How to avoid your local orthopedic surgeon OR

How to avoid your local
orthopedic surgeon
OR
How to live the athletic life
you lead or fantasize that
you lead
Sabine von Glinski, MD
Orthopedic Injuries in Life
•Soccer and other
youthful/collegiate sports
•Recreational Athletic Pursuits
•Pregnancy
•All of us
•Working, working, working:
ergonomics
•
Let’s just get soccer and all of the rest of these
sports out of the way:
Volleyball
Softball
Basketball
ACL disruption***
Ankle Sprain
Cutting & Jumping Sports/injuries
•
•
Females:4-6x more likely have an ACL injury than men
•
High School Female Athlete: total number 4x higher than
above (>40,000 serious knee injuries/yr)
Collegiate sports: 1/10 female athletes with ACL injury
(>15,000/yr)
The ACL
Injury of the ACL
Mechanism of ACL Injury
•
•
Noncontact injuries = 80% ACL tears
Female: Ç vulnerability due to neuromuscular
imbalances:
• Ligament dominance
• Unbalanced quad dominance
• Poor landing mechanics: single-legged landing
Preseason Prevention Training
•
•
Three Phase Training Program involving
• Plyometrics
• Strengthening: lower extremity & core
• Stretching
Focus
↓
↓
↑
↑
Peak landing forces
Valgus torque at knee
Hamstring function
Jump height
Prevention Training
•
Focus and Goals
• Avoid vulnerable positions
• Increase flexibility
• Increase strength
• Include plyometric exercises into the training program
• Increase proprioception though agilities
Prevention Training
•
This translates to correction of dynamic movement
patterns & muscle imbalances
ACL Injury Prevention Progams
•
Santa Monica Sport Medicine Group
• www.aclprevent.com
•
Dr. Tim Hewett
• fax: (513) 636-5958 / Email: [email protected]
•
Vermont Ski Association
• fax: (802) 229-6917 / Email: [email protected]
•
Oslo Sports Trauma Research Center
• Email: [email protected]
Overuse Injuries
•
•
Associated with:
• Poor biomechanics and technique
• Previous injury
Baseline Treatment once Injured:
• RICE =
Rest
Ice
Compress
Elevation
Ankle Sprains – the Universal Injury
•
•
Common to: volleyball, soccer, basketball,
softball, runners, triathletes
Associated with:
• history of previous injury
• pronation of hind foot
• decreased ankle mobility
Prevention of Ankle Sprains
•
•
•
•
Peroneal muscle conditioning
Increase ankle dorsiflexion
Improved landing technique:
• land with a wide based gait
• neuromuscular control of ankle
Prophylactic ankle taping or bracing
• lace-on stabilizers = better than taping
• Semi-rigid plastic braces
Running Injuries
•
•
•
•
•
•
•
•
Patellofemoral syndrome
Iliotibial band syndrome: +common running downhill
Shin splints
Stress fractures: +common when running >40mi/wk
Ankle sprains
Plantar fasciitis
Achilles tendonitis: +common if running hills
Other tendonitis problems
Avoiding Runner’s Injuries
•
•
•
•
•
•
•
Change shoes every 300-500 miles
Select shoes carefully
Improve running surface: avoid concrete
Select appropriate terrain
Stretching: before, after and between runs
Taping or bracing:
• taping or bracing for PF & ITB syndrome
• night splinting for plantar fasciitis
Anticipate that age will be a factor
Avoiding Runner’s Injuries
•
•
•
Minimize muscle imbalance
• strengthen hip abductors
• strengthen hamstrings
Increase training regimen gradually
• volume: duration, distance, frequency
• intensity: speed, terrain difficulty
Improve running biomechanics/ avoid overpronation
• decrease muscle imbalances: strengthening exercises
• orthotics: OTC (foot soldiers) or custom (orthotist)
Overuse Injuries in Triathletes
•
•
•
•
•
Incidence: 45-75% tiathletes
rate: 2.5-5.4 injuries/1000 training hours
+ common cause: training errors
• training hours
• technique
• poor hydration & electrolyte intake
+ occur during running
+ involve lower extremity: 72-77%
• knee is the most common site: 32%
Overuse Injuries in Triathletes
Overuse Injuries in Triathletes
•
+correlations with injuries
• History of previous injury
• Training hours: too little or too much
2x injury rate
• Biking: 5-6hrs/week = best
• Running: 3-4 hours/week = best
• Total: 8-11 hours/week
• Pre-training warm-up & post-training cool down:
• None or occasional only
Çinjury rate
• number of years of triathalon experience
• >5 years experience
Çinjury rate
• Higher Competition level
• National level or higher: 2x injury rate
Biking Overuse Injuries
•
•
Rare in experienced riders
Injuries common in 1st time century riders with
the following biking history:
<26 miles/week
<500 miles/year
at speeds <14 miles/hour
never biked >30 miles/single ride
never biked >100 miles/1 day
bought bike <1 year prior to century ride
Biking Overuse Injuries
•
•
•
•
•
•
•
buttock pain – butterfly saddles
knee problems - correct riding position, lower gear
neck & shoulder pain – correct riding position
hand & wrist pain/numbness (CTS)
foot or ankle pain - correct riding position
tendonitis – contrast baths
leg pain and cramping – massage, hydrate, electrolytes
Overuse Injuries for Swimmers
•
•
•
Otitis media
Shoulder pain
• Impingement syndrome
• Subscapularis bursitis
• Instability associated pain: especially in elite, younger
swimmers
Back pain
Overuse Injuries for Swimmers
•
Prevention shoulder injuries:
• Improved back posture in daily life
• Improved swimming technique
•
Prevention of back injuries
• Improve kicking biomechanics
• Improve breathing technique
Pregnancy and Exercise
•
Safe exercises:
•
Sedentary women: begin with 15min/3x per week
•
Eat & drink fluids appropriately
• most non-weight bearing exercises
• Swimming
• Stationary biking
• walking
• increase as tolerated
• follow talk test
• after 1st trimester avoid:
• supine exercises
• exercises involving prolonged standing
Pregnancy and Exercise
•
Active women:
• Continue regular exercise regimen
• Physical comfort should dictate types&levels of activities
• Expect gradual decline in performance throughout pregnancy
•
Competitive Athletes:
• Readjust goals
• Maintain basic fitness
• Do not attempt to stay at peak performance levels
Pregnancy and Exercise
•
Contact sports
• avoid after 1st trimester
•
Exercise at high altitude
• moderate exercise at altitudes up to 6000ft
• acclimatize gradually
•
No scuba diving
Women and Lifting
Proper biomechanics:
squat down bending at
the knees (not your waist).
Tuck your chin while
keeping your back as
vertical as possible.
The Non-exercising woman
•
Change this: begin slowly
• 15-20 minutes – 3x/week
•
•
•
Maintain proper posture
Maximize ergonomics at home and at work
Avoid obesity
Biomechanics and Strengthening
•
If you belong to a gym:
• Treat yourself to a personal trainer
• Improve your technique
•
If you don’t belong to a gym:
• Consider a home exercise corner
• www.fitter1.com
• www.exertools.com
• www.kettlebell-training.com
• Other internet sources and tapes
General Factors that can cause
Musculoskeletal Pain
•
•
•
Obesity
Tobacco use
Lack of regular exercise
Key Points
Cutting & Jumping
Sports/injuries
•Females:4-6x more likely have an
ACL injury than men
Prevention Training
•Focus and Goals
• Avoid vulnerable positions
• Increase flexibility
• Increase strength
• Include plyometric exercises
into the training program
• Increase proprioception
though agilities
Key Points
Overuse injuries
Rest
Ice
Compress
Elevation
The Non-exercising woman
•Change this: begin slowly
• 15-20 minutes – 3x/week
•Maintain proper posture
•Maximize ergonomics at home and
at work
•Avoid obesity
Resources
Home Based Fitness/Equipment
www.exertools.com
31 Boulevard Blvd, Suite F
Novato, CA 94949
1-800-235-15591559
www.fitter1.com
www.kettlebell-training.com
www.crossfit.com
www.powerathletesmag.com
Health Based Websites
www.sportsmedicine.about.com
www.sportsmedicine.about.com
www.physioroom.com
ACL Injury Prevention
•Santa Monica Sport Medicine Group
• www.aclprevent.com
•Dr. Tim Hewett
• fax: (513) 636-5958 / Email: [email protected]
•Vermont Ski Association
• fax: (802) 229-6917 / Email: [email protected]
•Oslo Sports Trauma Research Center
• Email: [email protected]
Braces, etc.
Demar Medical – night braces for plantar fasciitis
[email protected]
(925)-285-9461- Rich Belcher
Aircast Sport Stirrup
DonJoy ALP brace
Bicycle Seats
Butterfly Seat – Terry Fly models have the best overall
ratings
Kaiser Permanente Resources
For resources tailored just
for women, visit
kpwomenswellness.org
Healthwise® Handbook
Members may call 1-800-464-4000 for a
free copy
Resources for a healthy lifestyle
kp.org/healthyliving
•Healthy Lifestyle Programs
•10,000 Steps program®
•Health Classes
•Healthy Discounts
•Online Drug and Health Encyclopedia
•Health Calculators
•Featured Health Topics
•Message Boards
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