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Guest Post by:

Shane K. Woolf, M.D.
Chief, Sports Medicine Service
Medical University of South Carolina

Summer has arrived and folks of all ages are spending time outdoors pursuing their favorite active pastimes.  Tennis and golf are two of the more popular activities with about 12 and 30 million participants each year, respectively, in the United States.1  As our population ages, many participants fall (reluctantly) into the category of ‘mature’ recreational athlete. For these folks, staying healthy and avoiding injury is paramount to enjoyment of their favorite sport. The positive health benefits of athletic activity are quickly lost when injury occurs. Fortunately, some simple preparation and training tips can help to reduce your risk of injury in either sport!tennis player

Stay Flexible

Keeping a regular flexibility routine either through yoga or simple ‘sitting-on-the-floor-in-the-living-room’ stretches can help keep your joints, tendons and muscles ready for action in both tennis and golf. The shoulders and upper limbs as well as the trunk/back are under significant stress during the swing of a club or racquet.  Torque exerted during rotation of the torso or shoulder in order to make contact with the ball, can be among the highest stresses the human body might experience. It is a little like wringing out, or even whipping, a damp towel, if you think about it. Limber ligaments, tendons and muscles are more forgiving, allowing the necessary rotation to achieve motion and also to tolerate these stresses without resulting in a strained muscle or sprained ligament.

Maintain CORE strength

So what exactly is the ‘core’ that I keep hearing about, you ask? Think of it as the central framework and support structure for your whole body. The core is centered about your spine, abdominal musculature and pelvis. It is important for correct posture, balance, coordination, and is the key to many athletic moves. Consider a core routine as your Central Orthopedic Rehabilitative Exercise program. This would include abdominal strengthening, lumbar spine strengthening, hip strengthening, and balance training. Yoga and Pilates can be useful to achieve this. The web is also a fine resource for DIY core stability exercises such as planks, bird-dog/airplane, side-bridges, exercise ball activities and balance exercises. A fitness instructor at your local gym or wellness center can also help get you started in the right direction.

Keep the Arms and Shoulders Strong

Repetitive power gripping and the swing of a club or racquet can cause microtrauma to the rotator cuff tendons, biceps, and the extensors or flexors of the forearm (ie tennis elbow – lateral epicondylitis, and golfers elbow – medial epicondylitis). The backhand tennis swing coupled with wrist weakness has been linked to development of elbow pain. The soft tissues in older athletes are more likely to be degenerative and also more likely to be damaged with both repetitive use as well as improper mechanics. Similarly, the medial, or inside edge, of the elbow is under stress when forearm flexors are engaged during a golf swing.

Some keys to avoiding injury are flexibility of the forearm muscles, balanced strength from shoulder to wrist, and gradual increase in play. As anyone who has had a sudden increase in the number of sets or holes played will attest, these muscles are usually not happy for a few days afterward. 

Stay Hydrated

The hot days of summer can be especially dehydrating after even a short period of activity. Realize that the heat index will effectively make a hot day much hotter physiologically due to the effect of humid air on the body’s cooling mechanism. In dry climates, evaporative fluid loses can happen with little notice, thus resulting in dehydration without much warning. Dehydration can impair the cardiac, renal, and neurologic systems. Performance is diminished at best, and serious health risks can happen with deeper levels of fluid losses. Take regular water breaks or indulge in a sports drink, but be careful with the caffeinated beverages and avoid that adult beverage until AFTER your round in the hot sun. Alcohol and caffeine can worsen the effects of dehydration.

Consider a Medical Consultation Prior to Starting a New Activity

For mature athletes, especially those with existing conditions like diabetes, heart disease, lung disease, asthma, obesity, among others, it is advisable to consult with your primary care provider before engaging in a new or more strenuous activity (eg joining a competitive tennis league after a year of inactivity). Medical issues are not necessarily going to keep you off the court or course, but having your health optimized can make for a safer and more enjoyable experience. Primary care sports medicine physicians are especially in tune with your athletic passions and how to address the ailments that need to be considered. Similarly, existing bone and joint problems may be manageable in ways that allow sports participation, even without surgery. A visit with an orthopaedic sports medicine specialist to discuss your injury may help you find a way to get back into the action!

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1 www.usta.com, www.usga.org

Know someone who’s interested in becoming a doctor? The Medical University of South Carolina College of Medicine (COM) has an exciting opportunity for anyone considering, or in-process of, applying to medical school.

Our COM admissions department will be hosting a live Twitter chat on Wednesday, June 17 from 12:00 p.m. - 1:00 p.m. This don't-miss event will allow students to have their med school admissions questions answered and provide valuable advice on how med school applicants can really make themselves stand out among the competition.

Anyone who would like to follow the chat or take part in it, can do so by using the hashtag #muscapps or by visiting twitter.com/MUSC_COM on the day and time of the event. Our Twitter handle is @MUSC_COM if students would like to become followers of the COM.

We look forward to chatting with all you future doctors out there and getting lots of questions answered!

Guest post by:

Kathleen Choate, ATC, CSCS, CEAS
Athletic Trainer
MUSC Health Sports Medicine

No one likes being injured.  It's painful, expensive, takes time away from the sports we love, affects our daily life, and can even lead to pain and disability later in life.  Wouldn't it be nice if we could enjoy the sports we love without this risk?  While it isn't possible to completely eliminate the risk, there are ways to prevent them.

Stretch

            Before participating in physical activity, a good warm-up should be in order.  Both static and dynamic stretches are acceptable prior to participation, but you may choose one or the other depending what your goal is. Stratching on track

            Static stretches involve holding a muscle in a lengthened position for an extended period of time.  For example, a static stretch could include sitting on the ground in a pike position with legs fully extended, reach for your toes, and hold it for 30 seconds.  If you choose to primarily use static stretching prior to physical activity, try to incorporate things like jogging, jumping jacks, or squats to increase your body temperature.

            Dynamic stretches involve bringing a muscle through a full range of motion; it comes with an active movement that should be slow and controlled.  One benefit of using dynamic stretching over static stretching is that it also increases your body temperature, which helps to increase elasticity of the muscles right before physical activity.  An example of a dynamic stretch would include slow and controlled lunges with a straight instead of bent back knee. 

            Ballistic stretches involves a bouncing motion at the end range of a stretch and should not be used as a way to warm-up since it is likely to lead to a muscle strain.  Regardless of your warm-up, remember that it should never be painful.

Equipment

            Proper equipment should be a no-brainer with any sport.  Runners need shoes, football players need helmets, pads, and mouth guards, and wrestlers need headgear.  Not only are these pieces of equipment necessary to be worn, but they should also be fitted correctly.

            Shoes are especially important for sports with a high volume of running including cross country, track and field, soccer, field hockey, and basketball.  While quality shoes are pricey, they are the only piece of equipment a runner needs.  Running is a fairly straightforward movement compared to other sports.  It involves a series of repetitive movements over the course of several miles.  If your feet hit the pavement 1,000 times in one mile, then a faulty running gait or a worn out pair of shoes can cause injuries anywhere from your feet to your back.  It can be difficult to spend our hard earned money on a pair of running shoes; however this investment can prevent you from having to spend hundreds or thousands of dollars at the doctor’s office.  Since shoe needs are going to vary from person to person, consult with your Athletic Trainer for guidance prior to making this purchase.  Also, plan to replace your shoes every 300-500 miles.

Technique

            Have your coaches ever sounded like a broken record?  Maybe they told you ten times in one practice to follow through, keep your head up, or to bend your knees more.  Good technique doesn't just make you a throw a ball better, score more points, or run faster; it prevents injury.  The more obvious injuries are the ones that happen when a movement is performed incorrectly one time and sudden pain is felt.  The injuries that creep up on you are ones that arise from consistently flawed technique.  Next time your coach tells you to correct a motion, do everything in your power to fix it the first time!

Rest

            Rest is the word athletes never want to hear, but it's vital to preventing injury.  Give yourself at least one day off a week to let your body recover.  This may seem like slacking to some, but it will prevent overuse injuries and burnout. 

            As athletes, it’s tempting to play through pain, especially during a game.  The pain level may feel tolerable, and you don’t want to let your teammates down.  Choosing to continue to participate with a possible injury will most likely make the injury worse and recovery time longer.

Strength and Conditioning

            Condition your body for the sport you are participating in.  A great strength and conditioning program will vary depending on your age, level of training, sport, and time of year.  A strength and conditioning specialist is your best resource to put a conditioning program together with all factors considered.

Athletic Trainers

            Athletic Trainers are often thought of as the person that runs onto the field when a player gets hurt.  That may be when we are viewed most publicly; however we have many other roles with regards to injury management, including (but not limited to) preventing the injury from happening in the first place.  Consult with your Athletic Trainer about injury prevention to identify a plan that is specific to you as an individual.

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Guest Post by:
Lindsey Clarke, MS, ATC, CMT
Athletic Trainer
MUSC Sports Medicine

Daily training sessions, road trips, injuries, innumerable competitions…it’s all come to an end, and your season is over. Now what?  There is a very important phase in your performance as an athlete from the ranks of recreational to professional that should not be taken lightly at all.  This phase is called off-season training.  You could argue that off season training is the most important phase of any sport-specific conditioning plan. Not only will it help you, as an athlete to recover physically and psychologically, it can be used to address some of the physical imbalances that are inherent with playing competitive sport.  A good off season training program will address these imbalances helping to prevent both acute and chronic injuries.  Now is the time to shift your focus to overall health and move away from ultra-structured training. After all the hard work you’ve put in day in and day out for months on end, you have to treat yourself to some recovery. This period of off-season training should also be used as a time of reflection…identify your strengths and weaknesses, and outline your goals for next season.

By its very nature, sport places unequal loads on different parts of the body. One leg or arm is used more than the other. Larger, prime movers (like the quadriceps) are stressed to a greater extent while smaller, but very important stabilizing muscles are neglected while the large muscle groups grow stronger and more powerful.  For some athletes, particularly younger athletes, the off-season is a valuable time to improve in areas of physical weakness such as aerobic capacity, stability, or strength imbalances. It is also a time when injuries can be addressed and rehabilitation programs completed without the added pressure of preparing for or missing competition.  Whatever the case, the off-season should be individualized to meet the needs of the athlete and is a crucial time to ensure physical progress.

The key to a successful off-season is finding the perfect balance between an overly ambitious training plan, and being completely lazy.  The focus should not be on when the next season begins, but what you as an athlete should be doing outside your normal competitive season. Athletes playing professional and/or institute-based sports have strength and conditioning specialists to assist with the design, planning, and implementation of training programs for their athletes not only to complete within the season, but also to maintain, and in some cases, fine tune and develop fitness qualities in the off-season.  Most people don’t have these resources at their disposal, so it is important to communicate with your coach and/or athletic trainer to select the appropriate type of exercise for you.  Athlete education is key. Important information such as how many sessions needed to maintain fitness as well as what type of training should be completed will hopefully alleviate the problems of athletes returning out of shape for pre-season training.  Try to avoid the form of exercise you perform in competitively, and instead participate in activities that involve different movement patterns.  The off-season is a great time to focus on maximizing your strength. It will help prevent injury and prepare your body for next year’s volume and intensity of competition. Ideally, you want to focus on multi-joint compound exercises for optimal strength gains. You can include plyometric and functional sport specific exercises that will help improve performance as well.

Remember the off-season is not the time for skill work.  It’s the time to focus on readying yourself both physically and mentally for the next season, while providing adequate recovery between the rigors of competition phase. Most importantly, this period in your training will help you return in an optimum state to cope with the demands of the new season.  Keeping your training fun is an absolute must.  It is important that while you continue to train you must allow yourself the mental break from ultra-structured training. Training in the offseason can even be semi-unstructured to a point, but also keeping in mind the goals you’ve set for the next season. Don't take the off-season lightly.  Goal setting and allowing yourself the physical and mental rest will optimize your chance to come back stronger, faster, and more explosive than ever!

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Guest Post by:
Michael J. Barr, PT, DPT, MSR
Sports Medicine Program Manager
MUSC Health Sports Medicine

One win … two wins … could there be a Triple Crown?  From May to June, six of the most exciting words we hear are “and down the stretch they go” as millions of people around the world eagerly watch to see which horse crosses the finish line first.  American Pharoah has run into the hearts of millions and is trending online, as we again await the possibility of a Triple Crown winner.  The Triple Crown is arguably the hardest feat to obtain in modern sports; the last time occurring in 1978 when Affirmed won the three historic races.  We so often hear about the horses and their amazing power, who can weigh up to 1400 lb., with the capability of 40 mph running speeds and kicking with up to 1 ton of force6. When I’ll Have Another pulled out of the Belmont after winning the Kentucky Derby and Preakness in 2012 due to a lower leg injury, it was all over the sporting news.  But how often do we hear about some of the smallest athletes; the jockeys?  Who was the jockey on Affirmed in 1978? (Steve Cauthen).  Who is the jockey riding American Pharoah? (Victor Espinoza).

Professional race jockeys usually weigh between 108 and 118 lbs., and they have to control a horse that is basically one big mound of muscle weighing 1200 lbs.  When we hear about a traumatic injury occurring to a jockey, it’s usually due to being thrown from the horse, or the horse tripping and falling on top of the jockey.  However horseback riding is not just about the professionals; the US Center of Disease Control reports over 30 million people ride horses every year in the Unites States2, and according to the National Electronic Injury Surveillance Survey (NEISS) in 2009 an estimated 78,500 people were treated in emergency rooms for equestrian related injuries.7

Equestrian activities are popular in the US and include a variety of forms such as racing, dressage, cross-country, jumping/show competitions, polo, and trail riding.  Studies have shown that ~39% of all equestrian related injuries occur in patients under the age of 19 and in contrast to many other contact sports, the majority of these athletes are female.1 When mounted, a rider’s head sits approximately 9 feet off the ground; distortion and fractures of the upper extremities are the most common injuries that occur, followed by head injuries including concussion, mainly due to falls or being thrown from the animal.5Rider falling from horse

What we do not typically hear a lot about are the repetitive injuries that occur in equestrian related activities. Riding is an activity that requires prolonged muscular activation with constant changes to one proprioception in order to generate the stability needed to stay on the horse and control the mammoth animal.  In the low-country, riding is a very popular activity. I’ve seen a number of both pediatric and adult riders for repetitive or overuse injuries including shoulder instability, low back pain from the constant jarring and bouncing movements, hip and SI joint dysfunction from the prolonged squeezing of the horse with their legs, as well as general knee pain and even degenerative knee issues from the repetitive impact and stress on the joint.

The jockey Gary Stevens is being labeled the “Comeback Kid”; after retiring in 1999 and 2005 due to right knee issues, he came out of retirement again in 2013, but unfortunately the agony of bone-on-bone in his right knee caused him to undergo a total knee replacement in July of 2014.  Prior to the surgery Stevens said, “It’s six months for a normal, typical sort of surgery and a typical person, but I am not typical … they are not really use to seeing this type of person come in for knee replacement.”8 Stevens was back in the saddle a mere 91 days after surgery and jockeyed Firing Line to a second place finish at the Kentucky Derby.

Core strengthening and stabilization exercises, lower extremity flexibility training, and rotator cuff/peri-scapular musculature strengthening and stability exercises should all be incorporated into the regular injury prevention workout of anyone participating in equestrian activities.  The American Academy of Orthopaedic Surgeons has also published a list of injury prevention tips, some of which include: 7

·         All riders should always wear horseback riding helmets that meet ASTM and SEI standards.

·         Wear properly-fitted, sturdy leather boots with a minimal heel.

·         Be sure the saddle and stirrups are appropriate to your size and are properly adjusted.

·         Children and novice riders should consider safety stirrups that break away if a rider fall off the horse

·         If you feel yourself falling from a horse, try to roll to the side (away from the horse) when you hit the round.

* For the full list of tips for the AAOS go to http://orthoinfo.aaos.org/topic.cfm?topic=A00058

On June 6, 2015, all eyes will be on American Pharoah with hopes of seeing the first Triple Crown in 37 years, but don’t forget about the 5’2”, 112 lb. Victor Espinoza who will be risking his body to control the power and speed of the thoroughbred.  Please remember, if you are an avid rider or novice, preventative safety equipment and an injury prevention training program is essential to reduce the odds of you being one of the 79,000 equestrian related emergency room visits.

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Sources:

1.      Havlik, Heather.  Equestrian Sport-Related Injuries: A Review of Current Literature.  Current Sports Medicine Reports, American College of Sports Medicine: 299-302.

2.      Center for Disease Control and Prevention [Internet]: http://www.cdc/gov/niosh/updates/upd-04-30-09.html

3.      Lee KH, Steenberg LJ.  Equine-related facial fractures.  International Journal of Oral Maxillofacial Surgery.  2008; 37: 999-1002.

4.      Pedulla, Tom.  Thrill of the Chase Keeps Gary Stevens Coming Back.  The New York Times. May 12, 2015.

5.      Zoetsch S, Saxena AK.  Equine-Related Injuries in Pediatric and Adolescent Age – Analysis and Outcomes in a Level 1 Pediatric Trauma Center in Austria.  Pediatric Emergency Care. 2013; 29 (9): 1053-1054.

6.      Kriss TC, Martich V.  Equine-Related Neurosurgical Trauma: A Prospective Series of 30 Patients.  The Journam of Trauma: Injury, Infection, and Critical Care.  1997; 43(1): 97-99.

7.      Horseback Riding Injury Prevention. Ortho Info – American Academy of Orthopaedic Surgeons [Internet]: http://orthoinfo.aaos.org/topic.cfm?topic=A00058

8.      Paulick, Ray.  ‘Comeback Kid’ Stevens to Have Knee Surgery but Vows ‘I’m Not Finished’ [Internet]: http://www.paulickreport.com

 

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