My Items

I'm a title. ​Click here to edit me.

The Importance of Balance Proprioception In Pickleball

As most of us know, the key to being successful when playing pickleball is creating scenarios where your opponents are compromised in order to gain an advantage during the rally. Moving the ball around the kitchen and getting your opponents off-balance is a great way to create unforced errors. So, in order to be successful on the court, improving your balance and reaction strategies can help you stay in a point longer, and possibly avoid making unwanted mistakes. But what is balance, and how can you train it?

There are three main systems in our bodies that control our balance: visual, somatosensory (our brain’s awareness of touch, pressure, and body position [also known as proprioception]), and vestibular. We mostly rely on visual feedback during regular activities since our eyes are very good at judging depth and informing our brain on movements needed to balance. However, when playing pickleball, our heads move a lot, therefore making it harder to rely solely on vision since our eyes are constantly tracking the ball. Therefore, we have to use our vestibular system (inner ear) and somatosensory information (pressure through our feet) to compensate.

So how does each system affect our balance?

As mentioned earlier, the visual system is our primary feedback mechanism for balance. Our eyes convey most of the needed information to function in our daily activities. The vestibular system is based in our inner ear. We have two separate components in our inner ears: one that senses linear motion (for example, the feeling of going up and down in an elevator, or accelerating in a car), and the other that senses rotational motion (for example, during a somersault).

The somatosensory system takes all input from touch, pressure, heat, and proprioception to give our brain information about our position in space.

It’s important to know that no matter what your current balance level is (poor, fair, good), it can always be improved with targeted exercises. If you find that you lose your balance on a daily basis with basic activities or when playing pickleball, then incorporating balance exercises in your daily exercise routine will help you over time. Below you will find various exercises that will work on and challenge your balance. Remember, always start with the easy version, and progress as you feel comfortable. If you do not feel comfortable doing these by yourself, then seek out a physical therapist who will be able to help you with personalized attention.

For all the exercises listed below, there is a common progression:

Step 1: Eyes open, with hand support (holding on to something)
Step 2: Eyes open, no hand support
Step 3: Eyes closed, with hand support
Step 4: Eyes closed, no hand support
Step 5: Performing the previous 4 steps on an unstable
surface (such as a foam pad or a pillow)

Once again, always start with the easy step for each exercise, and progress to the next level if you are successful.

Exercise 1: Tandem Stance. Start at the kitchen counter with your hands on the counter. Place one foot in front of the other so that your heel from one foot touches the toes from the other foot. Make sure both feet are nicely lined up. Stand nice and tall, and try to maintain the position. The goal is to hold the position for 1 minute without loss of balance. Go through the progressions listed above, making sure to switch your feet position to work on both sides.

Exercise 2: Standing on One Leg. This might seem easy, but you would be surprised how many people struggle with it. The goal is to hold for 1 minute without any loss of balance.

Start at the kitchen counter with your hands on the counter. Stand nice and tall, and pick up one leg. At first, maintain your vision on an immobile object with your hands touching the counter. To progress this, perform without holding on. Then try it with your eyes closed (remember this will be more difficult since we are taking vision out of it), holding on with your hands. Then finally, eyes closed without holding on. Once you get good, you can also incorporate single leg balancing during some of your daily activities such as brushing your teeth.

Exercise 3: Stepping Up on a Step. This is a progression from Exercise 2. Be sure to feel comfortable with Exercise 2 prior to performing this one.

To perform the exercise, grab a medicine ball or a weight (start light and progress as you get better and more comfortable). Face a staircase or step stool, hold the medicine ball (or weight) close to your chest, and step up on the step with one foot. Maintain your balance on the foot without putting down the second foot, and hold as long as you can, then come back down and switch the lead foot. To progress this, as you step up on the step, extend your arms so that the medicine ball is farther from your body (the farther you reach, the harder it will be). Finally, you can also perform this same exercise by performing a sidestep up onto the step. Be sure to work both sides.

If you work through the progressions, you will see how difficult it becomes when you take vision out of
the equation, as well as when you stand on an unstable surface (take out sensation). However, every time you progress the exercise, you are challenging different parts of your balance systems, and therefore training them in various ways. Since your eyes are focused on the ball during a pickleball game, improving your other balance systems will help you feel more confident with your overall game and you will be in better positions on the court to be successful.

If you incorporate these exercises into your routine, and work through the progressions, you will see improvements over time, and you will become more confident in your ability to be balanced. This will translate into your pickleball game, especially as you add more dynamic variations to the balance exercises. Be creative, and if you think of innovative ways to challenge your balance, please post a video of you doing it on The Pickleball Doctor’s Facebook page.

If you have any questions, do not hesitate to reach out to thepickleballdoctor@gmail.com.



Posture of Pickleball

Sitting and standing tall are easy…not! If they were, few would end up with pickleball shoulder, neck, back, hip or knee problems.
Think of your body as a house. Picture an earthquake—I call it “Life happens”—where you are shaken to your foundation. None of your doors and windows (joints) open or close correctly any longer. Basically, when life happens, tissue issues begin to break down your parts. Add pickleball to the mix and (Presto!) your body starts to sustain injuries. If you’re younger (18-49), your rate of injury and repair is much shorter
than the 50+ group. If you’re over 70, surgeries can be inevitable.

When you build a structure, walls are even; floors and ceilings don’t slant. There is equal tension on stabilizing beams. The doors and windows glide open and closed. That’s the way your body is supposed to work as you age. Yes, we all have aches and pains and soreness, especially after playing pickleball, but reducing injuries by doing some preventive work is necessary.

Let’s go through some body parts and the effect of poor posture on each. Start with forward head, where your nose enters the room first and your chest is attached to the train tracks. The weight of your head pulls on your neck and back. Between pickleball games you may sit on those terrible chairs you bring to the court. Check your sitting posture—that posture becomes your life posture as your neck and back tighten and eventually wear out. Forward shoulders are next. When reaching for those high pickleball shots, if you’re using your neck muscles instead of back muscles, the rotator cuff and long head of the bicep tendon are being sawed off.

Dinking and bending for those low pickleball shots can ruin your hips, back and knees. If your hip flexors are getting tighter each time you play and if stretching is not in your repertoire every evening, the hips can become out of alignment with your femur (leg) bones. Either the hip socket bones or back, or both, start to wear down. The knees are two bones balanced on top of each other. If your feet or hips don’t balance, neither do your knees. Also, if your hip muscles are so tight that they don’t glide when you walk, then you’re using your knees as hip sockets. That kind of movement wears away at your knees.

The key is to stretch, stretch, stretch, which helps to repair the tight tissue from all that playing. Sit and stand tall. Your balance can improve and some of the body pain can subside. The chance that you’ll play stronger and safer pickleball increases because your balance is better, and you integrate more correct muscle strength.

Sit and stand tall. Your head is attached to the cable car wires. Your chest enters the room first. Your arms hang from your back, not your front. You’ll look slimmer, taller and younger with a brain that gets more oxygen. Your balance can improve and some of that body pain can subside. Give good posture a try. I’ll bet you’ll be happy with the results.


Stay Court-Ready with Immune-Boosting Foods

No doubt about it, COVID-19 put quite a block on pickleball play this year. While the future of the virus is unpredictable, one thing we do have some control over is how we take care of ourselves, including what we choose to eat.
Much like consistent pickleball practice improves abilities over time, healthy eating habits increase immune function over time, not overnight. Perhaps more accurately, a diet deficient in nutrients can weaken your immune system. A dedicated commitment to eating a varied, plant-strong diet, including foods with the following key nutrients, will give you your best shot at staying well and court-ready.

PROTEIN
We need adequate protein to build everything in our bodies including immune system cells and antibodies. High-quality protein can be found in both plant and animal sources. The average recreational player needs about .9 grams of protein per kilogram of body weight daily.
Best Shots: Beef, poultry, fish, eggs, dairy, beans, peas, lentils, quinoa, nuts, whole grains

VITAMIN C
Vitamin C is important for healthy tissues including skin and muscles. It plays a role in the immune system by taming wayward molecules that might otherwise do damage, and by stimulating antibody production. Fresh fruits and veggies are the highest sources of vitamin C; cooking or storing produce too long reduces vitamin potency.
Best Shots: Papaya, peppers, broccoli, strawberries, Brussels sprouts, pineapple, oranges, tomatoes

VITAMIN A
Some forms of vitamin A including beta-carotene can increase immune cell function and help keep tissues healthy. Orange and yellow fruits and vegetables tend to be highest in vitamin A.
Best Shots: Pumpkin, sweet potatoes, carrots, red and yellow peppers, apricots, dark green leafy vegetables, winter squash, chili peppers

ZINC
Important for T-cell function, deficiency in this mineral can reduce immune abilities quickly. Luckily symptoms can be reversed once zinc is reintroduced. Try keeping pumpkin seeds in your pickleball bag for a post-play snack.
Best Shots: Beef, lamb, pumpkin seeds, sesame seeds, chickpeas, hummus, lentils, quinoa, turkey, shrimp

PROBIOTICS and PREBIOTICS
Probiotics and prebiotics are important for gut health, an essential part of your immune system. Probiotics
are the good bacteria that help us digest food, make nutrients, and fight pathogenic bacteria. Probiotics can be found in cultural fermented foods. Prebiotics are the food probiotics need to thrive and are found in high-fiber foods like whole grains, vegetables, and some fruit.
Best Shots: Probiotics – cultured yogurt, kefir, fresh miso, fresh sauerkraut, kimchi, tempeh, kombucha tea; Prebiotics – bananas, leeks, garlic, onions, Jerusalem artichokes, asparagus, jicama, beans, whole grains

VITAMIN D
If you’re looking for an excuse to play more outdoor pickleball, this one is legit. Vitamin D is a hormone that humans make when our skin is adequately exposed to the sun’s ultraviolet light. We need D for immune system regulation, and for healthy bones and muscles.
Under ideal circumstances, it only takes 10-15 minutes of daily UV sun exposure to make enough vitamin D. Unfortunately, we face limiting factors including time of year (any season other than summer), living north of the 37th latitude (check your map), skin color (darker tones block UV rays), age over 65, and the important cancer-preventing use of sunscreens. These factors block vitamin D production like a Newman at the NVZ.
Because it’s hard to get enough vitamin D from food, this is one nutrient I often recommend supplementing. Ask your doctor what dose is right for you.
Best Shots: Summer sunlight, supplementation, wild-caught salmon, UV-exposed mushrooms, fortified foods like milk, soy beverage, orange juice, and cereal

GET THE WHOLE PACKAGE
Your favorite pro would never win gold with a strong serve alone; to make it happen, she also needs the drop, drive, volley, dink and that little bit of unexplained magic that the rest of us would love to get from a
bottle. The same rule applies to vitamins. Good-quality supplementation can help in a pinch, but even the best supplements can’t replace healthy food. Eating a wide variety every day is recommended so that you get the whole package, including those magical nutrients we haven’t discovered yet.

Immune-Boosting
Stuffed Peppers

High in protein, prebiotics, and vitamins C and A, this recipe is versatile, so you can make it your own way!
6 large fresh peppers (Hatch, poblano, or bell
peppers)
2 cups cooked protein (quinoa, ground beef, or
chicken)
1 small onion
4 cloves garlic, minced
1 cup cooked rice (brown or white)
1 cup cooked beans (black, pinto, or small red) 15 oz. can diced tomatoes
1 packet taco seasoning (or season your way to
reduce sodium)
1 cup cheese (Monterey Jack, cheddar, Pepper Jack, vegan)

Halve peppers lengthwise, removing stem, seeds and ribs. Pre-roast cleaned peppers on an oiled baking sheet at 350F for 10-15 minutes, or until somewhat softened. While peppers are pre-baking, sauté onion and garlic in 1 tablespoon cooking oil until softened. Add protein, rice, beans, tomatoes, and taco seasoning; heat through, mixing thoroughly. Fill prebaked pepper halves evenly and sprinkle with cheese. Return to preheated oven and bake until peppers are softened to preference and cheese is melted, about 15 minutes.








A Sight for Sore Eyes

Eyewear not only protects players’ eyes from the ball or a partner’s paddle, it can protect you from long-term overexposure to the sun’s UV rays.

Across the sports landscape, eye health and eye safety during play has become an increasingly serious topic of discussion. Not surprisingly, this discussion has recently come to pickleball. The ability to both play safely and win is affected by how players see the ball, the court, their partners, and their opponents. As with many other ball sports that are played mostly outside, pickleballers face two distinct hazards to their vision when they play: impacts to the eye from the ball, their partners’ paddle, or their partners themselves; and overexposure to UV rays from the sun. Over time, exposure can result in cataracts (clouding of the eye lens) and macular degeneration (deterioration of the central portion of the retina), both of which can lead to loss of vision.

A lot of play happens at the kitchen line, which means that players are usually only 14 feet from their opponents’ next shot. Even a speed-up moving at just 20 mph in the kitchen leaves a player with 0.5 seconds to react. If players don’t have protective eyewear, all they have is their reactions to keep from getting hit. Most people seem to think that eye injuries happen, but not to them. The problem with this kind of thinking, though, is that oftentimes getting hit in the eye is out of a player’s control, and when it happens, it can be incredibly serious—from detached retinas, to orbital blowout fractures, to even ruptured eyeballs.

The immediate solution to these problems is high-quality eyewear with polycarbonate lenses. While eye injuries from impacts can be serious, the good news is that 90 percent of these injuries can be prevented by wearing the proper eye protection (i.e. polycarbonate lenses). Not only that, but these lenses also block 100 percent of harmful UV rays. If the sunglasses are wrap-style, it’s even better. This extended curve helps prevent UV rays from reflecting off the inside of the lenses directly into a player’s eyes.

While protecting players’ eyes, the right eyewear can simultaneously enhance performance if its features are suited for the pickleball environment. Eye protection does not mean players should sacrifice on performance. With the proper tint, players can enhance the ball’s contrast against the court, improving their depth perception, timing, and reaction speed.

Recently USA Pickleball has partnered with RIA Eyewear, a startup based in New York that launched earlier this year. The new company’s first sports sunglasses line features polycarbonate ZEISS™ lenses that enhance the contrast of the pickleball against the court and blocks 100 percent of harmful UV rays. These proprietary lenses are housed in Italian-made frames that weigh less than 1 ounce and feature an interchangeable lens system to account for different light conditions.

RIA’s mission is to prove that eye protection doesn’t have to come at the expense of performance and, in fact, it can help players perform better. Its products have already gained traction with top professional players, partnering up with Michelle Esquivel and Rob Cassidy, founders of Ultimate Pickleball Academy, as well as Aspen Kern. “As an instructor, teaching long consecutive days under the sun can be brutal on the eyes. Quality sunglasses are essential,” said Cassidy. “From a player’s perspective, part of playing your best is playing without fear. Proper eye protection truly allows you to play with no fear.”

PICKLEBALL—A Sport for Creative Athletes!

SickTrx is a group of top pro players and ambassadors who have displayed the art of trick shots on the largest competitive stages around the world. Here, Brian Ashworth, Joey Farias, Ben Johns, Vicki Love, Irina Tereschenko and Kyle Yates share and reflect on some of their favorite SickTrx.

What is SickTrx, one might ask. SickTrx is a “pickleball philosophy”—a way of life, if you will—that puts imagination, creativity, fun and mentoring as core values for growing your game and the sport. Becoming a better pickleball player at any level is not just about drilling, discipline, 10,000 hours of deliberate practice, and trying to win at all costs. Pickleball is a unique game that unites and celebrates players of all individual styles, technical and physical skills. We commend all the players who are not afraid to bring some flare to their game and develop additional offensive options through the use of trick shots (or, as we fondly call them, SickTrx).

SickTrx is also a group of friends—top pro players and sport ambassadors—who have gotten pretty good at executing a large number of trick shots on the biggest competitive stages around the world and have a lot of fun sharing their skills with others during rec games, exhibitions, junior parties, and clinics. This article is an exploration and reflection on some of our favorite SickTrx. We hope it brings you joy and inspiration. Namaste.

Irina Tereschenko Top-Ranked Pro and 4-Time Pro Major Champion Team: Paddletek and Jigsaw Health Follow: sicktrx_irina (IG) and Irina Tereschenko (FB)

I am a big fan of the misdirection shots. This category really allows for individual playing styles and player personalities to shine as the options are almost endless: head fake, shoulder fake, inside out slice redirect, no-look flick, drop shot fake, lefty switch—you name it.

Every member of the SickTrx crew adds a different flair to the misdirection shots, and if you watch some of our matches more closely, you can definitely pinpoint the personal favorites! These shots are generally executed from the kitchen area (groundstroke or volley) and are designed to surprise your opponent, push them off balance, and set up the winner with the next shot.

I often disguise a drop shot from the kitchen as a powerful drive—especially when both or one of the opponents are back on the baseline—by taking a huge swing on a high ball but then letting the ball drop and gently placing it into the kitchen with tons of underspin. This is a very effective tactic at all levels if your opponent is not very quick and/or when you are trying to wear them down. Even if the opponent gets to the drop shot, they are very likely to pop the ball up and you are perfectly set up for a slam dunk as they fight to regain balance and re-establish themselves at the kitchen line.

Ben Johns 10-Time Pro Major Champion Team: Franklin Pickleball, Jigsaw Health, Fila Shoes Follow: benjohns_pb (IG) and Ben Johns: Pickleball (FB)

The “Jumping Erne” is my favorite trick shot. It distinguishes itself from a normal Erne shot (walking around the kitchen to stand right up close to the net) in that you can position yourself after your opponent makes contact with the ball by jumping. This makes it a difficult shot to avoid or see coming. If executed correctly, the shot is both effective and versatile. And bonus, it looks really cool!

The Jumping Erne can be played off any shot that gets too close to the sideline. This applies a lot of pressure to your opponent because it effectively shrinks their “safe” portion of the court by a couple of feet. It also has a wealth of placement options due to your contact point. The shot can be hit with a forehand or a backhand. I personally prefer to hit it from the left side with my backhand. Here are some keys to hitting the shot: 1. Jump with the foot that is closer to the sideline, landing on the leg that is closer to the middle of the court. 2. Attempt to time your jump so that your contact point with the ball is as close to the net as possible without going over it. 3. Make sure you turn your wrist DOWN to keep the ball in! You’ll often hit it long if you don’t, because of your close contact point and momentum.

Remember, it’s OK to look silly trying new things! Eventually you’ll start to feel the timing of your jump and when to go for it. Next time you go out to play, give this SickTrx a try!

Kyle Yates 12-Time Pro Major Champion Team: Paddletek, Jigsaw Health, PB1965 Follow: kyleyates.pb (IG), Kyle Yates Pickleball (FB) and Pickleball Vlog (YT)

One of my favorite shots in pickleball is the tweener! I’ve always had an affinity for exciting the crowds. A tweener, when executed in an effective manner, and at the right time, can surely get the spectators on their feet! The creativity involved with this shot is what truly defines it as a SickTrx.

Most of the time, some might consider this shot to be “unnecessarily flashy,” but I say NAY! Sometimes it’s absolutely necessary and an ideal option. As difficult as it may be, I’ve found it to be extremely useful on many occasions. For example, I recall pulling it off in a third set tiebreaker in the semi-finals of the US Open Pro doubles. The packed stadium roared in delight by what they’d witnessed. That crowd energy pushed us on to victory and ultimately the prestigious title.

Picture this: Your opponent has just hit a timely, well-struck lob over your or your partner’s head. You have no time to make a decision, and surely cannot jump high enough to immediately take the ball in the air. In a nanosecond, you swivel around to see the ball a half-court’s length away, and traveling quickly. Instinct kicks in and you make a beeline toward the ball as it bounces deep near the baseline. At this point, you can either call it out or run full speed, gain ground and catch up to the plastic ball as it reaches its apex, and begins to descend once again. You’ve got no time to concoct a plan. Once you reach the ball, you have no time, nor room, to move around the ball to take a normal swing; the ball is already between your legs. The only play is to simply keep your speed, and run right through/over the ball, and play it back right between your spread, galloping legs.

This delicate maneuver is not for the faint of heart, nor well-endowed. Simply getting the ball back over the net this way is a feat in itself… 25-30 feet away, full sprint away from the net, striking the ball between the legs, backward, and yet still dropping it perfectly, gently, over the net and safely into the kitchen. At this point, with the poise of a rocket surgeon, you must turn around and immediately return to battle and finish the point. It is SickTrx like this that really get my adrenaline pumping and reignites my passion for this great sport!

Vicki Love 0-Time “Pro” Major Champion Team: No affiliations Follow: Not applicable (Seriously, how am I part of this team?)

Any member of this team would be among the first to say that you should not be taking any pickleball skill advice from me. My playing style is…uniquely scrappy, and should not be replicated (unless you also thrive in chaos).

With that caveat, I’d have to agree with Irina that my favorite SickTrx shot is misdirection. For example, if you are in a cross-court dink battle and notice, using your peripheral vision, the player straight across from you is slowly moving toward the center of the court, then hide a last-second flick of the wrist (or push) to redirect the ball toward the body of the opponent in front of you or down the line. Hitting that player by surprise or “burning them down the line” is a potential way of keeping them accountable for protecting their side of the court and line.

Besides misdirection, I personally think that one of the best “shots” to master in an effort of elevating your game is not a shot at all. It’s simply being comfortable with letting out balls go.

Brian Ashworth
Winner of Numerous Silver Medals All Over the Globe and Founder of SickTrx Team: Pro-Lite
My favorite shot would probably be the drop-to-a-knee smash return. To execute this sorcery, first you need a well-placed pop-up to your opponent’s paddle hand and preferably close to the kitchen. Once you have executed this, you drop to your knee and get your paddle low. I do this because we have all been drilled to hit our opponent’s feet, so I place my paddle essentially where my feet would be. When your opponent smashes the ball, try your hardest not to smirk. Let your paddle hit the ball and let their force bring it back to them. Now is the time to chuckle but also stand back up. I promise you, no shot feels as satisfying as this one.

Joey Farias
Top Pickleball Pro Bronze Medal Specialist Team: Gearbox, Jigsaw Health, Tyrol Shoes, Black Ice Follow: jfariaspickleball on both Instagram and Facebook

The offhand flick is one of my favorite SickTrx shots. It’s a good way to add even more deception to your game, especially up at the kitchen by using your non-dominant hand to attack. I enjoy using it when I am dinking cross court for a while and faking my normal backhand dink while switching the paddle to my left hand and flicking the ball up the line to keep my opponent off guard.

The offhand flick should be used at the kitchen line due to most players’ lack of power with their non-dominant hand. From the kitchen line, deception can really affect the player, and not much power is needed if the shot is executed correctly. When trying to execute this shot, timing and accuracy are everything. You must pick the right time when your opponent either least expects it or has not seen it coming before. Accuracy is needed with this shot because you are trying to either hit your opponent’s weak spots, or keeping it away from their power side. Be careful trying this shot all the time, as players will start anticipating the attack.

Go home and enjoy trying to add this new SickTrx to your arsenal and keep bringing your own flare to pickleball.

SickTrx started with a group of young adult pickleball players who shared a common goal and vision for pickleball. They wanted to elevate the strategy and pace of the game by regularly incorporating SickTrx shots into competitive games. The idea is that by increasing the speed, unpredictability, and athleticism required to compete at the highest professional levels, this would increase the visibility, interest in, and passion for the sport from junior and younger athletes.

SickTrx has evolved from there with the aspiration that everyone can and should embrace the development of their own style and creation of their own SickTrx shots. We can all contribute to elevating the game of pickleball for all ages, levels and sexes by learning from one another’s creativity and pushing back on historical-based constraints that suggest there are only a few correct ways to play pickleball properly.

The SickTrx team is continually impressed and encouraged by the progress of the game, the increasing entrance of incredibly talented new players, and the heightened level and depth of competition. Keep trying different shots. Keep exploring your personal capabilities. Keep having fun in the creative process. And find that SickTrx style and shot that personalizes your game and separates you from the norm. Most importantly, when you successfully hit your SickTrx shot, shout “SickTrx” loud and proud.

Boost Your Game with Plant-Based Power

On the courts and off, the topic of vegetarian nutrition is hot!

Whether it be for health, ethical, or environmental reasons, many players are looking for plant sources to meet their energy needs. And with farmers markets in their full summer swing, this is the most delicious time of year to drop more plant power into the kitchen.

From a dietitian’s point of view, this trend is no fad diet. The evidence of health benefits from a well-planned vegetarian diet continues to grow, even for athletes. But how do you know if going vegetarian is right for you?

It’s Not All or Nothing Some people don’t like the idea of going completely without animal products, and that’s OK! Any increase in whole plant foods will add nutrients and reduce nutrient-empty calories, especially if you’re eating them in the place of processed foods and meats. There is a wide variety of vegetarianism out there, so let’s define the basics:

• Vegans eat no animal products.
• Vegetarians eat some animal-derived foods like dairy and eggs.
• Pescatarians are vegetarians who additionally eat seafood like fish and shellfish.
• Flexitarians are vegetarians who sometimes add meat to their mostly vegetarian diet.

Notice that I didn’t include the term junkatarians, the folks who boast of eating no animal products but whose diet consists of mostly chips and processed foods with little nutrient value. Like any diet, the key to healthy vegetarian eating is planning, so that your body gets all the nutrients it needs, especially for those getting out on the court.

Enough Protein? Not a Problem!
Athletes tend to have concerns over getting adequate protein, and rightfully so. It’s important to get enough so that you can build and maintain muscle. With mindful planning, vegetarians can meet their needs without eating any animal products. Beans, peas, lentils, nuts, seeds, whole grains, and vegetables all contain some essential amino acids, the building blocks of protein. By eating a variety of these healthy foods, players can get what they need.

So how much do we actually need? There is a simple formula, which varies based on your weight, health and activity level. Here’s a very basic breakdown for average, healthy pickleball players:

Average Recreational Player
.9 grams protein/kg/day
Example: 80kg person x .9g = 72 grams of protein
Endurance Athlete (playing several hours daily)
1.2-1.7 grams protein/kg/day
Example: 80kg athlete x 1.2g = 96 grams of protein
Here’s an example of what over 100 grams of vegan protein might look like:

• ½ cup steel-cut oats (10 grams)

• 1 cup walnuts (12 grams)

• 1 cup firm tofu (20 grams)

• 1 cup of lentils (18 grams)

• 2 cups of soy beverage (16 grams)

• 2 tablespoons nut butter (8 grams)

• 2 tablespoons chia seeds (5 grams)

• 1 cup brown rice (4 grams)

• ¼ cup pumpkin seeds (8 grams)

Vegetarian sources that are high in protein include eggs and dairy products. One egg contains about 6 grams of protein while a serving of dairy can vary anywhere from 8 grams in one cup of milk to 14 grams in a 5.3-oz. container of Greek yogurt.

Other Nutrients to Consider
Becoming low in any nutrient can keep you from playing your best. It’s always a great idea to discuss any new diet plan with your doctor, who may want to monitor your blood levels for potential deficiencies. The following list includes nutrients most commonly missed in vegetarian diets. In general, you can meet your needs by regularly adding my suggested vegan, vegetarian, or pescatarian “Great Shot” recommendations to your kitchen. While the following nutrients can be of concern, you are likely gaining more vitamins and minerals from a plant-based lifestyle than you’d ever lose.

Iron
Iron deficiency can mean low energy because of a reduced ability to circulate oxygen. This can be a real problem for athletes, females of childbearing age, and people who are avoiding meat. It’s always important to talk to your doctor if you’re feeling run-down more easily on the court. Vegan sources of iron, or non-heme sources, don’t absorb into the body as well as heme or animal sources. However, pairing high-iron foods with foods high in vitamin C (like fruit, peppers and broccoli) significantly increases iron absorption. Think along the lines of chili beans simmered with tomatoes, or a spinach and strawberry salad. Cooking with an iron skillet also adds iron to the diet.

Great Shots: lentils, beans (especially white and soybeans), quinoa, tofu, dark leafy greens like spinach and chard, pumpkin seeds, dark chocolate, clams, mussels

Vitamin B-12 (also known as Cobalamin)
The 2.4 micrograms of vitamin B-12 most adults need daily is almost exclusively found in animal products, with the exception of fortified foods like cereal and nutritional yeast. It’s an important nutrient; deficiency can lead to permanent neurological damage. If you are nearly or completely vegan, be sure to take a good-quality supplement, verified for purity by a third party like United States Pharmacopeia (USP).

Great Shots: fortified nutritional yeast, fortified cereal, fortified soy beverage, third-party-verified vitamin B-12 supplements, eggs, Greek yogurt and other dairy products

Zinc
Zinc is essential to a healthy immune system, which is of even greater concern on the courts lately.
Great Shots: legumes, seeds (especially pumpkin seeds), chickpeas/hummus, whole grains like oatmeal, shellfish

Calcium
Calcium is essential for bone strength, and for that winning smile in your medal photos. Traditional American dairy sources can easily be replaced with plant sources.

Great Shots: broccoli, dark leafy greens like kale and collard greens, legumes, calcium-fortified beverages like orange juice and soy beverages, dairy products, canned sardines or salmon with bones

By switching to a plant-strong diet, you may just gain the edge you’ve been looking for on the court!

Brandi’s Summer Salad
1 can black beans, rinsed and drained
1 cup jicama
1 red pepper, finely chopped
1 cup baby spinach, chopped
1 cup fresh or frozen corn kernels
1 can chickpeas
Juice from 2 or more limes
Combine all ingredients, and season with salt and pepper. Chill and devour. Serves 4.
Nutrition Information: 12 grams protein, 3 mg iron, 52 mg vitamin C

Powering Your Brain for the Mental Game

You had another lousy day on the court. You keep yourself physically fit and practice dinking diligently, but for some reason your mind hasn’t been in the game. Maybe it’s time to focus on how you’re fueling your brain.

Decades of research supports the fact that people who eat healthfully feel better mentally. Athletes who regularly consume the following foods may just get the cerebral edge over a less kitchen-savvy player.

Water: Dehydration can affect psychomotor learning, exercise performance and mood. Simply staying hydrated will help you stay alert and may keep you from becoming that grouchy club member no one will play with anymore.

Best Bets: Your kidneys will thank you for drinking plain water, but most drinks count toward staying hydrated, including milk, juice, tea and even coffee. Sports drinks can be a good choice on longer-play days when you’re sweating a lot, especially if you’re not taking the time to replace electrolytes with foods.

​Healthy Fats: Omega-3 fatty acids help the nervous system run smoothly and can reduce inflammation in the brain. In the long term, this aids in prevention of mood disorders, Alzheimer’s disease, and dementia.

Best Bets: Walnuts, Flax Seed Meal, Chia Seeds, Canola Oil, High Omega-3 Eggs, Sardines and Salmon.

Carbohydrates—yes, they can be good: Carbohydrate is the brain’s preferred fuel source. Simple carbohydrates are easily digestible and can offer quick energy. This can be beneficial when athletes are using a lot of fuel on tournament days. However, too many simple carbohydrates can lead to health problems over time, including unintentional weight gain. Complex carbohydrates are slowly digested, doling fuel into the body steadily, thereby helping to control mood swings.

Recent research shows an incredible connection between gut health and mental health. A healthy gut has a balanced variety of probiotics, or beneficial bacteria. Many complex-carbohydrate foods are also “prebiotics” or “microbiota accessible carbohydrates” (MACs), fancy words for foods that feed probiotics. Without MACs, our probiotic friends can’t thrive and produce neurotransmitters that promote mental well-being.

​Best Bets for quick energy: Fruit, Pasta, White Rice, White Potatoes, Sweetened Sports Drinks.

​Best Carbs for Gut-Brain Health: Bananas, Apples, Raisins, Berries, Beans, Lentils, Jicama and Whole Grains.

​Other MAC Foods: Asparagus, Dandelion Greens, Tomatoes, Spinach, Onions, Garlic, Leeks, Artichokes, and Jerusalem Artichokes.

​Vitamins and Minerals: Along with the rest of your body, the brain depends on a wide variety of nutrients to function well, including vitamin E, B vitamins, and flavonoids. Our bodies generally process these best when they come directly from food. Scientists know there are a great number of nutrients in food that we haven’t yet discovered, which means you couldn’t possibly get the same benefit from a vitamin pill or powder that you would from a serving of broccoli. Think about supplements as the back-up plan, not as your main source of nutrients.

​Best Bet: A plant-strong, varied diet. The Mediterranean Diet and The Mind Diet are both excellent, scientifically proven diet plans.

​Routinely adding these foods to your kitchen can volley the clarity needed to drop the third shot, execute that Erne, and maybe even remember the score.

In a Pickle - Eating for a Healthy Recovery

Hmph. That’s the pouty sound I make from the sidelines, nursing a knee injury. Here I sit waiting for surgery day, watching my husband use what was supposed to be my birthday present—boot camp classes with Tyson McGuffin. Hmph.

What can I do? Plot revenge for hubby’s birthday, of course. Then I’ll stop the pouting and plan meals for a healthy recovery.

Good food speeds healing. Here are some nutrients on which I’ll be focused, and lists of excellent sources for each. Some of the foods overlap, making them efficient options.

Protein - Extra protein is needed to repair injuries.
Sources: Beans, beef, chicken, chickpeas, dairy, eggs, lentils, pumpkin seeds, salmon, sardines, and soybeans

Vitamin C - Great for repairing tissues, including ligaments, tendons and wounds.
Sources: Asparagus, bell peppers, broccoli, Brussels sprouts,
papaya, pineapple, spinach and strawberries

Zinc - This mineral is important for keeping the immune system functioning well.
Sources: Asparagus, beef, cashews, chickpeas, lentils, oysters, pumpkin seeds, shrimp and spinach

Omega-3 - Healthy fats can help reduce excess inflammation.
Sources: Brussels sprouts, flaxseed meal, grass-fed beef, salmon, sardines, soybeans, walnuts

Fiber - Getting enough fiber fights constipation caused by pain meds and being more sedentary.
Sources (includes foods that feed friendly gut bacteria, a.k.a. prebiotics): Apples, artichokes, asparagus, barley, chickpeas, flaxseed meal, garlic, jicama, lentils, oats, onions, spinach, sweet potatoes and whole wheat

Thoughts on Supplements
While our bodies best absorb nutrients from real food, adding supplements may be helpful if we can’t meet recommendations. Choose products that have been tested for content by an independent third party, such as USP, and ask your doctor which supplements are safe for you.

See you back on the court very soon!

---
Brandi Givens has been a registered dietitian since 2010. Questions
or comments can be posted to her blog at www.abitdietitious.com.

Pain in Your Shoulder - It Won't Just Go Away Magically

Pickleball has provided an opportunity for people who played sports in their younger years to get back out there and enjoy the thrill of competition, while playing a sport that is social, fun, addictive and accessible! I’ve seen patients in the clinic who come to me with complaints of shoulder pain, often describing it as a subtle pain that started a few weeks back, but they don’t remember doing anything that would have caused an injury. They forget to mention that they’ve been playing pickleball six times a week for two to three hours each day!

The most common category of shoulder pain is called shoulder impingement. Impingement can be primary or secondary. A primary impingement is when there are anatomical structures in the shoulder causing pinching of tendons, bursae, and narrowing of the subaccromial space. Conditions like osteoarthritis, bone spurs, and certain types of acromion can cause primary impingement.

A dynamically unstable shoulder causes secondary impingement. This means that a combination of excess motion and decreased strength and stability around the shoulder is present, which in turn can lead to structures being compressed.

The shoulder joint is one of the most unstable joints in our bodies. In order to understand how impingement pathology can lead to more serious problems, it’s important to get a visual of the shoulder anatomy. With this article is a simplified picture of a right shoulder.

As you can see, there are a lot of structures under the acromion, including the bursa, and one of the rotator cuff muscles (Supraspinatus). In 80 percent of rotator cuff tears, the Supraspinatus is the muscle involved, and the reason is that it’s lodged in the tight space under the acromion.

A combination of both primary and secondary impingement is not uncommon, especially in people over the age of 60. Symptoms of impingement usually include pain with movement, especially at shoulder height, pain at nighttime and with lying on the affected side, reaching for the seatbelt, and pain with reaching behind your back or hitting overheads.

It’s important to stop performing painful activities when you have these symptoms, and consult a healthcare professional such as a physical therapist. Impingement can be corrected through an individualized rehabilitation program, but it won’t go away on its own. It’s crucial to shut down painful activities and start the healing process in order to prevent aggravation and possible tearing of the rotator cuff down the line. Fixing the mechanics and increasing the stability of the shoulder are key to avoiding further complications.

Most people train their upper bodies focusing on the main pushing and pulling exercises such as push-ups, pull-ups, bicep curls, tricep presses, etc. These exercises are not inherently bad, but they’re not enough in order to maintain a healthy and stable shoulder. Rarely do I see athletes incorporate rotational movements of the shoulders in their workouts. It’s no surprise that over time, this becomes a problem as there is an imbalance between the demands placed on the rotator cuff structures by the sport (for example hitting an overhead), and the strength and stability of the rotator cuff musculature.

The rotator cuff is comprised of four different muscles: the Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis, and are sometimes referred to as the “S.I.T.S.” muscles. These muscles surround the shoulder joint and provide stability of the humeral head inside the socket as our arm moves through the range of motion. Unlike the hip joint, which is a stable deep “ball-in-socket” type of joint made to bear a lot of weight, the shoulder socket is a very shallow joint that relies on ligaments and muscles for its stability. This means the rotator cuff musculature plays a vital role in stabilizing the shoulder during dynamic movements.

This is why it’s imperative to incorporate rotational movements in a strengthening routine, and to develop appropriate strength in the rotator cuff in order to avoid chronic shoulder pain and injury. If you would like to see some examples of rotational strengthening, visit www.thepickleballdoctor.com and go to the Strengthening tab to see a video demonstration of beneficial exercises. Always consult a professional, and preferably a qualified physical therapist, if you are unsure about how to strengthen your shoulder.

Playing pickleball with pain in your shoulder is not normal, and should be addressed. There are many techniques and treatments available these days to alleviate shoulder pain and get you back to playing without pain, and with improved strength and stability. Please don’t ignore the problem thinking it will get better with time. This method has been tested and doesn’t work. Be proactive and take control of your health—it’ll pay in the long run! If you have any questions, contact The Pickleball Doctor at thepickleballdoctor@gmail.com.

Pickleball and Lower Back Pain

I have suffered from periodic bouts of disabling lower back pain since my early 20s. I know all too well from personal experience the feeling of being unable to straighten up or move without great pain.

Unfortunately, most everyone suffers from lower back pain at some time in their lives, especially as they get older.

There are five vertebrae that comprise the lumbar spine. The 5th lumbar vertebra rests on the sacrum, and at the end of the sacrum is the coccyx. These bones are held in place by an interposed network of ligaments, muscles, cartilage and soft tissue. These structures hold the vertebrae together, add stability and allow motion. Between each vertebral body is a joint formed by the intervertebral disc. The disc is a fibrocartilagenous structure that helps to dissipate mechanical stress and it resembles a piece of gristle. Severe or repeated injury or insult can cause the annular fibers within the disc to herniate (protrude) or rupture (tear) and cause intense pain to the adjacent spinal nerves and surrounding soft tissue.

Mechanical lower back pain is classified as either intrinsic (postural and muscular) or extrinsic (pathologic). Extrinsic causes of lower back pain would include tumors, infections, osteoarthritis, scoliosis, and gynecological, prostatic or renal problems. Extrinsic causes of lower back pain can usually be diagnosed with a thorough history and a comprehensive physical examination. Extrinsic causes of lower back pain are caused by poor posture, lack of muscle tone, a weak core, and instability of the vertebrae or trauma.

In the past, treatment for a serious mechanical lower back injury consisted of traction, bed rest and medication. This regimen is generally ineffective, and may have aggravated the situation by allowing further muscle atrophy due to the inactivity. In addition, this lack of activity can have devastating emotional and psychological consequences on an athlete. The approach that most doctors now take is to actively rehabilitate the injured area. This is done with mild exercise, stretching, and muscle strengthening to prevent further injury. The vast majority of lower back and disc injuries respond well to conservative care, with only a small number requiring surgical intervention.

Unfortunately, pickleball does little to increase the strength of the abdominal or core muscles. These abdominal and core muscles play a key role in aiding the stability of the lower back and pelvic region. Adequate strength and endurance in the core and lower back is vital to reducing pelvic tilt. Stretching the lower extremities, especially the hamstrings, also helps to reduce the pelvic tilt.

FLEXIBILITY AND CORE STRENGTH
Significant contributing factors to lower back discomfort are a weak core, tight pelvic, hamstring, calf and lower back muscles. Stretching and strengthening these areas will lengthen and relax the hamstrings, reduce pelvic tilt and strengthen abdominal, pelvic and supporting lumbar paraspinal musculature.

Hamstring Stretch: Lie on your back with the right leg bent. Wrap the rope around the arch or middle of the left foot. Lock the knee and contract the quadriceps muscle group (front of the thigh). “Climb up” the rope with your hands and hold for 2 seconds. Return the left leg to the floor. After 12-15 reps, do the other leg.

Hip, Gluteal and Lower Back stretch: Lie on your back and fully extend the right leg. Bend the left knee and tighten the abdominal muscles. Grab the left leg with the right hand and the thigh with the left hand. Lift the left knee toward the right shoulder and ground as far as possible and hold for 2 seconds. Return to the original position and repeat 12-15 times, then do the other leg.

Lower Back and Pelvic Stretch: Lie on your back and bring both thighs up so they are at a 90 degree angle (perpendicular) to the floor. Place your arms at your sides and twist to the right and the left so that the down leg contacts the floor. Do this 25 times to each side

Scissors (rectus abdominus): Lie on your back with your arms and legs fully extended, hands and feet touching the floor (top photo). Slowly bring your arms and legs straight up at the same time so they meet directly above your torso, and then slowly lower to the starting position. Do 3 sets of 15-25 reps.

Trunk Raise (lower back muscles, erector spinae): Lie on your stomach with your hands behind your neck, arch your back while simultaneously raising both legs and hold for 10-15 seconds. Do 3 sets of 10-12 reps. For additional resistance add ankle weights and a light weight behind the head.

Lower back pain can also be caused or exacerbated by numerous other factors and activities other than pickleball, especially poor posture. Posture problems occur primarily with poor posture while sitting on a chair or to a lesser extent while standing. Slouching while sitting or standing rounds out the lower back and puts stress on and inflames the ligaments, muscles and tendons along the sides of the spine. These secondary factors caused by poor posture are a common cause of lower back pain. Many chairs, couches and car seats provide poor lower back support. A cheap and easy way to increase lower back support is to make a roll out of a thick towel and place it behind the lower back while seated.

TREATMENT OPTIONS FOR LOWER BACK PAINIf you do develop lower back pain, don’t panic; most incidents of lower back pain are not serious and will resolve within a couple of weeks with simple home self-care. Almost 85% of the population has back pain at some time in their lives and 97% of these people get well in 4-6 weeks with conservative treatment. In addition, there are many treatment options available to deal with this very common condition. Lower back pain is divided into one of three general categories:

1. Nonspecific lower back pain (85% of patients fall into this category); most classified as strains and sprains.
2. Back pain potentially associated with spinal conditions, such as spinal stenosis, disc lesions, vertebral compression and fractures.
3. Back pain potentially associated with another specific cause such as malignancies, space occupying lesions, infection or vascular problems.

There are certain signs and symptoms associated with lower back pain that can indicate a serious situation where emergency treatment is needed immediately.

1. Cauda Equina syndrome; this is a serious neurologic condition in which there is an acute loss of function of the lumbar plexus. It is characterized by numerous signs and symptoms including sudden loss of bowel and/or bladder control or dysfunction, severe or progressive neurologic changes, saddle anesthesia, weakness of the lower extremities, and possibly a drop foot.
2. Severe lower back pain following significant trauma.
3. Severe continuous abdominal and lower back pain could indicate an abdominal aortic aneurysm.
4. Night pain, weight loss, fever or other signs of infection or cancer that accompany severe lower back pain.

If you have developed lower back pain it is important to stay active and try to rest in a comfortable position. Take short walks or stretch every few hours to loosen up the muscles and tendons. Staying active is much better for recovery than strict bed rest. In fact, staying in bed for more than one or two days can actually worsen the condition by increasing stiffness and increase muscle weakness. If there is severe pain and muscle spasms consider the application of an ice pack for 15-20 minutes several times a day and taking over-the-counter medication. The medications commonly taken for this are known as NSAIDS or non-steroidal anti-inflammatory drugs, such as Ibuprofen(Advil or Motrin), Naproxen (Aleve or Naprosyn) or Salicylates (Aspirin). If the pain, inflammation and muscle spasms persist for more than a couple of weeks, consider seeing a health care specialist who specializes in the treatment of musculoskeletal disorders. Consider treatment with physical therapy modalities, rehabilitation, and mobilization. Surgery is rarely needed for lower back pain, even in the presence of a disc injury or nerve damage. Once you have a significant incidence of lower back pain, the problem is more likely to recur. To avoid future episodes of lower back pain keep your abdomen and core muscles strong, use good posture, keep your weight down and lift properly.

---
Alan Bragman is a chiropractor living in Atlanta, Georgia. He is a former Cat 3 cyclist and nationally ranked table tennis player, inline speed skater, a certified IPTPA coach and a 4.5 level player. He was on the medical advisory board at Bicycling magazine for 10 years and has written for numerous other sports publications.

Eye Injuries from Pickleball

Every year more than 600,000 recreational and sports-related eye injuries occur. Of these, close to 14,000 result in a permanent loss of sight. Racket sports rank 4th among activities causing eye injuries. About 90% of these could be avoided with the use of protective eyewear made of polycarbonate lenses. Polycarbonate lenses are highly impact resistant and are available in prescription and non-prescription lenses, and they offer UV protection. A change or loss of vision causes a significant lifestyle change, and has a social and financial impact. Pickleball is classified as a high-risk activity because it involves a ball and a paddle, both of which can potentially cause eye trauma. Eye injuries are classified into three different types.

BLUNT TRAUMA

This is when an object strikes your eye, and is the most common injury. This can result in orbital fractures, a ruptured globe (broken eyeball), a vitreous hemorrhage, or a detached retina. The retina is the posterior part of the eye sensitive to light and creates a visual image, similar to the film in a camera.

PENETRATING INJURIES

This is when something cuts your eye. It is very rarely seen in racket sports, unless eyeglasses are broken.

RADIATION INJURIES
This is caused by exposure to ultraviolet radiation from sunlight. Excessive exposure to UV light can cause eye damage, including cataracts, macular degeneration and temporary vision loss. The closer you are to the equator and the higher the elevation, the greater the UV exposure. From 10:00 a.m. to 2 p.m., UV exposure is greatest, and certain medications such as tetracycline, sulfa drugs, oral contraceptives, diuretics and tranquilizers increase exposure.

A pickleball can travel at one-third the velocity of a tennis ball, which means it can travel at about 40 MPH. With two players at the no-volley line it takes 350-400 milliseconds, or less than half a second, for the ball to travel from one paddle to the other. In other words, you do not have time to avoid being hit in the eye with a ball. You can test your reaction time at this website, http://www.mathsisfun.com/games/reaction-time. html. In addition to injuries from being hit by a ball, serious damage can occur from being hit in the eye with a paddle.

If you do suffer eye trauma playing pickleball, see an ophthalmologist immediately if the injury results in a loss or change in vision, significant pain, bruising or bleeding.

See the pickleball even better with these eye-saving glasses. The lenses are made of a shatterproof polycarbonate, and they offer UV protection.

Knee Pain and Pickleball

Knee pain is a very common complaint of pickleball players due to the effects of gravity and aging on the joints.

THE STRUCTURE AND FUNCTION OF THE KNEE

The knee is the largest joint in the human body and is formed by the articulation of the femur and tibia. This joint is a synovial pivotal hinge joint which permits flexion and extension with slight amounts of rotation. The joint is contained in a synovial membrane bathed in synovial fluid. The knee has two articular surfaces, the medial and lateral condyles, with the patella (kneecap) in the anterior portion. The patella is attached to the tibial tuberosity by the patellar tendon. The condyles are protected from rubbing and shock by articular discs known as menisci, which thin and wear out with age and trauma. The sides of the knees are stabilized
by the medial and collateral ligaments, while forward and backward movement is limited by the anterior and posterior cruciate ligaments. Extension of the knee is facilitated by the quadriceps muscles, while flexion is accomplished by the hamstring muscles.

CAUSES OF KNEE PAIN

There are numerous causes of knee pain, the most common being trauma, muscle weakness or imbalance,
overuse and arthritic and degenerative conditions. Fortunately the majority of knee problems are minor and can be resolved with rest, therapy, stabilization, rehabilitation, ice or medication. Persistent or more serious problems may require extended rest, injections, invasive or surgical intervention. In aging athletes, a common cause of knee pain is osteoarthritis-degenerative joint disease or wear and tear arthritis.

Unfortunately, this is an inevitable part of the aging process and the symptoms of this problem begin to appear as you reach middle age. The symptoms of osteoarthritis include:

• Pain and stiffness associated with movement or exercise
• Grating, rubbing or a crackling sound with movement, known as “crepitus”
• Morning pain and stiffness which usually improves with mild activity
• Tenderness and swelling around the joint with a painful and limited range of motion

Degenerative changes can be exacerbated or initiated by being overweight, long-term overuse, excessive weight bearing and unlucky genetics. This condition cannot be cured and it usually worsens with weight-bearing activities and aging. This condition can usually
be controlled with medication, exercise, rest, strengthening and rehabilitation. Glucosamine and chondroitin are natural compounds derived from articular cartilage that have been shown to benefit the synovial fluid by strengthening cartilage, particularly in the knee. In advanced cases injecting corticosteroids will provide temporary anti-inflammatory and pain relief, as will hyaluronic acid supplement injections such as Synvisc and Hyalgan. In extreme cases, a total or partial replacement of the joint may be indicated.

PREVENTING KNEE PROBLEMS: STRENGTHEN AND STABILIZE THE KNEE

The best way to prevent knee problems is by strengthening and stabilization, with exercises that focus on the hamstring and quadriceps muscle groups. The quadriceps consists of four muscles in the front of the thigh, while the hamstrings are three muscles in the back of the thigh. These two muscle groups are responsible for supporting and stabilizing the knee. The following exercises are designed to strengthen and stabilize these two muscle groups.

STEP-UPS: This exercise is for strengthening the quadriceps muscle group. Begin by standing in front of the step (12-15 inches tall) facing forward. Place your right foot in the middle of step and step up as you balance your body for 1-2 seconds on the right leg. Your left leg should be behind your body to help stabilize your weight as it is shifting. Step down with your left leg first and continue on down with your right. Try for three sets of 12-15 repetitions for each leg.

LEG EXTENSIONS: This exercise is used to strengthen the quadriceps muscle group. For maximum efficiency these should be done one leg at a time for better isolation, to prevent the dominant leg from doing an unequal amount of the work. Sit comfortably on the padded seat with your back firmly against the back pad. Adjust the machine so that the front pad comfortably contacts the front of the foot and ankle. Start with light weights that allow you to extend the leg with moderate resistance, and slowly increase the amount of weight as you develop more strength. Hold the head steady and face forward, grip the bars firmly at each side, exhale with maximum exertion and inhale on recovery. With each leg do 15- 20 repetitions and three to four sets.

SQUATS: Squats are primarily used to strengthen the quadriceps muscle group. These can be done with free weights or with the barbell in a squat rack. Initially this exercise should be performed inside a squat rack for safety purposes with light weights until you develop more confidence and strength. Stand with feet hip- or shoulder-width apart. Place the barbell just above the shoulders on the trapezius muscles (i.e., the “bulky” part of the shoulders). If you feel uncomfortable, use a bar pad or towel to protect your back. Bend the knees and lower into a squat position, stopping just before your knees are at a 90-degree angle to the floor, or before you lose the natural arch of your back. Make sure you are facing forward with the feet straight and your weight on the heels. Contract the glutes and legs while stabilizing your body with a strong torso. Slowly stand back up without locking the knees and repeat for two to three sets of 15-20 repetitions. Use care and be very cautious when doing this exercise for the first time. Start with a light weight you can easily handle and practice getting your form perfect before moving on to heavier barbells.

HAMSTRING CURLS: This exercise is used to strengthen the hamstring muscle group. Set the machine to fit your height and lie facedown on the leg curl machine with the pad of the lever comfortably on the back of your legs just below the calf muscles. As with doing the leg extension, it is recommended doing each leg individually to obtain better isolation. It is preferable to use a leg curl machine that is angled as opposed to flat, since an angled position is more favorable for hamstring recruitment. Keep the torso flat on the bench, stretch the legs fully and grab the side handles of the machine. As you exhale, curl your leg up as far as possible without lifting the upper leg or body from the pad. Once you hit the fully contracted position, hold it for a second. Inhale and bring the leg back to the starting position. Repeat for the recommended amount of repetitions, and then do the other leg. Start with light weights to perfect the technique and avoid injuring the hamstrings or lower back. Start with two to three sets and 15- 20 repetitions.

LEG PRESS: This exercise primarily strengthens the quadriceps and hamstring muscle groups with some partial benefit to the calf muscles. Using a leg press machine, sit down on the machine and place your legs and feet at shoulder width directly in front of you on the platform. Slowly and carefully lower the safety bars, holding the weighted platform in place and press the platform all the way up until your legs are fully extended in front of you. Your upper body and legs should make a perfect 90-degree angle. As you inhale, slowly lower the platform until your upper and lower legs make a 90-degree angle. Pushing mainly with the ball of your foot and using the quadriceps, go back to the starting position as you exhale. Perform three to four sets of 20-25 repetitions starting with moderate weight and slowly increasing as strength and stability increase.

DUMBBELL LUNGES: This exercise strengthens the quadriceps, hamstring and gluteal muscles. Initially begin doing lunges without holding dumbbells to get a feel for the exercise and to perfect the technique and develop strength. Start with 1-2 lbs. in each hand and slowly increase the amount of weight. Pick up the pair of dumbbells while standing upright with your feet facing forward, shoulder width apart and the arms fully extended. Lunge the right leg forward about 3 feet in a stepping motion until the knee joint forms a 90-degree angle. The right thigh should be parallel with the floor and the leg should be perpendicular to the floor. The back knee should almost be touching the floor. Contract the right leg muscles and return to the standing starting position. Repeat this exercise utilizing the left leg. Perform three to four sets of 20-25 repetitions depending on fitness level and goals.

ASSESSING, TREATING & RECOVERING FROM KNEE PAIN

Knee pain generally develops slowly and is usually precipitated by trauma, overuse injuries or a change in the exercise regimen. Do an honest assessment, looking for any changes or factors that may have initiated this onset of new symptoms.

Avoid significant changes in your exercise regimen, such as playing in cold weather without knee protection, worn-out or improper footwear, reduced stretching, not warming up properly and resistance training with excessive weight. The biggest problem with any injury in an athlete is the hesitation to take time off and rest, for fear of losing skill and fitness. Initially, take a few days off from playing and begin a regimen of topical/ oral analgesics, compression, elevation and frequent ice application.

NSAIDS (non-steroidal anti- inflammatory drugs such as Ibuprofen, Naproxyn and aspirin) help reduce pain, inflammation and swelling. Athletes with a history of ulcers or GI problems should consider using Tylenol, (Acetaminophen). The application several times daily of topical analgesics such as Capsaicin, bio- Freeze or Cryoderm is another effective way to help reduce pain, swelling and inflammation.

If there is swelling, elevate the knee on pillows and wrap the area in an elastic or Ace bandage while applying ice. To reduce pain, inflammation and swelling, apply ice or a cold pack to the area for 10-20 minutes, 3-5 times/day. Wrap the pack in a cloth or paper towel to prevent direct contact with the skin. After 48-72 hours, if the pain and swelling have decreased, begin applying heat several times a day to the area for 10-20 minutes.

You can now begin to do easy workouts, walking, swimming, elliptical or cycling with a gradual return to pickleball. After a week or so, if the pain has subsided, you can return to your normal playing regimen. If the pain persists for more than two to three weeks or returns after rest and other conservative treatment, it is time to visit a qualified health care professional for diagnosis and treatment. The first step will likely be a comprehensive examination followed by diagnostic studies to assess the location, type and extent of the injury.

Hopefully, the problem or injury can be treated using conservative, non-invasive treatment. Corticosteroid injections directly into the joint can dramatically reduce pain, inflammation and swelling. Unfortunately, the injections only provide relief for a limited time and more than three injections over the period of a year can be harmful. Cruciate ligament and meniscus tears are common injuries that can usually be treated with arthroscopic surgery. Before submitting to any surgery or invasive procedures, obtaining a second opinion is always a good idea.

"The Official Magazine of Pickleball"- USAPA

Pickleball Magazine has never been more illustrated: intensity, passion, meaning, insights, tournaments, products. Pickleball Magazine covers it all and goes out to over 100K readers every issue.

Pickleball Magazine 
11 Mayview Road
Canonsburg, PA 15317