Dr. Cindy Chang is a specialist in primary care sports medicine with almost 3 decades of experience. She has served as head team physician at UC Berkeley, chief medical officer for Team USA in 2008 & 2012 Olympics, and assisted in the WNBA COVID "Wubble." Chang takes an individualized approach to care, seeing athletes of all ages. She is Program Director of UCSF's Primary Care Sports Medicine Fellowship, board of trustees for the American College of Sports Medicine, chairs the Sports Medicine Advisory Committee for the California Interscholastic Federation & National Federation of State High School Associations, and past president of the American Medical Society for Sports Medicine. She earned her medical degree from Ohio State Univ. College of Medicine, followed by a residency in family medicine at UCLA Medical Center & a fellowship in sports medicine at Ohio State Univ. Medical Center.
Many runners experience GI or gastrointestinal related symptoms while running. To reduce the chances of experiencing these symptoms, runners should increase their intensity gradually, work on core and trunk stability, avoid large volumes of food and drinks 2-4 hours before exercising, stay well hydrated throughout the day, and be aware of the type of drink they have prior to running. Transcript: "First of all, rest assured, you are not alone. A large percentage of runners do have GI or gastrointestinal related symptoms to exercise and running. First of all, you talked about you've been increasing the intensity. It's really important that you do have a program where you're slowly increasing the intensity of your running. Sometimes too rapid of an increase in intensity will bring on the symptoms earlier. And so you may be having what's called a side stitch, or we call it exercise-related transient abdominal pain. But that's the same thing as getting a runner's cramp. And sometimes that can be associated with maybe drinking too high of a carbohydrate fluid prior to running. Sometimes it can be from just not good trunk stability when you're running, and there being some spasm in terms of the abdominal muscles as you're running. So one of the first things that you want to think about is to watch the intensity, gradually increase your conditioning, and make sure that you're working on trunk and core stability as you improve your running. Make sure you look at your running style. And avoid really large volumes of food and drink less than 2 to 4 hours before you exercise. I think that's a good rule of thumb. The bathroom situation, like feeling like you have to go to the bathroom. That's not unusual either. It's called runner's diarrhea. And that, again, can be related to too much volume of drink, type of drink that you have-- like, avoid the fruit juices or the high carb drinks-- and then the timing of the food before you exercise. I would say that another issue is hydration, the amount of hydration though. Remember that you have to hydrate well, not just before you run, or the morning before you run, but all day, the previous day. So, the previous day, you've got to be well hydrated that's what's going to reflect your performance when you run. Because as you run, your muscles will be using the blood flow, and that blood flow will be going away from the GI tract, and that's what sometimes causes that cramping and the feeling that you have to go to the bathroom. OK. If you have more follow-up questions, please ask."
It depends on the type of activity and how mono has affected the athlete. For contact sports, it is typically recommended to wait four weeks after the diagnosis or onset of symptoms before resuming. For light exercise such as jogging or biking, this can be done two weeks after the diagnosis or onset of symptoms. Transcript: "That is a great question. It depends about the type of activity. For one thing, if it's a contact sport versus a non-contact sport, that makes a difference. And the other thing is mono affects everyone differently. With one person, it could just be a low grade fever and a sore throat for a couple of days, and then they feel fine. With others, they could be in bed with a high fever, a really swollen sore throat, hard to eat, and extremely fatigued. So it really varies depending on how the model has affected that athlete. In terms of resuming light exercise, once the athlete doesn't have any fever, is not taking any medication to help with keeping the fever down or to help with sore muscles, and their baseline, they're back to normal. They don't feel tired, their sleep pattern is normal. Then they can resume some light exercise, like jogging, bike riding, and see how they feel. If they do OK from there, then they can gradually progress their activity. But keep in mind is what's really affected is the spleen enlarges during mono. And the architecture of the spleen gets inflamed. That virus can affect the spleen as well, and there's a risk of rupture. If it's put under too much pressure with exercise and/or there's a blow to the abdomen, and the spleen is big, the spleen normally is covered by the ribs. But when the spleen enlarges, it'll get larger than the rib cage. And that increases its likelihood of getting injured during a contact sport. So the rule of thumb is four weeks. No contact sports until four weeks after the diagnosis or the onset of symptoms of mono. You can sometimes fudge that a little bit, and it can't be early as three weeks. But that's a decision that's made by the athlete's physician and a sports medicine physician that really understands the athlete's demands and their sport, and can determine what the risk is of the athlete returning back to sport. So rule of thumb, four weeks for contact sport. But if they're feeling good, they can start some light exercise at around two weeks. I hope that helps. If you have any more questions, please ask or go see your physician. Take care."
The role of a team physician is to provide comprehensive health care for athletes, from head to toe. This includes addressing physical and mental health concerns, coordinating care with other medical professionals, and communicating with coaches and parents. The best part of the job is helping athletes reach their goals, while the worst part is not having enough time in the day to get everything done. Transcript: "To be as succinct as I can, the role of a team physician is to address all aspects of health care of your athlete, and that starts with from head to toe. I'm a primary care sports medicine physician. So with my primary care training, addressing all the illnesses and injuries that can affect an athlete from head to toe. Concussions, spine injuries, rashes, eye injuries, abdominal pain, knee sprains, you name it. It's also the mental health. Addressing the mental health and psychological health of an athlete is also paramount for a team physician. It's also coordinating care. So if there's something that is outside of my scope of practice, then it's referring to my trusted colleagues, whether or not that's my athletic trainer, physical therapist, sports psychologists, mental health care workers, my cardiologist. It's really forming together a team to be able to optimize the health and the performance of our athletes. That is the role of a team physician. It's also understanding the communication with the coaches and sometimes the front office, and being able to relate to parents, for example, if you're dealing with minors. Wow! It's a great job. I love being a team physician. I don't know the worst part. I'll start with the best part. The best part of my job is working with my athletes and seeing that we're helping to help them reach their goals, help them reach their personal goals, the team goals, and weighing the harms and benefits of certain types of aspects of training or anything in order to be able to help them. That's the best part. The worst part of my job as a team physician-- I wish I had 30 hours in a day. There's a lot of things that need to be done. And sometimes it's a challenge to juggle everything, but I honestly can't think of a worst part of my job. I love it so much thanks."
You should make sure that your entire body is fit to resume playing tennis, and ensure you have supportive and cushioning shoes for the court. Consult your health care provider if you have any more questions. Good luck! Transcript: "Congratulations. I'm glad you're feeling good a year after your surgery. Hopefully you went to physical therapy after your surgery, so that your foot and ankle are strong. And not only that, you want to make sure that your entire body is fit to resume playing tennis. So, you want to make sure that your rotator cuff muscles are strong, your upper back and your scapula stabilizers are strong as well, all the way through your core, down to your lower extremities, and down to your feet and ankles. You also want to make sure that you have good supportive shoe wear. So, if your foot and ankle specialist, the person who did your surgery, has any recommendations, that would be great. You definitely want to make sure you're wearing a shoe that's very supportive, it's a supportive court shoe, so that you avoid too much midfoot motion or valgus heel motion at all. And you want to make sure that you have a good, not only supportive shoe for the court, but also one that has good absorption, shock absorption. Because your arch is going to be more rigid now, because it was fused. And therefore, you want a shoe that's going to have more cushioning so you can absorb some of that shock while you're on the tennis court. Hope those answers helped. If you have any more questions, please ask, or please go back to your health care provider and have them reevaluate you, and see whether or not there's any other things that you can do to make sure that you have a successful return to the court. Good luck."
It depends on who you are and your level of play. Generally, wearing ankle braces can help prevent ankle sprains if you also make sure to have good balance and strength. Your sports medicine physician can help determine if ankle braces would be beneficial for you. Transcript: "Hi. It depends on who I is, meaning, are you a recreational player, where the play is more chaotic at the net, meaning, most of the ankle sprains are happening at the net, in the blockers and the hitters? And you come down on someone's ankle from across the net. And if that's the case, then, wearing ankle braces can prevent ankle sprains. But what's more important is making sure that you're also strong. Your balance is good. You're working on your balance of each leg. And you're working on what we call proprioception or balance training, and also, strength of your ankles all the way up to your core. That's really important in terms of making sure that your landing is good. And then you're not going to be landing just on one leg off balance because that will increase your risk of not only an ankle sprain, but also a knee injury. Ankle braces are also beneficial for even at a higher level of competition. And that would include high school club volleyball. When you get to the collegiate and the professional rings, it really-- that type of play is definitely more controlled, more elite level play. And those athletes will choose whether or not they want to wear an ankle brace, depending on whether or not they've had previous ankle sprains, whether or not they psychologically feel like the braces will help protect them during net play. And it depends on whether or not they already undergone a good strength program as I discussed previously. And so it's very individualized in terms of whether or not you feel that you should wear an ankle braces. But again, it's a question that you can pose to your physician and see what they think. Your sports medicine physician can do a good exam of your ankle strength and your flexibility as well as your functional abilities and can recommend a good physical therapy program or a good home program that you can do and then recommend whether or not they think ankle braces would be helpful for you. I hope that helped. Take care."
See your doctor if you experience any other allergic symptoms such as chest tightness, throat tightness, difficulty breathing, or swelling of your lips or eyes. Otherwise, keep a food diary to see if there are any foods that may be causing the itchy bumps and take an antihistamine before running. Transcript: "I would have the following questions for you. Are you a new runner? Did you just start to run and you've noticed this? Have you exercised in the past and had these are just with running? Did you change environment in which you're running? Did you move from a track, around a school, and you're starting to do more running up on trails in the woods? Or did you just change geographic locations as you move from the Pacific Northwest to the Southeast, and it's a total new climate of running? And the reason I'm asking all these things is because it can be very environmental in terms of why you're getting this urticaria. That's a fancy name for the itchy bumps on your skin. It can also be food-related. So if you're have introduced a new food type into your diet, if you are eating something that you could potentially be allergic to anyway, but then it comes out even more when you're exercising, those are all factors that could be contributing to this symptoms, these signs that you're having. First of all, the most important thing is making sure that you don't have any other associated allergic type of symptoms, like chest tightness or throat tightness or difficulty breathing or swelling of your lips or your eyes. If that's happening, you need to immediately stop running and go and see your doctor because we want to make sure that this doesn't become a more serious condition, where you're out running, and you're alone, and you start to get not only the itchy bumps but then also what we call anaphylaxis, where you're getting really the shortness of breath and things like that. So I told you a lot of information. I would suggest that you go see your physician. But if you don't have time yet and you want to keep running, try not to eat for hours before you run. Keep a food diary so that you know exactly what you're eating, your pre-run meal is and if whether or not you get itchy bumps in response to that. And if you do, you know to eliminate that food from your diet. And that's one of the ways that you can figure out what's going on. If you try to take an antihistamine before you run, that can oftentimes decrease your symptoms as well. OK. Quick answer. And if you have more questions asked, or go see your physician. Take care."