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Athletic performance

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Related Terms
  • Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.

Background
  • A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
  • Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
  • There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
  • The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
  • Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
  • The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
  • Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).

Integrative therapies
  • Unclear or conflicting scientific evidence:
  • Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
  • Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
  • Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
  • Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
  • Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
  • Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
  • Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
  • Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
  • Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
  • Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
  • Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
  • Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
  • Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
  • Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
  • Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
  • Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
  • Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
  • Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
  • Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
  • Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
  • Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
  • Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
  • Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
  • Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
  • There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
  • Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
  • Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
  • Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
  • Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
  • Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
  • Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
  • Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
  • Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
  • Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
  • Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
  • Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
  • Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
  • Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
  • Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
  • Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
  • Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
  • Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Fair negative scientific evidence:
  • Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
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  2. American Academy of Pediatrics. .
  3. Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
  4. Centers for Disease Control and Prevention. .
  5. Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
  6. Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
  7. de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
  8. Natural Standard: The Authority on Integrative Medicine. .
  9. National Institute of Allergy and Infectious Diseases. .
  10. Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
  11. Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.

Maintaining and improving athletic performance
  • General: Patients beginning an exercise program should choose activities that fit their levels of strength and endurance. Exercise that causes extreme pain or discomfort is considered by many experts as potentially harmful and it may even cause permanent damage to the body, especially to the joints, muscles, and tendons. The American Academy of Family Physicians recommends that patients choose exercise programs they will do consistently. They also recommend lower impact forms of exercise, such as walking or swimming, for pregnant patients and patients unable to handle more intense forms of exercise.
  • A qualified healthcare professional should be consulted before starting a new exercise plan. Exercise cautiously if pregnant, elderly, or with any longstanding medical conditions. Avoid high-impact forms of exercise with osteoporosis, nerve injuries, or if pregnant.
  • Nutrition: According to researchers, there is a connection between food consumption and athletic performance. Studies show that a poor diet almost always has a negative effect on an individual's athletic performance, regardless of how much they exercise. Individuals should consume a healthy diet that has sufficient amounts of calories, vitamins, minerals, and protein. The amount of calories needed depends on patient's age, size, gender, as well as the type and intensity of the physical activity being performed. The U.S. government issued a revised food pyramid in 2005 in an effort to help Americans live healthier. The new food pyramid provides 12 different models based on daily calorie needs, ranging from the 1,000-calorie diets for toddlers to 3,200-calorie diets for teenage boys.
  • Foods that are classified as complex carbohydrates are especially important for athletes because they provide energy, fiber, vitamins, and minerals. Examples of complex carbohydrates include pasta, whole grain bread, brown rice, whole grains, and bran. Oftentimes, athletes consume meals that are high in carbohydrates before they work out. This has been shown to improve an individual's athletic performance in endurance exercises that last longer than one hour. However, simple carbohydrates, such as sodas, white bread, jellies, and candies, are not recommended because they contain high amounts of calories and sugar, but little nutritional value. These food items may actually decrease an individual's performance before an athletic event.
  • Foods that contain protein are also important because they support the growth and repair of body tissues, including muscles. According to researchers, athletes only require slightly more protein than non-athletes. Also, according to the American Heart Association, most Americans already eat twice the amount of necessary protein. When an individual consumes more protein than the body needs, it is stored as fat.
  • In general, the Atkins dietT is not recommended. This is a high-protein diet that involves restricting the amount of carbohydrates consumed. Patients considering this diet should consult their healthcare providers. Some medical experts question the health safety of the Atkins dietT over the long term because the Atkins dietT allows consumption of foods containing saturated fats and proteins without any restriction. Health concerns include the impact of large amounts of protein on kidney function, the impact of saturated fats on cholesterol and heart disease, and the potential for some types of cancers to develop from eating a diet low in complex carbohydrates, antioxidants, certain vitamins and minerals, and fiber.
  • Hydration is another essential nutrient for athletes. Water and other fluids help the body maintain proper body temperatures. As individuals sweat, their bodies lose water. Sweat is necessary to help keep the body cool. Individuals should drink plenty of water before, during, and after exercising. Individuals should avoid drinks that contain caffeine before exercising. Caffeine is a diuretic that promotes fluid loss.
  • Patients should be careful not to drink too much water because it may lead to overhydration, or hyponatremia, which may be life threatening. This occurs when the body consumes more water than it loses. When there is too much water in the body, there are low levels of salt in the blood. As a result, patients may experience swelling in the legs, shortness of breath, and enlarged organs and veins.
  • When individuals exercise, the body loses electrolytes, including sodium and potassium, in the blood. These electrolytes are needed to regulate bodily functions. Individuals who are participating in strenuous exercise that lasts longer than a couple hours may benefit from sports drinks. These drinks, such as Gatorade®, contain electrolytes to help replace the ones lost during exercise.
  • Regular exercise: Regular exercise can help patients improve or maintain muscle mass, physical endurance, balance, and postural stability. Exercise includes cardiovascular activities, such as running or walking, as well as weight training. All workouts should begin with a warm-up routine and end with a cool-down segment that includes stretching exercises. After completing a weight-training workout, wait 24-48 hours before lifting with the same muscles.
  • Because lifting weights increases muscle mass, this type of exercise may also improve an individual's postural stability. The American College of Sports Medicine recommends that patients perform one set of eight to ten exercises with eight to 12 repetitions of each exercise, two to three days per week in order to improve muscular strength, endurance, and flexibility. There are three main techniques used for muscle training: isometric, isotonic, and isokinetic.
  • Isometric muscle training is the contraction of a muscle against an immovable force. For instance, muscles will flex and hold a stationary position when an individual pushes against a wall. This weight training technique involves no weight and very little equipment. Isometric exercise is primarily used in physiotherapy and rehabilitation following an injury.
  • Isotonic muscle training involves muscle contractions where tension is equal throughout the range of motion. Isotonic exercise strengthens the muscles in the entire range of motion while improving joint mobility. Isotonic muscle training is usually done with dumbbells, barbells, or elastic resistance bands.
  • Isokinetic muscle training is a type of contraction where the speed of movement is fixed and resistance varies with the force exerted. In other words, the harder an individual pushes or pulls, the more resistance is felt. This method is mostly used for sports training or rehabilitation following an injury. This form of training usually requires the use of a machine.
  • Balance may be improved with the use of physio balls, also called exercise balls. Individuals usually sit on these inflatable balls to perform sit-ups and lift arm weights. Patients can work many body areas, including the back, thighs, and buttocks. Sitting or lying on these balls forces individuals to use core muscles, including the abdominal muscles. At first, patients may feel like the ball is unstable underneath their weight. However, as muscles mass increases and balance is improved, it will become easier to use.
  • Cardiovascular training helps to improve an individual's physical endurance. The American College of Sports Medicine recommends that individuals engage in 20 to 60 minutes of continuous or intermittent (bouts of at least 10 minutes) aerobic activity at 55-90% maximum heart rate or at 40-85% maximum oxygen uptake three to five days per week to increase cardio-respiratory fitness.
  • Posture awareness: In addition to regular exercise, posture awareness may help patients improve their postures. This can help prevent neck and back pain as well as sore muscles, which are often caused by poor posture. Individuals can practice good posture in front of the mirror. When standing, a patient's weight should mostly be on the balls of the feet, which are shoulder-width apart. The back should be straight and the shoulders should be upright. The arms should hang naturally down the sides of the body. Do not lock the knees. The head should be square on top of the neck and spine, not pushed forward. Patients can test their standing posture by standing against the wall. The shoulders, buttocks, and back of the head should touch the wall.
  • Ergonomic furniture: Maintaining good posture when standing or sitting for prolonged periods is an important part of staying fit. Individuals should sit in furniture that promotes good posture. For instance, individuals can purchase chairs that have adjustable back supports. Footrests, portable back supports, or even a small pillow can be added to chairs to improve posture.
  • When sitting, the back of the head should be aligned with the back of the chair. The shoulders should be upright. Do not slouch or lean forward. Office chairs should be adjusted so that the arms can comfortably bend at 75-90 degree angles. The knees should be even with the hips. Keep both feet on the floor.
  • Supportive footwear: Wearing comfortable and supportive footwear may help improve posture. Avoid wearing high-healed shoes because they affect the body's center of gravity, which changes the alignment of the body.

Fall prevention
  • General: Individuals who are in poor physical shape are more likely to accidentally fall and hurt themselves. Accidental falls can lead to serious injuries such as hip fractures or even death. The elderly have the greatest risk of falling and hurting themselves. This is because muscle strength and coordination lessen over time. As a result, people tend to lose mobility, agility, and flexibility as they age. Increasing one's athletic performance may help prevent falling and minimize injuries. In addition to regular exercise, patients are encouraged to regularly visit their eye doctors, make the home safer, and use assisted mobility devices, if needed.
  • Regular exercise: Regular exercise can help build muscle strength and balance, which may help reduce a patient's likelihood of falling. There are many ways for people to exercise including gardening, walking, sports activities, and dancing. The type of exercise is not as important as a consistent exercise schedule. The U.S. Centers for Disease Control and Prevention (CDC) recommends that individuals engage in 30 minutes of moderate activity on all or most days of the week.
  • A qualified healthcare professional should be consulted before starting a new exercise plan. Patients beginning an exercise program should choose activities that fit their levels of strength and endurance. Avoid high-impact forms of exercise with osteoporosis, nerve injuries, or if pregnant.
  • Assisted mobility devices: Some individuals, especially the elderly, may require assisted mobility devices to help them walk. This may include a cane, walker, wheelchair, or mobilized chair. Individuals should talk to their healthcare providers to determine the best options for them.
  • Eye exam: Individuals, especially the elderly, should have their vision checked annually. Most elderly people suffer from varying degrees of vision loss and it may lead to an increased risk of falling.
  • Making the home safer: Patients should move things that they may trip over, such as shoes, clothes, and books. Remove throw rugs or apply double-sided tape to the bottom of such rugs to prevent them from sliding. Patients should keep most or all of their items in areas that do not require the use of a step stool. Grab bars can be installed in the shower and near the toilet. Use a non-slip bath mat in the shower or tub. Install proper lighting inside the home. Handrails and lights should be installed on the staircases of the home. Consider installing a ramp into the home if there are steps to the front door. Wear rubber-soled slippers that do not slip when walking around the home.

Supplements and enhancers
  • Energy boosters: Energy drinks, or energy boosters, are beverages that contain stimulants, vitamins, and/or minerals. Common ingredients include caffeine, guarana extracts, taurine, ginseng, maltodextrin, inositol, carnitine, creatine, and Ginkgo biloba. Energy drinks may contain as much as 80 milligrams of caffeine, the equivalent of one cup of coffee. Many also contain high levels of sugar or glucose. There are many different types of energy drinks. Some examples include Adrenaline Rush®, Red Bull®, Sprint®, Monster®, Diesel®, and Venom®. Most energy drinks contain some combination of B vitamins, which are thought to help the body convert sugar into energy.
  • Few studies have evaluated the safety or efficacy of energy drinks. Most scientific studies have investigated the role of energy drinks in obesity. Research suggests that energy drinks high in sugar lead to weight gain. Energy drinks act as diuretics and may potentially cause dehydration. Drink plenty of water after consuming energy drinks.
  • Because energy drinks contain stimulants, they may potentially interact with alcohol, a common depressant. Theoretically, the combination could lead to cardiopulmonary or cardiovascular failure. Two people died in Sweden after consuming Red Bull® and vodka. However, it is unclear whether the energy drink was the cause.
  • Avoid consuming energy drinks in excess, mixing them with alcohol, or using them during or immediately before or after rigorous physical activities. The National Collegiate Athletic Association (NCAA) and other professional sports leagues have banned certain energy drinks, such as Red Bull®, due to potential health risks. Avoid energy drinks that contain high levels of caffeine with heart disease, high blood pressure, and insomnia.
  • Protein powder: Protein powder is a powdered and refined protein intensive dietary supplement used by fitness enthusiasts and muscle builders who are trying to increase muscle bulk and strength. These powders can be mixed with a liquid for consumption as a protein shake, sprinkled on top of cereal, mixed with soups, or cooked into baked goods. Protein is necessary in the diet because of its role in muscle and tissue structure and function. Some examples of protein-rich foods include meats, fish, dairy products, dried beans and peas, and tofu. Protein powders are usually made from one of four basic sources: whey (from milk), egg, soy, or rice. Protein powders may be made from just one of these sources or may be a combination.
  • A study from Ohio State University, Columbus compared the effects of consumption of soy and whey protein bars in athletes. Researchers found that both the soy and whey groups showed a gain in lean body mass. However, the whey group, but not the soy group, showed a potentially harmful post-training effect on two antioxidant-related parameters. This led the researchers to conclude that soy and whey protein bars both promoted exercise training-induced lean body mass gain, but the soy had the added benefit of preserving two aspects of antioxidant function.
  • Recent studies involving whey powders have focused on its effects on muscle mass and resistance training in elderly males. Subjects who took whey protein powder immediately after exercise achieved positive results (less muscle wasting), while those who took the formula two hours or more after exercise had no significant change.
  • The consumption of too much protein may be unhealthy. Protein is broken down in the body by the kidneys. If a person has kidney problems, the consumption of protein may need to be limited. The daily recommended consumption of protein is based on a patient's weight, age, and activity level.
  • Testosterone enhancement: Testosterone enhancement is the illegal use of anabolic steroids to boost athletic performance. Anabolic steroids are male sex hormones, collectively known as androgens. Although these drugs may be prescribed for certain health conditions, such as hormonal disorders, it is illegal to use them without prescription. Many athletes illegally take these hormones to build more muscle and endurance than would normally be possible. Because anabolic steroids offer athletes an unfair advantage, they are banned by all major sporting organizations. Athletes are regularly screened for steroids in professional sports.
  • The most popular steroid used is called testosterone. This man-made chemical imitates the effects of the male hormones that are naturally produced in the body. Testosterone and other anabolic steroids that are used to increase muscle mass are taken by mouth or self-injected. Athletes often take multiple anabolic steroids.
  • Anabolic steroids may have significant adverse effects. In men, shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, and increased risk for prostate cancer have been reported. In women, growth of facial hair, male-pattern baldness, menstrual irregularity, enlargement of the clitoris, and a deepened voice have been reported. In children, prematurely halted growth has been reported.
  • There is widespread evidence that the use of testosterone and other anabolic steroids may have permanent harmful effects on the body. Anabolic steroids have been linked to many health conditions including liver tumors, cancer, high blood pressure, increased bad cholesterol (LDL), and kidney tumors. Psychiatric side effects may include extreme irritability, delusions, paranoia, unabated jealousy, and impaired judgment stemming from feelings of invincibility.
  • Individuals who share needles to inject steroids have an increased risk of developing infectious diseases, including hepatitis C and HIV/AIDS.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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