Thursday, September 30

Ask the Pro Doc

Shedding extra pounds...

Q: I am 225 lbs. I work out about 5 times a week, 2 hours of weights and 45 minutes of cardio. I can't seem to lose the weight. I eat mostly all protein. If I eat carbs, it is usually before 5:00 p.m., sometimes at night, I will eat some bread. I want to be at 200 lbs ... not sure what to do. I do not take anything to enhance my performance ... I bench 475 with ease. Also, will my strength go down if my weight does? Please get back to me. Thanks.
-- J, Chicago, Ill.

A: From Dr. William Straw, PTP member physician: "It sounds like you are doing a terrific job at exercise. When you are getting adequate exercise and can't lose weight, you need to look at the number and type of calories you are eating. I'd suggest writing down everything you eat and drink for a week. This will allow you to take a look at your eating habits. Many people find that by eliminating high-calorie, high-fat snacks in favor of healthier snacks like fruit, they can reduce their caloric load and drop a few pounds. Many people find that they never achieve their desired weight even though they are active and fit. Best of luck with your health and fitness."


Q: I get classic, painful, blinding, nausea-inducing migraines after I play sports. For the last 10 years I've been avoiding this by drinking Gatorade throughout the activity, and by eating a children's aspirin before I play -- a combination that works (or seems to work) about 95% of the time. I've talked to neurologists but they don't believe the migraines are exercise-related. I'd like to know (a) if this is a known syndrome, (b) if my Gatorade & aspirin cure makes scientific sense, and (c) if there's any way I can reduce my vulnerability -- e.g., by taking minerals or supplements that I might be chronically lacking. I've often wondered whether the migraines are related to dehydration, trace mineral deficiency, or if they have to do with, say, head movement -- I can get whammed after shooting baskets for 10 minutes. Thanks for your help.
-- Jon Miller, Lima, Peru.

A: From Dr. Donald Palatucci, Neurology consultant for the Oakland Athletics: "'Exertional migraine' is a very well known entity to neurologists and it certainly sounds like you have it. Your treatment approach makes eminent scientific sense. Increasing your blood-sugar level with Gatorade and taking an anti-inflammatory medication is ideal prophylaxis. There's an old principle of medicine: If what you're doing is working, keep doing it -- I don't have any better suggestion for you now. If what you're doing stops working, I'd recommend that you see a neurologist."

Pitching and weight lifting...

Q: I have been lifting weights for a couple of years now on and I'm not like huge muscle-wise. But the last couple of weeks I have been working hard in the weight room. My dad is starting to get angry at me because I am a pitcher and he believes the exercises I am doing are bad for me. My question is does doing curls with the dumbells have a negative effect on you performance pitching-wise. Also, if it is not too much trouble could you give me a little info on what would be good exercises for me. Thank you very much for your time
-- Randell Sierens, Webster, N.Y.

A: From Dr. William Straw, PTP member physician: "Your question about weight lifting is an interesting one. Experts disagree on the value of weight lifting for a pitcher. Many feel that specific exercises to strengthen the rotator cuff muscles in the shoulder and to keep the legs and back strong are beneficial. Most experts do not recommend heavy- duty body building because it may reduce flexibility and doesn't seem to help with pitching. Best of luck with your athletic endeavors."

Unstable knees...

Q: About 5 years ago, I suffered an ACL tear in my left leg while skiing. Because there wasn't an orthopedist at the clinic at which I was being attended, it took 6 months for one to do arthroscopic surgery. When he got into the knee, he said "What am I doing here?" According to him, the ACL had reattached itself so he just closed me up and sent me home with exercises. I am now 55, about 190 lbs.and in reasonably good health. I lift weights about 3 times a week and run about once a week. Recently, I have begun to feel my left leg slipping, that is to say that sometimes I can be just standing and all of a sudden, my lower leg slips either forward or to the side a slight bit. It's not very far but it sure hurts. It'll happen very randomly but it is happening more and more lately. It feels like the upper part of my leg slips backward as the lower part slips forward. I have tried to increase my leg exercises to help but they're beginning to hurt my patella! I am laying off them for awhile. When I run or water-ski, I have no problem. It's usually when I am totally relaxed and unsuspecting and then it hits. My new orthopedist doens't seem to be too concerned about it but it sure bothers me and I think it is getting worse. Should I push for treatment, an operation or what? Do you know any specific exercises I could do to strenthen the leg and knee. Thanks for your advice.
-- Richard Alcauskas, Davis, Calif.

A: From Dr. Jerrald Goldman, PTP member and team physician for the Oakland A's: "The anterior cruciate ligament (ACL) not infrequently tears from its femoral attachment and scars down to the posterior capsule and in part to the PCL. It can look good at the time of surgery but, in fact can be incompetent for two reasons. One, it has lost its inherent tensile strength, and two, it pulls on the flexible posterior capsule. As long as the secondary restrainers about the knee remain strong and if the patient is coordinated and aware he or she may do "okay". However over time this condition usually worsens resulting in the condition you describe in which your knee shifts. You did get some good years, so there was nothing wrong with a conservative approach, but now that your knee is slipping, surgical reconstruction can be considered.

There are very good ACL operations that are available today such as the Arthrex transfix system. I believe that a physiologically strong, active or "young" 55-year-old should not necessarily or automatically be precluded from considering this type of surgery because of his or her chronological age.

Incidentally, if you are doing knee extensions, i.e., sitting with knee bent 90 degrees and extending your knee against resistance as a means to build quad strength, it is the most likely the cause of your patellar pain. Besides, it is a non-physiologic exercise -- most sports are weight-transfer types meaning one is in a weight-bearing position, flexing and extending the knees as you would while skiing or playing baseball, tennis, golf etc. Also non-physiologic exercise can also cause anterior translation of the tibia on the femur, thereby further stretching the ACL. Therefore do squats, leg presses, toe rises leg curls, but not extensions."

Little League elbow...

Q: My younger brother is an extremely talented young baseball player. He is eleven years old and is a very active pitcher. After taking him to the doctor for a continuous pain in his elbow we were told that he had Little League Elbow. It seems that cartilage has broken off and is floating around his elbow. The doctor also told us that he should never play baseball or quarterback again. I was wondering what kind of medical options he had as far as treatment and recovery?
-- Anna Durnovich, Independence, Va.

A: From Dr. Bill Bryan, PTP member and team physician for the Houston Astros: "Your physician may be right. If there is OCD of the elbow, it needs prolonged rest. If there is a significant piece of cartilage loose in the joint, it may have to be removed (and the defect from whence it came grafted with articular cartilage). If his symptoms abate he could start throwing in a year and he might return. These are very tricky situations and I suggest you get a second opinion from another sports medicine doc in your area. A safe bet is to find out who the local baseball doctors are."


Q: I am 22 years old and I run 3.5 miles and lift weights approximately 6 days a week, along with backpacking and hiking. I am also getting more into mountain biking. However, I am concerned about any long term effects on my joints, particularly my knees. Do you have any suggestions for an intense exercise routine that will allow me to continue my backpacking and mountain biking well into my 50's?
-- Wade Shelton, Hamilton, N.Y.

A: From Dr. Henry Clarke, PTP member and orthopaedic surgeon for the New York Knicks: "In order to maintain your fitness program over many years, I suggest incorporating a general stretching and warm-up routine into your training program. This is important for minimizing injuries, especially as you get older. Also, you may wish to consider cross training and integrating a variety of non-impact activities into your schedule in addition to your running. Such activities include biking, swimming and nordic track."

Patella problems...

Q: I was recently diagnosed with a subluxed patella. This injury occurred while hitting baseballs in a batting cage. Is there a strong possibility of this injury reoccurring, especially while playing basketball?
-- Chris Butts, Athens, Ga.

A: From Dr. T.O. Souryal, PTP member physician: "Subluxating patella is a recurring problem with cutting sports like basketball. Exercises and a brace may be all you need. See a sports orthopaedists for more advice."

Shoulder dislocations....

Q: I suffer from a condition where my shoulder will spontaneously dislocate. Are there any athletes who suffer from this ailment? If so, how do they treat it?
-- Brian Dennert, Ill.

A: From Dr. Bruce Moseley, PTP member and team physician for the Houston Rockets: "In general, shoulders that dislocate can be successfully treated with surgery that restores full stability to the shoulder 95% of the time. This is true even for athletes who participate in contact or collision sports such as football, basketball, wrestling, etc. I would recommend a visit to your local orthopedic sports medicine physician and he or she can discuss the pros and cons of this and other options with you."

Rotator cuff....

Q: I have had rotator cuff surgery and an acromium plasy ( removal of a piece of bone??) to help my tendons, etc. move easier. I am 52 years old, what % of useage should I expect to regain. I am very active but have been hurt more times recently than I wish to mention. How long does the complete healing process take? How agressive can I be in retraining?
-- North Sydney, Nova Scotia

A: From Dr. Bruce Moseley, PTP member and team physician for the Houston Rockets: "Results from rotator cuff surgery vary depending on the size of the tear, the success of the repair, any associated problems (such as arthritis), the effort put into rehabilitation afterward, etc. All of these factors can affect the length of time to recover as well. However, most patients gain maximum recovery about one year after surgery for physical, strenuous activities. If it has been more than one year since surgery, you should discuss the situation with your surgeon to see if there is anything further that can be done."

Throwing soreness...

Q: What advice can you give to players who get severe soreness in their biceps after throwing the ball around? Ice or heat? Before or after?
-- Jim, Chicago, Ill.

A: From Christian Peterson, D.O., PTP member: "There are a variety of techniques to get your shoulder ready to play. It is important for you to realize that you need a specific program just for you. It is not as simple as ice or heat. Regardless of the level of competition, you need to get your shoulder in shape for your sport. This consists of a proper 'off- day' stretching and exercise program as well as a separate 'game-day' program. Most athletes will use some form of heat prior and ice after their game. During rehab, some feel that the ice will help with their pain management and this allows them to rehab harder. It is hard to go wrong with some form of ice and I would contact a local sports physician to help you set up a program to get your shoulder in shape and prevent any possible injuries."

Ice or heat...

Q: In the article about groin pulls the doctor mentions to use rest, ice, stretching and strengthening. My father was giving the instructions to use moist heat then use isometric exercises to strenghten the area affected. Which one works best, ice or heat?
-- John Craven, Tempe, Ariz.

A: From Dr. Robert Gotlin, PTP member and team physician for the New York Knicks: "Groin pain is a very common complaint for the active, athletic person. A 'typical' groin pull is a strain of a muscle, i.e. a partial tear of the groin muscle(s). This usually resolves within 3-6 weeks with relative conservative care. For the first few days after the injury, application of ice alternating five minutes 'on' and five minutes 'off' along with gentle stretching of the area and taking a mild anti-inflammatory medication (if not contraindicated by medical conditions such as ulcers or 'stomach' problems) is usually suffice to treat this. After the first few days, warm compresses are often helpful as this assists the muscle to gently stretch by pre-warming it. Isometric exercises are a good choice as the 'first' strengthening type of exercise to try once sufficient healing has occurred. This is the time when while performing the strengthening exercise there is little to no local groin pain. Isometric exercises allow the least muscle activity so they are okay as a starting point. One important time that isometric exercises are potentially problematic is if you suffer from hypertension (high blood pressure). In this case, isometric exercises should be withheld unless close supervision by a physician is available. If the groin pain is not resolving as described, other things to consider are: a hernia, hip joint pathology, low back pathology, a nerve injury and irritation of the groin bones (sometimes called 'osteitis pubis')."

Shallow knee caps...

Q: Last November, I injured my knee while in a football game. My doctor said that my knee caps were shallow and that this allowed my patella to slip out. After a few months I got most of my strength back but when I run hard in practice it swells up. I need to know how I can strengthen my knee further and prevent the swelling.
-- Nick, New York

A: From Dr. Henry Clarke, PTP member and team physician for the New York Knicks: "Problems with the joint between the patella and the groove in the femur that it runs back and forth in are difficult to manage, especially if you have a developmental abnormality as your doctor told you. In general, exercises that help you strengthen your quads but that protect your kneecap may improve the swelling. These exercises include bike riding (with the saddle up high to prevent you bending your knee greater than 90 degrees),and knee extension exercises on a Nautilus/Universal machine (making sure that you don't bend more than 90 degrees at the start and ending 5 degrees from complete extension). Lastly, avoid things like running up and down steps, stair- step machines, squats, or leg-press machines. You could also try a neoprene knee sleeve with a hole cut out over the knee cap as this sometimes help. If none of these things help I would suggest revisiting your MD as there may be another problem."

Patellar tendon tears...

Q: What is the surgical process for someone with a complete patella tear and how long is the rehab?
-- Matt Painter, New York

A: From Dr. Randy Wroble, PTP member physician: "I assume that you mean a complete tear of the patellar tendon, not the patella. The surgery that is performed is a repair where the ends of the tendon are literally sewn back together. Only in cases that have gone untreated for weeks are more complicated procedures used. After repair, the patient will typically remain in a brace on crutches for 4 to 6 weeks. Physical is employed to help regain motion & strength. Full return to sports or heavy work occurs after 4-6 months."

Vertical leap...

Q: I am 15 years old and enjoy basketball. I would like to know what exercises I could do to gain jumping ability. Either weight or aerobic.
-- Brian, Des Moines, Iowa.

A: From Dr. Randy Wroble, PTP member physician: "To develop better jumping ability, employ a combination of training techniques. These include strength training, aerobic/anaerobic training, and plyometrics.

Strength training is performed in 5-6 week cycles with 1 week rest in between. Do 3 sets of 6-12 reps of each exercise. Allow 1-2 minutes rest between sets and at least 1 day rest between training sessions. At the start of each session, do a 10 minute stretch and warmup. Exercises should include: squats, leg curls, lunges, leg press, calf raises, leg extension, and seated calf raises.

Jogging and biking provide you with good aerobic training and if you add in some interval (anaerobic) work such as sprints or longer bursts, you can add some power and muscle endurance to your lower body. Intervals should be 20 to 60 seconds in duration with full recovery. Perform anywhere from 4 to 10 intervals per session. Increase duration and intensity of intervals as you improve.

Plyometrics, or jump training is very important as well. Control while taking off and landing is critical with plyometric jumping. Be sure you are balanced and even on your takeoff. Begin with jumping up and down and landing with soft quiet feet. Land on the ball of your foot and eventually onto the full foot and absorb the shock by bending at the ankle, knee and hip joint. Repeat until comfortable. The basis of plyometrics is a soft landing followed by a quick takeoff. Begin as above and rebound as quickly as you can with a 4-6 inch squat upon landing. Progress to a 12-16 inch squat jump for a combination of power and strength. This work should be done at the end of your weight training session. Do 3 sets with 1 minute rest in between, starting 1x/wk, then moving to 2x/wk after the first 4 wks. Start at 10 reps and increase slowly to 30 reps per set.

Hold hands clasped behind your head and keep head up and have good posture when doing squat jumps. Other variations of plyometrics appropriate for your age would include hurdle/cone jumps and box jumps and the standing broad jump. Hurdle/cone jumps: Jump side to side and/or forward and back over a 12 inch hurdle or cone. Three sets of 15-20 would be appropriate. Box jumps: Jump forward or sideways up onto a 16-to 24-inch box or block. Work on explosiveness. (Jumping off the box back down is too much stress for your body at this point so don't try this) Standing broad jump: Two foot takeoff for distance. Stick the landing and hold 5 sec.

There are lots of resources about this kind of training. Ask your high school coach or athletic trainer what programs they use, too. Good luck."

Shoulder surgery...

Q: In two weeks I'm having my shoulder scoped, to fix a labral tear. I've had shoulder pain for years that was diagnosed as RC tendinitis. Since learning that I have a torn labrum, I have noticed that this seems to be a fairly common sports

injury that is just now being reported correctly. Is this because the technology is finally available to correctly diagnose these problems? In addition, I'm 32 and play competitive sports (softball, volleyball) and hope to return next spring and play well. Could you comment on my chances of returning to be able to play all out without excruciating pain?
-- David Pressley, Raleigh, N.C.

A: From Dr. Allan Curtis, PTP member and physician for the Boston Celtics: "In a 32-year-old throwing athlete, shoulder pain often is mutlifactorial. At the time of surgery, the first step is to examine your shoulder while you're asleep to make sure it is stable or not sliding out of the joint. The arthroscope is then inserted to examine the inside of the joint. This involves a good look at the labrum, rotator cuff, biceps and ligaments. In your case, there may be degeneration and tearing of the labrum as well as impingement. This would be addressed by debriding the labral tear, then doing a subacrimonal decompression - all athroscopically. If the labrum is detached superiorily near the biceps, this is called a slap lesion and can also be repaired through the scope. If your shoulder is unstable and the labrum is detached anteriorly then many surgeons would take care of this through an open anterior reconstruction. The key to success in a throwing athlete is to address the pathology in the least invasive manner possible, then get into a good rehab program. Good luck!"

MCL sprains...

Q: I suffered a sprain to my MCL while wrestling. They said I'd be good to go again in a few days or a week or so. I don't have the major pain anymore, but it's still tender and hurts now and then if I bend it certain ways. I wear my brace but still can't shoot takedowns without discomfort. Can you help me? What should I be doing to help make it even stronger? Will I always have this pain or will it fully heal, it's been about 5 wks. so far. Thanks in advance.
-- Mike Ciesnolevicz, Williamstown, Pa.

A: From Dr. Bruce Moseley, PTP member and physician for the Houston Rockets: "MCL injuries take a long time to become pain-free. While it is possible to resume activities fairly soon after the injury, the pain gradually subsides over 2-4 months or even longer. Occasionally there is an associated meniscus tear that might require arthroscopic surgery, but this is unusual. If your knee isn't becoming pain-free after 3-4 months or so you might want to have your orthopedic sports medicine physician take a look at it again to look for signs of a meniscus tear."

Arthritic hip...

Q: I am a very active 32 year old who was diagnosed with an arthritic hip over a year ago. At the time I was diagnosed, I was not experiencing hip pain. Over the last year, I have drastically changed my training activities and began taking chondroitin sulphate/glucosamine and anti-inflammatory drugs. I now experience the classic symptoms of arthritis of the hip. I have done some research into the subject but have found very little information regarding living a very active and relatively pain-free 30-something life.
-- Nick Ranalli, Chicago, Ill

A: From Dr. Henry Clarke, PTP member and physician for the New York Knicks: "Arthritis of the hip in a young person is a difficult problem with no perfect solution. The choices for treatment include reducing activities to minimize the symptoms, medications such as advil or prescription- strength anti-inflammatory medications, osteotomy (cutting the bone) to realign the joint in order to relieve contact on the arthritic areas, or hip replacement which has a high likelihood of needing to be redone during your lifetime. The extent of the arthritis and the nature of your symptoms are important factors in determining which of these is the best solution. I recommend you see a hip specialist for a comprehensive evaluation."

The information, including opinions and recommendations, contained in this website is for educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis or treatment. No one should act upon any information provided in this website without first seeking medical advice from a qualified medical physician.

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