Medical

New nutrition information, as a further service, WCHL would like to try and aid players in organising their diet, Wendy Richardson has written a document that contains information on the following:

  • What’s a balanced diet?
  • What to eat before a match
  • What to eat after training/competition
  • Fat
  • Carbohydrate
  • Protein
  • Fluids and hydration

Medical Overview
The demands of training, and club games every weekend means your bodies are constantly being pushed to a limit. Therefore, as elite hockey players its imperative to be in top-notch health. The person who is responsible for this is you. Whether it be managing an injury, wearing the correct safety equipment or ensuring your not taking any prohibited substances, it is you that will be effected by irresponsibility.

As a lottery funded athlete you are required to take the correct procedures to enable you to play hockey at an elite level. This chapter on medical issues covers the following;

  • Snippets
  • Kit bag
  • Injury prevention
  • Core stability
  • Injury management
  • Medical insurance
  • Anti – doping in hockey

Snippets: Creatine and vitamin supplement statements from the British Olympic Association

BOA STEERING GROUPS’ POSITION STATEMENT ON CREATINE

Supplementation with creatine may result in improved performance in short duration high intensity exercise. The biggest effects may be seen in training consisting with repeated high intensity efforts with short recoveries which may over time lead to performance enhancement. Not all athletes will benefit and any responses are variable although the greatest benefit may be experienced by vegetarians. Those who eat no meat or fish tend to have low muscle creatine content. A loading dose of 20 gms per day for three to five days has been shown to increase the creatine content of muscle but 3 gms per day over 30 days will have the same effect and 2 gms per day will maintain levels. There is no increase with higher doses.

It is not known how long creatine can safely be taken for. There is no evidence at present of long or short term detrimental effects, but there are several potential side effects. Weight gain is common and this may be of major significance in weight category sports. Other short term side effects are unclear and the long term effects of taking creatine are not known, in particular the effect of creatine supplementation on athletes under 18 years has never been studied thus athletes from junior squads should not take creatine.

Any supplement including creatine is taken at an athlete’s own risk and responsibility.
To help you to make a fully informed decision on whether or not it is an appropriate supplement for you to take, you should talk to your team physician or sports dietitian / nutritionist.

ADVICE TO UK ATHLETES ON THE USE OF SUPPLEMENTS

UK Athletes are strongly advised to be extremely cautious about the use of any supplements.
We cannot guarantee that any particular supplement, including vitamins and minerals, ergogenic aids (such as creatine), and herbal remedies, is free from prohibited substances and therefore supplements are taken at an athlete’s risk and personal responsibility. Always consult a qualified sports nutritionist, dietician or sports doctor before taking supplements, and if a vitamin or mineral supplement is recommended, pharmaceutical-grade products may reduce the risk of using a contaminated or poorly labeled product.

What is a medicine? What is a supplement?
Athletes should be aware that any product that claims to restore, correct or modify the body’s physiological functions should according to current legislation, be licensed as a medicine. Licensed medicines can be identified by looking for a product license number, which will look like this: PL0242/0028 (numbers will change with each product). Supplements will not contain a product license (PL) number as they are not licensed medicines.

Supporting Athletes
UK Sport, HCSCs, the BOA, the BPA and NSMI are committed to supporting UK athletes, and whilst a solution to this problem with contaminated and poorly labeled supplements may not be possible, we are working towards achieving this. The statement above is intended to protect the integrity and reputation of UK Athletes by highlighting the risks involved in using supplementation.

Vitamin and Mineral supplementation
For athletes consuming a normal, varied and balanced diet, that meets their energy requirements, there is no evidence that vitamin and mineral supplementation is necessary to enhance health or performance. In fact, excessive ingestion of vitamins and minerals can be dangerous to health.

There are some practical situations in which qualified medical practitioners, accredited sports dietitians and registered nutritionists, may recommend specific vitamins or minerals for certain individuals (e.g. if iron stores are low). However, these should be taken with qualified expert advice and only used as directed or prescribed. Caution is needed because some multi-vitamin, mineral and nutritional supplements may contain prohibited substances that are not recorded on the label.

Ergogenic Aids
Ergogenic aids include many substances that are banned in sport. Furthermore there are many ergogenic aids which could result in a positive drugs test. One ergogenic aid that is widely used and is not on the banned list is creatine monohydrate. Some creatine products have been found to contain prohibited substances that were not identified on the label. UK Sport and the BOA cannot provide a guarantee as to the safety of ergogenic aids and therefore advise extreme caution is an athlete chooses to use them. For more information on creatine, consult the BOA Statement on creatine for notes on its use and safety.

Herbal Remedies
Herbal remedies have also been found to contain prohibited stimulants or other substances which may not be listed on the label.
These products are difficult to quality assure and therefore a guarantee cannot be given as to their safety or legality.

Kit Bag

Whilst our Physio’s and Doctor take 184 pieces of medical equipment to either camps or tours, its also a good idea if you take your own medical stuff

Waterproof plasters and scissors
Spare pair of contact lenses (if you wear them)
Spare gum shield

Before taking any of your own medical stuff, always check with your Physio, that they don’t contain banned substances.

INJURY PREVENTION

I’m sure you have heard the old clichés “Prevention is better than cure” and no truer words have been said about the human body. There has been many times in a season when I wished I had a spare pair of lungs for the next game. However, the creator of our gorgeous bodies unfortunately didn’t provide us with spare parts. So it’s important you should do everything you possibly can to prevent injuries.

There are two main causes of injuries in hockey;

DIRECT CAUSES. “Injuries commonly caused as a result of a fall or a blow”. Whilst falling on an astro turf pitch usually only results in grazes and burns, more serious injuries do occur. The way in which you land can cause dislocation, breaks or ruptures of any limb that gets in the way. Unfortunately for us the game of hockey was created using a hard ball, which brings tears to the eyes of the toughest when being directly hit.

INDIRECT CAUSES. Muscular injuries occur as a result of overuse, poor technique, not warming up, under recovery or inappropriate equipment. Indirect injuries not only occur during the actual game, but often occurs during physical training.

Overuse- a practice that involves continual repetition such as injecting corners, drag flicking or even hitting can result in overuse. The best way to prevent overuse is to put a set limit of how many sets will be completed before resting before the next set. Finally, always be aware of niggling pain that may herald the start of an overuse injury and seek medical advice.
Poor technique-injuries resulting from poor technique occurs due to the unnatural movement that the body is required to perform. Players should be especially careful when training with weights, as poor technique often leads to injury. Poor technique may also result from physical imbalances in your body i.e. lack of flexibility in the hamstring region could result in poor technique of tackling, therefore putting extra strain on the back.

Warm ups- as boring as warming up may seem it is an essential part of the body’s preparation to perform. In simple terms dynamic stretching alerts the muscle that it will be required to work. Without stretching this information is not relayed and the muscle may become damaged when asked to work. For example, a muscle that has been dynamically stretched is less likely to be damaged when sprinting out at short corners than a muscle that hasn’t been stretched.

Under recovery- as players we want to get back to playing as quick as possible. However, after sustaining an injury the build up to training has to be gradual and always with the approval of your Physio. Returning to training to early in your recovery stages often leads to further injury and thus longer away from playing.

Safety equipment – Lets face it hockey is played with a very hard ball. So we suggest you wear the right gear that’s of the highest quality.

Shinpads-The Performance Unit stipulates all players MUST wear shinpads in International matches.Gum shield- if you like your teeth then we suggest you wear a dentist made to measure gum shield for training and matches

Hand guards- By wearing a handguard you minimise the risk of breaking your hand and ripping your knuckles to shreds.

TOP TIPS

Listen to your body. Niggles are a warning sign that there is a problem
Carry spare gum shields, shin pads and hand guards.
Warm ups and down prepare the body and mind.
Be aware of potential injury risks, i.e, poor technique, overuse and under recovery.

CORE STABILITY

The medical team assures me that core stability provides better central control of your body. In simple terms it keeps your centre of gravity in the optimal position.

Hockey is a sport that requires you to both run and use a stick at the same time (I hope that comes as no surprise!), requiring complex movement patterns. If the wrong muscles are used the body will lose efficiency , making you vulnerable to injury. By doing core stability exercises you reduce the risk of injury.

CORE STABILITY TRAINING

So what’s all this about then?!? There are two types of muscle that are used in this type of training.

Mobilisers – These muscles move joints and limbs, they work at high speed, but cannot work for long periods. They are often superficial and long. E.g. hamstrings.

Stabilisers – These are the opposite to the above. They create little movement, but stabilise joints and can work for long periods of time, which is a good thing as they also, stop us becoming floppy rag dolls. They are often responsible for controlling rotary forces, very important for hitting movement.

Core stability exercises can be performed at anytime, anywhere. Most players use a “Fitball” to aid their development of core stability muscles. Your Physio will help you design a core stability programme and teach you techniques to perform the exercises.

WHERE CAN I FIND CORE STABILITY MUSCLES?

Abdominals- there are 3 abdominal muscles; rectus abdominus, internal and external obliques and transverus abdominus. It is the latter (TAB) that is the main stabiliser and the one you should be working to develop.

Multifidus- This is a stabiliser muscle found deep in the back between each vertebra. It stops us being floppy and allows controlled movement in the back. These are very important in hockey where lower back problems often occur.

SO WHATS IN IT FOR ME?

1 Decrease risk of injury through better muscle control.

2 Increase ability to change direction.

3 Greater capacity for speed generation

4 Improve your balance and co-ordination.

TOP TIPS

Core stability can help prevent injury
Perform core stability exercises on a regular basis to gain maximum benefits
A Fitball can be used to make core stability as hard or as easy as the individual requires.

INJURY MANAGEMENT

It is very likely that every player will sustain some level of injury that will effect his or her performance. On some occasions an injury may be so severe that it demands hospital treatment, however most injuries in hockey involve damage to the soft tissues.

The process of rehabilitation can be a very frustrating time for an injured hockey player. The extent of the injury will dictate how long the injury will take to heal. However severe the injury, the player is encouraged to keep fitness up by not using the injured area. The physiologist and physiotherapist will work together to design a way in which fitness can be maintained, i.e. aqua jogging, cycling, and swimming.

Once the injured area has recovered the Physio will assess whether you are fit to train and will conduct a small fitness test to assess whether you are fit to play. It is important not to feel isolated when you become injured. Rehabilitation is a process that focuses on the player to regain playing fitness, which involves communication between player, Physio/Doctor, Physiologist and Coach.

SOFT TISSUE INJURIES
In the medical world they like to categorise things. Soft tissue injuries are categorised as;

1st degree injuries: mild injuries, where swelling, bruising and pain are slight and self-treatment possible.

2nd degree injuries: characterised by moderate swelling and bruising, with pain on any movement; you should seek advice from a Doctor or Physio.

3rd degree injuries; where there is a complete tear of the injured tissue, significant swelling and bruising with severe pain, even at rest, you should seek medical advice as soon as possible

SELF HELP

For 1st and 2nd degree injuries use the RICE guide for the first 3 days. This process accelerates the healing process by reducing the inflammation of the injured area. You will be able to recognise the signs and symptoms of inflammation: heat, redness, swelling, pain and inability to have full range of movement in the injured part.

R: Rest
I: Ice
C: Compression
E: Elevation

REST
A major part of injury management is REST. Rest prevents further damage and bleeding. Whilst it is possible to do gentle exercise to the uninjured part, it is advised to avoid strenuous activity as this will increase your metabolic rate, leading to an increase in blood flow and an over- reaction in the inflammatory process. Depending on the severity of the injury will dictate the rest period.

ICE
Ice minimises bleeding, swelling and pain. It should be applied immediately by placing a damp towel containing chipped or crushed ice. Apply for 10 – 30 mins every 2 hours. Always wrap the ice in a towel as direct contact to the skin can cause ice burns and nerve damage. Not Nice!!!

COMPRESSION
This is the most important part of the healing process.. There is a certain technique to applying a compression bandage so check with your Physio that your on the right lines and not about to cut your circulation off!

ELEVATION
Your right, you are going to look stupid, but to restrict the blood flow to the injured area, it is advised that the injured part be raised above the level of the heart as soon as the injury has occurred. If possible the injured part should be supported on pillows or in a sling.

TOP TIPS

“ The healing process cannot be rushed. Your body recovers at a set rate. Trying to rush any stage of healing often results in delay”.

The medical staff’s job is to get players fit to play again. It is in your best interest to listen and adhere to their advice, as they know what they are talking about. So make sure you are always honest about your injury

Use the RICE guide for 1st and 2nd degree injuries.

If you are in any doubt about the management of any injury, always seek medical advice.

MEDICAL INSURANCE

The NHS does not prioritise injuries that have occurred through playing sport. Of course they will fix you up, if say, you have broken your arm, split your cheek or dislocated your shoulder. However, as elite hockey players we need to be attended to as soon as possible. Therefore, it is essential that we use our lottery money to buy medical insurance, which will allow us to be treated as soon as possible.

The Performance Unit recommends we use BUPA. Medical insurance. There are different categories of insurance that you can buy, which will cover a range of resources.

The Performance Unit recommend OPRO Mouthguards, which are individually designed to fit your mouth. Opro sponsor all funded players, so we get the mouth guards free!! Plus, if you are wearing an Opro mouth guard and you do have your teeth knocked out, Opro will pay up to £1000 dental cover.

If you have any concerns over medical insurance it is important to contact the medical staff.

TOP TIPS
Get medical insurance- if you don’t it could cost you a small fortune to get the treatment you need
The performance Unit recommends BUPA for all medical insurance.
Always wear a Gum Shield. Take spare gum shields to every game, they are so easy to loose.
Contact Medical staff if you have any worries about insurance

ANTI – DOPING IN HOCKEY

It is a known fact that over the years competitors have used drugs and doping in an attempt to improve their performance. These people are known as CHEATS!!!. Cheating not only effects you, it will get the team banned, it will effect your health and it will degrade your integrity and those that support you. The EHA believe in a drug free sport and thus adheres to the IOC (International Olympic Committee) list of prohibited substances and methods.
WHAT DRUGS SHOULD I BEWARE OF?

“ A drug is any substance that effects your emotional state, body function or behaviour “.

Social drugs –classified into soft drugs such as cannabis and hard drugs such as heroin, cocaine and crack. These drugs although often worsen your performance are banned by the EHA. Any one caught in the possession of these drugs will be dropped from the team.

Performance-enhancing drugs – the International Olympic Committee (IOC) and the EHA have banned all substance, which will attempt to improve an athlete’s performance. Different types of performance – enhancing drugs will be discussed in more detail further on.

Medications – (e.g. cough and cold remedies and painkillers). AS a hockey player you need to know that there are some over the counter medications you should not take, as they contain performance enhancing substances i.e. Lemsip and Sudafed. If you do have a cold or cough it is essential you check the ingredients before taking it. If in any doubt ring UK Sports Ethics who will check for you on 0270 380 8030. Examples of cold and hay fever medication containing PROHIBITED STIMULANTS are:

1 Benylin day and night cold treatment
2 Contact 400
3 Sudafed
4 Lemsip powder
5 Dimotane plus
6 Haymine

Nutritional Supplements – always check with the medical staff at the EHA before taking any Nutritional Supplements. Although many of these products only contain vitamins and natural herb extracts, they are not subject to stringent licensing. Thus, their content and status cannot be determined. For this reason, UK sports Council, the BOA and the EHA cannot give any guaranties to these products. They are taken at the player’s own risk.

Caffeine – This is a stimulant that is prohibited if found in large enough quantities in the body. The concentration of caffeine in a urine sample must not exceed 12 MICROGRAMMES PER MILLELITRE. The level of caffeine in your body depends on a number of factors including your weight, metabolism and hydration status. A general guideline is that you should not have more than 4 strong cups of coffee or 9 cans of cola in a short time prior to testing.

PROHIBITED METHODS

Blood Doping – this is where red blood cells are inserted into the competitor body to artificially increase the level oxygen carrying cells in the body. This can be very dangerous and the side effects are infection, blood clots and allergic reaction.

Manipulation of sample- this is an attempt by the competitor to effect the urine sample given at a drug test, E.g.;

Catheterisation

Urine substitution

DOPING CONTROL

UK Sport has introduced a doping control process to catch those who misuse drugs or use doping methods. The process they use may mean that you could be required to provide a urine sample for testing at major competition and training camps. By signing a drug consent form you have given permission to be tested both in and out of competition. More recently hockey players have been tested at their homes, without prior warning. Competitors are selected for testing by random draw of names from a squad list provided by the Performance Unit.

Testing procedure

You are allowed to have a representative of your choice present during the whole of the testing procedure, apart from in the toilet, then your on your own !! You will be allowed to do the following things before reporting for a test:

Receive medical attention
Attend a medal ceremony
Perform a warm – down
Complete a current training session.

Notification – if you are at a training camp or competition the Physio or Doctor will let you know that you are the chosen one. However, if you are at home, you may be given no notice of the test. If you are contacted by phone, you will need to meet the drug tester as soon as possible to provide a sample

Providing the sample – don’t let anyone tell you any different, the 1st time you have do this is so embarrassing. When you’re ready to produce a sample, you will be asked to select a sealed collection vessel and pop off to the loo with the tester. Unfortunately the tester has to see you provide the sample, so often clothes will have to be removed Don’t worry stage fright and small talk about the weather is very common.

Sealed bottles – the tester will now ask you to check the security seal is intact on your containers. When satisfied, open the kit. The kit will contain two bottles: A and B. you will then be asked to divide your sample between the two bottles and to seal them tightly. It is essential to always check there is no leakage from the containers.

Labelling – the tester will write the sample numbers on the sample collection form. Make sure the numbers are correct. You will be asked for details of any drugs or medications that you have taken during the last 7 days.

Confirmation – Finally, the tester will ask you and your representative to check all the information recorded on the form. If you agree, you will be asked to sign the form

Lab testing – Your sample is then sent in a sealed bag for testing at an IOC accredited lab.

Negative result – If the A sample is negative you will be informed by the EHA and the B sample will be destroyed.

Positive – If sample A gives a positive result, you will be given the opportunity to have the B sample analysed. If this result is also positive you will stand before a disciplinary panel at EHA. Whilst your case is reviewed your lottery money will be automatically be stopped and you will be dismissed from all training with your England team.