Exercise Caution

How to stay safe while keeping fit

Exercise is essential to good health. But if you don’t use common sense while working out, you’re putting yourself at risk for injury.

As a primary care and sports medicine specialist at Rush University Medical Center, as well as a team doctor for the Chicago Bulls and Chicago White Sox, Kathy Weber, MD, MS, sees firsthand the injuries that can result from overdoing it or not using proper form during physical activities.

Here, she offers advice for safer workouts — and explains why the latest exercise craze can potentially do more harm than good.

Common exercise-related injuries.

Exercise-related injuries are commonly overuse injuries, such as stress fractures, muscle strains, patellar tendinitis or rotator cuff tendinitis, and illiotibial band syndrome (a hip disorder from injury to the thick band that runs from your hip to the outside of your knee). Basically, any activity that involves repetitive movement — running, cycling, hitting a tennis ball, swinging a golf club, etc. — can cause damage to a specific area or areas of tissue over time.

Injuries can also occur when you’re not properly conditioned for a certain type of exercise, or when you return to an activity too quickly and don’t give your body time to adjust to increased levels of activity.

Always start out slowly in terms of both the duration and the intensity so your body has time to adapt. You should gradually increase first the amount of time and then the intensity level of your workouts. Depending on your level of conditioning when you get started, you may do only 15 to 20 minutes per workout the first week or two. But that’s OK.

After you’ve built up your endurance and have a great baseline, then you can start to work out at a higher intensity. If you do a gradual build, you’ll be a lot less likely to end up with overuse injuries.

Also, make sure that you’re giving your body a sufficient recovery period between activities. Recovery time should always be individualized. Initially, a day or two in between exercise bouts should be adequate, but make sure to listen to your body.

Clues that you are not allowing enough recovery time may include continued muscle soreness and/or fatigue. If you try doing high intensity workouts seven days a week, the risk of breaking down and sustaining an injury is high. Your body needs time to recover and rebuild. That’s true even for elite athletes. They train hard, but they also take time to rest.

Yoga safety.

It’s interesting that yoga is generally perceived as this relaxing Zen kind of thing. But the thing about yoga is that it can involve getting into positions that your body hasn’t adapted to, and that’s when injuries may occur.

If you’re starting out and have never done yoga before, use common sense as you would with any type of exercise program. If your body doesn’t seem able to get into a pretzel position, that’s probably not a good position for you. If you feel pain, that’s a sign something’s wrong.

When you’re in a class setting, you may push yourself too hard because everyone around you is doing these positions, so you think you should be able to do them, too. You may feel a bit of embarrassment or self-consciousness. What you need to remember is that some of these people who make it look so easy have been doing yoga for a long time.

Just take a moment and ask yourself, “Does this seem like a position that is comfortable for my body? Since I’m just starting this, should I really be trying to put my foot behind my head?” If you ease into it and use common sense, you’ll be less likely to get hurt.


We all want to get in shape and lose weight yesterday, but as we get older, it takes more time for the body to adapt to changes. You have to think of exercise as a lifelong pursuit — it’s a marathon, not a sprint.


No pain, no gain? 

It’s true that you might experience a little muscle soreness from exercise and feel achy the next day. But pain is always an indicator that something is not right. If you have pain that’s not going away on its own, and if that pain is affecting your quality of life — including your ability to participate in physical activities — you should get it checked out.

When we say “no pain no gain,” we’re talking about Olympians and high level athletes who are really pushing hard to achieve and excel and be competitive. For everyday folk, “no pain no gain” shouldn’t be the mantra. You should feel like you worked out hard, but you shouldn’t feel like you have to sit down because you just killed yourself.

Most strains heal on their own within 4 to 6 weeks. But for instance, if you’re at the gym and you tweak your shoulder, and it’s still bothering you after a couple of weeks of rest and ice, make an appointment with an orthopedic specialist.

Don’t try to tough it out, and definitely don’t engage in activities that may make the injury worse. Of course, if you’re exercising and you feel something pop and have immediate pain or swelling, or if you hit your head, you should see a doctor right away.

The reality of DVD-based workout programs.

People assume that if there’s a hot new program like P90X that everyone — including celebrities — is trying, it must be the best program. But what’s right for one person isn’t necessarily right for another.

The reality is, I’ve seen a lot of P90X injuries in my practice. You’re given a DVD featuring someone who is supposedly an expert in their field, and you’re trying to mimic the exercises with no supervision. No one is telling you if you’re doing everything correctly; you’re just following a DVD.

But what you need to keep in mind is that there are some exercises people with certain conditions shouldn’t do. For example, if you have knee problems, you may not want to do exercises that are high impact or require you to twist your knees.

If you want to try a DVD-based program, I suggest not trying to do the whole DVD the first time. P90X is a 90-day program, and that’s a lot of exercise for the body to adapt to quickly, which is why it’s easy to injure yourself.

Start out doing 10 to 15 minutes at a lower intensity, and if an exercise doesn’t feel comfortable or you’re not sure about the proper way to do it, skip that particular exercise. Gradually increase the amount of time you spend on the workout. Once you’re able to do the whole DVD at a moderate level of intensity, then you can start to increase the intensity.

We all want to get in shape and lose weight yesterday, but as we get older, it takes more time for the body to adapt to changes. You have to think of exercise as a lifelong pursuit — it’s a marathon, not a sprint.

Creating a safe and successful exercise program

I would say the key is doing a variety of exercises — asking your muscles to do some different activities and working different muscles in your body, giving specific muscle groups breaks. Also, your program should include flexibility, strength and aerobic components. That’s extremely important.

If you’re stronger, you’ll have better endurance and be less likely to sustain injuries. People like to do activities at which they excel. I have patients who are very flexible and don’t need to work on their flexibility, but they are drawn to activities that require greater flexibility, like yoga, because they’re good at it. I also see people who are very good at aerobics, and that’s all they want to do; they don’t want to lift weights.

But they should be doing some weight training because fitness is really about balance: You need to have good flexibility, good strength and good aerobic conditioning to optimize your body’s overall condition.

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Concussion Alters Neuromuscular Function in Collegiate Athletes

Despite being cleared to return to play following a concussion, research has suggested that athletes may be at a greater risk for other kinds of injuries – namely, those affecting the lower extremities. However, the mechanism for this increased risk of a lower extremity injury after a concussion is unclear. Neuromuscular changes following concussion that persist beyond return to play may contribute to this increased injury risk.


In this study, the investigators identified altered lower extremity stiffness in the hip, knee and leg stiffness in a jump-landing task – finding this increased stiffness in athletes who had sustained a concussion when compared to uninjured matched teammates.


Changes in lower extremity stiffness have been shown to be a risk factor for lower extremity injury. Clinicians may need to include neuromuscular measures during concussion treatment programs. This may improve patient outcomes and decrease risk of lower extremity injury when these individuals return to sports activity.

For more information, view the abstract

7 Common Youth Basketball Injuries

By Sean Leninger, PT, DPT for Athletico

Basketball is a popular sport among youth athletes, but the duration of the season inyouth-basketball-injuries combination with the athleticism required by players can lead to injury.

Some of the most common injuries experienced by youth basketball players include muscle strains, ankle sprains,  Jumper’s knee and shin splints. Fortunately there are ways to prevent these injuries from happening. Read below to learn more about seven types of injuries that young basketball players are at risk for, as well as some injury prevention tips to help keep young athletes on the court.

  1. Muscle Contusions

One of the most common acute injuries suffered by young basketball players is a muscle contusion, which occurs secondary to impact. In basketball, it is not unusual for a player to accidentally ‘knee’ another player in the thigh causing a bruise to develop. Although painful, this type of injury is typically not serious.

With acute muscle contusions (less than 72 hours after injury), typical treatment includes rest, ice and compression. Once beyond the acute phase of injury, gradual return to activity is recommended and may include light stretching, progressive strengthening, and eventual return to sport once pain has subsided and full function is regained.

  1. Muscle Strains

In addition to muscle contusions, many young basketball players experience muscle strains, or ‘pulled’ muscles. The hamstring, calf and adductors (inner thigh) are common sites for muscle strains to occur given the functional demands of a sport like basketball. Strains can vary in severity from mild (Grade I) to serious (Grade III). Grade I strains occur when the muscle/tendon is overstretched. Small micro-tears in the muscle may or may not occur and the integrity of the muscle remains intact. Grade II strains involve a greater amount of torn muscle fibers and require longer recovery than a Grade I strain. Lastly, Grade III strains occur when the muscle tears or ruptures completely. This type of strain may require surgical intervention for full function to be restored.

Depending on the severity of the muscle strain (Grades I and II), return to sport may take anywhere from 2-6 weeks in most cases. As mentioned previously with muscle contusions, treatment for a muscle strain may include modalities (e.g. ice or heat), stretching, gradual strengthening, eventually progressing to advanced therapeutic exercises, along with sport specific activities such as drills, running, cutting, jumping, etc.

  1. Ankle Sprains

Most people have experienced the classic ‘low’/lateral ankle sprain that is the result of rolling/inverting the ankle. In basketball, ankle sprains can occur when cutting, accidentally stepping on an opponent’s foot or landing awkwardly.  Lateral ankle sprains involve over-stretching of the ATFL (Anterior Talofibular Ligament) and/or CFL (Calcaneofibular Ligament). Much like muscle strains, sprains are graded on a scale from I through III, with Grade I sprains being mild and Grade III sprains being considered severe.

Acute ankle sprains (Grades I-II) are typically treated with RICES (rice, ice, compression, elevation, stabilization). Once beyond the acute phase of healing, gradual pain-free restoration of range of motion, strength, ankle stability, balance and functionality is addressed in order to facilitate safe return to play.  Improper progression or returning to play too quickly may place the athlete at an increased risk of re-injury.

  1. Concussions

Many parents worry about concussions in their young athletes. While most associate concussions with aggressive contact sports like football, hockey, lacrosse and rugby, this type of injury can also occur in basketball players. Such mechanisms of injury may include a player going up for a rebound and getting elbowed in the head, diving for a loose ball and hitting their head against the court, or during the process of defending or executing a layup if contact is involved. Concussions can be a complicated injury and may require rest, follow up with a physician, as well as a proper plan of care under the guidance of a Physical Therapist that specializes in vestibular rehabilitation for safe return to activity.

  1. ACL Injuries

The Anterior Cruciate Ligament or ACL is one of the four main ligaments providing stability to the knee. ACL injuries typically occur in sports that involve quick changes of direction, pivoting, cutting and jumping. Although ACL sprains can be managed conservatively with physical therapy, an ACL tear/rupture requires surgical intervention to reconstruct the torn ligament. It is also important to note that there are multiple predisposing factors (e.g., gender, bony structure, landing mechanics, playing surface) for ACL injuries. Athletes can take steps to reduce the risk of ACL injuries by engaging in a comprehensive strength and conditioning program.

  1. Overuse Injuries

Overuse injuries such as Patellofemoral Pain Syndrome (PFPS), Jumper’s knee/patellar tendinitis, shin splints and stress fractures tend to develop over the course of a season. Many athletes are hesitant to bring up injuries to their coaches because they don’t want to miss playing time. That being said, overuse injuries tend to get worse as the season progresses. This is because overuse injuries can be linked to repetitive jumping, hip/ankle weakness, muscle imbalances (e.g. quad dominance), and running/playing/practicing while not allowing for a proper rest and recovery period. Because of this, coaches and parents should encourage young athletes to speak up when they are feeling unusual pain and discomfort.

  1. Apophyseal Injuries

Apophyseal injuries are specific to the pediatric population. These types of injuries occur at sites where tendons attach to bony prominences and include inflammation and soreness to avulsion fractures. Common sites of apophyseal injuries in youth basketball players include the calcaneus/heel (Sever’s disease) and the tibial tuberosity/shin (Osgood-Schlatter’s disease). Apophyseal injuries are typically associated with skeletal immaturity, flexibility deficits, repeated trauma (e.g. repetitive jumping and running) and muscle imbalances. Conservative treatment is usually effective in managing such conditions, making physical therapy an excellent treatment option.

The Importance of Injury Prevention

Injury prevention is important because it lessens potential healthcare costs and keepsathletico300x250 athletes playing their respective sports at a high level. As such, many chronic and even some acute injuries may be mitigated or prevented through a proper “pre-hab” exercise program along with incorporating a sport-specific warm up routine. For example, youth basketball players may benefit from balance training, dynamic and static stretching, hip/ankle stability exercises, as well as strengthening of the core and lower extremities.

Should an injury linger, further follow up with a physician and formal physical therapy treatment may be the best route for optimal outcomes.

Athletico also provides complimentary injury screens at a location near you. Click here to get started.

Lessons on Aging Well, From a 105-Year-Old Cyclist

robert-marchant

Robert Marchand, age 105, in Paris on Jan. 5, 2017, a day after setting a new one-hour cycling record.

At the age of 105, the French amateur cyclist and world-record holder Robert Marchand is more aerobically fit than most 50-year-olds — and appears to be getting even fitter as he ages, according to a revelatory new study of his physiology. The study, which appeared in December in the Journal of Applied Physiology, may help to rewrite scientific expectations of how our bodies age and what is possible for any of us athletically, no matter how old we are.

Many people first heard of Mr. Marchand last month, when he set a world record in one-hour cycling, an event in which someone rides as many miles as possible on an indoor track in 60 minutes. Mr. Marchand pedaled more than 14 miles, setting a global benchmark for cyclists age 105 and older. That classification had to be created specifically to accommodate him. No one his age previously had attempted the record.

Mr. Marchand, who was born in 1911, already owned the one-hour record for riders age 100 and older, which he had set in 2012. It was as he prepared for that ride that he came to the attention of Veronique Billat, a professor of exercise science at the University of Evry-Val d’Essonne in France. At her lab, Dr. Billat and her colleagues study and train many professional and recreational athletes.

She was particularly interested in Mr. Marchand’s workout program and whether altering it might augment his endurance and increase his speed. Conventional wisdom in exercise science suggests that it is very difficult to significantly add to aerobic fitness after middle age. In general, VO2max, a measure of how well our bodies can use oxygen and the most widely accepted scientific indicator of fitness, begins to decline after about age 50, even if we frequently exercise.

But Dr. Billat had found that if older athletes exercised intensely, they could increase their VO2 max. She had never tested this method on a centenarian, however. But Mr. Marchand was amenable. A diminutive 5 feet in height and weighing about 115 pounds, he said he had not exercised regularly during most of his working life as a truck driver, gardener, firefighter and lumberjack. But since his retirement, he had begun cycling most days of the week, either on an indoor trainer or the roads near his home in suburban Paris.

Almost all of this mileage was completed at a relatively leisurely pace. Dr. Billat upended that routine. But first, she and her colleagues brought Mr. Marchand into the university’s human performance lab. They tested his VO2 max, heart rate and other aspects of cardiorespiratory fitness. All were healthy and well above average for someone of his age. He also required no medications.

He then went out and set the one-hour world record for people 100 years and older, covering about 14 miles. Afterward, Dr. Billat had him begin a new training regimen. Under this program, about 80 percent of his weekly workouts were performed at an easy intensity, the equivalent of a 12 or less on a scale of 1 to 20, with 20 being almost unbearably strenuous according to Mr. Marchand’s judgment. He did not use a heart rate monitor.

The other 20 percent of his workouts were performed at a difficult intensity of 15 or above on the same scale. For these, he was instructed to increase his pedaling frequency to between 70 and 90 revolutions per minute, compared to about 60 r.p.m. during the easy rides. (A cycling computer supplied this information.) The rides rarely lasted more than an hour. Mr. Marchand followed this program for two years. Then he attempted to best his own one-hour track world record.

First, however, Dr. Billat and her colleagues remeasured all of the physiological markers they had tested two years before. Mr. Marchand’s VO2 max was now about 13 percent higher than it had been before, she found, and comparable to the aerobic capacity of a healthy, average 50-year-old. He also had added to his pedaling power, increasing that measure by nearly 40 percent.

Unsurprisingly, his cycling performance subsequently also improved considerably. During his ensuing world record attempt, he pedaled for almost 17 miles, about three miles farther than he had covered during his first, record-setting ride. He was 103 years old.

These data strongly suggest that “we can improve VO2 max and performance at every age,” Dr. Billat says. There are caveats, though. Mr. Marchand may be sui generis, with some lucky constellation of genes that have allowed him to live past 100 without debilities and to respond to training as robustly he does.

So his anecdotal success cannot tell us whether an 80/20 mix of easy and intense workouts is necessarily ideal or even advisable for the rest of us as we age. (Please consult your doctor before beginning or changing an exercise routine.) Lifestyle may also matter. Mr. Marchand is “very optimistic and sociable,” Dr. Billat says, “with many friends,” and numerous studies suggest that strong social ties are linked to a longer life.

His diet is also simple, focusing on yogurt, soup, cheese, chicken and a glass of red wine at dinner. But for those of us who hope to age well, his example is inspiring and, Dr. Billat says, still incomplete. Disappointed with last month’s record-setting ride, he believes that he can improve his mileage, she says, and may try again, perhaps when he is 106.

By

OSTEOARTHRITIS & YOUR KNEES

More than 27 million Americans have OA and the knee is one of the most commonly affected joints. There are many treatment options available including several non-pharmaceutical and non-surgical choices.

WHAT IS OA OF THE KNEE?

Osteoarthritis is commonly known as “wear-and-tear arthritis,” but did you know that young people get it, too? Osteoarthritis, or OA, is the most common type of arthritis; it happens when the body’s natural cushioning—cartilage—wears away between joints. Think of cartilage as a shock absorber for your knees; less cushion results in bone rubbing against bone, and that can cause stiffness, pain, swelling decreased mobility and bone spurs. OA typically develops slowly and becomes worse over time. There is no cure for OA, but there are many treatments available that can ease the pain and help people to retain or regain their mobility.

WHAT CAUSES OA?

The ability of cartilage to heal decreases as people age, but the causes of knee OA vary. It can be hereditary or can be the result of injury, infection, overuse or excess weight.

In osteoarthritis, the cartilage in the knee joint gradually wears away. As it does the protective spaces between the bones decrease resulting in bone rubbing on bone, producing painful bone spurs.
  • Obesity is the No. 1 driver of knee OA and the No. 1 cause of disability in the U.S.
  • Weak muscles around the knee can cause OA
  • Every extra pound of weight adds 3 to 4 pounds of extra weight to the knees; extra weight increases pressure on knees
  • Genetic mutations can make a person more likely to develop knee OA; abnormalities of bones surrounding the knee joint can also cause OA
  • Women ages 55 and older are more likely to develop knee OA
  • Athletes who play soccer, tennis or run long-distance may be at higher risk
  • Activities that cause a lot of stress on the joint—kneeling, squatting, lifting heavy weights of 55 pounds or more—can cause OA of the knee due to repetitive stress
  • Those with rheumatoid arthritis or metabolic disorders are at higher risk to develop knee OA

WHO GETS KNEE OA?

  • More than 27 million Americans have OA; the knee is one of the most commonly affected joints with more than 11 million people diagonosed in the U.S.
  • Chances of developing OA increase after age 45 and according to the Centers for Disease Control, the average onset of knee OA is 55 years old.
  • More than 40 percent of knee replacements happen over the age of 65, so many people have to find other forms of conservative, non-invasive and non-addicting methods to control pain and maintain an active lifestyle.
  • Women aged 55 and older are more likely than men to develop knee OA.

WHAT ARE MY OPTIONS IF I HAVE KNEE OA?

There are many options available for those with knee OA, including several that are non-pharmaceutical and non-surgical choices. You’ll want to talk with your health care provider about the treatment or combination of treatments that’s best for you; here are some you may want to explore and consider:

MOTION IS MEDICINE

  • Activities; walking, strength training, swimming, biking, yoga, tai chi and other low-impact activities may help with pain and function of the knee
  • Lighten up; a 2007 review found that overweight people who lost a moderate amount of weight had reduced pain and disability from knee OA
  • Braces, sleeves other devices can help reduce pain and stiffness, take weight load off the affected joint and improve confidence and function for those with knee OA
  • Transcutaneous electrical nerve stimulation, or TENS uses electrodes to send a mild current to the affected joint, which can help alleviate pain
  • Acupuncture, balneotherapy (soaking in warm mineral springs) or heat or cold therapy may help ease joint pain for some people with knee OA
  • Medications can include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, prescription medications, corticosteroid or hyaluronic acid injections and more
  • Glucosamine and chondroitin sulfate, some studies have shown, can reduce pain and improve physical function; natural supplements, including avocado, soybean, capsaicin and turmeric, may have anti-inflammatory benefits for some people
  • Joint replacement or joint-preserving surgery may be an effective option for some people

DJO 600

HOW CAN DONJOY HELP?

If you have mild to severe knee OA and experience intermittent to chronic knee pain, or if you are not a candidate for surgery, ask your doctor about the science of bracing. DonJoy pioneered the concept of functional knee bracing more than 30 years ago and offers the most advanced technologies available.

Most importantly, they can help people return or continue to live an active lifestyle. No one person with knee OA is treated the same, so it’s important to look at all of the available solutions to find what is right for you. Some people may need a lot of off-loading capabilities, while others need just a slight push and comfort that surrounds the muscles around the knee.