perpetuation of their injuries. Indeed, several scientific papers in recent years have raised concerns about inadequate nutrition and its effects upon female athletes.

Female athletes who are at the greatest risk for nutrition related problems are those who participate in sports that encourage “leanness” because of a need to wear contour-revealing clothing or those that are involved in competitions that involve scoring on the basis of body appearance. It is these women who often have inadequate nutritional intake.

Sports that emphasize “leanness” or a particular body aesthetic include:

• Gymnastics
• Distance running
• Diving
• Figure skating
• Classical ballet
• Bikini/Figure competitions

Indeed, some studies have found that female dancers, for example, consume less than 70% of recommended daily energy needs. Too often such restrictions are employed to achieve a certain “look” rather than to achieve maximum physical performance. And, very often, this is where problems begin.

Therefore, in order to formulate a winning nutritional plan the athlete’s sex and body size, the demands of the activity performed, and the duration for which that person performs the activity, or trains for that activity, must all be carefully considered.

What Are Macronutrients And Micronutrients?

The essential nutritional components are categorized as “macronutrients” (calories, carbohydrates, protein, and fat) and “micronutrients” (fluids, electrolytes, vitamins, and minerals).



Carbohydrates are necessary to meet energy needs. Carbohydrates are, generally, more important to endurance athletes than strength athletes.

When creating a sports nutrition plan, carbohydrate needs are generally formulated on the basis of an athlete’s body size and activity level. There is no optimum carbohydrate intake that universally suits all people in all circumstances. However, for discussion purposes, some researchers suggest that persons engaged in moderate-duration sports/exercise require at least 2.5-3.5 g of carbohydrates per pound of body weight. Those participating in long-duration endurance sports/exercise might require 3.5-5.5 g of carbohydrates per pound of body weight. Again, proposed nutrient ratios such as these constitute very general guidelines that are not prescriptive since they do not take into consideration individual factors relevant to each individual athlete.

Fruit, vegetables, brown rice, enriched whole-grain breads, whole grain cereals, rolled oats, beans, legumes, and sweet potatoes are examples of valuable carbohydrate foods for athletes and active people.


Active individuals have a higher protein requirement than less active people. This is due to the fact that active people and athletes: 1) generally have a higher percentage of lean muscle mass to support, 2) they need protein to repair muscle tissue that is damaged during exercise, and 3) they require additional protein for energy during exercise.

The amount of protein each athlete requires, again, depends on the type of activity being performed. For the purpose of discussion, some researchers conservatively recommend a minimum protein intake of around .5 grams per pound bodyweight/day for individuals participating in endurance sports and around .75 grams per pound bodyweight/day for those involved in strength/anaerobic activities. Again, these protein intakes are not prescriptive for all individuals under all circumstances. Certainly, those athletes who have achieved an “elite” level in strength sports, contact sports, and bodybuilding would probably find these dietary protein ratios inadequate for their needs.

The benefits of emphasizing protein over carbohydrates can include the following:

• Enhanced weight loss
• Reduction of fat in the belly and waist areas
• Optimal maintenance of blood sugar levels
• Improved blood lipid profiles/improved cardiovascular risk factors

Protein-rich foods include lean beef, chicken, turkey, fish, eggs, whey protein, and other low-fat dairy products. Women at risk for having a low protein intake are those who restrict their energy intake to achieve weight loss or those who eat a vegetarian diet. It is often difficult to persuade vegetarian women who visit our office with chronic injuries or overtraining syndrome that they may need to increase their intake of quality proteins. However, we often note that when protein intake is improved in these individuals their strength, power, muscle tone, and recovery from injury rapidly improves.

We occasionally encounter questions as to whether a high-protein diet can cause kidney damage. In this regard, there has been no conclusive evidence suggesting that a high-protein diet negatively affects healthy adults with normal kidney function.


Fat provides essential elements for the cell membranes and is essential for the absorption of fat-soluble vitamins. Many researchers suggest that fat provide 25-30% of a person’s energy intake. Diets should be limited in saturated and trans-fats, while providing adequate amounts of essential fatty acids (EFA’s). For female athletes, the following essential fatty acids are very important:

• Linoleic acid
• Alpha-linoleic acid intake (ALA)
• EPA (eicosapentaenoic acid)
• DHA (docosahexaenoic acid)

Essential fatty acids are important in the regulation of blood clotting, blood pressure, heart rate, and immune function. Omega-3 fatty acids (EPA, DHA) may play a role in reducing inflammation, regulating blood sugar levels, and optimizing brain lipids.

Dietary fatty acids should come from naturally lean protein foods, grass fed meats, certain nuts & seeds, fatty fish (eg, salmon, mackerel, anchovies), fish-oil supplements, flaxseed oil, safflower oil, canola oil, sunflower oil, olive oil, avocados, and egg yolks. Women should avoid consuming fats found in processed foods because of their highly saturated nature.

Low-fat diets are not recommended for high activity individuals. Low-fat diets decrease energy and nutrient intake, reduce exercise performance, and decrease oxidation of body fat stores. Fat provides the most energy per gram of all the macronutrients and can help in achieving a positive energy balance. Dietary fat also maintains concentrations of sex hormones and may prevent menstrual problems.



Fluids and electrolytes

Dehydration impairs performance. It is important that athletes are well hydrated. Adequate fluid intake starts with approximately 1/2 gallon per day for women aged 19-30 years. Increased drinking is required for active individuals or those doing activities in hot environments.

Athletes should consume 14-20 fluid ounces of water 2 hours before exercising. During exercise, 6-12 fluid ounces should be ingested every 15-20 minutes. For exercise lasting longer than 1 hour or occurring in hot environments, the fluid may be a drink containing carbohydrates and electrolytes. Post-exercise meals should include fluids and foods containing some sodium, because increased urinary output may occur with the ingestion of plain water alone.

Vitamins and minerals

Female athletes are at increased risk for iron, calcium, vitamin B, and zinc deficiencies. These nutrients are vital for building bone and muscle and for energy production. Vegetarians are particularly at risk for developing deficiencies in these vitamins and minerals.

Iron insufficiency is one of the most prevalent nutritional deficiencies among the female athlete because of menstrual losses. Iron deficiency may lead to fatigue. On the other hand, excessive iron ingestion by iron over-supplementation may also cause problems, including gastrointestinal distress, constipation, and iron toxicity.

For female athletes that spend most of their time indoors, supplementation with vitamin D-3 may be appropriate. The impact of vitamin D on women’s health is very important. Low levels of vitamin D have been linked to breast cancer, colon cancer, ovarian cancer, high blood pressure, and strokes. Vitamin D is also involved in maintaining bone density.


Signs of Nutritional Deficiencies in Females

Girls and women with low energy and nutrient intake may develop the following signs and symptoms:

• Fatigue
• Dehydration
• Delayed growth
• Decreased immune response that make the body more susceptible to foreign invaders and increase the frequency of conditions such as upper respiratory tract infections.
• Irritability
• Poor performance

Among athletes, a lack of proper nutrition can have many negative effects, including the following:

• Loss of motivation
• Decreased maximal performance
• Increased short- and long-term fatigue
• Poor concentration
• Preoccupation with food
• Hormonal imbalances
• Muscle soreness
• Increased frequency or lingering of musculoskeletal injuries


Inadequate nutrition can lead to the absence of a menstrual period in a woman of reproductive age. This is called “amenorrhea.”  Inadequate nutrition can also delay or arrest puberty in some girls. Amenorrhea can also occur because of emotional or physical stress, such as intense training. Amenorrhea is more prominent in the female athlete population (3-66%) than in the general female population (2-4%).


The Female Athlete Triad – An important warning to athletes and parents

The so-called “female athlete triad” can lead to severe and long-standing effects. Characteristics of this triad are the following:

• Amenorrhea
• Disordered eating
• Osteoporosis (loss of bone density)

At least one study has demonstrated that athletes competing in “leanness sports” (70.1%) are more likely to be at risk for the female triad than those participating in “non-leanness sports” (55.3%).

Disordered Eating

Examples of disordered eating or deficient nutrient intake include the following behaviors:

• Skipping meals (eg, because of busy schedules, training, work, school, and/or desired weight loss)
• Engaging in unsafe weight-loss methods, such as consumption of ultra-low calorie diets, fasting, laxative abuse, self-induced vomiting, or use of diet pills, energy drinks, “fat burners,” or “pre-workout” drinks.
• Using supplements to compensate for inadequate diets

Healthy Weight Control

Weight loss can be accomplished in a healthy manner. It should be achieved during a period without competitive events scheduled.

The goal of maximizing fat loss while minimizing loss of lean tissue is best accomplished with a gradual weight loss of no more than 1-2 pounds per week.

Energy intake should not be restricted to less than 1800 calories per day in highly active athletic women. Severe caloric restriction can lead to many of the complications described above.

Nutrition in Endurance Athletes

Triathletes and runners have been known to consume 5 or 6 meals per day, whereas cyclists may consume 8-10 meals per day. Bodybuilders are also famous for multiple feedings, but of different composition. This frequent eating ensures that the athlete’s high-energy needs are met, while decreasing the gastrointestinal discomfort associated with consuming large meals.  It is very important that endurance athletes maintain good hydration, as mentioned previously.


Nutrition in Strength Athletes

Studies indicate that women who are focused on gaining muscular mass and strength appear to rely less on glycogen during exercise than on other body energy sources. They are less responsive than men to carbohydrate-mediated glycogen synthesis (“carb-loading”) during recovery. Therefore, to enhance their training and general health, the diet of these women should focus on good-quality proteins and fats rather than on a large amount of carbohydrates.

Female strength athletes should also include high-quality proteins in their diet because they provide essential amino acids, vitamin B-12 and vitamin D, thiamine (vitamin B-1), riboflavin (vitamin B-2), calcium, phosphorus, iron, and zinc. These women should consume protein-rich foods every day before and after exercise, as well as between meals to maintain and promote the growth of lean muscle.

Many of our patients ask us about creatine supplementation. Creatine has been shown to improve anaerobic performance. Creatine augments strength and gains in lean body mass when it is used in conjunction with weight/resistance training. However, in our clinic, we find creatine supplementation unnecessary in those athletes consuming frequent red meat meals.


About Us

Our facility, Performance Sport-Care in Walnut Creek, CA, offers a variety of state of the art exercise and nutritional programs that target the needs of people that seek recovery from injury, better physical performance, increased strength, weight loss, weight gain, and improved overall wellness. Our programs involve the same protocols and equipment used in professional sports, but are custom tailored to be compatible and safe for people of different ages and fitness levels. If you are interested in improving your strength, improving your physical appearance, and reducing injury risk factors please contact us with your questions or concerns.

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

How Women Can Prevent Knee Ligament Injuries And Develop Great Looking Legs


Every year 350,000 people seek ACL (anterior cruciate ligament) reconstruction surgery in the United States. An estimated 24 to 30% of high school athletes who undergo ACL reconstructive surgery re-tear their ACL within the next several years.

Young women facing the greatest risk for ACL injuries are those who play sports involving frequent pivoting, such as soccer, basketball, lacrosse, and handball. The most common age for women to sustain such injuries is 14 to 17 years.


Although ACL reconstructive surgeries appear to be the best available treatment for ACL tears, they do sideline most athletes for 6 to 12 months and many athletes do not succeed in returning to their previous level of athletic performance. In addition, the risk of developing osteoarthritis in the knee, a degenerative condition, is increased after such injuries. Therefore, effective strategies to prevent ACL injuries in the first place or to preserve a healthy knee joint in order to reduce risk factors for a recurrence of ACL injury would be very valuable.

A research paper published in the December 2014 issue of the British Journal of Sports Medicine suggests that some training methods are better than others at preventing knee ligament injuries in young women. Based on a meta-analysis of 14 previous studies, the researchers concluded that training programs that focus on strengthening the legs and hips, and stabilizing the abdomen, are the most effective for preventing injury to the anterior cruciate ligament.

The researchers carefully considered the effects of balance, jump training, abdominal stabilizing exercises, and strengthening of the legs and hips. But it was programs that focused on building strength in the back of the legs and in the hips that most significantly reduced the number of ACL injuries compared to exercise approaches that did not. Programs that focused on strengthening and developing more control of the abdomen were also shown to be very beneficial.

Our facility, Performance Sport-Care in Walnut Creek, CA, offers a variety of state of the art strength training programs that target the calf, hamstring, buttock, low back, and postural muscles as well as abdominal strengthening/toning protocols. Our programs involve the same protocols and equipment used in professional sports, but are custom tailored to be compatible and safe for people of different ages and fitness levels. If you are interested in improving your strength, improving your physical appearance, and reducing injury risk factors please contact us with your questions or concerns.

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

Stop Doing Exercises That Hurt You!


by Dana McDaniel, Strength & Conditioning Coach at Performance Sport-Care

In our facility, corrective exercise and strengthening exercise is an important part of our treatment of patients. In the world of health care, Doctors make treatment decisions that must take into consideration the benefits versus the risks of a specific treatment or procedure. For example, a medication may improve certain symptoms, but may create other, potentially severe, problems for some people. Therefore, the benefits of ANY treatment or procedure must always be weighed against the risk of additional problems or damage. When the risks of a treatment outweigh the expected benefits, then that treatment needs to be seriously questioned, if not abandoned in favor of something different, better, or safer.

The same is true of all decisions we make in life. We weigh benefits against risks. And that should certainly be a consideration when selecting exercises for your personal exercise program. Whether you are exercising for general fitness, sports performance, bodybuilding, or injury rehabilitation, there may come a point in which a decision must be made as to whether certain exercises or activities are really worth doing.

With the passage of time, particularly if you have been engaging in rigorous workouts without expert coaching or, at least, periodic supervision, you may find that one or more exercises causes pain in a joint, muscle, tendon, or a certain body area. Chronic pain/injury may have now established itself after performing certain exercise(s) on an ongoing basis.

As early as possible, pain or problems need to be recognized and the reason(s) for them should be accurately determined. People visit our office to find out these reasons and get things fixed.

Many times pain and injury develop as a result of performing exercises with improper or sloppy form, from performing exercises too rapidly, or from improper or excessively heavy weight/resistance selection. We are not surprised to find that even those people with years of exercise experience have convinced themselves they are performing their exercises optimally, when, in fact, they really are not.

Some examples of improper of improper exercise form:

.deadlift_right_and_wrong bad_form

Too strong for his own good:


In some situations, we get too strong for our own good and this leads to problems. Unfortunately, the ego can often interfere with an honest self-examination of proper methods and procedures when it comes to exercise performance. This is why an objective evaluation by a professional that is truly experienced in exercise, strength training, and injury can be very valuable.

In other situations, wear, tear, and injury develop because some people are simply not mechanically suited for certain exercises. Inevitably, it should be evident that performing some exercises are just not a very good idea. For example, a person with neck or shoulder pain is likely to aggravate their situation by doing barbell presses behind the neck. Similarly, a person with lower back trouble is not well advised to be deadlifting or squatting heavy….particularly with incorrect form.


Often, people visit our office reporting that they only feel pain with a specific exercise. Sometimes this is due to issues relating to individual body mechanics. For example, we see patients who report knee pain when doing hack squats, but no pain when performing regular squats. Or, they may report knee pain when performing leg extensions on a BodyMasters brand machine, but not with a StarTrac brand machine. Others can do flat bench presses with dumbbells without any problem, but if they use a barbell they are stopped dead in their tracks with pain. The examples are endless.


If you are not willing to seek professional evaluation to determine your underlying problem and get it fixed, then the simplest solution is to avoid those exercise movements that you know from experience are causing you pain or are just not safe for you. Unfortunately, for some, this easier said than done. Sadly, and too often, people get “brainwashed” by articles they read on the internet or by comments from people in the gym into believing that if you don’t perform certain “critical” exercises, your fitness or bodybuilding dreams will all come to an end. Deadlift, they say, or else you will never have a decent back. Squat, or else you won’t be able to develop your legs. Bench press or else your chest muscles won’t develop. Do it or else you’ll get nowhere, they say. Such advice could not be more misguided.

And, even worse, if you believe these “know nothings” and insist on doing exercises that hurt you, you will sabotage your body. Your physical development will only be compromised in the long term. Your workouts will be less effective as you try to train through pain or you will eventually miss training time entirely while your injury heals (hopefully). Progress will only take longer as you gradually attempt to regain any of the size or strength you lost. In short, people make less progress when they are hurt. Think about it. Certain areas like the lower back and shoulders are involved in the performance of so many different movements that if you hurt them badly, your exercise program may be severely compromised. Is that what you want?

Achieving the highest levels in fitness or bodybuilding often involves training around injuries, correcting body imbalances and utilizing all the available “tools” in the gym. At Performance Sport-Care in Walnut Creek, we are experts at this. You can build a great back without deadlifts. You can develop terrific legs without squats. We have developed “work arounds” for all sorts of exercise/training problems that deliver big time results!

Here are some take home points:

1) If you have existing pain or past injuries that are aggravated by certain exercises, you are being foolish if you insist on doing them. It doesn’t matter if they are ‘must do’ exercises according some internet personality or some guy in the gym.

2) As early as possible, pain or problems need to be recognized and the reason(s) for them should be accurately determined.Then get them fixed!

3) An objective evaluation by a professional that is truly experienced in exercise, strength training, and injury can be very valuable in identifying your problem(s) and getting them fixed.

4) Be open minded to the possibility that your exercises could be performed in a better fashion or that alternative exercises might suit you better.

5) Be your own person. Listen to your body. Don’t believe everything that is said in the gym or on the internet.

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

Proper Weight Selection For Rapid Muscle Building Progress

by Dana McDaniel, Strength & Conditioning Coach at Performance Sport-Care
 If I was to ask people who lift weights what key factor is required to make the most progress toward building a strong, well developed body, most people might reply by saying things like “dedication,” “hard training,” “high protein intake,” “balanced nutrition,” and so forth. But my personal experience as well as my experience training injured people and athletes at Performance Sport-Care has convinced me that the biggest factor preventing most people from making maximum gains from their training program is training with weights or resistance that is too heavy.

To be sure, every successful strength athlete or bodybuilder on this planet attained championship level by constantly attempting to use increasing poundage/resistance in their workouts. This is concept is called “Progressive Resistance Training.” The training principle is a simple one: as we became stronger, our muscles also become firmer or larger as a result of our muscles adaptation to the greater resistance or exercise challenge placed a upon them.

Unfortunately, problems arise when trainees insist on using weights they can’t handle in proper form, or by performing weight training exercises in rep ranges that do little to stimulate growth. This also raises the probability of injury in the former case and slower training progress in either case.

Walk into any busy gym. Look around. Let’s see what we find. Oh, here’s a guy on the bench press. He says his goal is to develop larger pectoral muscles like a competitive bodybuilder. But every time he comes in to the gym he is always attempting to increase his one-rep max on the bench press exercise. Why? Is it to put himself on a fast track to a shoulder or chest injury? Ego gratification for this guy is all I can think of. If he was a powerlifter, performing such maximum lifts might be better understood. Powerlifters need to be able to bench press a lot of weight for one rep. Bodybuilders, or even the ordinary person starting an exercise program usually seeks a larger, more aesthetically shaped chest. Training like a powerlifter will not make you look like a bodybuilder!  Yet you see guys attempting to use so much weight that their spotter has to risk back injury in order to assist them from the very first rep. More often than not, this constitutes a waste of time and effort.

Many studies have been done to determine the optimal rep ranges for building strength vs. muscle mass. Training for pure strength requires that you handle very heavy loads, usually in the 1-5 rep range. To stimulate muscle growth, however, the reps need to be higher: 8-12 in general. In the bodybuilding world, many have found success with even higher reps for legs, as in 12-20. The key thing to remember is that optimal growth stimulation from exercise requires that you keep the muscles under the right amount of tension/load for the right amount of time. Going too low on the reps means you are stimulating the nervous system more than the muscles, not to mention greater stress on joints and structural components. Going too high on the reps means you are building muscular endurance. That’s fantastic for sports like triathlons, not optimal for those seeking bigger or more shapely muscles.

But even after selecting the optimal repetition range for their exercises we still find some misguided people that insist on using so much weight that they have to heave, swing, and use momentum to perform their exercises, thus recruiting a variety of muscle groups unrelated to the target muscle group they are supposedly trying to develop. Again, you can see it in the busy gyms, especially the CrossFit gyms: the people using such a heavy barbell or pair of dumbbells for curls that what they are doing more closely resembles a clean and jerk. Others using so much weight that they need to cut the range of motion short. Every gym has at least one guy who loads up the bar with 405 or more for squats, then proceeds to “bust out” 3-inch reps, going down nowhere near parallel, grunting and screaming all the while. And usually what you find is that most of them have very little leg development to show for the big weights and theatrics on display.

There is one very important concept from the bodybuilding world that anyone can benefit from…..and it is the critical difference between bodybuilders and the other 95% of people who train with weights. When performing weight training exercises most people simply move a weight from point A to point B, whereas a bodybuilder strives to feel the target muscle forcefully contract and stretch with each rep. The very best exercise results come from an understanding that we are ‘training the muscles,’ not just lifting weights!

Getting stronger is certainly important. And increased strength will inevitably come from faithfully following a properly performed exercise routine. So, remember this above all else: only increase your exercise weights IF you are using good form, getting enough reps, AND you are feeling the target muscle do the work. The muscle(s) that you are exercising should get pumped after just a few good sets. But, if you’ve just done a marathon workout of 12 sets of 3 different types of curls and your biceps aren’t pumped, tight, and burning with lactic acid, then something is wrong….(and probably not with your body) and is likely related to over/improper training!

Every gym has dozens of guys who train very heavy, yet aren’t particularly impressive to look at. Far more rare is the man or woman with an impressive physique that immediately identifies them as something beyond ordinary. Watch them train, and you’ll usually find some things that are very different. They train with more precision, better focus, and typically with somewhat higher reps than the average person. You can see their target muscle working when they are performing an exercise because they know how to isolate that muscle and make it do the work, regardless of the weight used or the particular exercise being performed. They are in tune with their bodies and what their muscles are doing when they exercise. Strangely enough, in the big commercial gyms sometimes populated by “haters,” these correct exercisers will sometimes be criticized for being ‘weak’ by the smaller gym members who don’t understand how and why muscles grow. They operate under the myth that heavier weights at all costs mean bigger muscles, without understanding all the other factors involved that we have been discussed above.

In conclusion, never hesitate to go a little lighter if that’s what it takes to improve your exercise form and allow you to feel your muscles working. If your goal is to build a body that sets you apart not only from the general public but also from the herds of “knucklehead” weight lifters in commercial gyms everywhere, ignore your ego, select weights that you can handle properly, and work like heck on those movements/exercises. You will be well rewarded.

Big commercial gyms and health clubs are not always the best places to obtain information or instruction on proper exercise program design or performance.

One final thought. Big commercial gyms and health clubs are not always the best places to obtain information or instruction on proper exercise program design or performance. Very often, people receive misinformation or acquire bad exercise techniques in such environments. We provide expert exercise instruction and design for beginners as well as competitive athletes. We provide close, individual attention in a safe, private, distraction-free, positive environment. Health histories and personal goals are carefully reviewed by a licensed health care professional in order to provide a customized exercise program designed to achieve your physical performance goals. Feel free to contact me directly, if you would like an improved and more effective exercise experience at

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

“POLICE”: New Management Guidelines For Ankle Sprains


Ankle sprains may not seem like such a big deal, but in the United States, alone, an estimated 28,000 ankle injuries occur every day. Most people assume that these injuries are destined to resolve with rest, alone, and minimal self management. However, this is certainly not the case for everyone. In fact, at least one systematic review, published in the American Journal Of Medicine, reported that only 35 to 85% of sprain ankles heal in three years.

Recently, there has been increasing suspicions among clinicians and researchers that the failure of some ankle sprains to fully resolve is attributable to outdated or incorrect advice given to patients and/or the general public with respect to the care and management of ankle sprains.

The Common Ankle Sprain (Inversion Type)


If there is a severe in-turning of the foot relative to the ankle, the forces imposed upon the ankle cause the ligaments (that hold the bones together) to stretch beyond their normal length.  This is known as a ‘sprain.’ If the force is very strong, the ligaments can tear. You may lose your balance when your foot is placed unevenly on the ground. You may fall and be unable to stand on that foot. When excessive force is applied to the ankle’s soft tissue structures, you may even hear a “pop”. Pain and swelling result. A black and blue discoloration may soon also appear.


The amount of force imposed upon the affected ankle ligaments determines the grade of the sprain. A mild sprain is a Grade 1. A moderate sprain is a Grade 2. A severe strain is a Grade 3.

Grade 1 sprain:

Slight stretching and some damage to the fibers (fibrils) of the ligament.

Grade 2 sprain:

Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.

Grade 3 sprain:

Complete tear of the ligament. If an examiner pulls or pushes on the ankle joint in certain movements, gross instability (excessive and/or inappropriate movement) occurs.

The acronym ‘RICE’ appears all over the Internet and in various self-care books, pamphlets, and resources in regard to advice about ankle sprains. This acronym represents the traditional management prescription of Rest, Ice, Compression, and Elevation.

As noted earlier, an increasing number of clinicians and researchers believe that the ‘RICE’ paradigm is outdated and does not necessarily reflect modern science or current clinical experience, certainly in the sports injury setting. A 2012 editorial published in the ‘British Journal Of Sports Medicine’ has called for the replacement of ‘RICE’ with a different set of guidelines with the acronym ‘POLICE.‘ These guidelines are organized as follows:

P = Protection

OL = Optimal Loading

I = Ice

C = Compression

E = Elevation

The fundamental difference with these new guidelines, particularly in regard to grade 1 and grade 2 sprains, is the de-emphasis on rest. Instead, patients are advised to start moving most sprained and strain joints soon after the injury.

Rest should be of limited duration and restricted to a brief window of time immediately after the inciting injury/trauma. An increasing body of scientific evidence suggests that longer periods of rest/unloading are actually harmful and produce soft tissue changes that are not optimal for the restoration of full strength and desired biomechanics.

Of course, no one is suggesting that people be forced to walk or certainly run on their sprained ankles right away. But some randomized controlled trials have shown that beginning range of motion exercises within a couple of days, followed by gradually increased loading, can get patients back on their feet more quickly. Joint manipulation by trained health care providers has also shown success in these trials.

For grade 3 ankle sprains (complete ligament tear), a study published by the National Athletic Trainers Association advises initial immobilization of the joint for 10 days. After that, they recommend that patients should begin moving the injured joint.

Skrecenia i niestabilnosci stawu skokowego

Braces and supports, like the type shown above, can provide protection that can enable an early return to weight bearing and walking, as well as protecting the joint from unexpected/undesired movements, or losses of balance.

The use of canes, crutches, and walkers can reduce effective body weight. This can help provide optimum loading so that an early return to walking and standing can be achieved more comfortably and to make sure that the load bearing capabilities of the injured ankle are not exceeded so that healing can progress.

The use of ice, cold packs, or cold water immersion can reduce the sensation of pain for many people and can also help control swelling. Cold application should not be prolonged in order to prevent thermal injury or vascular responses that are counter to the intended purpose of cold application.

The use of wraps, tape, or various bandages can provide compression that can reduce the leaking of fluids from capillaries into tissue spaces. This can also help reduce swelling.

Elevation of the legs can keep blood from pooling in the injured foot/ankle. This, too, can help reduce or control swelling.

There remains a general consensus among clinicians and researchers that extreme swelling adds days, if not weeks, to the healing process. The general belief remains that if one can control swelling, a faster return to sports or normal activities will transpire.


As a side note, an emerging controversy over the use of Non-steroidal Ant-inflammatory Drugs (NSAIDS), such as the one shown above, is worth mentioning. Some researchers point out benefits to injured body parts that occur during the initial stages of inflammation. NSAIDs, some believe, might interfere with those benefits. As a result, there are some clinicians and researchers that now recommend that NSAIDs not be consumed during the first 48 hours after injury.

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

Disclaimer: The images, text, video, or other media displayed above are intended  for informational purposes only and are not considered specific medical or chiropractic advice. Transmission of this information is not intended to create, and receipt does not constitute, any form of doctor-patient  relationship. Internet subscribers and online readers should not act upon this information without seeking their own professional  consultation. The information contained in this web site is provided only as general information, which may or may not reflect the most current health care/scientific developments. This information is not provided in the course of a doctor-patient relationship and is not intended to constitute medical or chiropractic advice or to substitute for obtaining health care advice from a duly licensed health care provider in your state.









“Kipping” Handstand Pushups – An Injury Awaits


A “kipping” handstand push-up is a handstand that employs an explosive hip and leg thrust (kipping) that is intended to generate momentum to more rapidly launch the handstand. It is an exercise activity frequently observed in CrossFit training and competitions. It enables this community of exercisers to perform more repetitions, with more speed than would be otherwise possible by performing conventional handstand pushups in strict form.

The following instructional video link was produced by a California CrossFit facility and describes what is considered to be the proper technique for performing a kipping handstand pushup:

This instructional video clearly indicates that it is acceptable for the trainee to rest or make contact with the head (on a mat/ or directly on the floor) at the bottom position of this handstand push-up. Thus, the kipping handstand push-up involves a headstand as well as an explosive handstand. Therefore, the injury risks from both of these components warrant serious consideration.

A strong upper body and plenty of practice is necessary to perform a headstand posture, alone, in a safe fashion. The shoulder, arm, chest, and upper back muscles should support your body weight when performing a headstand. If they are not strong enough to hold you in a stable posture, there is risk of damaging the cervical spine because most people’s necks are not designed to bear all or even a portion of the body weight . This damage could involve bones, discs, facet joints, muscles, ligaments, nerves, or some combination thereof. Needless to say, if you have an existing neck injury, doing a headstand or handstand pushups is unwise.

The following is an image of a normal neck x-ray:


The following is a flexion x-ray image of a normally healthy person, experienced in the performance of headstands, who sustained significant neck injury and instability from performing the simple headstand:

headstand_neck injury

Of course, one would expect that many CrossFit aficionados will vociferously take issue with this presentation and respond with the general argument that the described risks are overstated and that kipping handstand push-ups are completely “safe” when performed with “correct form.” Unfortunately, the reality is that CrossFit participants often perform exercises rapidly, in increasingly higher repetitions, and to a point of exhaustion, or momentary muscular failure. Even under the best of circumstances, musculoskeletal training injuries are certainly possible under such demanding conditions. Moreover, training form is almost always compromised when exercises are performed rapidly or to the point of exhaustion. Repetition speed up or, particularly, down may not remain under control.  Under these conditions the likelihood of situations ranging from a simple strain type injury to landing out of position, or coming down too fast or too hard onto the head and neck is a very real possibility. And, unfortunately, it doesn’t take a full-on crash onto the head and neck to cause a serious injury. Much lesser forces can certainly accomplish this.

But the risks of injury do not end here. Additional risk factors include high blood pressure and glaucoma. The inversion associated with headstands and handstands can increase intracranial blood pressure significantly. A person with high blood pressure can experience increased pressure in the blood vessels supplying the brain and eyes. This can lead to ruptured  blood vessels in the eyes, retinal tears or, in very rare instances, stroke. In glaucoma, pressure builds up within the eye, impairing vision. Inversion of the body exacerbates this pressure. Also, if the blood vessels in your eyes have burst or if you have ever seen “floaters” then headstands, handstands, or handstand push-ups are not for you. The consumption of anti-inflammatory medications may also be an added risk factor, in regard to strenuous activities involving inversion.

Therefore, when everything is taken into consideration kipping handstand push-ups are  not advisable for most people other than, perhaps, the “genetic elites.” They certainly cannot be endorsed for the general population seeking to pursue an exercise activity.

For those seeking to engage in kipping handstand push-ups anyway, the following opinions and recommendations are in order:

  1. Do not engage in any strenuous activity involving inversion of the body (i.e. headstands, handstands) if you have high blood pressure, glaucoma, ruptured blood vessels in the eye(s), an active neck injury, or a past history of significant neck injury.
  2. Avoid taking anti-inflammatory medications immediately prior to performing strenuous activities involving inversion of the body.
  3. Make sure you have an adequate strength base in the shoulders, arms, chest, upper back, and neck before attempting any handstands, or even a headstand.
  4. A minimum  strength “benchmark” of 15 strict handstands pushups or 10 strict overhead barbell presses with 1.25 times bodyweight  should be demonstrated before proceeding with kipping handstand pushups.
  5. Do not perform kipping handstand pushups alone or without someone nearby to assist you if you experience an injury.
  6. Direct strengthening exercises for the neck are strongly recommended. Exercises such as those depicted in the following link are suitable, if carefully performed:

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or

Growing Concerns About The Abuse/Misuse of ‘Plyometrics’


Plyometrics represent a form of exercise that has been employed over the last 30 years by elite athletes in order to promote speed, explosiveness, and faster reaction times. But more recently, plyometrics have found their way into the mainstream as a result of the wildly increasing popularity of jump filled workouts such as high intensity interval training, CrossFit, and Boot Camp classes. What has followed is an increase in injuries, particularly for the everyday exerciser.

Plyometrics is defined as any exercise in which muscles are repeatedly and rapidly stretched and then explosively contracted. Examples of this include jumping high off the ground or doing push-ups with a clap between each repetition. Playing catch with a medicine ball can also be considered plyometrics, along with skipping, bounding, and jumping. Plyometrics is believed to teach muscles to react faster. Plyometrics are believed to produce more power because the faster a muscle can contract, the more powerful it becomes. As a result, it has been a part of training for elite and professional athletes in a variety of sports, particularly those who engage in rapid stop /starts like basketball and tennis players.

Unfortunately, there is an increasing body of evidence that demonstrates that plyometrics is associated with pain and accelerated aging/degeneration of tendons, particularly when performed too frequently or improperly. The clinically painful tendons that can be produced by plyometric performance are now characterized at the microscopic level by collagen fragmentation, increased ground substance, and neovascularization of the affected tendon(s). These tissue abnormalities are believed to develop from an ineffectual healing response to the repetitive microtears within a tendon(s) that can be produced by plyometrics. The natural healing process may not be sufficiently capable of healing the repetitively strained tissue once these abnormal tendon changes develop.

Proper instruction and guidance is essential to the safe performance of plyometrics. It appears that most injuries occur when people attempt plyometrics without proper supervision and instruction. Also, a good strength base is essential before proceeding with any plyometric training programs. Because they can be so hard on the tendons even well-trained athletes are well advised to limit plyometric drills to no more than twice a week.

An increasing risk group for plyometric induced injury is the CrossFit crowd. This represents a younger population of exercisers who are willing to expend a lot of energy in the pursuit of high-end goals by following a high intensity, constantly varied exercise activity schedule that is performed several times per week.

There has been an increasing and worrisome misconception that plyometric training is somehow beneficial for weight loss. This simply is not so. Those exercise novices and overweight individuals who incorporate substantial amounts of plyometric training will encounter injury far sooner than any appreciable loss of body fat. It is far better to accomplish weight loss with other exercise/nutritional strategies before embarking on a plyometric program. Certainly, the load on muscles and tendons will be less…..and less likely to produce injury.

For the beginning to intermediate level exerciser, some guidelines for incorporating plyometrics is in order: Beginners should perform plyometrics no more than once a week, for five minutes, at low intensity. Certainly not every day. Plyometric jumps should not be performed until the exerciser is capable of performing squats in proper fashion with his/her own body weight. Whenever possible, or whenever in doubt, one should seek proper instruction before performing plyometric drills and techniques. Moreover, instruction on proper landing techniques is essential in order to avoid lower extremity, hip, and spine injuries. Activities like jumping over cones, skipping, and ladder hopping on the ground do train the neuromuscular system. They seem deceivingly simple and easy to perform. However, when performed repetitiously and at high intensity these activities have the potential to produce significant pain and injury.

In short, plyometrics can provide definite training benefits to athletes, but should be carefully integrated and performed in order to avoid potentially painful and costly problems.

We are a Sports Chiropractic and Rehabilitation facility located in Walnut Creek, CA. Feel free to contact us with your questions or concerns at (925) 945-1155 or