It is well recognized that getting 7-9 hours of sleep for adults and 8-10 hours for adolescents is an essential component of health and general well-being. In the more recent years, there has been accumulating evidence regarding the importance of sleep for recovery from athletic training and competition as well as it’s effect on athletic performance. Unfortunately, athletes have been shown to consistently average les than 8 hours of sleep along with higher reports of poor sleep quality amongst elite athletes.

Barriers to Sleep in Athletes

• Poor self-assessment of sleep need, duration, quality making athletes less likely to seek guidance or medical help
• Excessive training volume
  • Studies showed an Increase in acute training load was associated with decreased sleep duration and quality in youth female soccer players and Australian football players
• Training schedule: sleep duration significantly impacted by early morning training
• Long distance travel and the associated disruptions in mood, stress, and anxiety
  • Retrospective 40 year study of NFL night game competitions show a consistently higher success rate for west coast based NFL teams compared to east coast teams due to altered sleep schedules and disruption of circadian rhythms
• Increased levels of stress, anxiety, and insomnia around competition
• Concomitant academic pressures in youth and collegiate athletes
• Sleep-disordered breathing only affects 4% of the population but has been estimated to be present in 14% of professional football players

 Sleep and Performance

• Poor quality sleep was an independent predictor of lost competition in a recent study in Brazil on elite male and female athletes
• In team sports, improved sleep duration and quality are associated with increased changes of competitive success

Endurance and Anaerobic Power

• Sleep deprivation inhibits performance perhaps through perceived exertion
  • 30-minute self-paced treadmill test was administered to 11 male subjects randomly assigned to normal night’s sleep and 30 hours sleep deprivation
    • The deprivation group had a decreased distance covered without differences in thermoregulatory functions or oxygen consumption
  • One night of sleep loss shown to decrease time to exhaustion in progressive testing in volleyball players
  • A single night of restricted sleep after a heavy exercise bout resulted in a 4% decrease in 3-km time trial performance the following morning in adult cyclists
• Pre exercise muscle glycogen stores are decreased after sleep deprivation

Sprint Performance

• Evidence for speed and strength training and sleep deprivation is conflicting
• Studies vary in results for sprint tests with sleep deprivation as some results show increased times, decreased times and some no change

 Sleep, Injury and Illness

• Impaired or decreased sleep is associated with increased risk of injury
  • Study in middle and high school athletes found those who slept less than 8 hours per night were 70% more likely to report an injury
• The greatest risk for injury results when training load is increased and sleep duration decreased simultaneously, which is often seen in competitive travel and training camps
• The underlying mechanism may be related to impairments in reaction time and cognitive function or may contribute to higher levels of fatigue
• Decreased sleep is immunosuppressive and increases susceptibility to upper respiratory infection

 Interventions to Promote Sleep in Athletes

• Athletes with complaints of poor sleep or excessive daytime fatigue should be screened for medical conditions such as insomnia, sleep disordered breathing, restless legs syndrome, depression, anxiety, or concomitant illness
• A sleep monitor or daily sleep journal kept for 2 weeks can be used to quantify sleep duration
• Gradually extend sleep by 30-60 minutes per night utilizing the following sleep hygiene techniques:
  • Sleeping in a cool dark environment without electronic devices
  • Minimal ambient noise or distraction
  • Establish consistent sleep and wake times
  • Incorporate 30-60 minutes of quiet relaxation before bedtime
  • Portable electronic devices may suppress natural melatonin production and interfere with sleep, therefore restriction from use for at least 1 hour prior to bedtime may be reasonable
  • Over the counter sleep aids should be avoided
  • Caffeine and stimulants limited to the morning hours
  • Variation in training schedule should be minimized
  • Early morning and late evening training/competitions should be avoided when possible

In conclusion, optimizing your sleep duration and quality can have a large impact on not only sport performance, but can also reduce sport related injury risk and keep you healthy!  Proper scheduling, travel protocols, time management, stress management, and sleep hygiene in athletes can improve overall well-being and athletic performance success.

Watson, Andrew M., MD, MS. “Sleep and Athletic Performance” American College of Sports Medicine, Volume 16, Number 6: 413-418, (2017).

Total hip arthroplasty (THA) is one of the most common joint replacement surgeries performed around the world. In the past, it was common for patients to stay in the hospital for up to 2-3 weeks post-op and were typically forced to bedrest. Recently, however, there has been a shifting sentiment towards a “fast track” approach that greatly reduces the length of stay (LOS) in the hospital and leads to a quicker recovery overall.

In a study by Klapwijk et al, the first 6 weeks after a patient’s discharge from the hospital following a THA with fast track were observed. This prospective cohort study was performed in the Netherlands in 2015, and involved 94 patients who received a THA with an anterior approach. Each patient was provided a diary to document their pain and function on a daily basis for 6 weeks following their discharge from the hospital or outpatient center. These forms included…

• Hip injury and osteoarthritis outcome score physical function short form (HOOS-PS)
• Oxford hip score (OHS)
• EuroQol quality of life (EQ-5D)
• NRS pain score
• 12-item short-form health survey (SF-12)
• Intermittent and constant osteoarthritis pain score (ICOAP)

Out of the 94 patients who participated, 52 received an inpatient surgery and 42 were in an outpatient setting. The average LOS was one night for inpatient and released the same day for outpatient. Overall, the study found that over the first 6 weeks, patients reported gradual and significant improvements in a variety of factors including pain, sleep quality, walking ability, and functioning for daily activities (OHS, HOOS-PS, SF-12 PCS). Another result this study identified was that patients reported an improvement in a variety of these surveys within the first week post-op relative to their scores pre-op.

Although the study did have some limitations including limited sample size and only utilizing self-reported subjective values, it did shine a light on the efficacy of a fast-track approach following THA. They found that 97% of the participants reported that the were satisfied with their shorter LOS, and over the first 6 weeks patients’ pain gradually decreased as their function gradually increased.

Source:

Klapwijk LCM, Mathijssen NMC, Van Egmond JC, Verbeek VM, Vehmeijer SBW. The first 6 weeks of recovery after primary total hip arthroplasty with fast track: A diary study of 94 patients; Acta Orthopaedica 2017; 88 (2): 140–144

Golf is one of the most popular recreational activities in America, with approximately over 25 million players country-wide. One of the most appealing aspects of golf is the ability to continue playing well into our 60s, 70s, and even 80s, but although the sport may not seem as physically demanding as others, injuries can be quite common. Losing the ability to play golf due to back pain can be very frustrating, but there has been research into rehabilitation in order to return to the sport quickly as well as prevention strategies to reduce the risk of reinjury. In an article by Christopher Finn, MSPT, CSCS, TPI CGMP, these concepts are reviewed and discussed.

As people age, the spine’s mobility and ability to absorb forces decreases. This can lead to lower back pain (lumbar pain) which has been attributed to approximately 1/3 of all golf injuries. The majority of these injuries are caused by the repetitive motions of the golf swing over time instead of one traumatic event, and are more likely to occur if muscular imbalances or poor swing mechanics exist. These injuries can include muscular strains, facet joint inflammation, spondylosis, disc herniation, and even stress fractures of the ribs.

The treatment of these issues usually benefits from a multidisciplinary approach involving both Physical Therapy to assess muscular imbalances and weakness, and PGA pros to assess flaws in swing mechanics. Physicians may also order medical imaging for further diagnosis, prescribe medication, or utilize cortisone injections to help reduce pain in the short-term.

Physical Therapy has been shown to be very effective in treating low back pain and other injuries in golfers. During someone’s time in physical therapy, they can expect to receive screening and treatment to restore muscular balance throughout the body. These include:

• Core stabilization exercises
• Spinal mobility and range of motion assessment
• Diaphragmatic breathing techniques
• Muscular flexibility training
• Hip, trunk and shoulder strengthening
• Transversus abdominis and multifidus activation

Since the body works in unison throughout a golf swing, it is difficult to say any one exercise is the most important. Muscle groups are constantly activating while others are simultaneously turning off, all while the joints and muscles require the proper mobility and flexibility to freely move through their required range of motion during the swing. Therefore, it is beneficial to have a professional identify these areas of limitations in order to develop a personalized plan for recovery and reduce the risk of injury in the future.

If you are interested in reducing your low back pain while golfing or would like to learn of any muscular imbalances that could be affecting your game, physical therapy may be a great option for you! The therapists at Physical Therapy First have an extensive background in treating orthopedic and sports injuries of all kinds, and are able to dedicate the one-on-one treatment time that you deserve to get you to where you want to be.

Sources:

Christopher Finn, MSPT, CSCS, TPI CGMP. Rehabilitation of Low Back Pain in Golfers: From Diagnosis to Return to Sport. In Sports Health. July/August 2013. Vol. 5. No. 4. Pp. 313-319