Runner's Corner

July 2008 ::  Index of issues

Muscle Care For Athletes

August 2008 Runner’s Corner

By Kitty A. Consolo, Ph.D.

Athletes spend many hours in training to develop their muscles for peak performance. While training is a very important determinant of athletic performance, proper fueling and care of muscles following training are also important factors in maximizing muscle performance. Athletes are also at risk for developing muscle pain and delayed soreness that can reduce training and performance. This article will focus first on the proper fueling of muscles and then on methods to reduce muscle pain and soreness.

Part I: Fueling the Muscles
To fully understand the proper fueling of one’s muscles, it helps to also comprehend the primary energy systems muscles use and the differences that exist depending on whether one is focusing on building muscle strength, speed and size or endurance. The following chart is modified from the late Edward Fox, exercise physiologist from Ohio State U.

Primary Energy Systems

Our muscles are unique in that unlike brain and other cells, muscles are capable of working with or without oxygen present. Exercise and energy systems that do not require oxygen to be present (we still need oxygen in our body!) are referred to as anaerobic. Events that would be anaerobic are those that are of a high intense nature such as power lifting, field events in track and sprinting such as the 100m and 400m. Athletes in these events rely on muscle strength, speed and power and often seek to increase muscle mass to increase these components.

The Anaerobic Energy Systems

1. ATP_PC: The anaerobic energy system begins first with the ATP-PC system. This system relies on our bodies converting the food we eat into adenosine triphosphate or ATP. The chemical bonds between the phosphates in ATP are high energy bonds. When the muscle cells needs energy, they break the phosphate bonds so that energy is released. Chemically it looks like this: ATP= ADP + Pi + energy release (The adenosine triphosphate broke off one phosphate becoming adenosine diphosophate and provided energy for muscle work). The advantage of this system is it can release energy to the muscle very quickly and without oxygen, however it can only last a few seconds. Once the ATP is used, another anaerobic system is used to produce ATP, the PCr system or phosphocreatine system. In this system, phosphocreatine can help replenish ATP allowing for the demands of jumping, lifting, throwing or sprinting. The chemical description looks like this. PCr + ADP = ATP + Cr. This system is still anaerobic and can supply energy quickly that lasts up to a minute.

Many athletes training for the demands of athletic events that require jumping, lifting, throwing or sprinting are now using creatine supplements to boost muscle recovery. The rationale behind this is that if they can increase phosphocreatine (PCr) they will in turn increase ATP and their energy supply which will transfer into better performance. The recommended amount is about 20 grams per day for 5 to 6 days followed by a maintenance does of 2 grams per day. Proper hydration is critical when using creatine as there have been cases where athletes have suffered dehydration. Also continual high doses have led to kidney damage in a few athletes. The safety of long-term use of creatine is not yet known. Thus take care if you decide to use this supplement and know that it is no substitute for hard training.

2. Lactic Acid System: For intense anaerobic athletic events ranging from 30 seconds to 2 minutes, the next energy system that kicks in is the lactic acid system. This system relies on breaking down glucose into a compound called pyruvic acid which is then converted into lactic acid. The advantage of this system is that it can provide ATP rapidly without oxygen needed in the muscles and lasts much longer than the ATP-PC systems. Athletic events using this system would be the 400 m sprint or swimming 100 m. The disadvantage to this system is that this high rate of ATP production can not be sustained for long periods of time and that lactic acid increases the acidity of the muscle leading to fatigue. Highly trained athletes learn to tolerate high levels of lactic acid but are still eventually limited once levels become high. However, very light exercise following an intense event will promote the circulation of lactic acid out of the muscles to the liver where it will be reconverted into glucose. This glucose can reenter the bloodstream where it is available for cell uptake. Thus if the athlete has multiple events in one day, doing a light cool down after each event will facilitate lactic acid removal and resynthesis of glucose to improve recovery for the need event.

Importance of Carbohydrates for Anaerobic Events
Note the importance of glucose as a fuel in the lactic acid energy system. Unlike fat and protein which need oxygen to be burned, glucose is the only fuel that can be oxidized under anaerobic conditions using the lactic acid system. Hence athletes in these events need to have adequate carbohydrate stores and carbs in their diet to provide this glucose. Muscles and the liver are able to store extra glucose in the form of a polymer called glycogen. However, repeated intense training without enough carbohydrates in the diet can lead to low glycogen stores and thus lower glucose availability for energy. Worse yet is that the brain and nervous system rely on glucose and will resort to drastic measures to get their glucose if deprived. The body can make glucose from the amino acid alanine. This process in called the glucose alanine cycle and the downside to this is that it literally breaks down muscle tissue in order to make glucose for the body. Thus the strength athlete needs to be sure to consume enough carbohydrates to spare protein stores.

Importance of Protein for Anaerobic Events
Most strength athletes know the importance of needing adequate protein in their diet but few know how to calculate how much they need. Some experts recommend for athletes building a strength-training program that 1.7 grams of protein per kilogram of body weight be consumed. To calculate this amount, you would take your body weight in pounds and divide by 2.2 to convert to kilograms. Then multiply this amount by 1.7grams to calculate your protein needs. More research is needed in this area but the need for extra protein is to allow for muscle protein synthesis. This amount is nearly twice the RDA for protein for nonathletes. However exceeding this amount is unlikely to bring further gains in muscle synthesis and excess protein consumption can be hard on the kidneys increasing urine production, dehydration and possibly kidney stones in people with a family history. Once the desired muscle gain is realized, protein intake can be reduced to 1-1.2 grams per kilogram of body weight.

Protein and Carbohydrate Supplements for Anaerobic Athletes
The need for adequate carbohydrates and additional protein is essential for the athlete training for muscle strength, speed, power and size. The challenge is how to consume adequate amounts of each and also be sure of getting essential vitamins and minerals. Many foods with protein also contain a large amount of saturated fat shown to be harmful to the arteries. Also a lot of athletes are squeezing in their workouts during the day or before work and do not have the time and resources to cook meals that will maximize muscle recovery. For those short on time and looking for foods to maximize muscle recovery, look for packets of chicken, turkey, salmon as well as egg beaters. These foods contain protein without a lot of fat with it. Also fruits such as organic dates travel well and store well and have lots of grams of carbohydrates as well as potassium but are low on the glycemic scale so as not to cause a sugar high and then a crash.

The Aerobic Energy Systems
For events that last 3-9 minutes such as the 1500m and 3200m running event, there is about a 50/50 use of anaerobic and aerobic energy systems. Once events reach 15 minutes there is a shift to about 80% reliance on aerobic systems and for the marathon, a distance to cover of 26.2 miles, there is almost a 100% reliance on aerobic energy systems.

Carbohydrates: The Prefered Fuel
For the endurance athlete that does distance running, cycling or triathlons, the challenge is keeping enough carbohydrates in the body. Carbohydrates should be at least 5 grams per kilogram of body weight and for those who engage in endurance training and events lasting 60 minutes or longer per day may need as much as 7 grams per kilogram of body weight! In fact some marathoners and triathletes need as much as 10 grams of carbohydrates per kilogram of body weight. These carbohydrates are broken down in the body using oxygen, so they do not produce lactic acid as when glucose is burned anaerobically. The advantage to the aerobic metabolism of carbohydrates is that it can produce a lot of ATP and the by-products are carbon dioxide which is easily exhaled and water which is easily excreted. Thus carbohydrate is one of those fuels that when burned aerobically, burns clean in the body. Carbohydrates, as mentioned above, also help spare the use of protein as a fuel. However, research has shown that the use of protein as an energy source may be increased during prolonged endurance exercise and will be more likely if the endurance athlete fails to fuel properly with carbohydrates.

Thus it is important that the athlete endurance athlete consume carbohydrates before, during and after exercise.

Pre-Endurance event carbs
If the athlete has 4 hours or more before their event, a large amount of carbohydrates, 4-5 grams per kg of body weight is recommended. These can be consumed in liquid form as juices or as fruits and starches. Fiber and fat content should be as close to none as possible. A baked potato, slide of bread, apple, orange or sports drink all yield 15 grams of carbohydrates to give you an example. However for the larger athlete, there may be too much volume to consume in order to get enough concentration of carbs and thus hi-carb energy bars may be preferred.

If the athlete is short on time, about 1 hour prior to exercise, 1-2 grams of carbohydrate per kg of body weight are recommended. Carbohydrates consumed without 10 minutes of exercise should be in a 50% solution. To make a 50% solution take 10 teaspoons of a glucose polymer (such as Gatorlode) into 3-4 ounces of water.

Post-Endurance Exercise Carbs
Post exercise, the endurance athlete needs to maximize muscle glycogen resynthesis. Research suggests that ingesting a combination of protein and carbohydrate within 2 hours of finishing exercise boosts glycogen resynthesis better than carbohydrate or protein alone. Amounts given by Zawadzki et al showed 112 grams of carbohydrates with 41 grams of protein to maximize this effect.

This could be achieved by a large bagel, 3 ounces lean turkey breast and 24 ounces of a carbohydrate drink.

Signs of Carbohydrate Depletion
Some of the signs for the endurance athlete to look for which indicate glycogen depletion in the muscles is a feeling of heaviness especially in the muscles used. There may also be a lack of desire to train. The athlete may also be more prone to colds and experience a lack of appetite and inability to sleep. If any of these signs occur, cut your training to ½ to ¼ of what you normally do plus increase your carbohydrate intake. Do not resume normal training until these symptoms disappear which can take a few days.

Protein: Needed for Endurance Athletes
Research now suggests that the endurance athletes also have an increased need for protein intake above the RDA. For those engaged in moderate intensity endurance events, the suggested amount is 1.2 grams of protein per kilogram of body weight. For those who perform high-intensity endurance training, 1.6 grams of protein per kilograms of body weight is recommended. In addition, keeping adequate carbohydrate intake can help spare the use of protein. As mentioned earlier, lean chicken, turkey and salmon can provide protein with low fat or using Ideal Meal to get protein and carbohydrates quickly into the body after a workout or competition will promote muscle recovery and glycogen resynthesis.

Signs of Protein Breakdown
One can tell if one is burning protein by the appearance of a strong smell of ammonia in one’s sweat. Ammonia is a by-product of protein breakdown and the odor is easily recognized and different from the usually sweat smell. If you notice this odor, again be sure to add more carbohydrates to your diet and also cut back on your training as it can take a few days to resynthesize muscle glycogen back to normal levels.

Summary
Both anaerobic and aerobic athletes need more protein than the sedentary person. Getting adequate carbohydrates will spare muscle protein and provide energy for both anaerobic and aerobic exercise. Making these nutritional adjustments is essential to the athlete’s muscle recovery and athletic performance.

Part 2: Reducing Muscle Pain and Soreness

There is a fine line between training and straining and both strength and endurance athletes often find themselves facing muscle pain and soreness.

Acute Muscle Soreness
Acute muscle soreness is usually experienced in anaerobic training. One cause can be ischemia or a reduction in blood flow such as when one lifts heavy weights. Allowing for rest bouts in between lifts as well as gently relaxing and contracting the muscles without any weights can restore blood flow and relieve pain. Another cause for acute muscle soreness can be the elevation of lactic acid in the muscles such as when one is doing intense anaerobic sprints. The best way to relieve this soreness is in doing a light active recovery such as walking or very slow jogging to promote the circulation of lactic acid out of the muscles and to the liver where it can be converted into glucose and reused as fuel.

Delayed Muscle Soreness
Delayed muscle soreness is muscle discomfort that occurs 12 to 48 hours after exercise. This type of muscle soreness appears to be related to the type of muscle contraction. Eccentric muscle contraction, in which the muscle is elongated or lengthened when contracting such as when running downhill or lowering a weight is more likely to generate greater delayed muscle soreness than isometric and concentric muscle contraction when the muscle shortens. Thus when starting an exercise program or new routine, the athlete should be careful how much eccentric muscle contraction is introduced and to gradually build up.

For those starting a weight training program, be sure to perform warm up exercises before lifting the desired amount. Less soreness is also likely to occur if the resistance used is enough to generate some fatigue in 12-15 repetitions rather than a heavier amount that would generate fatigue in 6 to 8 repetitions. After a few weeks of training the resistance can be increased and the reps decreased.

The cause of delayed muscle soreness is not completely understood but several hypotheses have been offered. One theory is the connective tissue damage hypothesis that suggests damage to the connective tissue of the muscle and tendinous attachments. Some researchers have found elevated levels of hydroxyproline, a metabolic product of connective tissue damage in the urine of those who experienced muscle soreness. Another theory is the skeletal muscle damage theory that suggests tissue damage to the muscle itself. Some researchers have found elevated cellular enzymes such as creatine kinase in those reported delayed soreness indicating muscle damage.

Pain Relief
Regardless of the exact cause of delayed muscle soreness, having painful muscles can be very uncomfortable. The downside though is several available pain reducers can cause stomach irritation, ulcers and bleeding. There are also individuals who can not take these medications due to allergies. Here are some options to consider.

1.RICE: Rest, ice, compress, elevate
If you have ever had first aid or athletic training, you’ll recognize the RICE principle. Many athletes ignore ice when pain first appears and add to their pain further by soaking in hot water. Avoid heat the first 48 hours of any acute pain and instead, use ice, preferably by massaging an ice cube around the area (except for delicate tissues like the eyes where a barrier should be used), then applying a compression bandage such as an ACE bandage during the day (never sleep with one), and elevating. Of course you should also curtail your training and this is when a lot of athletes go from a minor injury into a major one by being afraid to reduce their training. If you listen to your body do the above, there is a good chance you will be back training in no time.

2. Pain Extinguisher: relief without pills
An additional option for those who have muscle pain is to try the topical cream called Pain Extinguisher. It contains pain fighting ingredients including wintergreen, Emu, Evergreen Blackberry, Cranberry, Thyme, Peppermint and Tea Tress to work on increasing circulation and decrease inflammation. It can be used up to four times a day and lasts longer than other over the counter topical pain creams that I have tried.

3. Pain Rx
Another product to consider for pain is Hi-Tech Pharmaceutical’s Pain Rx. Like other pain medicines it has C0X-2 inhibitors which have the ability suppress C0X-2 or cyclooxygenase-s, a “bad” enzyme that causes inflammation and pain. The downside to these meds is that they also inhibit C0X-1, which is a “good” enzyme that maintains the health of the stomach lining. This is why these drugs also have such bad effects on our stomach and gastrointestinal systems. Unlike many pain relieving drugs like ibuprofen, Pain Rx contains phellodendron which contains berberine, which is a C0X-2 inhibitor that does NOT inhibit C0X-1, thus it stops pain and inflammation without the negative stomach effects. Pain Rx’es safety is further enhanced in that it does not cause platelets to aggregate as does Vioxx which increases the risk of strokes. Thus because of it’s phellodendron component, Pain Rx offers pain relief as well as safety in regard to the typical stomach, gastrointestinal and cardiovascular side effects experienced in other pain meds. In addition to relieving muscle pain, Pain Rx can also be used for headaches, migraines and rheumatoid arthritis. With any product however, read the instructions carefully and be sure not to exceed the recommended dosage.

4. Joint Rx
A product you may want to consider using daily is Hi-Tech Pharmaceutical’s Joint Rx. This product is for both muscle pain management and joint stiffness and pain. Joint Rx contains a grade of glucosamine/chondroitin that is extremely high quality. The chondroitin sulfate that goes into Joint-Rx is 95% pure low molecular weight which is the same material selected by the National Institutes of Health for a major clinical study. The tablets are also “delayed release” allowing safe transport into the small intestines for absorption. In addition Joint Rx contains S-Adenosylmethionine wher studies in Italy on 22,000 patients showed an 80% success rate on pain management. Joint Rx also contains a combination of anti- inflammatory agents such as Boswellia, turmeric and hops. Like Pain Rx, Joint Rx contains a plant extract from phellodendron amurense which works on stopping inflammation without interfering with the enzyme that protects the stomach lining. A study of 252 patients who took Joint Rx showed significant improvement in joint mobility as compared to those on a placebo. Joint-Rx has also been shown to stimulate the production of collagen which is the protein portion of the fibrous part of the joint as well as stimulate cartilage production. For athletes performing heavy training, daily use of Joint Rx can help with mobility as well as muscle pain and inflammation.

Summary
Proper training, warm up and minimizing eccentric muscle contraction can reduce the likelihood of muscle soreness and pain. If delayed soreness does appear, act quickly and use the RICE method. If relief is not found, consider the above pain products as a safer alternative to the over the counter pain meds that often have stomach, gastro-intestinal and cardiovascular side effects. For joint and muscle health, consider Joint Rx as a daily supplement.

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