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Ask Doctor Hannah

11/13/2019, 6:30pm CST
By Breanna Simon-Seibel

How can you best warm up? What should you eat? Why does my back hurt?

Dr. Hannah Dickman is a former Division 1 athlete turned doctor and business owner. Dr. Hannah founded The Girlie Project in 2019 as a way to empower girls and women and to help them feel better. Specifically, Dr. Hannah has a passion for working with female athletes. Her mission is to educate girls and women on how to get out of pain, move properly and eat well in a way that is specific to females.

For this article, I collaborated with Dr. Hannah to have your anonymously submitted questions answered. We also need to offer Dr. Hannah a huge “thank you” for taking time out of her day to help educate female athletes! As always, be sure to consult your physician before making any changes!

What are some good warm up exercises?  

There are a few key aspects that make for a solid warm-up. With hockey players, I encourage incorporating a warm up before putting equipment on – ideally 15-20-minutes before stepping on the ice.

First, I encourage athletes to utilize a foam roller (or a rolling stick) on muscle groups that will be heavily utilized during performance to increase mobility and improve fascial glide. For hockey players think quads, hamstrings, glutes or calves based on where you feel the most restricted, or “tight”. Don’t go crazy with it - pick ONE muscle group, maybe two, and spend 20 seconds per side for said muscle group.

Next, we want to incorporate some dynamic stretching. Again, we don’t want to go crazy as over-stretching (more specifically, static stretching) can lead to decreased performance and can even increase risk for injury. I recommend an oscillating kneeling lunge. This may sound easy but it’s the number one stretch I see performed incorrectly.

KEY POINTS when performing a kneeling lunge – lunge forward and drop that back knee to the ground. The femur, of the knee on the ground, should be completely perpendicular to the ground, while the other leg should form a 90-degree angle. Next, tuck your pelvis, contract your abdominal muscles, contract your glutes, then translate your weight forward (towards that foot on the ground) about 1-2 inches. You should feel a nice stretch in the front part of your hip. If you don’t feel the stretch, be sure your pelvis is tucked, you are contracting your glutes and not over-arching your back. Then oscillate at that end range of motion, about three times, return to the starting position and repeat for 30 seconds each side.

Next we want to cue those muscles we are about to be using. There are three exercises I recommend.

1. Single-leg glute bridges. KEY POINTS: lie on your back with your knees bent and feet flat on the floor, imagine a towel under the arch of your back and tilt your pelvis back as if you are smashing that towel into the ground (now spine should now be flat on the floor aka “neutral”), contract your abs, contract your glutes, raise one foot off of the floor, and use your glutes to drive through your heel to raise your buttock off the ground. Hold for a second at the top and then slowly lower back to the ground. Be sure to maintain that neutral spine while continuing to contract abs and glutes. Also, your abs/pelvis should remain level while going through this motion and there should be no rotation – if you had a puck on your bellybutton it should not slide-off during this exercise. Perform 10 times per leg.

2. Walking lunges. Use the same technique as performing the previous kneeling lunge (contract glutes/abs, don’t overarch back), just put it into motion. Perform 10 each side.

 

3. Squat jumps. Focus on getting low, while maintaining a neutral spine, then exploding through the heels and jumping as high as you can with a soft land. Perform 10.

Warm up example at a glance:

  1. Foam roll quads – 20 seconds each side
  2. Kneeling lunge – 30 seconds each side
  3. Single-leg glute bridge – 10 each side
  4. Walking lunge – 10 each side
  5. Squat jumps – 10

How do I get rid of lower back soreness from after a hockey game?

Preventing low back soreness after a game really comes down to figuring out why the pain is occurring in the first place. There is a good chance this could be due to movement pattern dysfunction, but there could be more going on. So, my first recommendation would to be to get evaluated to determine what is causing the pain. If it is strictly muscle soreness there are three biggies I always incorporate to prevent, or rid, low back pain.

1. Breathing. We want to make sure we are breathing properly! Proper breathing dynamics means breathing with our diaphragm and not our chest. A good way to practice proper breathing technique is to lie flat on your back, put your feet up on a chair so that your hips are flexed 90-degrees and your knees are flexed 90-degrees, place one hand on your chest and one hand on your stomach, brace your abs and take a deep breath in. During this breathe the hand on your chest should not move at all while the hand on your stomach should rise towards the ceiling. You should feel air fill your abdominal cavity 360-degrees, so you should feel your belly expanding forward, out to the sides and into the ground. Imagine having a belt tied around your belly and it expanding in all directions.

2. Strengthen abs. This can be achieved through a number of exercises. My go-tos include planks, dead bugs and bird dogs. My favorite plank variation is performing an elbow plank on an exercise ball while “stirring the pot” (moving your arms in a clockwise motion, then in a counter-clockwise motion).

3. Control your pelvis. Being able to control the motion of your pelvis is key in preventing low back pain. To do this lie on your back with your knees bent and feet flat on the floor, place a towel under the arch of your back, contract your abs, and rotate your pelvis back smashing the towel into the ground, hold for 3 seconds, then relax. Perform for 3 sets of 10 reps.

What exercises or preventative measures should girls do to prevent concussions in hockey?

Increasing neck strength can have a positive effect in preventing concussions. Here are two exercises every team should be incorporating into dry land work.

1. Lie on your back with knees bent and feet flat on the floor. Retract your chin back slightly – you’re doing this right if you have a nice double-chin after retraction! Then raise your head about 1 inch off the ground – no higher. Hold this position for as long as you can without your chin jutting forward (breaking the double chin). This is a difficult exercise to hold If you have never done it before. So start with 10 seconds holds then rest. The ultimate goal is to be able to hold this retracted chin for 2 minutes. Once that is achieved, do it with your helmet on! Then work towards being able to hold this exercise for 2 minutes with your helmet.

2. Get into a quadraped position (hands and knees on floor), make sure you have a neutral spine and retract your chin creating a nice double-chin. Hold that position for 3s and release. Repeat for 3 sets of 10 reps. Once this is easy, you can progress this exercise by adding rotation after the chin retraction. So, retract chin, look to left shoulder, pause, rotate back to looking at the ground, relax. Perform 5 reps each side for 3 sets.

My daughter has been experiencing growing pains. She plays a hockey, soccer and runs cross country. With her growing so fast does she need to stretch more and eat more protein to help in the growing development? Should she also take more than just a multi vitamin daily?

First, growing should not be painful. There is no evidence to show that growing is painful so this may be something to keep an eye on. It’s time to see a doctor when these pains continue to persist, are present constantly (even upon waking up) and if they are located at the joints. However, with the amount of activity going on I could see where pain could arise whether it’s overuse, delayed onset muscle soreness or dysfunctional movement patterns leading to pain. It is a great idea to incorporate a solid warm-up routine before every practice/game/workout like the one discussed in question one. Also incorporating more protein into her diet (and calories in general) could be beneficial –growing children need adequate calories and also nutritious, whole-foods! However, even with nutritious whole foods, the reality is we don’t get enough nutrients and vitamins from our food. So, along with a multi-vitamin I recommend a good fish oil, vitamin D and a fruits and greens powder at minimum. These supplements need to be from a GMP registered company, organic and non-GMO. The effects of supplement lie in the quality. So, find a practitioner who can help you get pharmaceutical grade supplements (you can email drhannah@thegirlieproject.com for further questions). Be sure to speak with your primary care physician before trying any new supplements.  


Do you have any suggestions for an iron deficient female athlete? I get so tired. I've tried iron infusions and iron pills but they make me feel sick. I have very heavy periods.

This is a tough one without labs and more information. If it simply is low iron, I would try a multivitamin that has iron – may be easier to handle than strict iron pills. Also, take your iron with Vitamin C. Vitamin C increases the absorption of iron so think of taking it with some broccoli, kale, bell peppers or other foods high in vitamin C. However, my number one suggestion is to get evaluated. What catches my attention are the heavy periods – this could be normal for you but it could also be PCOS, endometriosis or something else more serious going on. So, get it checked and find the root of the problem. 


What can I eat in between periods? What can I do to boost energy on days with two games?

Having energy for a full day of hockey requires proper nutrition throughout the entire day. Start by eating real, whole foods 1-2 hours prior to game-time and including a complex carb like a sweet potato, brown rice or oats as well as a solid protein like eggs, chicken or grass-fed beef. Before puck drop, and between periods, you need energy NOW. So the best way to do this is by ingesting fast acting carbs along with a liquid form of protein. This can be achieved by having a banana with some nut butter and a protein shake. After a game, and before the next, it is important to replenish energy stores that were lost through performance, so get a meal in shortly after. This meal should have a carb, a protein and a healthy fat (I recommend a heavier meal if you have a good amount of time between games). Also, don’t underestimate the power of being properly hydrated! Be sure you are drinking enough water leading up to game time and throughout the game. Caffeine can also help with energy. I recommend a more natural source such as coffee over an energy drink. It is smart to consult your doctor before experimenting with caffeine during performance.


Why does my SI (sacroiliac) joint constantly get locked and crack?

It is hard to say without a proper evaluation, so I definitely recommend getting this checked out as it could be a simple fix after evaluating you and your movement patterns. However, often times I have patients who feel like their SIJ is gets “stuck” and they can feel it “pop out of place”. Intuitively they think they need to stretch it and get more motion to the joint. However, it is almost always the opposite! This bad boy needs stability and focusing on firing, and strengthening, your core, pelvic floor and glutes will be key. Some things I recommend for stabilizing the SIJ are proper breathing technique (refer to question 2 for breath work), marching glute bridges, and clam shells to start. If these stabilizing exercises don’t cut it, or mobility feels like the real need, focus on dynamic stretches that target your hamstrings (back of thigh), adductors (inside of thigh), hip flexors (front of hip), and a little guy called piriformis (deep to the glutes).


I had no idea that I could eat for my period or that I should be training differently on my period. What does that even mean? What should I be doing differently?

This is a loaded question as there is so much you can do! The key to this is first understanding your cycle. You need to know when you’re in your follicular phase, when you are ovulating, and when you are in your luteal phase. Once that is understood then you can create a nutrition and training plan around your cycle! For example, during your follicular phase, is when you should be lifting heavy things, training hard and going for your PRs. When you are ovulating, and estrogen is high, you are at higher risk for injury due to tendon and ligament laxity. Then your luteal phase is a good time to mix in a rest day or mix in a yoga session as you may notice strength is down as your body is preparing for a potential pregnancy. Again, this is a heavy question so follow me on Instagram (@hannahdickman) as I plan on dive deeper into each of these topics in the coming weeks!


I am a coach and work with high school aged girls. What can I tell about nutrition? It seems that they do not care enough to eat healthy and don’t realize how much their nutrition really does impact their play?

Through working with high school athletes in my office, and as a high school lacrosse coach myself, this is something I struggle with regularly. The best way you can help them is to tell them all the things they can eat, not the things they can’t. I’ve found success with this through creating lists of healthy carbs, fats and proteins and telling them to pick one thing from each category every meal. I also give high-schoolers, or younger athletes, guidelines like “two treats per day”, where they eat from their list most of the day then can have a cookie or a slice of pizza. Lastly, I always say, after a practice or game, “eat something that’s good for you! - Something that is good for you body (a healthy meal) and something that is good for your soul (treat)” I find my girls respond well to this and will get in a good meal yet don’t feel restricted because they can “treat” themselves.


How much does drinking alcohol really affect me and my training?

Like anything in health and wellness, it depends on your goals and how serious you are about training. Alcohol can cause a whole slew of issues when it comes to training and performance. It will affect your body composition, your strength, your performance, your recovery and really your overall health. Short-term alcohol can cause dehydration (and also hangovers), which would not allow you to perform your best. Bigger picture, the way alcohol is broken down takes away from the production of other nutrients that give you energy. Basically, when you consume alcohol, your body has to get rid of it, so when it starts to break that alcohol down you are not able to make as much glucose and glucose is what you need for energy to perform! At the end of the day alcohol is a toxin - our bodies don’t want it! So it will prioritize getting rid of it which can lead to a decrease in burning fat (aka weight gain) and decreased nutrient absorption. Alcohol can also affect your hormones, preventing you from gaining muscle size and strength. If you’re someone who wants to go on to play D1 hockey, I would avoid the alcohol, period. If you just want to play well during season, avoid alcohol in season if you can and definitely the day before. Consuming alcohol while training can be manageable but bottom line is you will never be as good as you would with zero alcohol.


What are your thoughts on athletes and vaping?

Honestly, it depends on how serious of an athlete you are. Regardless of what you are vaping, smoke inhalation is going to cause inflammation of the airway and will affect performance negatively. Bottom line: if you are serious about being a high performing athlete, or the best athlete you can be, don’t vape.


My coach says I should be stretching and cooling down after every game. Is that true? What are some ways that I can cool down?

Smart coach! Similar to my warm up philosophy, I also like a dynamic cool-down. Think yoga, like going through a warrior flow to stretch dynamically. It is also important to calm down the nervous system. This can be done best by performing the following after training/practice/games: take your shoes/skates off, lie on your back, put your calves over a bench so that your hips and knees are at 90-degrees of flexion, make sure your feet are not touching anything (this is key!), stick your arms straight out the sides (creating a “T”) with your palms facing up, make sure your hands are not touching anything, close your eyes and focus on taking a deep breath through your nose (that fills your belly) and releasing the air out of your mouth. Do this for three-five minutes. If you need some cues with breathing focus on breathing in for 3 seconds, holding that breath for 3 seconds and exhaling for 4 seconds.


My daughter’s hormones are crazy. They are all over the place. One minute she loves me and is happy and the next she can’t stand to be around me. I feel like I’m losing her… What can I do to help balance them out? She has tried birth control but I’m looking for some more natural remedies.

Whew. You’re doing great, momma. I say this with sympathy because it wasn’t that long ago I was that teenager and am forever owing my mom because I was so terrible. So first, I want to offer hope that things will get better! Sooner rather than later if you take the proper steps. First, I would get a hormone test done. The test I recommend is called a DUTCH test. You need to figure out what exactly is going on hormonally to be able to supplement it naturally. Often, birth control can exacerbate some of the mood issues, so talk to your prescribing doctor and look at other options.  Birth control is for one thing– to prevent pregnancy. If you’re not trying to prevent pregnancy, I don’t recommend using it to fix hormonal issues as it will just mask the underlying issue when you need to get to the root of the problem. Second, I always always always recommend therapy. Find a therapist or counselor that she can talk to on a regular basis. 


What can I do mentally to get me through a season with a terrible coach? Like he is actually a horrible person and very mean.

There really is nothing more difficult than dealing with a coach you don’t’ see eye-to-eye with (to put it nicely…). I’ve been there and there are the things that allowed me to push through.

1. At the end of the day, they are the coach you are the player and you need to respect that. It doesn’t matter if you agree with their methods, personality or even their morals, they’re running the show. So, remember why you play, and every time you’re out there think of that and play for you and your teammates.

2. Keep a positive mind. I know this can be difficult, like really difficult. BUT, what may be hard to see now is that you will come out a stronger person and stronger player after the season with this coach is over. Use it as an opportunity to grow. Keeping positive is also healthy for your teammates who may be feeling the same way towards your coach. This can help you come together and show everyone that a crappy coach WONT ruin your season.

3. Trigger words. When I was struggling with a coach I had three “trigger words” I would say to myself when my mind starting going negative. These were three words that meant something to me and reminded my why I played and what I was working so hard for – think big picture. Theses can be words such as a teammate you respect, the college you have your sights on attending someday, the reason you play (ex. Sallie, Minnesota, strength). This may seem silly but it worked for me! Say these words when things get tough, then go kick ass and prove to your coach and everyone, it doesn’t matter what you throw at me or how you treat me I will always come out on top.


If you had one piece of advice for female athletes looking to take their game to the next level what would it be?

My number one piece of advice is to commit. Commit to going all in on your training program, your nutrition and your sleep. Commit to getting better every time you show up to a training session, practice or a game. Commit to not only working on the physical aspect of becoming better but the mental and emotional aspect as well. In my opinion (and experience) leveling up is a choice and If you are willing to commit, and I mean really commit, you will become the best athlete you are capable of being.

That is total a cop-out to give more than one answer but you have to be all in if you want to step up your game! If you aren’t sure how you should be training/moving/eating/sleeping to improve performance, find someone who will help you or do the research. Oh and most importantly, surround yourself with people who are just as committed and it will make it all that much easier (and fun!).


More information on Dr. Hannah and The Girlie Project

My name is Dr. Hannah, founder of The Girlie Project (TGP). I created TGP to help girls and women like you! I have a passion for working with athletes and found that there weren’t a lot of resources for female athletes to learn how to eat, move, train or sleep to get out of pain and improve performance. I basically saw a gap in the industry and wanted to help in any way that I could!

For follow-ups or clarification I can be reached via email at drhannah@thegirlieproject.com or via Instagram @hannahdickman . Want to learn more about TGP or work with me in person? All the details are on my website www.thegirlieproject.com 

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