Sports Medicine

Posted by Steven M. Cohen

Variety is a key element of any fitness program. Why? To prevent plateaus.

You see, our bodies are amazingly efficient machines. This is both a blessing and a curse. The blessing is the body’s efficiency enhances our ability to survive. The curse is the difficulty this efficiency can cause in an exercise program. Our muscles, when stressed by exercise, recover, and become stronger. This principle is the basis of all weight and cardiovascular training. However, as the muscles become stronger, they also become more efficient. The next time a muscle is put through the same routine, it is able to move the same load with a lower expenditure of energy – the definition of efficiency. Over time, the same exercises become less effective at changing your body, because your body can get through the routine with less effort. At that point, your fitness progress will stop.

In order to prevent stalling out in a fitness program, variety of exercises and is the key. Changing routines frequently will keep your body “confused” and will allow you to make the biggest possible fitness gains in the shortest time. Now that’s the kind of efficiency that I like.

Posted by Steven M. Cohen

In a fitness program, which is more important, diet or exercise? That’s kind of a loaded question, as both are important. But, which is more important?

The answer to that question is another question – what are your goals? Exercise, of course, is vitally important for all of us. Without exercise, all of our muscles will slowly atrophy, leaving us weak, inflexible, and prone to injury and illness. On the other hand, a poor diet will leave us either fat (too many calories/fat/sugar) or weak (too few calories, as seen in some “weight loss” programs). The key is to find a happy medium.

So, which is it? Again, the answer is related to one’s goals. If one is looking at general overall health, then diet and exercise are equally important. But if the goal is peak athletic performance then diet, in my opinion, becomes the more important variable. That’s because no matter how hard one exercises, without proper fuel in the form of adequate numbers of calories, proteins and carbohydrates, the body will be unable to repair itself from the “damage” done by exercise. It is the repair process that leaves us stronger.

Similarly, if one is looking to lose weight, or develop a “beach body” for summer, diet is vitally important. One must be careful to stay within the recommended daily amount of calories and protein, in order to promote the fastest possible metabolism and shed excess body fat. If the diet is bad, no amount of exercise will help one look “ripped”. Only “clean” eating habits (no junk food) will give the desire results.

Posted by Steven M. Cohen

Lots of people work hard and exercise, in order to prevent sports injuries. For those of you who are over 40, like me, and still work out hard, good for you. I’ve been at it since I turned 21, and felt that I was becoming an out-of-shape blob before my time. I had a like-minded roommate at the time, and we invested in a weight bench and a standard weight set and started training in our apartment. Over time, I added running to my repertoire, for cardiovascular conditioning. The weight training and running regimen has served me well through the years. But, something was missing.

Until recently, I had never worked on my flexibility – and I paid for it. After years of running, I had become so tight, especially in the hamstring region that I couldn’t come close to touching my toes. However, I recently started doing yoga with my wife. I always felt that yoga was more of a women’s thing, but I was wrong. After three months of flexibility training, I’ve become reacquainted with my toes. I feel stronger, and more durable than I’ve felt in years. For all you active adults, I highly recommend adding flexibility work to your exercise routines.

Posted by Steven M. Cohen

This morning, after exercising, I took a minute to “inspect” the ugly, 8 inch scar that tracks along the inner aspect of my left patella. That’s the remnant of an anterior cruciate ligament surgery I had almost 28 years ago. I tore the ligament playing soccer at age 15, and had surgeries at ages 16 and 17. As I contemplated my long-ago ordeal, it got me thinking how far treatment for sports injuries has progressed since my injury.

For example, when I was initially injured, I was diagnosed as having “internal derangement” of the knee. That is doctor-speak for “something’s wrong with your knee, but I’m not sure what”. I was injured in the late 1970’s – the MRI scanner hadn’t been developed yet. Instead, I underwent regular a regular x-ray exam, which was negative (ACL tears do not show up on routine x-ray). I also underwent two arthrogram procedures. This (now antiquated) procedure was somewhat effective in diagnosing meniscal (cartilage) tears, but was ineffective for visualizing my problem, a ligament tear. If I had been injury today, a 20 minute non invasive MRI would reveal my ACL tear – no fuss, no muss.

I suffered along for almost a year and a half, before my doctor finally tried a newly developed diagnostic technique on me – arthroscopy. At arthroscopy, my true problem, the ACL tear, was revealed. He then went on to do a repair, using “open” technique, resulting in the large scar I carry today (arthroscopic surgery hadn’t been developed yet). Had I undergone surgery today, the repair would have been less invasive, arthroscopic surgery, with equally good results. Yep, it’s really amazing how far sports medicine has come.

Posted by Steven M. Cohen

Today, the Los Angeles Times ran a story in the Health Section following the results of six runners from last weeks’ LA Marathon. As I read the piece, I couldn’t help think that each of these runners is insane – not because they ran the marathon (I did that myself in 1996, and I don’t consider myself insane) – but because each ran with either an illness or an injury. These runners describe back pain, calf pain, cramping, sinus infections and the flu. It seems to me that each of these runners had a very good reason to either skip the race entirely, or drop out early. Yet, all six runners finished the race. Luckily for them, they didn’t seem to do any long term damage to their bodies.

Exercise is great. I work out every day. But they idea of exercise is to improve your health, not ruin it. Injuries and illness are reasons to back off of exercise. It’s neither smart nor “courageous” to finish a race under those conditions. Just ask the family of the unfortunate individual who died at the last Chicago Marathon.

Posted by Steven M. Cohen

Repetitive motion injury strikes again. This time, Chinese NBA star Yao Ming, was the victim. The Houston Rockets announced that their star center is suffering from a stress fracture in his foot. He is scheduled to undergo surgery that will likely end his NBA season. Yao is expected to be ready to represent his home country in this summer’s Olympic Games in Beijing.

While Yao has a professional obligation to try to play through pain, his stress fracture illustrates the consequences of meeting that obligation. Instead of taking a few days off to allow recovery, the continued pounding cost the Rockets their center until next year. By playing smart, and listening to your body, you can prevent falling victim to stress fractures in the lower extremities.

Posted by Steven M. Cohen

Tiger Woods has picked up in 2008 where he left off in 2007 – as the best golfer in the world, by far. He showed his dominance again this week, winning the Accenture Match Play Championship, for his fourth straight PGA Tour win, and his sixth win in his last seven tournaments worldwide. Aside from his monster talent, Woods’ dedication to fitness and flexibility that has kept him on top of the golf world, even after two decades of repetitive wear and tear on his body.

Although Woods usually declines to discuss the details of his fitness regime in the media, he clearly incorporates both strength training (look at him in those form fitting shirts he wears!), and stretching/flexibility work. As I’ve emphasized in this space, strength and flexibility are both necessary to maintain peak athletic performance, and to avoid injury. Although Woods suffered from a knee injury earlier in his career he has remained remarkably healthy. This is in stark contrast to many other professional golfers who look (how can I say this diplomatically?) like pro golfers - and not in a good way. Many a talented member of the PGA Tour has underachieved in his career secondary to injury (see Fred Couples, David Duval, et. al.). An overall commitment to fitness is the best way to avoid this fate.

Posted by Steven M. Cohen

Although most weekend athletes don’t give much thought to the seriousness of muscle injuries, muscle tears and strains of key muscle groups, though, are not to be taken lightly. Just ask Kevin Garnett of the Boston Celtics. He’s been out of action since January 25, due to a strained abdominal muscle. While it’s likely that Garnett will return to the Celtics’ lineup next week, the injury will have cost him almost a month of playing time.

I don’t know how Garnett prepares for games – even with proper conditioning, muscle injuries can occur. Garnett’s injury should serve as a reminder to all us “weekend warriors” of the importance of a proper warm up and stretching in the prevention of muscle injuries. If a muscle strain can sideline a highly conditioned profession athlete for four weeks, imagine how a similar injury would affect a recreational athlete.

Posted by Steven M. Cohen

Curt Shilling has had a great career, but the 41 year old pitcher for the Boston Red Sox has likely reached the end of the road. It’s been widely report this past week that Schilling has a rotator cuff tear in his pitching shoulder, and is in terrible pain. A doctor, not affiliated with the Red Sox, feels that Shilling needs surgery to possibly regain his pitching form. The team, however, wants Schilling to try conservative treatment first, in hopes that he can pitch in the latter part of this season (Schilling has said that the 2008 season will be his last). The Red Sox fear that rotator cuff surgery will sideline Schilling for all of 2008, and have threatened to void his $8 million contract if he undergoes surgery without team approval.

According to this ESPN.com report, Schilling’s rotator cuff resembles “linguine”. Although I haven’t seen any of Schilling’s medical records, if his rotator cuff does, in fact, resemble pasta, there is little chance that Schilling will be able to pitch effectively without surgical repair. In fact, if the tear is bad enough, surgery might relieve Schilling’s pain, but may not restore his ability to pitch at his previous high level.

The troubling thing about this situation to me, as a medical professional, is the fact that the financial considerations outweigh what is best for the patient – immediate surgery, with appropriate post-operative physical rehabilitation. While this option may harm the Boston Red Sox in the short run, it really is the best course, in my opinion, for Curt Schilling.

Posted by Steven M. Cohen

This week, Rod Woodson, former NFL player and future NFL Hall of Famer, was interviewed by Jen Murphy of the Wall Street Journal about his exercise routine since retiring from the NFL in 2004. Mr. Woodson relates that after a brief period of post-NFL laziness, he found himself suffering from back pain due to two degenerated discs. While playing pro football, Mr. Woodson was careful to keep his abdominal muscles and lower back strong by exercising. This, he says, kept his back pain-free.

After a brief layoff from exercise, Mr. Woodson tells Ms. Murphy how he began a new exercise program of non-impact cardiovascular exercise (stationary bike or elliptical machine), and weight training for muscle strength. The new program is a success, according to Mr. Woodson, as he has maintained his weight at 201 lbs since his retirement from football, and his back pain has disappeared.

The only problem I see with Mr. Woodson’s program is his admitted lack of flexibility training. In order to maintain optimum muscle and joint function, flexibility work should be included in a workout program. Routine stretches and yoga are helpful for both recreational and professional athletes alike.