Staying In The Game
INCREASINGLY, IT SEEMS THE KEY TO LIVING A LONG LIFE IS TO LIVE AN ACTIVE LIFE. In a world that makes it so easy to be endlessly and comfortably sedentary, it’s important to take the ol’ bones out for a spin now and again to work through the creaks and get the blood flowing. But when injury strikes, you may need a little help getting back in the game. That’s where sports medicine specialists come in.
SRQ: Briefly explain the purview of sports medicine.
John Moor, M.D., Advanced SportsMedicine Center: Sports medicine is a sub-specialty within orthopedic surgery, and our bias is widespread because athletes get injuries all the way from the neck to the toes. The idea is that we take these sports injuries and return people to play. Not just to get by, but to get on with their lives again. What we do is restore anatomy; we take the anatomy that’ s there and we let the body heal it.
What are the most common injuries you see? Moor: Because Sarasota is a little bit older than the average population, we see sports medicine not so much in the college or high school level, but more golfers and tennis players, which means a lot of shoulder problems, some knee ligament injuries and a lot of arthritic problems. Ken Kaufman, D.C., Sarasota Sports Medicine: My practice is a little more diverse. I see less of the older population and more of the high school, college, younger athletes. A lot of overuse injuries. Moor: In the younger athlete, high school level, it’s a matter of impingement and instability like shoulder dislocations and labral tears. In the older population it’s arthritic problems and rotator cuff problems. Kaufman: My practice is geared toward injury prevention and helping to rehab and pre-hab patients. My treatment is a bit on the conservative side, if they get to the point where they have a shoulder problem or rotator cuff problem, Dr. Moore takes care of them. But underlying the dislocations and the labral tears and rotator cuff problems is weakness in the shoulder girdle and shoulder rotator cuff muscles. I can step in and prevent them from getting to that point.
How often are these problems preventable? Moor: With rotator cuff problems, it’s almost an eventuality. Just like our skin changes, so do other tissues in our body, and the rotator cuff is one of those tissues. But most people with rotator cuff problems don’t end up with surgery; there are non-surgical approaches as well. On the younger end of the spectrum, if you’ve got internal impingement or a labral tear, an overuse injury, then it’s a matter of changing mechanics and giving these people relative rest. Most shoulder and knee injuries from sports don’t end up in surgery either. Most involve isolating the problem, isolating what caused it, trying to work around it, and avoiding that exact mechanism of injury again.
How do you diagnose the problem and then go about reshaping those movements? Kaufman: If it’s mechanical in nature, the most valuable thing to do is to watch the person perform the activity. One of the most common problems with a throwing athlete or tennis player is trying to decelerate a particular motion. They won’t, for lack of a better term, follow through with their movement. Instead of allowing the natural movement to slow down, they’re using other ancillary muscles, trying to slow down the velocity of their arm. That puts a tremendous amount of strain on posterior ligaments and muscles. Moor: Most of the time, they’ll tell you what’s wrong with them, but they don’t realize they have other problems that are more subtle. Physical examination then pinpoints exactly what is going on. Between history, testing the patient and imaging studies like MRI, we get to the bottom of the problem. Asymmetry is a good way to do it. Whenever I do my exam, if I can elicit different things in different limbs, then it’s abnormal.
How do you define successful treatment in the patient? Moor: 100 percent based on what the patient thinks. The measure really is, ‘can the patient go back to play?’ ‘Were they successful in getting back to the level they once achieved?’ And then you have to tell people about the expectations, because some injuries are huge, and it’s not possible to take them back to 100 percent normal. There will always be relatively minor things, like a little bit of stiffness. Some joint injuries make permanent cartilage damage and turn it into an arthritic problem. As long as the patient knows what happens, knows what to expect, you can have a good result. Kaufman: For an athlete or an adult who’s extremely active, one of the biggest challenges is allowing them to get the proper rest. Asking them to shut things down, to stop doing the activity that’s causing their shoulder problem. They’re usually type-A personalities, they want to be out there, they want to get back out. The biggest thing is to just get the proper rest to allow the body to heal.
How do you manage patients’ expectations? lifestyle? Moor: We tell our patients what we’ ve seen, our expectations and what the literature says. There’s a spectrum – you can have the ideal result or you can have the not-so-ideal result, depending on how badly you’re injured, how much your body has a chance to heal itself, how strong the tissues were, that sort of thing. And here’s where we say that it’s not going to be a quick-fix sometimes. Sometimes, it is a quick-fix, sometimes it’ll be a year of rest and rehab.
Who do you recommend to help them through this process? Moor: It’s a very multi-factorial process from being injured to being back. The surgical part of that is one hour out of your lifetime. After that, we don’t just take them from surgery and give them to the rehab specialist, but direct them along the way. It’s very important to have people who will follow that along. Just because it feels good doesn’t mean it’s ready to go again.
How often is surgery necessary? Moor: The great majority of patients who come into my office don’t end up with surgery. The body wants to heal, which is in our favor. We try to take advantage of that; take an injury, isolate it, avoiding re-injuring while it’s trying to heal. Surgery actually is a little bit damaging. You make some things worse to set things up to heal. Part of the art and science of surgery is to know how much damage you can inflict and still have a good result at the end. You put all those things into play, and surgery is just a small part of it. The rest of it is the art and science of getting them back, ready to play, full speed, 100 percent. Kaufman: My clinic is a bit more conservative, being a chiropractor and rehab. We use a Class 4 deep-tissue laser therapy, designed to decrease inflammation and increase micro-capillary circulation. The most important aspect of any painful condition is the inflammation and the surrounding tissue. So we use deep-tissue laser therapy and we do soft-tissue manipulation, to get any muscles that are overactive to stretch out and relax. And then functional exercise rehab to help strengthen up those imbalances, correct for those asymmetries that we talked about.
What is deep-tissue laser therapy? Kaufman: It’s a modality that uses infrared light at a wavelength that will penetrate the skin and get at the tissues. The light photons affect the mitochondria, the tissue cells, and from that stimulation it increases the production of ATP and nitrous oxide. The nitrous oxide is a vasodilator and helps open up the blood capillaries to allow oxygenated blood to get into the area . At the same time, it opens up the lymphatic channels to flush away the inflammation and waste products. What kind of habits should they get into to avoid these types of injuries? Kaufman: They need to focus on shoulder stability and core stability. A vast majority of the people is very sport-specific, and so they’re doing the same motion over and over again, and never cross-training. That same repetitive motion creates habits and patterns that are not always good. Also using machines takes away the stress to stabilizing muscles. If you’re doing a chest-press on a machine, you’re working your pecs and your deltoids and your triceps, but you’re not strengthening the rotator cuff and shoulder stabilizer, because the machine is taking over the stabilization. Using dumbbells, exercise bands and body weight exercises will help build up those stabilizer muscles while you’re going through an exercise motion.
Moor: Number one, don’t smoke. That’s our number one health hazard in the country. Number two is weight. The more slender you can be, the more your body can tolerate the stresses being given it, and reasonable exercise and then diet. High protein, low fat, low sugar diets are very able to prevent injuries from a nutritional standpoint. We used to stretch for a long time before we play. Now we’ve found that warming up is more important than stretching, so we go toward that. Kaufman: Stretching has been shown to not be beneficial at the very least and detrimental in some cases. And something that patients can do on their own, when they’re properly trained, is foam rolling. It’s a self-myofascial release that puts pressure on trigger points and myofascial structures and helps release those structures and release those trigger points.