In speaking with an osteopath over the weekend, he really got me thinking about core function. We were discussing the current state of the literature and he pointed out that while the research to date are all fine and dandy, there doesn’t seem to be anyone who’s utilized truly healthy individuals that are free from visceral/organ dysfunction. That’s not to say that the subjects who have participated in McGill’s, Hodges’ and others’ studies are not “healthy”, but it seems as though such particular issues have yet to be addressed.

The rationale behind his insight was the fact that our current society consumes far too much *you know what* to ensure that our abdominal organs are functioning optimally. And as a result, many in today’s society suffer from certain inflammatory conditions that may have negative effects on proper core muscle function.

Take for example the Transversus Abdominis. This is one of the deep muscles of our core and through research, has been shown to have a delay in firing in those with chronic low back pain. Now if our intestines and organs are “inflamed”, the possibility of influencing muscle function surely exists. Think about the length-tension relationship and the ability to generate force. So perhaps the T.A. may be dysfunctional in those with chronic low back pain due to the above.

On a different level, think about the role stress plays on organ function? Aside from the negative cognitive consequences it may have on those with chronic pain, what about those with chronic low back pain?

So where do we go from here? We were in mutual agreement that we should probably start with inclusion and exclusion criteria. Don’t get me wrong, I know that this is not an easy task but perhaps we may be able to get an even better idea of what truly goes on in the core with more optimal subject population.

But in the meantime, if we’re working with people suffering from faulty core function, perhaps it may be prudent to spend even more time considering the role of stress and common allergens.

And that’s why I think I need to strongly consider the assistance of a naturopath and a psychologist.

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Authors: W. Meehan

Journal: Clinics in Sports Medicine

Date: 2011

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Summary:

• Here is a little review of potential interventions in one of the most influential and highly discussed injuries in ice hockey today, concussion. While the current state of the literature may still be in its infancy, each incident of this “traumatic brain injury”, particularly in professional hockey, seems to make front page news and cast a shadow of doubt on the safety of our sport. This paper by Meehan discusses various therapeutic options that may be rendered in the presence of such injury.

• First introduced is the role of physical rest in the recovery process. The stepwise return to play protocol is discussed although it is mentioned that studies have begun investigating the role of light physical activity during recovery. Since quantitative cognitive deficits have been demonstrated in the presence of such injury, academic accommodations via cognitive rest were suggested for student athletes.

• Often considered an “invisible injury”, Meehan proposes that education regarding the typical recovery process be one of the mainstays of therapeutic intervention. Studies have demonstrated fewer symptoms at follow up in those that were informed about their symptoms, coping strategies, and the likely course of recovery.

• While most athletes achieve spontaneous recovery of symptoms within days to weeks, some experience prolonged recovery to which pharmaceutical intervention may be warranted. It should be noted that the evidence for such interventions is very minimal and the following information should be taken as a summary rather than a recommendation of care. Meehan suggests that pharmacologic treatment only be considered in the presence of the following:

1. Symptoms exceeding the typical recovery period,
2. Symptoms negatively affecting quality of life to the degree that the treatment benefits outweigh its risks, and
3. The clinician rendering treatment is both knowledgeable and experienced in the management of (sport) concussion.

• Meehan asserts that pharmacologic treatment has yet to be demonstrated to speed the recovery process and that standard approaches are lacking. Instead, he reports that medications are utilized for the treatment of its signs and symptoms. Since previous literature has grouped symptoms related to sport concussion in the categories of sleep disturbance, somatic (i.e. headache), emotional, and cognitive, chosen medications must be specific to the symptom experienced.

• In the presence of sleep disturbance, sleep hygiene that includes the elimination of constant stimuli (i.e. television, computers, caffeine, etc) is strongly considered. Medically, Meehan’s first line of defence for the presence of sleep disturbance is Melatonin. Other considerations are discussed although benzodiazepines seem to be advocated against due to their negative arousal and cognition effects.

• Somatic symptoms such as headaches are common in the presence of sport concussion. Meehan discusses the potential roles of antidepressants (i.e. amitriptyline – his preferred treatment) as well as the potential negative effects (“rebound”) of analgesics such as ibuprofen. Other medications are introduced as well as physical therapy, psychotherapy, and trigger point injections.

• For athletes suffering from emotional disturbance, for example stemming from participation restrictions, Meehan suggests tricyclic antidepressants and serotonin reuptake inhibitors as a complementary intervention to coping strategies, familial support and psychological counseling.

• Finally, since cognitive symptoms are common complaints in those suffering from sport concussion, potential pharmacologic treatment may include methylphenidate for attention and speed processing deficits as well as the domaminergic agent amantadine for executive function and prefrontal cortex glucose metabolism, in addition to cognitive rehabilitation.

• It should be noted that the majority of athletes recovery both spontaneously and quickly from sport concussions. The preceding review merely discusses potential medical interventions that may have complementary roles to physical and cognitive rest and rehabilitation. It must be reiterated that the above MUST NOT be taken as prescription but merely as a review of Meehan’s academic paper, intended for medical professionals. If you or your family member has sustained a concussion, you MUST consult a physician for care.
  

Meehan WP. (2011). Medical therapies for concussion. Clinics in Sports Medicine, 30; 115-124.

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Yet:

• I knew Selena Horner, a Physical Therapist from Michigan said they were crap [SnippetPhysTher. 2010. The International Journal of Twitter. Vol 8].

• I had read Science-Based Medicine‘s post on these wristbands.

• And I had read Skepticblog‘s article as well.

However, I have always respected that there are somethings in life that even science cannot explain.

Therefore, rather than immediately discrediting it as utter B.S., I thought I’d give this popular fad an opportunity to shine before I formed my own opinion. I mean, these guys did:

After the first 24 hours, no significant differences in my normal activities of daily life were noted. The following day, however, I experienced something I had not experienced in over 10 months.

I failed on not one set during a bench press workout but two!

I understand that far too many variables may be involved in failing a set but I had been progressively increasing my weight during the past 2 months of training and the week prior was even considered a deloading week. That said, I do know that this is a power balance wristband and I was in no way testing my vertical jump or performing shenanigan exercises on a bosu, but nonetheless, I thought this was an interesting observation.

Several days later, I travelled back home to Toronto and with only 5 hours sleep, wanted to get another workout in early in the day. Interesting observation number 2. I forgot to put the wristband on prior to the workout but notably, was able to press 20 more lbs than that day I failed. Fun stuff!

The last straw.

Yesterday’s workout called for barbell reverse lunges. No different than the last three weeks. The weight for this exercise was the same, as was my warm up, my assistance exercise, and my work:rest ratio. On set 2 of 4, I strained my quadriceps tendon…and you guessed it…the wristband was on.

Now again, I want to stress that I was more than open to experience a positive effect from this wristband but ultimately, I cannot say that it has helped me in any way. Not even psychologically. Lucky underwear maybe, but not the power balance.

So for those of you wanting to improve your performance by wearing something on your wrist, rather than spending your money on a power balance, may I kindly suggest one of these. The folks at the leukemia and lymphoma society will thank you for it.

Purchase at elitefts.com

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“athletes of various abilities utilize psychological skills in their attempts to enhance performance, although the consistent practice of highly structured skills are generally displayed by higher performing athletes”.

Similarly, I had also posted about the potential psychological intervention of kinesiology-type taping in sport (click here to refresh your memory) and discussed the potential of a more tangible method of improving performance.

Apparently I am not the only one with such curiosity.

Tara Parker-Pope of the New York Times just wrote a nice piece on lucky underwear and performance. Whether you subscribe to this belief or not, make sure you have a read.

Does Lucky Underwear Improve Athletic Performance

Photo source

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Last week I wrote about the rise and “potential” fall of Kinesiology-type taping. Please click here if you have yet to read “Kinesiology-type Taping: A Psychological Intervention in Sport?”

Well as it turns out, this “old” taping method MAY in fact be psychological after all! But before I proceed any further, I must point out the fact that I said “old” because this taping method has actually been around for over 25 years.

So now that you have read my preceding post, you will know that I braved the snowstorm and travelled down to Calgary this past weekend to attend a SpiderTech Taping seminar. I do not hold any ties with its parent company, Nucap Medical, and therefore will try to give you as objective an opinion as possible (disclaimer: I apply these products on my patients and therefore must disclose this information)

As a health care practitioner with no prior “formal” training in this method of taping, I came away from this seminar impressed with this particular taping system. Here are 2 simple reasons why:

SpiderTech admits that it may work via psychological mechanisms.

Yes, that IS correct. While the main therapeutic effects stated are via microcirculatory, structural, and neurosensory mechanisms, SpiderTech admits that psychotherapeutic effects may also occur. That is, through an increased conscious awareness and increased perception of stability, a decreased fear of activity may subsequently result. For those of you who work with elite-level athletes, you will know that psychology plays an important role in high performance and thus, if an increased perception of joint stability results in increased confidence, then yes, SpiderTech may also enhance performance through psychological means.

SpiderTech seems to be grounded in sound, scientific principles

As a site dedicated to “evidence-informed sport health”, I strive to incorporate scientific principles as much as possible. It seems as though this company does the same. I was really impressed with the 2+ hours of scientific information presented to us before we were permitted to utilize the individual tape applications! Though research may apparently be underway to evaluate the efficacy of this taping method, the theoretical principles pertaining to its mechanisms of action via neurosensory pathways most certainly seems plausible. In fact, the certification manual’s reference list contains over 70 references from peer-reviewed literature pertaining to the information presented to us.

So is this method a psychological intervention in sport? Maybe. But in the event you are presented with multiple interventions to choose from, may I suggest you give these guys a second look.

Photo source: www.nucapmedical.com

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• Part 1: Personality
• Part 2: Motivation
• Part 3: Anxiety and Arousal
• Part 4: Stress and Coping

This is the final installment in my series of “Psychological Characteristics of the Elite Performer”. I hope you’ve enjoyed this oft-forgotten aspect of sports performance. While many of the concepts I’ve addressed may have seemed quite simple, its theoretical bases have been researched extensively and therefore are grounded with practicality. Therefore, here’s a little information on some interventions used by athletes for performance enhancement.

Interventions

Athletes of various abilities utilize psychological skills in their attempts to enhance performance, although the consistent practice of highly structured skills are generally displayed by higher performing athletes. These skills; goal setting, imagery, self-talk, arousal regulation, and attention control are typically more useful in enhancing performance when athletes

1. Recognize their importance;
2. Understand how to use them; and
3. Consistently practice until they become valuable in competition.

Goal setting tends to be the most common form of skill utilized by elite athletes and can be viewed as the practice of establishing desirable objectives for one’s actions. While many athletes regard this skill as being only moderately effective, those that set goals that are specific, measurable, adjustable, realistic, and timely (SMART), tend to improve their performance since their self-confidence and sense of satisfaction both become enhanced.

Athletes also utilize imagery when preparing for competition. By incorporating various senses such as sight, auditory, tactile, and kinesthetic to their visualization procedures, and practicing these on a daily basis, their confidence levels in sport tend to improve. As a result, they become better able to regulate their arousal and anxiety levels and likely, channel their energy and focus into peak performance.

The use of self-talk in athletes has also been researched extensively. What has been revealed is that this skill seems generally more advantageous when used in a positive manner (“I can”). In addition, athletes tend to be more successful with this skill when verbalizing their self-talk in an overt manner, that is, making it publicly known. Using self-talk that is perceived as very motivating (i.e. higher intensity) seems to also enhance the effectiveness of this skill in optimizing performance. As with all other skills, the more frequent this skill is used, the more successful the athlete tends to be.

Various techniques have been utilized by athletes to regulate their levels of arousal, especially in those who have learned to identify which mental and emotional states are necessary for success. Depending on the level required, arousal may be regulated via relaxation or by “psyching up”. When athletes recognize personal levels of overarousal, those athletes who seem to achieve higher success tend to be ones who are able to implement breathing and progressive relaxation strategies both prior to and during competition. Breathing techniques generally achieve deep or momentary relaxation while progressive techniques tend to facilitate immediate relaxed states (i.e. just prior to taking a penalty shot). Meditation of the mind and autogenic training of the body are also utilized to achieve deep relaxation, although these generally seem to be most successful in sports that utilize gross motor movements (i.e. running).

Also, levels of arousal often need to be increased when faced with high performance in sporting events. Generally, techniques employed to increase arousal are often used by elite athletes who recognize that they are in an underaroused state and need to psych themselves up. Such methods used by athletes, as well as coaches, include; pep talks, bulletin board postings (i.e. quotes from previous successful athletes), pre-competitive workouts to enhance activation, verbal cues to generate energy, and breathing techniques (opposite of those used for relaxation). Like those psychological characteristics previously mentioned, an athlete’s ability to effectively regulate their level of arousal may dictate whether or not they fall under the category of the elite.

Since attention is regarded as fundamental to skilled motor performance, those athletes who practice the performance of two tasks simultaneously (attention-sharing), while only focusing on relevant cues (cue-selection), tend to achieve higher levels of success and performance. In addition, practicing performance routines to be used before key sport skills (free throws) and using attentional (verbal, visual, and physical) cues on a consistent basis also have the potential to improve levels of performance. However, in order for these skills to be effective in achieving control over one’s attentional focus and consequently, enhancing performance, these tasks must be repeatedly practiced in sport-specific settings.

Well there you have it, the psychological characteristics of elite performers. Note that for the most part, I used the term “elite performers” rather than elite athletes. In my opinion, elite athletes are commonplace in sport and while I take nothing away form them, elite performers are few and far between. So while an exact template of an “elite performer” does not exist, many psychological characteristics contribute to the facilitation and development of elite performers. From personality to specific skills, superior athletes tend to display common characteristics that are in optimum balance and interaction with the external environment.

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• Part 1: Personality
• Part 2: Motivation

Part 3: ANXIETY AND AROUSAL

Athletes with a high tendency to perceive competitive situations as threatening, likely experience greater levels of “moment dependent” anxiety during game situations. This type and level of anxiety may lead to a predisposition to detrimental performances and therefore may not be evident in elite athletes. You’ll likely witness this anxiety trait in “chokers”. Regardless, all athletes, despite their level of ability, experience certain situations that increase anxiety.

• Some examples: individual sports, competing away from one’s home arena or field, playoff games, and the role or position one plays on the team (i.e. goalkeeper).

However, looking specifically at skill levels and experience, higher performers generally report lower levels of “moment dependent” anxiety, lower levels of physiological anxiety symptoms, and view anxiety symptoms to be more facilitative toward their competitive performance. Essentially, athletes who tend to perform better than others generally demonstrate the ability to use their coping skills to manage natural anxiety responses both before and during competition.

Relaxation
Self-talk
Cognitive restructuring
Imagery

Recognizing that athletic performance is a complex behaviour, some researches have described the cusp catastrophe theory: the relationship between competitive anxiety and performance is dependent on an interplay between a spectrum of both cognitive state anxiety/arousal and physiological arousal. According to this theory, enhanced performance is predicted when one variable is balanced by the other and therefore, those athletes displaying this optimum balance tend to perform better than others.

It also seems clear that those athletes who view their anxiety symptoms as necessary for performance tend to display higher performance abilities and success.

Tomorrow’s post: Stress and Coping

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Part 1: Personality

Part 2: Motivation

Motivational constructs must also be considered as one of the distinguishing psychological characteristics of elite athletes. Looking at motivation, it is evident that motivation is best understood by the interaction of the individual and his/her situational influences. There are many theories that attempt to explain motivation, however, certain factors remain consistent in achieving optimum performance. Athletes with high perceptions of competence and self-control tend to facilitate intrinsic motivation, aka motivation from within. (Attention all hockey parents, I suggest you read that last statement again!) As a result, the confidence in one’s abilities tends to develop via the overcoming of obstacles through persistence and positive feedback. This is also further perpetuated when goals are task oriented rather than outcome oriented. That is, goals that focus on a particular skill accomplishment versus the attainment of, for example,  a medal (for some, this may be hard to believe but my guess is that more often than not, personal bests are sought). Furthermore, athletes who perceive rewards as being informational and educational, tend to develop an increased competence, self-worth, and self-determination. This positive feedback influences one’s motivational levels and consequently, may facilitate elite performance. Lastly, having a high level of autonomy tends to increase one’s self-determinant motivation, and thus, also potentially contributing to one’s athletic success. Therefore, while intrinsic motivation seems to be the driving force behind sport success, motivation is best conceptualized by the interaction between the intrinsic and extrinsic environments.

Taking both into account may further provide insight into the distinguishing characteristics of elite athletes!

Tomorrow: Anxiety and Arousal

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The Oxford English dictionary defines the term “elite” as being “a group regarded as superior and favored”, and although many components of sport and exercise exist, “elite” athletes tend to display certain psychological characteristics that facilitate their superior development and subsequent achievement of success. There are many determinants that influence the psychological characteristic of an athlete and the presence and interaction of these may help distinguish what constitutes an elite performer. Through an examination of current research and theories in personality, motivation, arousal and anxiety, stress and coping, as well as specific skills such as goal setting, imagery, self-talk, arousal regulation, and attention control, I will “attempt” to identify those psychological characteristics belonging to athletes and performers classified as being elite.

Part 1: Personality

No distinct personality profile exists for elite athletes. That is, not all elite athletes share the same personality traits.  Some sport performers tend to be competitive and self confident, while others tend to be the complete opposite and more reserved or laid back. This is likely so since personality seems to be composed of several different traits that combine to influence specific behaviors. Regardless, there exist several personality factors that may lead to the development of an elite performer.  This is especially so since according to the model of personality by Hollander, personality may be “a function of the psychological core that represents the foundation of an individual’s personality, as well as the role related behaviour that is dictated by the immediate situation at hand and the expectations of how one should behave”. For example, while an athlete may be a consistently hard-working individual, he may or may not demonstrate this quality based on his role on a particular team (i.e. captain versus 7^th defenseman in hockey). In the latter case, the development of an elite performer seems unlikely. What is clear however, is that the combination of a competitive nature, healthy (adaptive) perfectionism, and mental toughness (allowing athletes to cope with competition demands) may contribute to the development of elite performers. It should be noted though, that caution must be observed as personality should not be used to predict performance. Situational contexts must be respected due to the important interaction between the athlete’s internal and external environments.

Tomorrow’s post: Motivation

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