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“Merging COACHING with SPORT SCIENCE & MEDICINE” Winter 2013

Athlete Focus Kaillie Humphries

First Canadian woman to win a gold medal in bobsleigh at the Olympic Winter Games

Sport Research Intelligence sportive


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Working together

The road to the podium is paved with knowledge 2

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Editorial Welcome to 2013 and the eighth edition of the HP SIRCuit. Coaches and IST members will find this issue particularly helpful as it highlights key strategies and techniques designed to improve the results of our high performance athletes. •

Carl Petersen’s article, the third in a three part series, focuses on assisting the high performance athlete in recovery from exhaustive exercise. If you missed the previous two articles, we encourage you to refer back to the Spring and Summer 2012 issues.

The psychological challenges that athletes face are examined in an excellent article by Dr. Saul Marks who also shares insights to how he has helped to resolve various issues.

The description and techniques presented in Dr. Jane Labreche’s review on challenges in prevention of exercise-induced bronchospasm are especially helpful for those who have athletes exercising in the cold and/or in closed environments such as speed skating and swimming.

Will George, a Biomechanist with CSI Ontario, compares immediate and delayed feedback with regards to the performance impact on the athlete using very relevant examples from his work with Rowing Canada.

As we continue to learn from each other, check out the Athlete Profile on Kallie Humphries as well as articles and commentaries from the IST Journal club, the SIRC resource centre and upcoming events, including this year’s SPIN Summit Symposium at the new WinSport Facility in Calgary, September 16-18, 2013. On behalf of Own the Podium, SIRC and everyone involved with the production of the HP SIRCuit, thank you for your generous feedback; keep it coming; and we’ll continue to build a publication that answers your high performance questions. ∆

Version française HP SIRCuit is partially funded by

Editor Creative Director Design Team Content Director

Debra Gassewitz David Roberts Kim Sparling Nancy Rebel

Contributing Editor Special Thanks

Dr. Jon Kolb, OTP Cara Thibault, OTP Paul Dorotich, OTP Kaillie Humphries Nathan Cicoria and All The Contributors

Sport Information Resource Centre (SIRC) is Canada’s national sport library, established over 40 years ago. Mailing address: SIRC 180 Elgin Street, suite 1400 Ottawa, Ontario, Canada K2P 2K3 Tel: +1 (613) 231-7472 Fax: +1 (613) 231-3739 Disclaimer: Author’s opinions expressed in the articles are not necessarily those of SIRCuit, its publisher, the Editor, or the Editorial Board. SIRC makes no representations or warranties whatsoever as to the accuracy, completeness or suitability for any purpose of the content. Copyright © 2013 SIRC. All rights reserved. No part of the publication may be reproduced, stored, transmitted, or disseminated, in any form, or by any means, without prior written permission from SIRC, to whom all requests to reproduce copyright material should be directed, in writing.

Debra Gassewitz President & CEO SIRC

Jon Kolb, PhD Director, Sport Science, Medicine and Innovation, Own the Podium


Performance Performance 4 8

Airways and Athletes Consurrent versus delayed feedback: Biomechanics in Rowing

Competitive Intelligence 16

Competition Anxiety and Elite Athletes: Debilitative or Facilitative?

Proactive & Preventative Medicine 20 26

Fit to Play™High Performance Recovery Part 3 Sports Psychiatry: An often misunderstood and under-serviced area of medicine in the world of sport

Departments 14 30 31 32 33

Athlete Focus - Kaillie Humphries Stay Informed with SIRC Upcoming Events Recommended Readings from SIRC IST Journal Club


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Airways and Athletes Jane Labreche, PhD - Own The Podium


sthma is a common airway disorder that is described by an elevated response of the trachea (large airway) and bronchii (smaller airways) to stimuli. It can include three main variables: airflow obstruction, airway hyperresponsiveness (AHR) and airway inflammation. In athletes with high ventilations and flow rates, exercise-induced bronchoconstriction (EIB) can occur. When the vessels located in your bronchial tree constrict in this manner, the result is a transient (short term) airway narrowing during or following exercise.


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Prevalence, Risk, Symptoms

Clinical presentation of asthma in athletes includes dyspnea (breathlessness), coughing, phlegm production, and chest tightness. In 2002, the International Olympic Committee (IOC) required testing to confirm the diagnosis of asthma and justify the use of associated medications. This provided valuable documentation of asthma in athletes competing at the Games. *Asthma was found to be the most common medical condition in the 2006 and 2008 Olympic Games with estimates of 8.2% and 8.3% of athletes using inhaled corticosteroids (ICS) and/or inhaled β2agonists (IBA) to treat bronchoconstriction and airway hyperresponsiveness (AHR) (11). The highest prevalence in summer sport Olympians has been shown in cycling, triathlon, and swimming (~11-13%). In winter sport, endurance ski events and speed skating (~13-16%) were affected the most 6.

• Irregular airway response is common in athletes. Symptoms are not always overt, and are often overlooked as a “normal” response to heavy exercise. • The triggers, the severity of response itself, and the implications to oxygen delivery, are all highly individual and vary depending on the sport. • Confirmation of airway constriction should be evaluated by a formal test, with a treatment and prevention prescription based on these results.

These sports demand high ventilations making them more susceptible. In sport, common triggers include the following: cold air, irritants like particulate matter (eg dust, pollens, air pollution), or chlorine by-products. Sports that have a well-controlled environment relatively free from irritants, and/or have a low ventilatory demand are considered to have a lower risk. These low-risk sports may have more of a technical focus, or may have training/ competition patterns that are more intermittent in nature (vs continuous). There is no clear inheritance pattern despite a frequent family history reported in asthma sufferers. In an athletic population, the interaction between genetics (family history) and environment (irritants/triggers) appears to be the most appropriate explanation 7. In some athletes, a link to allergies and gastrointestinal irritation is evident. Seasonal allergies and acid reflux can be common co-morbidities.


The main stimulus or cause is water loss by evaporation causing drying and cooling of the airway surface leading to a cascade of events. An increase in osmolarity (Na+, Cl-, Ca2+, K+ concentration) causes a release of inflammatory mediators (leukotrienes, histamine, prostaglandins) inducing bronchoconstriction, airway narrowing, smooth muscle contraction and airway obstruction (Fig 1) 1. At high work rates, the large airways can no longer humidify the air appropriately and the small airways are recruited. As these airways are vulnerable, inflammation often amplifies airway narrowing. Furthermore, when exercise intensity is high, EIB is made worse if the airway is hyperreactive.

Key Points


Athletes who are hyperresponsive may react to a stimulus that is relatively less intense, or, the response to a typical stimulus becomes more dramatic.

Figure 1. Depiction of an airway response during an asthmatic reaction Click image to enlarge

The inflammatory response

Associated inflammation has been indicated by elevated leukotriene levels reported in sputum samples of athlete populations 3 with an exaggerated response in swimmers specifically 4. This inflammatory effect is linked to pool (chemical) exposure and duration of training hours 2. In an elite athlete under chronic exposure, continuous inflammation can potentially lead to abnormal healing process, resulting in structural changes or airway HP SIRCuit Winter 2013

“remodeling” including airway wall thickening and a reduction in airway caliber 5. In athletes, high ventilation rates expose the airway epithelium to increased sheer stress and transmural pressure gradients which can amplify epithelial injury 10. A compromised epithelium in swimmers or triathletes promotes penetration of aeroallergens (water droplet aspiration) and therefore increases the susceptibility to airway hyper-responsiveness.

acetylcholine receptors are stimulated to cause airway smooth muscle to contract. Indirect tests include exercise, eucapnic voluntary hyperpnea (EVH), and hyperosmolar aerosols (saline and mannitol). These tests indirectly cause airway smooth muscle to contract via the release of mediators. The sensitivity of methacholine testing in athletes has been reported to be low, and it is thought that a greater potency of mediators is released in response to indirect stimuli. The EVH test (see image 1) is the current gold standard as stimulus mimics the respiratory demand during exercise. The challenge involves 6 minutes of maximal ventilation (non-exercise). The aerosol tests, similar to methacholine, examine the response to an increasing concentration of the selected stimulus. In some cases a bronchodilator reversal test can be utilized when the patient’s baseline values are below normal indicating airway obstruction at rest.

Threat to performance

Any narrowing or injury to the airway surface has potential to compromise gas exchange and therefore limit oxygen delivery to the working muscle during exercise. When a group of asthmatics were treated with corticosteroids to reduce bronchial inflammation, gas exchange efficiency was increased accompanied by an improved performance in these individuals 9. *Mechanically, a smaller airway will cause an increased work of breathing whereby the respiratory muscles demand additional blood flow (and oxygen) to facilitate this extra cost during exercise. At maximal loads, there is potential for the respiratory muscles to “steal” blood flow from the working (limb) muscles therefore preventing optimal performance 8. Females are particularly susceptible as they generally have smaller airway diameters and lung surface areas resulting in a higher metabolic cost of breathing when compared to males 13.

Figure 2. Example pulmonary function test result: Normal vs. obstructed airway Click image to enlarge


All testing involves lung function measures or spirometry. Volume and speed of airflow are measured pre and post challenge. The degree of airway narrowing is assessed by the drop in forced expired air in 1 sec (FEV1). The shape of the expiratory portion of the loop, along with the numbers generated indicate a positive test (Fig 2). The challenge protocol is what distinguishes the tests from each other. There are two main types of tests: direct and indirect. A direct stimulus often used is methacholine whereby


Image 1. The EVH Test

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*Vocal cord dysfunction (VCD) is a condition that can be confused with bronchoconstriction 12. Symptoms are similar but the mechanism, assessment and treatment are unique. Individuals with VCD will not respond to inhalers. Spirometry can be used to assess the occurrence of VCD, but will be seen on the inspiratory portion of the loop (Fig 3).

Figure 3. Example pulmonary function test result: Normal (A) vs. VCD (B) response Click image to enlarge


The goal of treatment is to reduce or prevent symptoms, to optimize lung function, and to minimize limitation to performance. Inhaled, fast-acting bronchodilators (β2agonists) are prescribed to target the constrictive response. These can be used to prevent a reaction (pre-exercise) or to provide relief from symptoms (during or post exercise). The effects can be felt immediately. This treatment is often combined with inhaled corticosteroids to manage the inflammatory response. Only a physician can prescribe these medications and fill out appropriate therapeutic use exemption (TUEs) forms. Some medications are allowable while others are restricted under WADA. *Athletes often confuse symptoms of bronchoconstriction and inflammation (eg. coughing and wheezing) with a “normal” response to high intensity exercise in athletes. Confirmation of the diagnosis of EIB via objective measures is essential for targeted treatment. Appropriate treatment will not only optimize respiratory health, but will also help to ensure that training quality and performance outcomes are maximized.

In a recent review, it was shown that the most effective and consistent warm-up strategy to attenuate bronchoconstriction is to involve high-intensity and variable-intensity exercise within an individual’s prerace routine 14. Other methods to prevent reactions surround the use of medications. Diligence in using corticosteroids on a daily basis (as prescribed) will reduce the severity of airway narrowing over time. Fast-acting dilators (pre-exercise) are useful in targeting specific training and competition situations where a bronchoconstrictive response is likely. In winter sport, warming the air prior to inhalation (using any material to cover the neck, mouth and nose while training) may also assist. ∆ For references, click here


Warm-up is an important component in preventing or reducing the constrictive response. In the average person, exercise induces a sympathetically mediated vasodilation in the bronchial tree. This allows for an increase in airflow thereby improving oxygen delivery to the alveoli

for diffusion. A refractory period is associated with this dilatory effect, providing some protection over the period of time between warm-up and competition. To take full advantage of the refractory period, perform warm-up as close as possible to competition time in order to optimize airway diameter, in addition to enhancing blood flow to the working muscle.


Dr. Jane Labreche has over 10 years of experience as an applied physiologist working with both Olympic and Paralympic athletes. Her doctoral research examined exercise-induced arterial hypoxemia, asthma and pulmonary edema during exercise. Jane currently works for Own the Podium as a Sport Science and Sport Medicine Advisor for summer sport.

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Concurrent versus delayed feedback: Biomechanics in Rowing Will George, MSc - Canadian Sport Institute Ontario


or some time, international rowing teams have been measuring the biomechanical characteristics of athletes during training in an attempt to provide athletes with constructive feedback. The aim of such feedback is to elicit positive change in technique and therefore increase boat speed in an attempt to win races.


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Research has shown that important biomechanical characteristics which impact on boat speed include: • Boat acceleration (m/s2); • Total angle covered between the oar entry and exit from the water, per rowing stroke (Θ). Known as ‘arc length’; • Angle of the oar when entering the water (Θ). Known as ‘catch angle’; • Angle of the oar when exiting the water (Θ). Known as ‘finish angle’; • The amount of force (N) being produced at different oar angles during a stroke.1,2 For each of these variables, normal and ‘gold standard’ results for different rowing boats and athletes have been identified.3 Also, a high degree of synchronicity of these characteristics between athletes’ in the same boat produced increased boat speeds.4

• In rowing, concurrent feedback elicited technique change more effectively on a short term basis than delayed visual and verbal feedback. • To improve retention on a long term basis, delayed feedback should also be used. • Concurrent verbal feedback should be used with caution since it can inhibit learning retention if athletes don’t also heed their perceptual feedback.

During June 2011 the coaching and support staff of the Canadian Women’s U23 team support staff considered the concept of amending the established method used to feedback biomechanical information. The aim of this was to enhance the learning experience of the athletes, thereby facilitating quicker technique improvement which would lead to increased boat speed. By assessing the established method of feeding back biomechanical characteristics it became clear different options were available. For example, ensuring the preferred feedback stimuli was provided to each athlete where practical. To assess whether amending the method was worthwhile, a case study was performed with the U23 team where a different feedback strategy was trialed.

Providing concurrent feedback in the coaches boat.

Providing this information to athletes is a source of augmented (external) feedback designed to improve the learning experience of the athletes. Since this type of feedback has several variations which are each known to be more and less effective at facilitating learning for different individuals and in different circumstances, the method used to feedback the information was considered. Variations of extrinsic feedback include, content, timing, frequency and stimulus of the feedback. For example, some individuals are affected by the stimulus of the feedback and learn more effectively following visual augmented feedback and some from auditory.5 Reinforcing positive content of feedback produces the greatest improvements in learning, followed by negative reinforcement. Other variations include the timing and frequency of feedback.6

Key Points



Biomechanical data was collected during typical training sessions from the same day, using ‘Peach Powerline

Figure 1. Peach Powerline Rowing Instrumentation Click image to enlarge

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a straight line without current or wind. Each rower was depicted by a different color. The data recorded during the sessions was downloaded and analyzed by comparing it to previous research into optimal biomechanical characteristics (Figure 4). Each athlete’s data was compared to this benchmark and any discrepancies were observed. After a delay of approximately three hours, the established method of feedback was provided by the coach and the performance technologist whereby a combination of verbal and visual feedback (data shown in Figure 3) was used to identify technique points for future focus. Figure 2. Peach Powerline Rowing Instrumentation Click image to enlarge

Rowing Instrumentation’ (Peach Innovations Ltd, Cambridge, UK) (Figure 1 & 2). This equipment measured the oar angle and the force applied by the rowers oar on the oar pivot. In addition to the biomechanical characteristics detailed above, further parameters were measured by the instrumentation which indicate performance.2,7 These parameters were: • A graph of Force (N) against the oar angle for each of the eight rowers in the boat; • Values for the Power (W) of the athletes; • Boat speed (m/s). This is the most important measurement and indicates performance; • The amount of strokes taken by the crew in one minute (strokes per minute). Increased stroke rate often increases boat speed. Values for these parameters were collected from the initial training session (Figure 3). Data for each rower was calculated by averaging approximately 200m of rowing in

Figure 3. Biomechanical data collected during the U23 team’s initial training session. Click image to enlarge


Figure 4. ‘Gold standard’ graph shape for the force against oar angles by each rower in an eights boat.7 Click image to enlarge

Initially, this intervention had little success in changing the athletes’ technique and biomechanical characteristics. In an attempt to improve the athletes’ learning experience, a different method of information feedback was trialed. Discussion with the athletes and coach revealed that the athletes’ preferred method of learning was auditory. Research has suggested that skill acquisition in various skill based sports was improved by concurrent auditory feedback.8 In an attempt to attenuate improvement of the athletes’ biomechanical characteristics, a method of providing concurrent auditory feedback was established. In order to trial this feedback mechanism, technology that had not previously been used by the Canadian women’s team was trialed. An ‘add on’ to the ‘Peach Powerline Rowing Instrumentation’ enabled data collected by the data logging system located in the rowing boat to be concurrently transmitted to a computer within approximately 150m. The data was viewed concurrently and the coach was able to verbally identify better and worse strokes as they occurred with regards to ‘gold standard’ biomechanical characteristics. HP SIRCuit Winter 2013


Between Figure 3 and 5, differences in results included: • Boat speed increased by 21.04% from 4.61 m/s to 5.58 m/s; • Stroke Rate decreased by 3.12%, from 38.5 SPM to 37.3 SPM; • Average Power increased by 9.88%, from 334W to 367W.

This finding was expected since concurrent augmented feedback has been shown to enhance task-intrinsic (perceptual) feedback and therefore enhance skill learning.9 Skill learning has also been improved when relevant features of perceptual feedback that are difficult to determine are enhanced using concurrent augmented feedback.10 For example, the activation of specific muscle groups at specific times which are required by rowing. However, it has also been suggested that in order for learning to be retained on a long term basis, delayed feedback of the results should also be used.10 Allowing time for the athletes to subjectively reflect on their performances in relation to task-intrinsic feedback positively influences learning.10 Research has warned that concurrent verbal augmented feedback should be used with caution since concurrent augmented feedback commonly produces a negative learning retention effect when learners direct their attention away from the perceptual feedback.10

Figure 5. Biomechanical data collected during the U23 team’s training session with concurrent auditory feedback. Click image to enlarge


Since performance (boat speed) increased between the two training sessions with different methods of feedback, the results show that concurrent augmented feedback elicited rowing technique change more effectively on a short term basis than a combination of visual and verbal delayed feedback. Although it should be noted that the outdoor and variable conditions often encountered when rowing may have contributed to the differences in results. Screenshot of typical data Click image to enlarge

The coach of the U23 team involved in the present case study was provided with the outcomes, and now incorporates them into her coaching strategy. However, to ensure these teaching methods are fully effective and further enhance the learning experience of athletes in future work, data collection and analysis of performance should be repeated after a significant time period to enable evaluation of skill retention.

Delayed feedback to the athletes and coach


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Discussion How can this article be used as a solution in other sports? The technique used in this case study was ‘benchmarking’. The objective of benchmarking is to understand and evaluate the current position of a business or organization in relation to “best practice” and to identify areas and means of performance improvement.11 It therefore lends itself nicely to a ‘gap analyses’ whereby one compares themself with where they want to be, which can identify how to bridge such a gap. Such a method for self-improvement could be used to improve performance in any sport. A flow diagram describing this process is shown below. •

A flow diagram describing this process Click image to enlarge

could reveal an inexpensive, cheap, off the shelf solution. For example, for around $10 an iPhone app will measure your acceleration. Preferred learning styles. Different people learn more effectively when different methods of communicating information are used. Optimal learning could be facilitated using visual, audial, touch or participation based communication. Asking athletes how they learn best could be beneficial. Feedback/communication methods. As previously discussed, different methods of feedback have been proven to be more and less effective at facilitating athletes to retain skills. Knowledge of feedback mechanisms coupled with a strategic approach to what information you feedback, how and when maybe improve an athlete’s learning. For example, in a previous High Performance SIRCuit edition (Summer 2012), Ryan Atkinson noted “feedback that contains extremely precise information about errors is ignored (e.g. 0.03s too early)”. ∆

What can HP SIRCuit readers take from this article to benefit their cause? Although this case study is sport specific, it touches on several areas which could be applicable to coaches/support staff in different sports. For example; • Identifying and Researching optimal values for Key Performance Indicators (KPI’s). Analyzing and researching the world leaders in a sport from a particular perspective (e.g. physiology or biomechanics) will reveal the ‘gold standard’ characteristics they display and which of those impact most on performance. This could be achieved by literature searches or hands on testing for example. Access to historical data is invaluable during this research. • Methods of measuring KPI’s. A multitude of technologies are available to complete this. A conversation with a colleague or internet research


For references, click here

Will George is Sports Biomechanist for the Canadian Sport Institute Ontario (CSIO) based at the CSIO in Toronto and the London (ON) Rowing Training Center. Originally from Great Britain, Will completed his B.Sc. (2005) in Sports Engineering at Sheffield Hallam University and his M.Sc. (2010) in Sports Sciences (Human Performance) at Brunel University. His studies specialized in laboratory techniques and the biomechanics of rowing.

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Committed to Making Canada a World Leader in High-Performance Sport

Faisons du Canada un meneur mondial dans le sport de haute performance

To find out more about Canadian athletes’ quest to own the podium, please visit us at

Pour en savoir plus sur la quête des athlètes canadiens pour conquérir le podium, veuillez visiter


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Athlete Focus Kaillie Humphries

Position: Pilot Height: 170 cm Weight: 73 kg Date of Birth: September 4, 1985 Place of Birth: Calgary Residence: Calgary Twitter: @Bobsledkaillie Web site:

Background Kaillie started bobsleigh at the age of 17, and spent her first four years in the sport as a brakeman on the World Cup circuit, culminating in her being named to the 2006 Olympic Team, and attending those Games. Following the incredible Olympic experience in Torino, Kaillie quickly emerged as one of the world’s best bobsleigh pilots after moving into the driver’s seat during the 2006-07 season, and made history in 2010 becoming the first Canadian woman to win a gold medal in bobsleigh at the Olympic Winter Games in Vancouver, when she dominated the field in record-setting fashion, becoming the first-ever Olympic gold medallist in the sport for Canada at just 24 years of age. She added to the history books in 2011, where she became the first Canadian woman to win the World Championships, completing a golden sweep of North American stops on the elite circuit: Whistler, Calgary and the World Championships in Lake Placid. With only a few months of driving under her belt, Kaillie’s success steering the sled was instant. She was the overall points leader on the Europa Cup in 2006-07, capturing three victories in four races, and settled for a silver medal at the World Junior Championships. In 2008, she advanced onto the World Cup circuit where she captured her first World Cup bronze medal as a pilot en route to finishing fifth overall. She added two silver medals under her belt during her second season in the driver’s seat, but it was in 2010 that she demonstrated her dominance in the sport setting six start records and two track records around the world while racking up four medals to finish second overall in the World Cup standings. Formerly an alpine ski racer, Kaillie competed until she was 16 years old. Her dream was to be on the National Team and win an Olympic gold in alpine


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skiing, but realized she was never quite good enough. However, bobsleigh has allowed her to realize her dreams and she has never looked back. As a lifetime resident of Calgary, Kaillie has made a commitment to giving back to the community when she is at home during competition breaks and the off-season. At Christmas time, Kaillie and her family donate time to

help feed those less fortunate through a dinner program at the homeless shelter. Kaillie is also an active member with three elementary schools in the Calgary area, Cedarbrae Elementary, Woodbine Elementary, and the Big Rock School (Okotoks). At these schools, Kaillie is a mentor and speaks to students about the importance of setting goals, exercise and saying “No” to drugs. ∆

In this video, produced by Own the Podium, Kaillie explains what motivates her to continue competing after already achieving the highest level of success. Also, Nathan Ciccoria, HP Director for BCS, speaks to the balance between the individual needs of the veteran athletes and the broader needs of the high performance program as a whole. Click on the video to see the full interview.

Career Highlights Pilot • 2010 – Olympic Winter Games, Whistler, CAN: 1 • 2012 – World Championships, Lake Placid, USA: 1 • 2012 – World Cup, Calgary, CAN: 1 • 2012 – World Cup, Whistler, CAN: 1 • 2012 – World Cup, Konigssee, GER: 2 • 2011 – World Cup, La Plagne, FRA: 1 • 2012 – Overall World Cup Standings: 5 • 2011 – World Championships, Konigssee, GER: 3 • 2009 – World Championships, Lake Placid, USA: 5 • 2008 – World Championships, Altenberg, GER: 5 • 2010 – Overall World Cup Standings: 2 • 2008 – Overall World Cup Standings: 5 • 2010 – World Cup, Whistler, CAN: 3 • 2010 – World Cup, Igls, AUT: 3 • 2010 – World Cup, Königssee, GER: 2 • 2009 – World Cup, Altenberg, GER: 1

• 2009 – World Cup, Lake Placid, USA: 3 • 2009 – World Cup, Whistler, CAN: 2 • 2009 – World Cup, Park City, USA: 2 • 2007 – World Cup, Lake Placid, USA: 3 • 2007– Overall Europa Cup Standings: 1 • 2007 – World Junior Championships: 2 • 2007 – Europa Cup, Igls, AUT: 1 • 2007 – Europa Cup, Cesana, ITA: 1 • 2007 – Europa Cup, Winterberg, GER: 1 Brakeman • 2006 – World Junior Championships: 2 • 2003 – World Championships, Königssee, GER: 8 • 2005 – World Cup, Cortina, ITA: 4 • 2004 – World Cup, Calgary, CAN: 8 (Set Canadian Push Record) 15

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Competitive Intelligence

Competition Anxiety and Elite Athletes: Debilitative or Facilitative?

A Commentary on the Literature Nancy Rebel - Sport Information Resource Centre (SIRC)


nowledge can give an athlete the competitive edge. Competitive intelligence equips coaches, sport scientists and practitioners with the latest information that may assist in the quest to put an athlete on the podium. SIRC receives thousands of publications from around the world each year ranging from peer reviewed journals to practical guides and our information specialists are constantly reviewing various articles in order to identify competitive intelligence resources. In this issue we take a look at the research examining competitive anxiety.


This article is also available as a podcast, click here to listen

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When it comes to the competitive sport environment, athletes at all levels face a complexity of emotions surrounding the experience. Most would agree that emotion plays a significant role in how an athlete responds to a competitive situation. It generally comes down to how an athlete perceives and adapts to the emotional elements that affects their ultimate performance. Of particular interest in the area of elite level sport is the notion of anxiety as it relates to competition. Researchers agree that anxiety is not, however, a uni-directional emotion. At times it may hinder an athlete (debilitating) and for others it motivates them (facilitative). The good news for high performance sport is that studies have indicated that elite athletes are more likely to view anxiety symptoms as facilitative than non-elite athletes. However, this does not negate the variable experience of anxiety when it comes to high level performance. Elite athletes need to be able to adapt effectively mentally and physically to high level competitions. It is argued that since elite athletes are competing at the highest levels, physical skill is at a similar level between competitors and/or teams, leaving the biggest variable in the psychological realm. Elite athletes are under the constant demand to perform at their best and performance or competition anxiety has proven to be one of the most significantly detrimental factors in their performance (Abrahamsen & Pensgaard, 2012; Coelho, et al, 2012; Lundqvist et al., 2011; Mellalieu et al., 2008). However, theorists have noted that anxiety can also be viewed in a positive light as it facilitates the athlete’s ability to pursue higher level goals (Hanton and associates, 2002,2003, 2005, 2008). Wadey & Hanton (2007) suggest in their findings that many elite athletes maintain the presence of competition anxiety pre-competition, and rather than use relaxation, they use goal-setting, imagery,

Key Points • Competition anxiety can be interpreted as either debilitative or facilitative for elite level athletes • The literature suggests that direction of anxiety perception is a more sensitive variable than is the intensity of the response • Anxiety may be mitigated either by removing the precursors to the performance anxiety or by training athletes to cope with the occurrences

and/or self-talk to direct the anxiety to reinforce higher levels of confidence and subsequently boost perceived improvements in performance.


Much of the research in the area of competition anxiety focuses around three components of an athlete’s perception: situation criticality, skill level, and self-confidence. Competitive anxiety mediates the relation between self-confidence and performance (Kjormo & Halvari, 2002). Measures such as the Modified Sport Anxiety Scale or more commonly the Competitive State Anxiety Inventory-2 (CSAI-2) have been used to explore the complex relationships between anxiety and performance. However, researchers have indicated that these measures may fail to fully account for the directional interpretation of anxiety effects. Directionality becomes a player in anxiety research in the context of its reference to “the extent to which individuals’ interpret the intensity of their symptoms associated with precompetition anxiety as either facilitating or debilitating to performance” (Hanton et al., 2008). The literature goes so far as to suggest that direction is a more sensitive variable in anxiety than is the intensity of the response. Direction is defined in terms of facilitative and debilitative interpretations of anxiety symptoms. When an athlete has a positive expectation that they can cope with the emotions evoked by an event and that they can attain their set goal, they are more likely to anticipate anxiety symptoms as facilitative to their performance. Conversely, those that have a negative expectation of coping and doubt their


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motivational framework of the Achievement Goal Theory, elite athletes engage in achievement situations such as competitions in order to demonstrate perceived athletic ability (also known as perceived skill level). Ego-oriented athletes will have anxiety related to how they measure their ability in relation to others, while task-oriented athletes will experience anxiety around self-measured aspects of athletic ability. Therefore, while ego-oriented athletes tend to be more susceptible to performance anxiety due to the outward measure of ability, adopting a single achievement goal would make task-oriented athletes less likely to experience anxiety. Competition anxiety arises in the elite athlete context due to the focus on a performancefocused environment. This research recommends creating a context that emphasizes skill mastery in the competitive context to aid in the relief of anxiety.

Psychological Support Team

ability to attain their goal, will most likely view anxiety symptoms as debilitative to their performance. It is important to note that skill level is one variable that is consistently found to discriminate between athletes’ directional responses. While elite and non-elite athletes generally do not differ in intensity of response, elite athletes report more facilitative interpretations and greater self-confidence (Hanton et al, 2008). Experience also follows along the same trajectory, those with more competitive experience tend to see more facilitative interpretations of anxiety symptoms as well. Since elite athletes have a higher level of skill and generally more competitive experience, it follows that they are then more likely than non-elite athletes to view competitive anxiety symptoms as more facilitative to performance.

Researchers agree that anxiety is a highly complex and variable emotion in the athletic realm. Finding ways to mitigate an athlete’s reaction, and in essence use the anxiety-related emotion to motivate can prove significantly beneficial to high performance athletic achievement. ∆ For references, click here

Coaches and athlete anxiety

Coaches of elite athletes can play a vital role in diminishing athlete anxiety by being aware of what shapes or moderates it. Studies have examined how the coach-created environment may impact athlete anxiety levels (Abrahamsen & Pensgaard, 2012). Previous work shows that anxiety may be mitigated either by removing the precursors to the performance anxiety or by training athletes to cope with the occurrences. Based upon the

As can be clearly seen, the sport psychologist also can play a significant role in the mastery of debilitative anxietyrelated issues. Neil et al. (2012) discusses a two-pronged strategy which aims to improve the self-confidence of athletes in specific circumstances and focuses on the training of psychological skills associated with facilitative features of the anxiety. Like the coaches’ role studied by Abrahamsen & Pensgaard (2012), psychologists can help athletes focus on personal achievements and improvements by focusing on past experiences and how they contributed to successful performances, keying athletes in on how they can change their behaviours to improve future outcomes. The second prong focusing on psychological skills relating to facilitative anxiety centres around the natural occurrence of competition anxiety and emphasizes reflection techniques promoting athlete self-awareness of why they are experiencing anxiety. With self-awareness, athletes are then taught techniques like imagery and selftalk to aid in reestablishing focus.


Nancy Rebel is the Director of Library Services at SIRC. Nancy is responsible for content management of SIRC’s collection and its catalog database design. Nancy has been responsible for: the content submissions for the worldrenowned SportDiscus database; aiding in the coordination of in-house and international terminology submissions and organizational structure of SIRCs internationally recognized SIRCThesaurus as Editor.

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Proactive & Preventative Medicine

Fit to Play™ High Performance Recovery (Part 3) Carl Petersen BPE, BSc(PT) - City Sports and Physiotherapy


thletes, coaches and sport science and medicine personnel must always strive to find a balance between the stresses of training and proper recovery. Some athletes work out or compete when they are sick or injured and they sometimes do too much, too fast, too hard, too soon and risk problems associated with over-stress, over-training or overuse injuries. With the pressures of work, school, family and travel it is often difficult to ensure proper recovery guidelines are followed after and between training and competing. Athletes often neglect using recovery techniques unless they are injured therefore effective recovery strategies must be built into the training and competition schedule. Heavy training should not commence until fully recovered from previous training, competition, travel, injury or illness. Adequate time should be allowed for recovery, and training modified to optimise taper and peak if getting ready for an important competition.


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Key Points

Short Term Rules of Recovery Table 1: Short Term Rules of Recovery Short Term Rules of Recovery (daily)

(adapted after Petersen, 2003, Petersen & Nittinger 2007, Petersen, 2009)

Rule #1 - Re-hydration Rule #2 - Re-fuel Rule #3 - Recovery work Rule #4 - Re-align the body Rule #5 - Re-set the balance clock Rule #6 - Re-connect the core Rule #7 - Release the soft tissue Rule #8 - Regain & maintain muscle length Rule #9 - Re-play & review your training or competition Rule #10 - Reinvigorate with recovery menu Rule #11 - Relaxation Rule #12 - Rest (passive)

• Re-playing training or competitive situations is a useful way to evaluate performance and aid in psychological and emotional recovery • Athletes might be best advised to use a combination of three recovery techniques; recovery workouts, release of soft tissue techniques and reinvigoration with a recovery menu

* Rules #1, 2 & 3 were covered in Part 1 and Rules #4 to 7 were covered in Part 2 of this article series.

• The body requires a certain period of time in order to recover from fatigue and stress, especially fatigue that is built up slowly over a period of time.

Rule # 8-Regain & maintain muscle length The state of tension in muscle groups should be assessed on a daily basis and new stretches added to ensure that a good length-tension balance is maintained in all muscle groups. Facilitated stretches like hold relax and contract relax PNF techniques have been shown to be more effective than just static stretching (Enoka, 1994), (Lucas & Koslow, 1984). Facilitated stretches make use of the inverse myotatic reflex, where nerve receptors in the tendon are sensitive to isometric contraction and relax the muscle when it occurs. Two methods may be used: Contract-Relax: tighten the same (agonist) muscle, then stretch and Hold-Relax: tighten the opposite (antagonist) muscle, then stretch. Use a partner you can trust who takes the muscle slowly to the point of tightness, applies appropriate resistance (approx. 25–30%) for 6–8 seconds, and then assists you to stretch further into the range or use a solid object like a wall or tree. Go slowly and respect the signals your muscles are giving you. Static stretches prior to exercise did not prevent lower extremity overuse injuries, but additional static stretches after training and before bed resulted in 50% fewer injuries occurring (Hartig & Henderson, 1999). Static stretches should be held for 30 seconds to the point of tension-NOT pain and repeated 3 times. Muscle soreness is believed to be decreased with mild stretching exercises performed during the cool down period (Prentice, 1983). Performing both static and PNF stretches helps to optimize muscle and tendon length post training. Athletes should develop their own set of stretches based on an evaluation by their sport science and medicine team and be adjusted as the training emphasis and demands change. Practical Application

PNF Hamstring Stretch

Static Hamstring Stretch

Static Posterior Sholder Stretch

Stetches can be done both post activity and during the whirlpool session


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Rule # 9-Re-play & review the training or competition

Re-playing training or competitive situations is a useful way to evaluate performance and aid in psychological and emotional recovery post performance. Helping athletes to understand the process that went into the outcome, including fatigue, emotions, execution of strategy can be helpful in it’s own right to give athletes an increased sense of control over their performances (Peterson, 2003). A systematic and constructive approach that focuses on “process� rather than outcomes can provide players with achievable performance goals that they can manage and monitor (Hogg, 2002). It lets you objectively evaluate your performance and plan what changes are needed in training, practice and competition.

Practical Application Start a training diary and take short notes on what you practiced, what went well, what went poorly and what you have to work on in the next few days or weeks. You can only improve if you recognize your weaknesses, work on them and stick to your strengths.

Work with your coach to look at the positive aspects of your performance.

Rule # 10-Reinvigorate with recovery menu

Coaches and athletes alike need to be made aware of the importance of restoration and regeneration following heavy workloads and how to use the equipment, facilities and modalities available to facilitate recovery (Petersen, 1988). These include adequate warm down, the use of whirlpools or spas and massage, as well as nutritional and psychological techniques (Brukner & Khan, 2002). Researchers have shown that when you compare lactate clearances following (1) passive rest, (2) light exercising (active recovery) and (3) contrast immersion techniques, that lactate levels were recovered equally fast by using either the contrast water immersion protocol or the active recovery protocol. Lactate recovery following passive rest was significantly slower (Calder, 2003). Researchers have also demonstrated that underwater massaging (using the jets in a spa) following plyometric training helped athletes to maintain explosive leg power. In contrast passive rest (doing nothing) after such training resulted in a significant reduction in leg power (Viitasalo et al, 1995). Therefore athletes might be best advised to use a combination of three recovery techniques; recovery workouts, release the soft tissue techniques and reinvigorate with a recovery menu. It is important for coaches to recognize that they also need to recover as they undertake large amounts of physical work and stress (Calder, 2003). Recovery sessions provide an opportunity for both the athlete and coach to start to unwind, recover and prepare for the next day. Try one or more of the following recovery techniques. Alternate stimulation with hot/cold makes you feel perky and pepped up and may help wash out waste products and metabolites and brings oxygen to the fatigued muscles. Showers: Shower promptly after training to clean the pores in your skin and help flush out waste products. Remember the skin is the largest organ in the body. Repeat often, especially on hotter days.


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Practical Application Suggested Contrast Temperatures Utilizing contrast temperatures is more an art than a science and depend on the facilities available to the athlete. The literature suggests hot/cold of 30-300 seconds of one temperature extreme followed immediately by 30-300 seconds of contrasting temperature and repeat for four to thirty minutes (Wilcock et al, 2006). This information while useful does not give practical examples athletes can use. Following are some suggested routines that over the years have worked well to re-invigorate athletes and coaches alike. Hot & Cold (A) Hot (comfortable) for 2 minutes followed by cold (as possible) for 30 seconds and repeat 6 to 10 times. Hot & Cold (B) Cold (as able to stand) for 1 minute followed by hot (as comfortable) for 30 seconds repeat 8 to 10 times.

Water Pressure (Hose) Cold water hose applied for 45 seconds to each leg and 30 seconds to each arm followed by a warm shower for 30 seconds each leg and 20 seconds each arm. Repeat 5 to 7 times.

Sauna/Cold Plunge (use at least one hour after training) Start with a warm to cool shower for 3 to 5 minutes and then towel dry. Use the dry sauna for approximately 7-10 minutes followed by a cold plunge or cold shower for 15 to 30 seconds then rest with feet up for 5 minutes. This routine can be repeated three times before a day off and should only be repeated once before a training or competition day. Finish with warm shower for three to five minutes.

Rule # 11-Relaxation

Learning to recover and relax is a great advantage for optimizing high performance. Relaxation exercises that assist in relaxing the mind as well as the body may help decrease stress related fight or flight chemicals. They can also assist in acute and chronic stress management. Recharging the batteries or refilling the energy tank helps you regain your physical and mental strength to train or compete at a high level. To get the best results in relaxation try a different combinations of techniques, and see what works for you. There are many different ways to relax and everybody has individual preferences. It is best to combine a couple of your favorite relaxation techniques and get into a personal routine. Physical relaxation can include sauna (see recovery menu above), slow running, walking or massage. Other relaxation techniques include progressive muscle relaxation, autogenic training, controlled breathing, yoga, stretching or imagery.


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Practical Applications A)Make no plans for the rest of the day. Instead have an adventure and explore the environment or the city you are staying in. B) Slow life down a little. Drive a little more slowly if you usually drive fast. Spend a few extra minutes listening to music in your car before rushing out.

Rule # 12-Rest (passive)

Rest is one of the most important principles of training. The body requires a certain period of time in order to recover from fatigue or stress, especially fatigue that is built up slowly over a period of time. Sleep is probably the best form of rest to aid recovery and high performance athletes may require up to 10-12 hours of sleep a night (Hawley & Schoene, 2003). Lack of sleep may interfere with glucose metabolism, which muscles depend upon for recovery and the brain needs to function. Lack of sleep can overwhelm your body’s ability to adapt, increasing the potential for injury. Your muscles need the rest and recovery time during sleep to rebuild the tissue stressed during a workout. Lack of sleep can also make you more prone to illness because the added stress depletes the immune system.

Practical Application To ensure a good nights sleep minimize caffeine in the late afternoon and avoid excessive alcohol. Keep the sleeping room cool and avoid hot showers and heavy exercise just before bedtime since a higher than normal, body temperature makes it harder to sleep. Avoid long afternoon naps and try sticking to a schedule and getting up at the same time each day to avoid becoming sleep lagged.


The challenge for most coaches and athletes is to identify which specific capacities are fatigued and then select appropriate recovery strategies to restore the athlete to a normal functioning state. Athletes, coaches, therapists and parents all need to be more aware of the importance of physical, psychological and emotional restoration and regeneration following heavy workloads and how best to use the equipment, facilities and modalities available to facilitate recovery. ∆

For references, click here Carl Petersen is a partner and Director of High Performance Training. He treats and trains athletes to keep them Fit to Play for a variety of sports. Throughout his over 25 years as a physiotherapist and fitness coach he has worked with numerous gold medal winners from a variety of sports most notably alpine skiing. He traveled on the World Cup Ski Circuit from 1984-2003.


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Invitation to Submit Papers for the 2013 SIRC Research Award SIRC invites Canadian researchers to submit sport related research papers in consideration for the 2013 SIRC Research Award. The Research Award recognizes outstanding sport research in Canada. The winner of each category will receive $2,000, a SIRC membership, media coverage, inclusion in the SIRC Collection and international exposure to the sport and academic community through SIRC’s publishing channels. The 2013 SIRC Research Award has three categories:

• The social impact of sport on the community • The impact of applied research on athletic excellence / high performance. • The impact of Olympic values on positive mental health development and sport participation Important Information: •

Winners will receive international exposure, prizes and $2,000

Winners will be notified by June 23, 2013

• •

Final electronic and hardcopy submission by April 19, 2013

Presentation of award will take place on Olympic Day at a location to be determined

For additional information please visit:


To receive the SIRC High Performance SIRCuit or SIRC newsletters

Click here

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Proactive & Preventative Medicine

Sports Psychiatry: An often misunderstood and under-serviced area of medicine in the world of sport Saul Marks, MD - University of Toronto


port Psychiatry made its defining entry into the scientific literature in May of 1992, in the American Journal of Psychiatry, in a paper titled “An Overview of Sport Psychiatry” by Dr. Daniel Begel. As a medical specialty, psychiatry has been recognized since the middle of the nineteenth century; however the interface between psychiatry and the world of sport has often been misunderstood. Dr. Begel defined sport psychiatry as the implementation of psychiatric knowledge and treatment methods to the world of sport. Elite athletes are subject to massive somatic, social and mental stress. Although the public has great interest for athletic achievements, the emotional strains brought on by such “heroic moments” until the last two decades have been absent in the scientific literature. Over time there have been more and more papers in the scientific literature and presentations at international scientific conferences on the subject. The field, however, has suffered from a lack of controlled studies (and data) on incidence, phenomenology and treatment of psychiatric disorders in athletes. Although there remained to be few scientific papers on the subject in the 1990’s thru the first half decade of the 2000’s, more recently increasing numbers of papers can be found in the scientific literature. 26

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Recent research shows that the prevalence of mental health issues in athletes to be as high, if not higher, than in the normal population.3,4 In the past it was believed that because athletes are, “emotionally very strong people” mental disorders did not exist in athletes at the elite level. Also if they did they could only exist at the same level as the normal population. Figure 1 below illustrates the percentages of the most common psychiatric disorders in athletes. It should be noted that figure 1below does not include Attention Deficit Hyperactivity Disorder (ADHD), as it is from a paper published in a journal in France. In France there is a belief that ADHD does not exist. In almost all other countries in the world there is a belief it not only exists, but ADHD would take up a large percentage of the figure in the world of sport.5,6

Key Points • Recent research shows that the prevalence of mental health issues in athletes to be as high, if not higher, than in the normal population • Primary areas of specialty: (1) optimize physical and mental health; (2) ethically improve athletic performance including optimizing coping mechanisms and positive psychological strengths, and (3) manage psychiatric symptoms or disorders • The included case studies show how a sport psychiatrist can make a difference not only in treatment decisions, but also diagnose problems the average physician can tend to overlook of taking medication and although decreasing as time moves forward, the stigmatization and possible ostracizing by teammates of seeing a psychiatrist.10

Figure 1. Psychiatric diagnosis by percentage of elite athletes diagnosed with a Psychiatric Disorder. Click image to enlarge

Other diagnosis and issues not listed in figure 1 include, performance enhancing drugs, retirement issues, abnormal or arrested development of life skills, child and adolescent issues, sexual harassment and abuse in sport, the coachathlete relationship, aggression or lack of aggression and confidence and last sport specific issues.2,5,6,7,9 To truly understand sport psychiatry one must know what a sport psychiatrist qualifications are and what they can offer an elite athlete that is novel and progressive. A sport psychiatrist is a physician who has specialized in psychiatry. They also have an expertise of all common psychiatric disorders in elite athletes and how to diagnose them. This allows for the most advantageous treatment of problems and symptoms, with the fewest side effects to the athlete. It also offers a better understanding of the difficulties the athlete is facing, with the athletes consent, by communication to the coach, their teammates, their family and significant others. Sport psychiatrists also have an understanding of the prohibited substance list, how to obtain a therapeutic use exemption form, an athlete’s fear


The primary aims of the specialty are to (i) optimize physical health, (ii) ethically improve athletic performance including optimizing coping mechanisms and positive psychological strengths, and (iii) manage psychiatric symptoms or disorders. This is different from both general internal medicine and from psychology.2 Once a diagnosis is made, the sport psychiatrist has a myriad of treatment options. Treatments can be optimized for the athlete to experience the least side effects from medication that can be found in evidence based scientific literature. For many athletes and coaches medication can be seen as a treatment of last resort, which is understandable considering their side effects and that other treatments are increasingly available. Psychotherapies such as supportive, cognitive behavioural, analytic and mindfulness bass stress reduction are available both individually and with groups and families.3 Mindfulness bass stress reduction groups utilize visualization, imagery, yoga and using the mind to control emotional reactions and take time to step back and better understand ones feelings.8 Performance-enhancing techniques and strategies, substance abuse/dependence management and treatment, mental skills training and selfhelp groups are also available.

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The following two cases will illustrate why a sport psychiatrist can be helpful:

Case 1

A 21 year old male short distance runner, JB, previously on the Senior National Team has started the new school year at university, having just finished competing at the Senior National Athletics Championships. He narrowly missed qualifying for the National Team again, which was a major setback for him. Within weeks of the new school year his girlfriend unexpectedly ends their relationship. As the fall semester progresses his coach notices a fall in JB’s performance. He is late for practice and has been irritable. His grades have fallen however JB continues to claim that he has “sleeping difficulties” and states that everything else is alright. His teammates begin to refer to him as a “head case”. After several talks with his coach he is sent to the team doctor who refers him on for a sport psychiatry consultation. After several appointments with the sport psychiatrist, JB admits to having many more symptoms then insomnia alone. He has been feeling sad, irritable, has had no appetite and difficulty concentrating. He is guilty about his recently ended relationship with his exgirlfriend, hopeless and has had thoughts of suicide. He is diagnosed with depression and the sport psychiatrist wanted to start him on Wellbutrin XL.

psychiatrist gives the athlete a better chance at recovery. Warning signs that an athlete is suffering from depression as listed in figure 2. Depression is seen in sport commonly and presents at many different times in an athlete’s carrier. An athlete can suffer from depression as anyone in the normal population. After a concussion the coach and the athlete’s integrated sport team (IST) should be aware of the risk of a depression occurring.13 Over training can lead to athletic burnout and depression as can excessive exercise and athletic training as a defense against underlying depressive issues. Last, retirement from elite sport is an extremely risky time for an athlete to become depressed.

He initially had many concerns regarding taking any medication. This came from having seen a fellow teammate once put on an anti-depressant which had caused fatigue and hurt his performance. He was also reluctant to take medication because of the prohibited substance list and having always been told to always stay away from medications. After reassurance and a lengthy discussion that it was not on the prohibited substance list and his concerns were valid, he agreed to start the medication. He was educated regarding the medication. He was told the anti-depressant had the fewest possible side effects for an athlete. The medication was also known to help depressed patients energy level and concentration return to normal. Within 6-8 weeks JB appears to be his old self again, but continued to discuss his difficulties with his sport psychiatrist. This case illustrates how specific skills that a sport psychiatrist has can help in returning an athlete to their sport quickly and without a decrease in performance. It also shows by sometimes asking sport specific questions and understanding the world of sport the sub-specialized


Figure 2. The signs and symptoms of clinical depression Click image to enlarge

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Case 2

LM is a 17 year old female up and coming diver. She has been on both the Junior and Senior National Team and has already won international medals. One day in practice she starts having difficulties with attempting one of her dives. She keeps stopping at the end of the board, which is known as a baulk. She also starts clearing her throat repetitively. This starts to happen more and more frequently until she can rarely complete the dive. Over the ensuing months she starts to baulk on all of her dives and is having increasing difficulty not only finishing a practice, but doing several of her dives. LM and her coach are becoming increasingly frustrated. She first sees the team doctor who eventually refers her onto a sport psychiatrist.17


Once first seen by the team doctor, LM admits to becoming increasingly perfectionist to try and please her coach, a previous Olympic Champion. She is obsessively thinking of perfect dives and the more she does this, the more she is compelled to baulk. She wants to stop these thoughts and this behavior, but cannot. She is diagnosed with obsessive-compulsive disorder, one of the anxiety disorders and started on Zoloft, one of the medications of choice. LM finds herself gaining weight and sluggish. After seeing the sport psychiatrist, Zoloft is replaced by Cipralex, which has far less side effects for the athlete patient. She loses weight and feels herself again. Slowly her diving begins to improve. Once seen by the sport psychiatrist it becomes obvious to him that she is also suffering from ADHD. She begins treatment with individual cognitive behavioural therapy to work on techniques to remain focused on the task at hand. Her diving continues to improve, but not to the level she had previously achieved. Since it has been shown that a psycho stimulant is the medication of choice for ADHD, her sport psychiatrist obtains a therapeutic exemption form to start her on the medication concerta, a psycho stimulant. Her diving now begins to progress to a level where she once again makes the National Championships. She continues to work with her cognitive behavioural therapist and begins to once again enjoy the sport had always loved.

It has been found that sport psychiatry is an underserviced area in the world of sport. Although all the advantages of seeing a psychiatrist who is specialized in athlete centered patient care are not yet known, there is an increasing body of scientific literature that advocates for this specialized care to enhance performance in elite athletics. Positive collaborative relationships are being forged with other professionals– sport psychologists and sports medicine specialist being two examples. There are now professional teams and team assistance programmes managed by psychiatrists. The ISSP (International Society for Sports Psychiatry) was founded in 1994 to advance the specialty of Sports Psychiatry. Membership is open internationally to psychiatrists and other clinicians interested in the field and membership is listed to aid in the elite sport teams and the international press finding sports psychiatrists when necessary. The website which is a good resource is www. The societies name just added an “s” to the end of the word “Sport” to come in line with sports medicine to attempt in forging ever increasing collaborative relationships with all ISTs. With ever escalating demands on elite athletes, sports psychiatrists are another resource to enhance performance of the elite athlete on the international sporting stage. ∆ For references, click here

This case illustrates how a sport psychiatrist can make a difference not only in treatment decisions that benefit the athlete, but also diagnose problems the average physician can tend to overlook. This not only allows for optimum treatments, which all athletes’ deserve, but enhances the performance of the elite athlete.


Dr. Saul Marks holds a lectureship in the Faculty of Medicine, Health and Disease, Department of Psychiatry, at the University of Toronto. He has a special interest in Sport Psychiatry and is a member of the Executive Board of the International Society for Sport Psychiatry. He is the Honorary Secretary of the FINA Sports Medicine Committee and on the Therapeutic Use Exemption Committee for the CCES.

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Stay Informed with SIRC Where Can I Find...

After watching the London 2012 Olympics this past summer and seeing a lot of the athletes using kinesio tape, I was curious to know if kinesio taping actually improves and/or prevents injuries? Would you have any articles on topic? Kenso Kase, a Japanese chiropractor was the first to develop kinesio taping (KT) in the 1970s as a way of assisting the physical treatment of damaged tissue while maintaining full range of motion; unlike traditional methods of taping which restrict movement. Over the years many famous athletes have been seen wearing the tape and with the London 2012 Olympics, their popularity has sky rocketed. Read more

Dear SIRC...

New Books @ SIRC

There seems to be a lot of information on periodization for individual athletes and not as much information on training programs for teams. I am particularly interested to know if you have any articles that deal with the competition phase of periodization and team sports. Any help you can give would be great.

Burkett, Brendan (2010). Sport Mechanics for Coaches. Champaign, IL: Human Kinetics.

Findlay, Susam (2010). Sports Massage. Champaign, IL: Human Kinetics.

Periodization provides a structure for the training and competitive season with the goal being to optimize the training for a particular sport. The competition phase for team sports can vary greatly depending on the strength of the opposition, the amount of time between games and the game location.

Huber, Jeffrey J. (2013) Applying Educational Psychology in Coaching Athletes. Champaign, IL: Human Kinetics.

Read more

Skolnik, Heidi, and Chernus, Andrea. (2010) Nutrient Timing for Peak Performances. Champaign, IL: Human Kinetics.

Did you know... In most studies, tapering has been shown to result in a performance improvement of 2-4 %

Tanner, Rebecca K., and Gore, Christopher J. (Eds.) (2013). Physiological Tests for Elite Athletes. 2nd ed. Champaign, IL: Human Kinetics.

Read Article


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Calendar For more events, check out the SIRC Conference Calendar.

January 2013 30-31

The 2013 Canadian Sport for Life National Summit Jan 30-31, 2013 Gatineau, QC

February 2013 21-24

13th STMS World Congress of Tennis Medicine Buenos Aires, Argentina


II Conference on Communication and Sports University of Coimbra, Portugal

26March 3

18th International Hypoxia Symposium Lake Louise, Alberta

March 2013 1-3 2-5

14-15 19-21 26-29

MIT Sloan Sports Analytics Conference Boston, MA

IV International Congress on Sports Medicine, Exercise Science, Physical Education and Sports Madgaon, GOA, India Tackling Doping in Sport 2013 Twickenham Stadium, London

The Biomedical Basis of Elite Performance London, United Kingdom

International Conference on Sports and Exercise Science Bangkok, Thailand

April 2013 1-6


13-14 17-21

International Sport Science Online (Web-base) Conference MalĂŠ, Maldives

2013 International Association of Physical Education and Sport for Girls and Women (IAPESGW): Physical Education and Sport - Promoting Gender Equity Conference Havana, Cuba 42nd Annual Sports Medicine Symposium Boston, MA

2013 American Medical Society for Sports Medicine 22nd Annual Meeting San Diego, California


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Recommended Readings from SIRC When 30,000 articles cross your desk each year, you start to notice trends as well as the research that seems particularly strategic. We are pleased to highlight some of the key articles in various topics that have attracted our attention.



Respiratory physiology: adaptations to high-level exercise. McKenzie, D. C. (2012). British Journal Of Sports Medicine, 46(6), 381-384.

Skin Manifestations of Athletes Competing in the Summer Olympics. De Luca, J. F., Adams, B. B., & Yosipovitch, G. (2012). Sports Medicine, 42(5), 399-413.

Strength Training for Athletes: Does It Really Help Sports Performance? McGuigan, M. R., Wright, G. A., & Fleck, S. J. (2012). International Journal Of Sports Physiology & Performance, 7(1), 2-5.



Adaptation Processes Affecting Performance in Elite Sport. Schinke, R. J., Battochio, R. C., Dube, T. V., Lidor, R., Tenenbaum, G., & Lane, A. M. (2012). Journal Of Clinical Sport Psychology, 6(2), 180-195.

How Do Coaches Experience Psychological Momentum? A Qualitative Study of Female Elite Handball Teams. Moesch, K., & Apitzsch, E. (2012). Sport Psychologist, 26(3), 435-453.

Perfectionism and Athlete Burnout in Junior Elite Athletes: The Mediating Role of Motivation Regulations. Appleton, P. R., & Hill, A. P. (2012). Journal Of Clinical Sport Psychology, 6(2), 129145. Perfectionistic Profiles Among Elite Athletes and Differences in Their Motivational Orientations. Gucciardi, D. F., Mahoney, J., Jalleh, G., Donovan, R. J., & Parkes, J. (2012). Journal Of Sport & Exercise Psychology, 34(2), 159-183. The Role of Reflection in Sport Expertise. Jonker, L., Elferink-Gemser, M. T., de Roos, I. M., & Visscher, C. (2012). Sport Psychologist, 26(2), 224-242.

Transcontextual Development of Motivation in Sport Injury Prevention Among Elite Athletes. King-Chung Chan, D., & Hagger, M. S. (2012). Journal Of Sport & Exercise Psychology, 34(5), 661-682.


The Value of Emotional Intelligence for High Performance Coaching. O’Neil, D. A. (2011). International Journal Of Sports Science & Coaching, 6(3), 329-332.

PERIODIZATION Periodization Paradigms in the 21st Century: Evidence-Led or Tradition-Driven? Kiely, J. (2012). International Journal Of Sports Physiology & Performance, 7(3), 242-250. Case Study: Nutrition and Training Periodization in Three Elite Marathon Runners. Stellingwerff, T. (2012). International Journal Of Sport Nutrition & Exercise Metabolism, 22(5), 392-400.

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The IST Journal Club The goal of the IST Journal Club is to share ‘must reads’ on cutting edge performance based applications, training/competition variables, and proactive medical interventions, selected by performance service experts representing various professional disciplines associated with Integrated Support Teams.

Preventing motor skill failure through hemisphere-specific priming: Case from choking under pressure.

Beckmann, J., Groepel, P, & Ehrlenspiel, F. (2012) Journal of Experimental Psychology: General, online September.

Commentary by Dr. Judy Goss Some athletes may improve performance under pressure by simply squeezing a ball or clenching their left hand before competition. Is this actually true? In three experiments with soccer and badminton players and judo experts, researchers tested the athlete’s skills during practice and then in stressful competitions before a large crowd or video camera. Righthanded athletes who squeezed a ball in their left hand before competing were less likely to choke under pressure than right-handed players who squeezed a ball in their right hand. The concept behind this experiment is that for skilled performers many movements have become so automatic with no real conscious thought. When the athlete is under pressure, the tendency is to think more about their own movements rather than relying on the years of motor skill development. Thinking too much can interfere with the performance of the task. Thinking or rumination is associated with the brain’s left hemisphere while the right hemisphere is associated with performance of automatic behaviours. So squeezing the ball with the left hand, activates the right hemisphere and reduces the likelihood of performance impairment. The researchers do indicate that ball squeezing probably won’t help performances based on strength or stamina. The effects apply more to those athletes whose performance

is based on accuracy and complex body movements. Also this research was only conducted on right-handed athletes. ∆

A scientific nutrition strategy improves time trial performance by ≈6% when compared with a self-chosen nutrition strategy in trained cyclists: a randomized cross-over study.

Hottenrott, K., Hass, E., Kraus, M., Neumann, G., Steiner,M., & Knechtle, B.(2012). Applied Physiology, Nutrition, and Metabolism,37, 637–645.

Commentary by Heather Hynes This research article describes how a scientific nutrition feeding protocol can have a direct impact on endurance cycling performance. The purpose of the study was to compare an athlete’s self-chosen nutritional intake to a scientific feeding schedule and whether these differing nutrition strategies would impact time trial performance. In order to highlight the importance of exogenous carbohydrate feeding, a 2.5 hour endurance cycle at 70% VO2 max preceded the 40 mile time trial. The research and guidelines for endurance feeding are presented and are used to develop the scientific feeding protocol. The self-chosen feeding strategy is recorded by each participant prior to the start of the exercise trials to ensure that their individual strategies were not affected by the scientific trial. The performance differences in this randomized cross-over design were significant. The scientific feeding protocol resulted in a significantly faster time trial performance (128 min vs. 136 min) and a significantly higher power output (212 ± 36 W vs. 184 ± 34 W) compared to the selfchosen feeding protocol. The article 33

provides a full description of the scientific feeding strategy used which can be very useful when working with endurance athletes in the daily training environment. ∆

Sensor fusion: let’s enhance the performance of performance enhancement.

Lee, J.B., Ohgi, Y., and James, D.A. (2012). 9th Conference of the International Sports Engineering Association. Procedia Engineering, 34, 795-800.

Commentary by Allan Wrigley This article is particularly relevant considering the proliferation of commercially available inertial sensor technologies available for coaches, athletes, and sport scientists for use in the daily training environment. A strong argument and rationale is developed for the fusion of these inertial sensor devices with video to ensure that the appropriate information is delivered, interpreted, and applied in a manner that allows for increased rates of performance improvement. People will respond to visual information that they can relate to, and often inertial sensor data just seems like a jumble of numbers or a bunch of jagged lines. By having a visual record of the performance along with the measurements, you are able to get quantitative assessments of the action as well as the ability to relate these measurements back to the performance, which ultimately facilitates learning. A number of interesting examples are presented relating to cricket, Australian Rules football, swimming, and post-injury rehabilitation. Although this is a highly technical area, the article is written as to appeal to a broader audience and highlight the implications for the high performance training and competition environments. ∆

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For more information Pour plus d’information


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Interactive magazine designed with high performance coaches in mind

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Interactive magazine designed with high performance coaches in mind