How Sport Psychology Can Improve Your Game

How many times have we seen elite athletes making unexpected mistakes when under pressure? Why is it that playing the last point of a tennis match feels so different than playing the first one? How come a golf swing is so free of thoughts and trusting in the driving range, but tentative when on the golf course?

Regardless of how good we are at any sport, we intend to do our best based on our given talent and expertise. Whether you compete to win or to have fun, there is an inherent emotional component that goes beyond our skill and knowledge of the game. When we compete, there is a desire and hope that the achieved outcome proves our true talent. However, when a desired outcome is on the line, our talent alone may not necessarily prove our worth. Emotions play a huge role in performance. So much so that elite athletes come to understand that to consistently achieve their best, they need to incorporate skills that will help them manage typical emotional pressure situations that are an integral part of competition.

Sport psychology is normally synonymous with helping athletes achieve their peak performance. However, its scope goes beyond that. It includes supporting coach-athlete relationships and addressing a variety of performance symptoms, such as: eating disorders, anger management, and substance abuse. It also conducts research to better understand triggers that lead to performance improvement.

There are typically three different mental strategies that athletes learn to use to help them navigate pressure situations: self-talk, breathing relaxation, and imagery.


It refers to the use of powered words for the purpose of generating self-motivation, increasing focus, breaking bad habits and enhancing confidence. Powered words are positive short expressions expressed in the present tense that are easy to remember and are intended to generate positive momentum. The use of powered words serves to re-direct thoughts so athletes remain focused on the task at hand rather than being overly concerned with a prior or future event. Because thoughts are not isolated from emotions, they lead to emotional responses that can either increase focus or create distractions.

Athletes may approach a game having negative or positive thoughts even before competition starts. The athlete may be facing a known opponent and is already feeling optimistic or pessimistic; he/she may have fearful thoughts about losing as he/she wants to win in order to move up in his/her rankings. There are limitless counts of thoughts that cross the athlete’s mind at any moment. The key is to be aware of those thoughts and make sure that positive ones are repeated. Some of the most common self-talk words are: let’s go, strong and powerful, now, effortless speed or easy does it.

Some athletes claim that negative self-talk can enhance performance. This technique may be effective if only used on a limited basis as it will eventually undermine the athlete’s confidence. It was also found that Asian athletes tend to use more negative self-talk than European athletes. Cultural background may play a role on self-talk effectiveness as its interpretation may be more important than the nature or content of the self-talk per say.

Breathing relaxation

The quality of our breathing is immediately affected by our emotions. If the athlete approaches a nervous situation, the breathing will speed up; if the athlete feels fear, the breath will slow down. The breath will immediately respond to the environment. In fact, the breathing will respond quicker than our thoughts. Hence, it is important that awareness is placed to how the athlete is breathing.

Breathing in and holding your breath increases muscle tension whereas breathing out decreases it. Learning proper breathing can surely help athlete release tension, especially is they are performing a physically rigorous exercise. It is quite common that basketball players take a deep exhale right before shooting a free throw. It helps them release any extra tension that their bodies may be holding in.

Diaphragm breathing relaxation is one of the most common exercises for the purpose of regulating emotions and breathing patterns. The exercise consists in inhaling through our nose while noticing how our belly expands outwards. Then, exhale through the nose and repeat the process again. The key is to bring awareness of the breathing pattern and, if necessary, make quick adjustments to make sure it is done by relaxing the diaphragm. Under pressure situations, it is very common that the breathing will change. However, diaphragm breathing is connected to a nervous system that triggers calmness, hence it is quite useful and practical for any athlete to know how to use.


Imagery is bringing to mind a picture of an ideal performance and see it to is completion in order to mentally program the sought after result athletes want to accomplish. The brain has a way of directing physiological and biological responses by visualizing it. Some professionals call it mental rehearsal. In essence, the brain has the capacity to respond to what it is being instructed to do if it is done on a repeated basis and having complete trust.

Imagery is commonly used by skier and golfers. Skiers run through their minds the visual image of how exactly their bodies will react as they approach and exit each gate. They feel it in their bodies, legs, arms, shoulders; they feel their heart beat pumping a bit faster as if they were really racing. By imagining the race, the body is mentally rehearsing each move and will become more responsive by the time the race takes place. Jack Nicklaus was very committed to visualizing each one of his shots. He pictured the exact trajectory of the ball and imagined how his body would move to execute such a shot.

Imagery is a very powerful mental strategy. It provides a great source of confidence, self-motivation and high self-esteem. It elevates the athletes’ self-belief and improvement in concentration. Commitment toward practicing it is very important, but even more important is having the awareness that, if fear or self-doubt creep in, the positive image stays until the action is positively and successfully done.

Sport psychology has wonderful benefits to help athletes reach their peak performance. It brings mental comping skills to help them manage pressure situations so they can successfully navigate stressors. Strategies learned in sport psychology are also very practical as life skills. Concentration, mental toughness, focus and tenacity are attributes that go beyond athletism. It also wonderfully serves in academics, work, and family life. A truly useful skill to learn!

Alex Diaz, PhD

Sports Mental Edge

Healing Heels

Plantar fasciitis is hard to escape these days. The most common cause of heel pain, it is easily the most common type of musculoskeletal sports injury I see in the office. Whether you’re Peyton Manning, an ultra marathoner, or a weekend warrior, it seems to affect people of all age groups, activity levels, gender, race, size and shape. It can be a quite debilitating injury with long delays in returning to your activity of choice. It can many times be stubborn and resistant to many conventional treatments. First line treatments often include targeted stretching and strengthening exercises, rest, icing, support for the fascia (in terms of strappings or orthotics), and many times we will add anti-inflammatory measures such as oral medications, topical medications, or steroid injections. Many times, these methods go a long way in relieving symptoms. Previously, when these treatment methods failed, the final resort would be surgery. However, more advanced pre-surgical treatments have become available including extra corporeal shock waver therapy, MLS laser therapy, PRP injections, and the FAST procedure.

Briefly and simply stated, the plantar fascia is a structure on the bottom (plantar surface) of the foot which originates on the heel bone, and runs along the arch of the foot, eventually splitting and sending slips to all five toes. The purpose of the plantar fascia is to help maintain the arch of the foot. Fascia is a tough tissue with some elasticity (picture a tendon rolled flat into a sheet). There are three main bands of the plantar fascia, and it Picture 1seems to be the medial band (and sometimes the medial portion of the central band) closer to the inside of the foot which causes all the problems. Leading theories believe that the fascia undergoes a series of micro traumas resulting in small tears, usually close to its bony origin (aka enthesis). Due to a notoriously poor blood supply, these tears usually heal with fibrous (scar) tissue which is denser and less elastic than the fascia is meant to me, and leads to pain in the heel. This pain usually starts as pain after periods of res, especially in the morning, but as the condition becomes more chronic, pain can occur throughout the day with increased activity.

Extra corporeal Shockwave therapy: So the name may sound a bit medieval, but this is a non-invasive therapy used for treating various musculoskeletal conditions and has been studied to have a positive benefit for plantar fasciitis. There are two forms of ECSWT, high energy and low energy. The high energy machine is used less often these days, and typically needed a local anesthetic block to avoid discomfort. Most practitioners will use low energy therapy in their office, also known as EPAT (or extracorporeal pulse activation technology). Essentially, the machine has a hand held device which creates an acoustic pressure wave which stimulates local metabolism, increased blood flow and anti- inflammatory factors. I often explain to patients that it’s sort of like tricking the body into thinking there is an injury somewhere that the body is then forced to try and heal, and helps incorporates the body’s own healing response. Patients usually undergo 3-5 treatments about a week apart. There are no real side effects (although there can be some discomfort during or after treatment), and there are typically no activity restrictions.

Picture 2MLS Laser: Cold lasers or pain lasers have been in use for a while. New pain lasers (class IV lasers) are now used to treat a variety of musculoskeletal conditions. Essentially, the MLS laser uses specific wavelengths of light that have strong anti-inflammatory and pain reducing effect on tissues that are exposed to the laser. Painful conditions accompanied by swelling or inflammation benefit the most. Photons of laser energy penetrate deeply into tissues and accelerate cellular reproduction and growth (it is believed the laser increases the amount of ATP available to cells, essentially the cellular “energy currency”). The goal is to decrease inflammation and increase healing time. The laser has no known negative side effects, although patients are asked to wear protective eyewear during the treatment. Typically, patients will have 6-10 laser therapy sessions.

Picture 3Protein Rich Plasma (PRP) Therapy: This minimally invasive treatment method has gained a lot of traction in sports medicine in recent years. Again, tissues like the plantar fascia and many tendons and ligaments, have a poor blood supply. In PRP therapy, your own blood is drawn, and then placed in a centrifuge. The centrifuge separates the blood into several component layers, one of which is the PRP layer which contains an aggregate of healing factors. The PRP is then placed in n syringe and is injected back into an area of poor blood supply, in an effort to ramp up the body’s natural healing mechanism. The procedure can be done in the office or operating room. Most patients will wear a Cam walker for some time after the procedure (typically 2-3 weeks)

Picture 4The Fast procedure from Tenex Health: The last minimally invasive technique to discuss is one of the newest, the Fast procedure. Again, due to a poor blood supply, as the micro-tears in the fascia heal, they leave behind thickened, fibrous, scar tissue. Using ultrasound imaging, we are able to identify the exact area of diseased (thickened) tissue. A micro-incision is then made, and a specialized probe is inserted through the incision, and uses ultrasonic energy to precisely break down and remove only diseased tissue without disturbing healthy tissue. This selectivity is a huge benefit of the procedure, along with the minimal incision and recovery time. Most patients will wear a protective boot for several weeks after the procedure.

Picture 5So, if you’re suffering from a stubborn case of plantar fasciitis, that has not responded to more conventional treatments, don’t feel discourage. There are several advances in technology that will put you back to your desired activity quicker than you think.

Don’t Get Hurt This Winter

Winter is upon us, and so is the increased risk of injury from shoveling snow and falling on ice. Being mindful of some very basic concepts can help to significantly reduce these prevalent, yet often preventable, injuries.
According to the American Academy of Orthopedic Surgeons, in 2014, over 200,000 people were treated for snow shoveling and ice removal injuries in emergency rooms, clinics and doctors’ offices. Sprains/strains, particularly in the back and shoulders, and herniated discs are among the most common snow shoveling injuries. Other risks are exhaustion, dehydration and heart attacks

Here are some basic tips to minimize the risk of injury while shoveling snow:

  • Warm up! Think of snow shoveling as any other form of exercise. It is always important to warm up for at least 10 minutes with dynamic stretching and light calisthenics. When done correctly, snow shoveling can actually be a great workout. Take advantage of the opportunity, but do it safely.
  • Stay hydrated.
  • Take breaks when feeling tired.
  • Use a shovel that is comfortable and not too heavy. Space your hands to increase leverage.
  • Push the snow instead of lifting when possible.
  • When lifting is unavoidable, lift small loads instead of loading up the shovel. It is helpful to get out early and shovel in multiple shifts while the snow is still light. This may be inconvenient, but think of it as more time for precious physical activity with less strain on your back.
  • Lift correctly with good technique. Do not bend the lumbar spine forward while lifting. Instead, keep the spine straight and hinge/bend at the hips. The knees will naturally bend as well, but greatest amount of bending should be at the hips. The gluteal muscles are powerful and designed to handle higher amounts of stress, so use them!
  • After lifting the small amount of light snow, walk it to where you want to dump it keeping the spine straight and shoulders squared. Avoid twisting and throwing the snow, as in throwing over the shoulder. Also avoid holding the arms out too far in front of you while holding weight. Try to keep the elbows as close to your trunk as possible, as this will minimize stress on the spine and shoulders.
  • Wear appropriate shoes with slip resistant rubber treads or spikes, and appropriate clothing to keep warm and dry.
  • If at any point you experience chest pain, shortness of breath or any other symptoms of heart attack, stop immediately, call 911 and seek emergency care.
  • If you have a history of heart disease or are at risk, consult a physician before attempting any vigorous exercise.

Slip and fall injuries are another common occurrence which can have serious consequences. These injuries can result in sprain/strains, fractures, bruising, brain and spinal cord injury. Statistics show that the majority of these injuries occur in parking lots. The most important measure one can take, besides avoiding walking on ice/snow all together, is to wear proper shoes. Insulated and water resistant boots with slip-resistant rubber treads are the best option for walking on icy or snowy ground. Over-shoes with rubber or spiked treads placed on regular dress shoes are another helpful option. Keeping an extra pair in the car or at work just in case of an unexpected storm is not a bad idea. You can never be too prepared.

Enjoy the winter, but most of all stay healthy and safe!

Robert Inesta, DC, L.Ac, CCSP

Knee Ligament Injuries in Skiers and Snowboarders

Rick Weinstein, MD, MBA
Director of Orthopedic Surgery Westchester Health Associates

As of the writing of this article in mid-January, New York has had almost no snow. Despite this, I have already seen several injured snowboarders come to my office. Snow enthusiasts are willing to travel out West or North to find powder. However, when conditions are bad on the mountains, injuries are much more common. This has to do with the sudden starts and stops that occur when snow quality is not ideal. While gliding on snow, when you suddenly hit a brown patch, your body continues forward and your skis and feet stop. The force of your body weight and forward momentum will all go through your knees, hips or lower back. If your knee is pointed to the side and you pivot on it with the sudden stoppage, you can tear your ACL or MCL.

The anterior cruciate ligament (ACL) connects the femur bone above the knee to the tibia bone below the knee. We often hear about this ligament because when it is completely torn, it never heals. Athletes, or even non-athletes, who want to go back to pivoting activities will need this ligament reconstructed. The medial collateral ligament (MCL) also connects the femur and tibia but is on the inside part of the leg. This ligament is even more commonly torn and sprained than the ACL, but unlike the ACL, when it tears, it will heal without surgery.

Surgery for the ACL takes typically 1-2 hours when done by an experienced surgeon, but the recovery is at least 6 months to return to sports. My best advice is not to get hurt! Prevent the injuries by making sure that before you hit the mountain you are in good enough shape. For weeks to months before going, your quads and hamstrings need to be strengthened, as does your core. It is extremely important to make stretching part of your routine and to warm up before you actually head down the mountain.

In this winter of warm to cold days, you need to know the condition of the mountain you are skiing on. Look out for the brown patches, but also be cognizant that the snow may freeze suddenly and become very icy, especially at the higher altitudes. Check conditions of the trails you are going to go down. Most injuries occur at the end of the day when your muscles are fatigued, so if your legs are feeling tired give yourself a break or stop for the day so you don’t end up stopping for the entire season. If you do get hurt, immediately put ice on the injury. If you suspect a fracture, get an x-ray ASAP. If it is a possible ligament injury, call me or your local orthopedic sports specialist and get it checked out. In my practice, I see emergencies the same day, and you should expect the same treatment from your sports doctor.

Don’t Be Toxic

Toxins in our environment often contribute to weight issues and to the increasing obesity epidemic in our society. Obesity is not just controlled by calories in vs. calories out.
In order to have a healthy metabolism, we need to eliminate toxins and heavy metals from our diets and boost the natural detoxification system in our bodies.

Toxins, which are broadly described as substances that don’t agree with us, are commonly viewed as poisons and contaminants. They are present both internally and externally. Even the healthiest among us are surrounded by toxins and have toxins in their bodies. Some toxins come from the environment and include chemicals and heavy metals (lead, mercury, cadmium, etc). Toxins are also internal byproducts of metabolism and normal bodily functions. All toxins are processed in the body by the liver and kidneys.

High levels of toxins can lead to increased inflammation in the body and cause oxidative stress. Since toxins are stored in body tissues, people with more body fat carry more toxins in their bodies. This may affect their liver and kidneys as well as damage the mitochondria, which are responsible for burning energy. Additionally, toxins in the body lead to lower thyroid hormone levels, which affects metabolism. Toxic metals can also block leptin, which is the hormone that tells your body that it is full.

Since it is impossible to avoid toxins completely, it is important to try and limit exposure as much as possible. Drinking clean, filtered water and eating organic foods are two important ways to reduce toxins. Engaging in regular exercise and drinking plenty of water help to naturally detoxify our bodies. Certain foods can also help the detoxifying process. Glutathione is the most important antioxidant and detoxifier in the body. It is important to get adequate glutathione, which comes from proteins, such as fish, poultry and meat. Other foods known to help the process are garlic, artichokes, green tea, cruciferous vegetables, cilantro and pomegranate. There are many supplements on the market that help with detoxification as well, such as NAC, alpha-lipoic acid, pycnogenol, quercitin, and probiotics. Detoxification cleanses also help to reboot your liver, kidney, and metabolism, leading to a less toxic body.

Power Plate

Power Plate equipment is a vibration device for wellness and performance for all ages, lifestyles and physical abilities. It stimulates the body’s natural response to vibration. These vibrations transmit waves of energy throughout the body, activating muscle contractions between 25 and 50 times per second, enhancing overall performance in sessions as short as 15 minutes a day, 3 times a week.

The Power Plate offers a wide range of benefits, ranging from an immediate improvement in blood circulation, to a variety of other measurable outcomes: such as increased muscle strength and flexibility, improved range of motion, decreased cellulite, increased bone mineral density, reduced pain and soreness and faster recovery. This has been proven in extensive academic and independent scientific medical research.