Altitude training involves spending several weeks at a higher altitude (preferably over 2000 m or 8000 ft above sea level) to adapt the body physiologically. At elevations greater than 1200 m or 3950 ft, there is a decrease in atmospheric pressure which reduces the partial pressure of oxygen in inspired air. This causes decreased arterial oxygen levels and leads to increased ventilation and cardiac output, along with an elevation in heart rate. Performance will decrease for individuals that have not acclimatized to the change in pressure and are consequently exposed to a risk of high-altitude illnesses.
Acclimatization is the process of adapting to the decrease in oxygen concentration at a specific altitude. With acclimatization, there will be an increase in heart rate, blood pressure, bicarbonate excretion, respiratory frequency and volume along with a reduction in plasma volume. To compensate for the decreased arterial oxygen levels, erythropoietin (EPO), a hormone in the body, will trigger more red blood cell production to aid in oxygen delivery to the muscles. Training at high altitudes allow athletes to produce additional red blood cells that will provide a greater cardiovascular effect on performance at competitions held at lower elevations.
Acclimatization requires an altitude exposure of more than 1 week. Staged ascents promote gradual and partial acclimatization when an individual resides at a moderate elevation before ascending to a higher elevation to reduce the adverse consequences of rapid ascent. The first stage of ascending should be greater than 3 days at a moderate altitude. Remaining at a moderate altitude for 3 to 7 days will reduce the symptoms and risk of altitude sickness. However, a time period of 6 to 12 days will improve athletic performance.
High-altitude illnesses can occur at elevations above 2500 m. Mild altitude illness can occur between 2000 and 2500 m.
Acute mountain sickness ( is commonly experienced by individuals 6 to 12 hours after ascending to elevations above 2500 m with the prevalence and severity increasing with higher altitudes. Symptoms include: headaches, nausea, dizziness, and sleep disturbance. Some risk factors may be a lack of previous acclimatization, history of migraines, age of 46 and above, or being a female. Symptoms typically resolve within 1 to 2 days with rest or with non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin. If symptoms become severe, descend immediately or use supplemental oxygen.
High-altitude cerebral edema (HACE) is a more severe form of altitude illness. Symptoms include: truncal ataxia (loss of body control), decreased consciousness, mild fever, and coma. If a headache is poorly responding to NSAIDs, then this is an indication of acute mountain sickness progressing to (HACE).
High-altitude pulmonary edema (HAPE) presents with a loss of stamina, dyspnea, dry cough, cyanosis (bluish skin), or pink, frothy sputum (phlegm). The risk of HAPE increases with increased altitude and faster ascents. HAPE occurs when fluid accumulates in the lungs due to rapid altitude ascent or ascent accompanied by strenuous exercise. Untreated HAPE may result in death approximately 50% of the time.
Prevention of high-altitude illnesses involve acclimatization before exposure, slow ascent, and appropriate pharmaceuticals for the corresponding illness. For mild AMS, take a rest day or descend 500 to 1000 m if there is no improvement in symptoms. For severe AMS, descend immediately and use supplemental oxygen at 2 to 4 L per minute. A hyperbaric may also be used for severe AMS. AMS may be treated with NSAIDs or acetazolamine. For severe AMS, use an appropriate dosage of dexamethasone.
Descend immediately if symptoms of HACE or HAPE are experienced. Use supplemental oxygen at 2 to 4 L per minute or a hyperbaric bag. Consider dexamethasone for HACE and nifedipine for HAPE. Consult a physician for more information on which drugs to use.
Finger sprains commonly occur in sports and every day activities that involve heavy lifting or repetitive hand motions. Falls or contact sports such as football may even force a finger out of its normal joint position resulting in a dislocation. The force to the finger may cause joints in the finger to hyperextend or move sideways. Sprains of the finger are classified according to the extent of injury or damage.
1) Grade I – Mild: A first degree sprained finger is present when the ligaments are only stretched but not ruptured. There may be localized swelling, slight pain, and slight reduction in range of motion, but strength remains unaffected. An individual may continue to engage in an activity. Taping of the injured finger may be more effective. Recovery is immediate.
2) Grade II – Moderate: A second degree sprained finger occurs when there is partial ligament tears, a greater reduction in range of motion and some loss of strength with more swelling and pain. The joint capsule may also be damaged. Recovery will take longer.
3) Grade III – Severe: A third degree sprained finger involves complete rupture of the ligament, complete loss of range of motion and typically dislocation of the finger. Significant pain and swelling is present. X-ray is required for diagnosis and surgery may be indicated.
In the first 48 to 72 hours after the sprain, the individual should protect the finger by taping it to the adjacent finger or by using a finger brace. Apply ice for about 15 min every two hours with a small ice pack wrapped in a dry towel or use a large cup filled with cold water and some ice for immersion.
Once swelling has gone down, the individual may begin light range of motion exercises by placing a soft object such as a tennis ball or rolled sock in the palm of the hand and gently squeezing the object. Repeat 10 times and stop if any pain arises. Surgery may be indicated for third degree sprains. Consult a physician for the appropriate diagnosis.
1) Ball Grip: Hold a ball in the palm of the hand with all fingers enclosing the ball and gently squeeze. Hold, then relax.
2) Pinch: Place a ball between the thumb and index finger. Gently squeeze, then relax.
3) Opposition: Hold a ball with the thumb and pinky finger. Gently squeeze the ball using the two fingers, then relax.
4) Side-Squeeze: Place a ball between any two fingers and gently squeeze, then relax.
Persistent pain between the shoulder pains, or interscapular pain, may arise from a number of varying causes. The scapula is the bone that connects the humerus (upper arm bone) with the clavicle (collar bone) on either side of the body. The intrinsic muscles of the scapula include the subscapularis, teres minor, supraspinatus, and infraspinatus, all of which make up the rotator cuff. The major muscles surrounding the scapula that make up the interscapular region include the rhomboids, trapezius, and levator scapulae.
Ever wondered whether to use ice or heat for your sore muscles, your healing fracture, or any injury? Both ice and heat have been commonly used to treat an array of injuries, but when to use either one is critical in preventing further damage and promoting faster recovery.
Acute irritation or inflammation of a muscle, ligament, or tendon is typically treated with ice. The cold application reduces inflammation and numbs the pain, especially when the superficial tissues are red, hot, and swollen. The inflammatory response associated with damage to tissues is a defence mechanism in the human body that lasts for the first several days to protect against infection. The response involves immediate changes to blood flow, increased permeability of blood vessels, and flow of white blood cells to the affected site.
Ice can be used for gout flare-ups, headaches, sprains, and strains. It is crucial to apply ice to the site of injury during the first 48 hours post-injury to minimize swelling. For soft tissue injuries such as muscle strains or ligament sprains, an ice massage involving elevation of the injured body part above the heart and circular movement of an ice pack around the affected area may promote faster recovery of these acute injuries. Apply for 10 minutes at a time, then take a break from icing for another 10 minutes. Repeat this process 3 to 5 times a day. Remember to wrap the ice pack in a dry cloth or towel.
Heat can also be used for headaches, sprains, and strains as well as arthritis or tendinosis. Heat causes blood vessels to dilate which increases blood flow and relaxes tight or stiff muscles and joints. Do not use heat during the initial inflammatory response as this will further aggravate the site of injury. For minor injuries, applying heat for 15 to 20 minutes at a time may be sufficient to relieve tension. However, longer periods of heat application such as 30 minutes to an hour may be required for major chronic injuries. Hot baths, steamed towels, or moist heating packs can be used as different heat options.
Recent research has shown that nearly 40% of 7 to 18 year old baseball players endure elbow and shoulder pain during their baseball season. Nearly half of these injured players report their ongoing participation despite having pain. A recent epidemiological study of ulnar collateral ligament (UCL) injuries in athletes 17 to 20 years old reported the number of UCL reconstructions has increased dramatically for this age group. Early education and detection of elbow injuries in throwing sports may help reduce the number of overuse injuries from developing.
“Little league elbow,” or known as medial epicondyle apophysitis, is most commonly found in young throwers. Sports such as baseball, softball, tennis, or golf, can result in this overuse injury to the growth plate on the inside of the elbow. Repeated stress to the growth plates may cause inflammation and lead to pain or swelling. Serious injury may even result in separation of the growth plate from the rest of the bone. Players may also experience a reduced range of motion and a decreased ability to throw hard or far. A child experiencing any symptoms involving their arm should cease activity and see a pediatric specialist or their family physician. X-rays may be required to determine the extent of damage.
Prevention begins with identifying causative factors early in the season and adhering to strict guidelines such as the pitch count for young players and the duration of participation in a given year. Total body conditioning that involves strengthening the hip, back, and legs may help reduce the strain on the athlete’s arms. See below for exercises on how to stretch and strengthen the forearm.
Up to 80% of individuals will experience some lower back pain at least once in their lifetime. Lower back pain (LBP) results in high costs and places a burden on society. These costs include diagnostic, treatment, and indirect costs associated with work disability. A number of conditions can lead to low back pain such as infections, tumours, fractures or dislocations of the spine. However, lifting heavy loads is generally thought to be a key predictor of LBP. An important element in prevention of LBP is to correctly stabilize the trunk during lifting by pre-activating the abdominal wall muscles. By doing so, the spine will increase in stiffness to reduce the effect of undesired spinal perturbations. Exercises aimed at bracing the abdominal muscles may reduce the risk of LBP.
There are two ways of stabilizing the abdominal muscles: an abdominal hollow or abdominal brace. An abdominal hollow begins by drawing in the lower abdomen (transversus abdominus) while maintaining relaxation of the other surrounding abdominal muscles such as the obliques. At the same time, small muscles of the lower back (close to the spine) such as the multifidus are contracted while the larger back muscles are relaxed. With contraction of the lower abdomen and small back muscles, intra-abdominal pressure is increased and the fascia surrounding the spine increases in tension. Combined, these contribute to provide intersegmental stability.
An abdominal brace is performed by activating all of the abdominal and lower back muscles, rather than specific muscle recruitment. By tensing the entire trunk without drawing the muscles in or pushing them out, global activation of the ab and back muscles may provide increased stability in all directions in various movement patterns.
Both the abdominal hollow and brace can help increase the stiffness of the spine to minimize lower back pain. The use of either one will depend on the desired movement pattern and the goals of the individuals in stabilizing their core. Strengthening the core muscles is also essential in reducing the amount of loading on the lower back muscles. Watch these videos below:
The Achilles tendon is the thickest tendon in the human body. It attaches the gastrocnemius and soleus muscles (together known as the triceps surae) as well as the plantaris muscle to the calcaneus bone (heel) of the ankle. These muscles combined allow for plantar flexion at the ankle and flexion of the knee.
Tendinopathy of the Achilles tendon refers to a condition that causes pain, swelling, or stiffness at the tendon connecting the muscles to the bone. Commonly found in athletes such as runners, overuse of the tendon, may result in microtrauma or repeated injuries to the Achilles tendon. Wearing improper footwear, having poor training or exercising techniques, making a sudden change to your training program, or exercising on hard surfaces may also cause minor injuries to this tendon. Pain and stiffness may develop gradually and are typically worse in the morning. Pain is generally worse after exercise, but may potentially arise during training. Overtime, symptoms may be so severe that individuals may be unable to carry out their usual daily activities.
Rehabilitation occurs quickly or over several months depending on the severity of the injury. Although pain may be present, expert clinicians and researchers recommend continuing daily activities within one’s pain tolerance. As complete rest should be avoided as much as possible.
In the early stages of Achilles tendinopathy, a treatment called iontophoresis may be used to reduce soreness and improve function. This treatment involves delivering a medicine (dexamethasone) to the painful area. Ice packs are also effective in reducing swelling. Apply ice pack wrapped in a towel or dry cloth to the affected area for 10 to 30 minutes at a time.
However, researchers have found that Achilles tendinopathy is often successfully treated with strength training guided by a physical therapist. Strength training relies on using one’s body weight with or without additional weight for resistance to load the tendon and associated muscles to strengthen the calf. Do exercises slowly to decrease pain, improve mobility, and return to normal functioning.
1) Heel-raise: Stand with your feet a few inches apart. Raise up on to your tiptoes and lift the heels by using both legs. Then lower yourself down using the affected leg. Perform 3 sets of 15 repetitions twice per day. This exercise can also be performed seated in a chair.
2) Calf stretch: Stand a few steps away from a wall and place your hands at about eye level. Place the leg you want to stretch about a step behind the other leg and bend the knee of the front leg until you feel a stretch in the back leg. Remember to keep your heels planted. Hold this position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat twice per day.
3) Towel stretch: Sit with both knees straight on the ground and loop a towel around the affected foot. Gently pull on the towel until a comfortable stretch is felt in the calf. Hold position for 15 to 30 seconds. Repeat 3 to 4 times before switching to the other leg. Repeat two to three times per day.
Acute sprains and strains may impede performance and delay return to a sport. Proper management, treatment, and prevention is essential to recovering effectively. An athlete must first understand the definition and recognize the differences between a “sprain” and a “strain.” A sprain is defined as a violent overstretching of one or more ligaments in a joint. A sprain can result in pain, tenderness, swelling or bruising at the joint. A strain is defined as a stress or direct injury to the muscle or tendon. A strain may also cause pain when moving or stretching the injured muscle, but can also cause muscle spasms.
1) Grade I – Mild Strain: slightly pulled muscle with no muscle or tendon tears and no loss of strength and low levels of pain
2) Grade II – Moderate Strain: partial tearing of the muscle or tendon at the bone attachment with reduced strength, moderate pain levels
3) Grade III – Severe Strain: complete rupture of muscle-tendon-bone attachment with separation, substantial loss in strength and high levels of pain
1) Grade I – Mild Sprain: minor tearing of some ligament, no loss of function
2) Grade II – Moderate Sprain: partial rupture of portion of ligament, moderate loss of function
3) Grade III – Severe Sprain: complete rupture of ligament or separation of ligament from bone, substantial loss of function
2) ICE: Sudden cold may help constrict capillaries and blood vessels to slow or restrict internal bleeding. Place an ice pack between a towel or dry cloth. Apply ice every hour for 10 to 20 minutes at a time.
3) COMPRESS: Compression can help reduce swelling post-injury. Wrap the injured part firmly with an elasticized bandage, compression sleeve, or a cloth. Do NOT wrap the cloth too tightly as it may cut off blood circulation and lead to more swelling.
4) ELEVATE: Elevate the injured part about level of the heart to reduce swelling and pain. Place a soft object such as a pillow or piece of clothing to use as a prop below the body part.
Continue to follow the above RICE method for two to three days post-injury. Daily stretching may help loosen the muscle. Key to prevention is to stretch the tight muscles and strengthen the weak muscles.
Watch the videos below on how to recover from a common ankle sprain or shoulder strain:
A catastrophic cervical spinal cord injury occurs with structural distortion of the cervical spinal column due to actual or potential damage to the spinal cord. Damage above the C5 vertebrae in the spinal column results in the greatest risk of immediate sudden death for an athlete. Above this level, damage may impair the spinal cord’s ability to transmit respiratory or circulatory control from the brain. Effective acute care is critical in preventing permanent dysfunction or death in an athlete as a biochemical cascade of events can occur during the initial 24 to 72 hours post-injury.