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Too Much Pain, No Gain: Avoiding Sports Injuries

Posted Aug 24 2008 1:49pm
DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. If you don't know yet, we're in the 21st century. So it's time to start exercising the correct way, and the incorrect way is to exercise and give yourself an injury or get an injury. We're going to be talking about injury prevention. How you can avoid injuries whether you're working out weight lifting, whether you're playing tennis, hockey, basketball, any of those activities. Joining me are two experts on the subject.

I've got Jim Ramsay, he's the Athletic Trainer for the New York Rangers hockey team. Sitting next to Jim is Dr. Jonathan Glashow, he's a sports medicine orthopedic surgeon at Lenox Hill Hospital in New York City. He's also a consultant to the New York Rangers, as well as other olympic athletes. Gentlemen, thanks for joining us. Dr. Glashow, can I call you Jonathan?

JONATHAN GLASHOW, MD: Please do.

DAVID FOLK THOMAS: Let's start out. What are some common injuries that people incur from working out, whether they're doing it the right or wrong way?

JONATHAN GLASHOW, MD: That's a good question. I think I'd like to group them in two ways. There is the overuse kind of injuries that we see which may be known as tendonitis, like a tennis elbow or shoulder tendonitis. Then there's the macro-traumatic injury, when somebody lifts a weight incorrectly and their biceps ruptures or they dislocate their shoulder. Most commonly we see those overuse injuries. People lifting improperly, lifting too much, not resting enough, not stretching, etc. They're the most common. Occasionally we see ruptured muscles, strained muscles, strained ligaments in the knee from improper technique, excessive weight with improper technique. So I think grouped both ways the more common one would be the overuse injuries that we see at the gyms. The hockey club probably sees a few more of the macro-traumatic ones and gross ligament injuries and fractures, and things of that sort.

DAVID FOLK THOMAS: The macro-traumatic, that would maybe be when you hear the popping sound or the breaking sound.

JONATHAN GLASHOW, MD: Or you see blood.

DAVID FOLK THOMAS: Jim, Jonathan alluded to, you work with the Rangers. What kind of injuries do you see with them? More of those intense injuries?

JIM RAMSAY: We do definitely see a lot of more acute type of stuff in terms of the sprains and strains, a strain being a muscle injury and sprain being a ligament injury. We have a lot of knee injuries. Mike Richter, for example, this year sprained his ACL.

DAVID FOLK THOMAS: Goal tender for the Rangers.

JIM RAMSAY: Excellent goal tender for the Rangers. He had ACL reconstructions. He's doing great. Then we also have a lot of strains, the muscular injury. A lot of players today in hockey are having what we call athletic pubalgia. A big word. Basically, it means that they're injuring or straining the lower oblique muscles in their stomach. Why? We haven't figured that out yet. There are numerous studies. But we do see a lot of major muscle and ligament injuries in hockey.

DAVID FOLK THOMAS: When you're setting out to prevent injuries if you're going to the gym and you have the mindset, "I'm going to do this right," are injury prevention techniques more important for those gradual injuries? What was the big word you used?

JIM RAMSAY: You liked that one?

DAVID FOLK THOMAS: Yes, I liked that word. But it seems like for a hockey team, it's hard to prevent an injury if a guy's smashing into the boards, so to speak. I imagine you can try to build the muscles up enough to negate that. But overall, for those gradual straining, spraining injuries, is that where this is most important?

JIM RAMSAY: I think it's for both, Dave. Really, I think you can prepare yourself and your body for the impact of a hit or you can prepare yourself for weight training. I think there are several key points. One being a gradual increase in weight. The first I should say is warmup. I think far too many people, maybe like yourself, run to the gym, don't have time to do that.

DAVID FOLK THOMAS: I do it correctly.

JONATHAN GLASHOW, MD: They don't warm up, they go in, rush to the weights, do a far too heavy weight first off and [MAKES UGH SOUND]. Especially first thing in the morning. I think most people run into trouble when they try to do big muscle groups first thing in the morning. I don't know what Jim thinks. But in a lot of the gyms you see people doing heavy leg exercise at 6:30 am. Things happen when you lie flat all night and you don't warm up and your muscles aren't ready to take that load. So a good warmup is key and it prevents a lot of injury. Stretching, which all of us hate to do because it doesn't show, but it actually prevents a lot of problems down the line.

DAVID FOLK THOMAS: What you just mentioned is something that I've always thought of. A lot of people work out early in the morning before they go to work. I've never enjoyed that and one reason I have told people is because I feel my body has to naturally wake up during the day. Just walking around the city or going to work. Your muscles are more ready for that. Do you have your players train in the morning or the evening? Does it matter to you?

JIM RAMSAY: We basically leave that up to the individual. Everyone responds differently to how their day goes. Me, personally, I'm a morning person. So I like to work out in the morning, get it over with. Again, following Jonathan's guidelines of a proper warmup on the bike or treadmill, or just going for a walk outside or something like that to warmup. Then taking part in a good stretching class or stretching out before I start lifting. Other individuals on our team, later in the day they prefer to practice and get warmed up through practice. Then making sure that they leave feeling pumped up and ready for the next day, they go into the weight room and do a little aerobic or anaerobic workout, then lift afterward. So everyone's different. Everyone has to do what they feel what works best for them.

DAVID FOLK THOMAS: What type of warmup is the best way? We mentioned stretching. Is that the best.

JONATHAN GLASHOW, MD: I think you have separate warmup from stretching a little bit. I can't overemphasize what Jim said about the players. Let people find their natural fit. For some people, working out with heavy weights in the morning is OK. If your body doesn't feel right doing it, it's probably not right for you. But to answer your question about warmup, I think the key in warming up and getting your body acclimated to an exercise is that you have to increase one's heart rate to maybe 70% of maximum. There's a basic formula, which is 220 minus your age in years is your heart rate roughly. If you go up to about 70-80% of that and do it for 10-15 minutes your body is more flexible, it's used to seeing stress and I think it will prepare you for exercise.

DAVID FOLK THOMAS: So stretching then would not be a true warmup.

JONATHAN GLASHOW, MD: It's just as important, but it's a different phase of warmup. I think the cardiovascular warmup was what I was referring to and I think you have to do both.

DAVID FOLK THOMAS: So what is that? On the bike, on the treadmill if you're in a gym?

JONATHAN GLASHOW, MD: Exactly. Any one of those depending on your inclination. Maybe you should vary it, bike, stair machine.

DAVID FOLK THOMAS: Jumping jacks.

JONATHAN GLASHOW, MD: You can do jumping jacks. It will get your heart rate up.

DAVID FOLK THOMAS: We've been doing jumping jacks since Kindergarten, I think.

JIM RAMSAY: That's right.

DAVID FOLK THOMAS: What about squat thrust? Does anybody do the squat thrust any more?

JONATHAN GLASHOW, MD: Probably the Russian military.

DAVID FOLK THOMAS: So would you want to then do the warmup and then go to stretching?

JIM RAMSAY: Basically that's what we try to do. Get the individual to warmup. Like Jonathan said, on a bike, on a treadmill, jumping rope, jumping jacks, anything that they feel comfortable with to get their heart rate up and feel like they're getting a little bit of a sweat. They're getting some beads. Then after that, the next phase is the stretching phase. With the Rangers we utilize two different types of stretching. We start off doing static stretching which involves basically taking one muscle or a larger muscle group and holding the stretch in a stationary position for an extended period of time, 20, 30, 40 seconds. Doing that three to five times. Then after we've stretched out the major muscle groups, then we do what's called a dynamic stretch which is kind of like a squat thrust and basically we might do some deep knee bends if the individual doesn't have knee problems. Just taking them down, holding the stretch a little bit at the bottom, back up, down. That's more of a functional stretching. Taking that individual into a functional position that they're going to utilize every day on the ice, at the grocery store when they're bending over to pick up something on the bottom shelf. So they're working the muscles that are working their core, and that they're going to use every single day. So we take that stretching to a different level and then we put them into the weight room.

DAVID FOLK THOMAS: Jonathan, why don't you tell us about strength conditioning as being important to preventing injuries to joints or ligaments.

JONATHAN GLASHOW, MD: The stability of a joint is made up by not on the bony anatomy, or for instance, in the shoulder where the ball fits into the socket, but the ligaments, the tight tissues around it and the muscles around those ligaments. So any compromise in any one of those areas will lead to a problem. So you can control the muscles more easily than the bones and the ligaments. So if you strengthen the muscles, for instance, around the shoulder you'll make it more stable, you'll theoretically have fewer problems with instability or looseness, or even tendonitis type problems because the muscles will be better prepared. So it's easier to control the muscles, and doing exercises to make for a stronger group of muscles around the joint, will probably, all else being equal, reduce the frequency of injury and problems.

DAVID FOLK THOMAS: One thing before we go. I have to ask this because I suffered a couple of these injuries back in my old high school days. But the hamstring. Every time it seems you pick up a newspaper and look at the disabled list, whether it's a hockey player or a baseball player. They're out with a hamstring injury and they're out for long periods of time. Why don't you explain what the hamstring is, and how can you possibly ever build that up so that you are not at risk?

JIM RAMSAY: The hamstring muscle is basically on the back of your thigh. It's a major muscle group that helps flex the knee, or bring your heel to you butt, and it also stabilizes some of the low back and is involved in running, walking, skating, inline skating. What happens to a lot of different athletes, recreational athletes and professional athletes alike is, that muscle becomes very strong and acts as a stabilizer, and at the same time becomes very inflexible. The individual hasn't warmed up properly or doesn't have a proper flexibility program that they've done to work on that muscle. What can happen is you get a strain. You get a pull in the muscle. The damage is either to the tendonous part of the muscle or the muscle itself and it is a very difficult muscle in terms of the length of time that it takes to heal. Professional athletes, football players, basketball players, they're loading up that muscle with such a high level of impact when they're up and jumping up for a rebound and coming back down, or a lineman jumping off the line to block another player. That muscle becomes so loaded and then has to explode. That's where they run into problems if the muscle is weakened by overuse injuries, or again, by an acute injury where it just strains itself because of inflexibility or not enough strength.

DAVID FOLK THOMAS: Jonathan, anything to add to that?

JONATHAN GLASHOW, MD: I think it's a unique muscle. It's very long. It has a unique sort of anatomy to it. Again, it's part of the core muscle group and it's used in almost any lower extremity exercise from skating to running. So it's overused, it's frequently tight, it's hooked into the low back so people with low back problems also have hamstring problems. It's very true, it's frequently injured, hard to get better, but you need it do any thing in sports.

DAVID FOLK THOMAS: But just remember for you folks out there unless you're a professional athlete, you still have to show up for work with your hamstring injury. Guys, thanks a lot for joining us on the webcast talking about injury prevention. So get out to the gym, go out to the tennis courts, the basketball courts, listen to what these guys just told you. Do things the right way and you'll avoid those injuries that may put you on the disabled list. Thanks for joining our webcast. I'm David Folk Thomas. We'll see you next time.

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