Sports Medicine

Sports Medicine
The University of Toledo Medical Center's Division of Sports Medicine and Family Medicine is made up of a team of sports medicine fellowship-trained physicians, orthopaedic surgeons, family physicians, athletic trainers, physical therapists, occupational therapists, and licensed/registered dietitians.

Research

Stay Slim in Winter

By: David L. Weldy, M.D., Ph.D.

As weather gets colder and snow and ice cover the ground, the forays and excursions outside for that daily walk or other physical activity are less enticing. It also can be more dangerous. There is also the advent of more rich food and other goodies to eat starting with that bag of candy extorted from the neighbors on October 31 or conveniently left over from that holiday. Then on to Thanksgiving with no time to recover before Christmas and New Years.

At the same time, there are enticements to just sit and watch all of those holiday TV specials and football games complete with snacks and beverages. Back in the wild, most animals eat extra in the summer to build up reserves to carry them through the winter with little food available, but us humans in North America do just the opposite.

So, how does one prevent Dunlap’s disease (belly dun laps over the belt) by spring time? Other than doing push-always (from the table), here are some helpful hints.

First, even though the general recommendation for exercise is a minimum of 30 minutes of moderately vigorous exercise most days of the week (5 or 6), this is for improving cardiovascular fitness. However, it usually takes 60-90 minutes of this type of exercise to maintain or lose weight. We all know this is particularly difficult during the busy holiday season. For that reason, it is important to get started now to work exercise into your daily routine starting with 10-15 minutes of light exercise if you are just getting started.

Those that have a gym set up at home or always go to the gym can continue to do so although extra time may be required to burn those extra calories. The real problem is for those with limited space and/or funds.

People who can get out of the house but can’t afford a gym membership may be able to go to a mall to walk. Start slow and increase gradually. They can also increase activities of daily living by taking stairs instead of elevators, or go “the long way around” to the bathroom or someone else’s office.

A stationary bicycle in front of the TV doesn’t take up much space and often can be found at yard sales or on Craig’s List (get one with a heavy flywheel or fan). One can also read a book or study while stationary cycling (spinning).

Light calisthenics such as sit-ups (crunches), modified pushups (knees on the floor), modified pull-ups (heels on the floor), and core strengthening with bridges, planks, and leg lifts require almost no space.

Nordic Track Skiers can also be found at garage sales and on Craig’s List. They take up a bit more space but fold small enough to be stored upright in a closet when not in use.

Small hand weights and dumbbells are also available inexpensively and can be used in limited space.

All of these items and many more are particularly available, used, after the holiday season.

What ever you do to burn calories and increase fitness, do it daily. Just as you eat every day, you should exercise every day and spend about the same time doing each. Remember to start slow, but don’t stay there. Progress gradually and steadily. You will be amazed how much better you feel.

Tennis Elbow

By: Dr. Jason Levine, M.D.

Tennis elbow is a form of tendonitis that causes pain over the bony prominence called the lateral epicondyle on the outside of the elbow. It is often referred to as lateral epicondylitis.

Tennis Elbow

WHAT CAUSES IT?

Many doctors feel that micro tears in the tendon lead to a hyper-vascular phenomenon resulting in pain. The pain is usually worse with strong gripping with the elbow in an extended position, as in a tennis back hand stroke, but this problem can occur in golf, skiing, and other sports as well as with repetitive use of tools.

Aging appears to make these tendons more prone to breakdown. Therefore, lateral epicondylitis is more common once we get into our fourth decade of life and beyond.

HOW DO I KNOW IF I HAVE TENNIS ELBOW?

The Diagnosis is made by physical exam. No special tests are needed. The patient may present with symptoms when pressure is applied to the outside of the elbow. The patient frequently cannot remember an injury, but will have noticed pain either at the beginning or end of an activity that requires wrist and elbow movement.

HOW IS TENNIS ELBOW TREATED?

Before surgery is considered a trial of at least six months of conservative treatment is indicated and may consist of a properly placed forearm brace and modification of elbow activities, anti-inflammatory medication and physical therapy. If the above treatment is not helpful, a cortisone injection can be beneficial but no more than three injections are recommended in any one location in a year. A newer approach includes PRP (platelet rich plasma) injections which are performed under ultrasound guidance. This is a new emerging technology, but initial therapy results are encouraging.

Conservative treatment is in two phases and after Phase I (Pain relief) has been successful, Phase II (Prevention of recurrence) is equally as important and involves stretching and then later strengthening exercises, so the micro tears will not occur in the future.

If conservative management fails, then there is surgery. Surgery consists of removing the diseased tissue and stimulating an environment for healing. This can be performed using the standard open approach or using minimally invasive techniques such as arthroscopy.

Knee Pathology in Basketball Players

By: Burt Rogers

There is a large misconception which reflects a mindset suggesting only athletes involved in contact sports are susceptible to knee injuries. More accurately, non-contact injuries make up a significant percentage of knee pathology in basketball players. Injuries may range from overuse syndromes leading to patellar tendonitis (“jumper’s knee”), medial/lateral retinacular (next to the kneecap) or plica (discomfort next to the kneecap) patellar (kneecap) tracking abnormalities. In most cases the variables which create these problems are often related to overuse, i.e. long training throughout the season or too aggressive training early in the season, lack of flexibility, decreased strength, poor proprioception (awareness of body position while in space or while landing from a jump), poor foot mechanics and leg length discrepancies. Additionally, it must be understood that idiopathic (unknown) knee pain may be a referred pattern with originating pathology in the hip or lumber (lower back) regions.

While the pathologies listed above are primarily non-contact and may increase in severity over time, and, basketball is considered a non-contact sport, acute injuries, however may also occur. Basketball requires quick directional changes. This occurs when the knee is in the loaded position. This mechanism may occur as a result of an abrupt position change or an awkward landing from a rebound. When the knee is loaded and torsion or valgus/varus forces (forces pushing the knees into knock need or bull-leg position) are applied there is the risk of damage to the ligaments, cartilage, patellar dislocation or injury to the growth plate. The result may be immediate or delayed effusion pattern, restricted range of motion, diminished strength and proprioception and an often an inability to continue play.

The injury rates for men and women basketball athletes are similar with the exception of injuries to the anterior cruciate ligament (ACL). The evidence continues to support ACL tears in women are 3-5 times in greater than men. There is much debate on the reasons for this discrepancy. The variables may be wider hips and a more angular configuration leading to an increase of knee valgus stress under a torsion load, decrease in lower extremity strength and reaction time, a smaller interchondylar notch and changing hormone levels during the menstrual cycle. There is empirical evidence defining the preovulatory phase (days 9-15) when the hormones estradiol are increased and progesterone levels are decreasing when women are statistically more vulnerable to ACL rupture. While this injury is traumatic and most athletes can not play without treatment, there are references to isolated cases where athletes continue to play but often complain of their knee “not feeling right”. Any athlete, especially women who suffer insult to a knee, directly or indirectly where a “pop” is heard or perceived should seek medical attention regardless of functional status. While there is frequently acute swelling with ACL tears, a lack of swelling may lead to under diagnosis. Therefore, lack of immediate swelling or an ability to continue to play should not be viewed as having “dodged the bullet”. As equally important is the need for physician intervention for less acute but never the less debilitating knee pathology.

Healthy Weight Loss

By: Alexis Golesh

If you are trying to lose weight, you are definitely not alone. During the past 20 years, there has been a dramatic increase in obesity in the United States. Two out of every three American adults are now overweight and about one-third of the entire adult population is on a diet at any given time. Obesity is defined as a Body Mass Index (BMI) of 30 or greater. BMI is calculated from a person’s weight and heath and provides a reasonable indicator of body fatness and weight categories that may lead to health problems. Obesity is a major risk factor for cardiovascular disease, certain types of cancer, and type two diabetes. Losing weight may be one of the most important things you can do to improve your health.

The quest to lose weight leads many to fad diets and unhealthy weight loss programs. It is natural for anyone trying to lose weight to want to lose it very quickly. Evidence shows that people who lose weight gradually and steadily (about 1 to 2 pounds per week) are more successful at keeping weight off. Healthy weight loss isn’t just a “diet” or a “program”. It’s about an ongoing lifestyle that includes long term changes in daily eating and exercise habits. The changes you make should become part of your everyday routine. Starting with small changes can make a big difference. For example, by drinking just one less soda or sweetened beverage every day for six months, while keeping everything else the same, the average person would lose more than five pounds. The secret is consistency and patience. Make changes you can stick with, even if the changes seem small at first.

To lose weight, you must use up more calories than you take in. Since one pound equals around 3,500 calories, you need to reduce you caloric intake by 500-1000 calories per day to lose about 1 to 2 pounds per week. Eating less and eating “better” is important. Try eating a piece of fruit instead of cookies after lunch, or replacing your French fries with a green vegetable. That’s not much, but minor everyday changes can make a big difference over time.

Today’s portion sizes are often double or triple the recommended amounts. This is why it is so important to know what a single portion really looks like. For more information about serving sizes for specific foods, visit www.mypyramid.gov.

 Healthy Food Portions

Reading food labels can also help. Avoid extra calories by watching out for packaged foods or beverages that contain two or more servings. Estimating portions and reading labels can help you eat less. Just one or two smaller meals or snack a day can add up to another five or ten pound weight loss during the year if you stick to it.

Becoming healthier is not just about what you eat, it’s also about what you do. Regular activity helps control body weight by balancing the calories you eat and drink with the calories you burn every day. Experts recommend 60-90 minutes of physical activity daily for people trying to lose weight.

Start by setting realistic goals. The healthier habits that you include in your everyday lifestyle, the more successful you will be in reaching and maintaining a healthy weight.

• Start off your day with a healthy breakfast: Studies show that people who are successful at maintaining a healthy weight start the day with a good breakfast. A healthy breakfast gives you an energy boost and helps control cravings throughout the day.

• Don’t skip meals: Eating regular meals helps keep you from getting hungry. Missing lunch could lead to overeating at dinner or excess snacking in the afternoon.

• Snack smart: Healthy snacks keep hunger in check and prevent overeating at meal times. Good examples of snacks include low fat yogurt, nuts, fruits or vegetables. Try to keep snacks under 200 calories.

• Improve your carbs: You do not need to eliminate carbs to lose weight. Choose nutrient dense carbohydrates like whole grains, fruits and vegetables which also help you feel full. Empty calorie carbs like sweetened beverages or candy do not provide nutrients and leave you hungry.

• Watch your fats: Fat contains more than twice the calories of protein and carbohydrates, so don’t eat many high fat foods. Also, replace the saturated fats from meats and cheeses with unsaturated fats from fish and nuts.

• Don’t deprive yourself: Include foods you love that may not be the healthiest choice but include them in smaller quantities and a little less frequently to keep from feeling deprived.

The key to lasting weight loss is to find healthy habits that you can live with. Over time these new habits will add up to sustainable weight loss and improved health.

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Last Updated: 10/17/13