Transcription:
Common Injuries in Active Adults

Introduction: Here's another edition of the BayCare Health System’s podcast series, BayCare HealthChat with Melanie Cole.

Melanie Cole: Welcome to BayCare HealthChat. I'm Melanie Cole, and today we're discussing common injuries in active adults. Joining me is Dr. Fred H. Brennan Jr. He's a Family Medicine and Sports Medicine Physician with BayCare. Dr. Brennan, it's a pleasure to have you join us today. Before we get into these injuries, tell us about the physical activity guidelines. What are they and how can we meet those recommendations? What are the latest that we know about those now?

Dr. Brennan Jr.: Well, thanks for having me. First of all, I appreciate you bringing me on and very good questions. And I think the reason we bring up the physical activity guidelines is that if we're encouraging people to be more active, the reality is they're probably going to be more injuries that we're going to see just because they're more active. And so in 2018 the physical activity guidelines were updated and basically this is for active adults. Children, we recommend at least 60 minutes a day of rigorous or vigorous activity. And for adults the guidelines changed a little bit where they're recommending that we as adults are active with moderate activity, about 150 total minutes a week. So if you say 30 minutes, five days a week, that's 150 minutes. And that could be like a brisk walk or a bicycle ride, swimming, it doesn't have to be running or sprinting.

The other option though is to be more active and more vigorous and that would be 75 minutes of a vigorous activity, for example, running or sprinting or aerobics or something of that nature where you're really getting your heart rate up there. So it depends on what you decide to pick. Most people like to do something like a brisk walk. It's easy, just put your shoes on and out the door you go. And then also recommending some weight training about three days a week, 30 to 45 minutes of some sort of weight training where you're, you know, you're working the major muscle groups like your arms and your abs. Your abdominal muscles and your legs. So those are just some of the recommendations that were made in 2018, just to try to get people more active where we know it's such an important part of our lives in how it can really prevent and treat illnesses. But with that we'll bring other problems, right, with overuse injuries, et cetera, that we have to be careful to prevent those injuries from happening when we are encouraging people to be more active.

Host: Well, you're certainly right about that. And as the American College of Sports Medicine says, exercise is medicine. So we know we are supposed to get this amount of activity. But as you said then injuries and the ones that you see go up, what are the most common that you see, Dr. Brennan, what are you seeing people come into you for?

Dr. Brennan Jr.: The two biggest things are overuse injuries and then traumatic injuries, right? So traumatic injuries can be from falling off your bike or you know, somehow falling off some sort of, in a rollerblading or something like that. So we have our traumatic injuries, which could be upper extremity or lower extremity. Then a lot of what we see in our sports medicine clinics are a lot of overuse injuries. Just basically doing too much, too quickly, not recovering. You know, especially after the New Year, their New Year's resolutions and they go to the gym and they start pushing the weights or running hard on a treadmill and then we see these overuse injuries. And so I think those were the two categories of things we see with active people. We see the traumatic injuries from the falls and the wrecks and things like that. And then we see the overuse injuries and you know, for the upper extremity, I would say the biggest thing we see in our clinic is our shoulder problems like bursitis or tendonitis in their shoulder. And what I often tell people the shoulders are really not meant to be weight bearing joints.

You know, when we're younger, when I say that and I'm in my fifties I can say this is when you're in the thirties and below, doing things above your head, pressing things above your head, like a military press, you know, we can get away with that, that's no problem. But as we get into our late thirties and forties and you're making a non weight bearing joint, i.e. the shoulder a weight bearing joint, you get into trouble when you start pushing things overhead. So I often will tell my patients, you know, we have, we, those of us over 40 have no business pressing or pushing things up over our head. It's just not going to be a good outcome. We're going to get shoulder problems, tendonitis, bursitis. And so that's some of the general guidance I give people over 40, if they're going to start lifting weights and things, really keep it from shoulder height below. Don't be pressing heavy weights over your head. I think you're going to get problems with bursitis and tendonitis in your shoulder, which is one of the most common overuse things that we see in active adults, especially over 40

Host: That's really great advice and something I give my patients as well. So Dr. Brennan, tell us a little bit about some of the other injuries because as you say, lifting weights over our head. But golf is a big one for active adults hitting the ground can cause all kinds of injuries, you know, and even the weekend warrior getting out there, sports specific trainings have problems certainly with our youth athletes. But when we're talking about these overuse injuries for adults, you know, they're not sports specific as much. They're not, you know, really intense. We're talking about weekend warriors here. So what do you want them to know about sports like golf and tennis and things like that, that people really like to play to keep active. And sometimes those are the ones that cause your knees and your hips and your back and your elbows to flare up.

Dr. Brennan Jr.: Yeah, no, excellent question. And I think where we get into trouble is you know, our minds, again as we get to be active adults and into our thirties and forties, you know, our minds think we can still do things that we could do when we were in our twenties. And what we tend to do is we go all out, say to you that I haven't been golfing in a while and you go out and you play 36 holes of golf the first day out. And the reality is, you know, these are different muscle groups that we haven't used in awhile potentially. Or even if you're an active golfer that does golf a lot. If you golf too much and you're not giving yourself, enough time to recover. Again, when we were younger, you take a day to recover. When we get older you might take two or three days to recover from the 36 holes of golf. So I think we have to be realistic as, as we do get older to, you know, A, don't do too much too quickly. B, is definitely allow ourselves time to recover. And part of that recovery is hydration, you know, rehydrating and refueling with quality foods, i.e. not sugary sweets and you know, things of that nature.

And just realize that we can do all these things that we enjoy doing, but we have to start off slow, gradually work it out, do some strength training, especially for golfers. Their back. You got to be careful. That's motion with twisting and swinging the golf club that is not a normal motion for our everyday life. And so we have to gradually work your way back into it. If you haven't been golfing for three months, the first day on the golf course, you shouldn't be out there, you know, doing 36 rounds or hitting, you know, three large buckets of balls on the driving range that's just going to ask for trouble potentially in your elbow or your back, your shoulder. And the same thing goes with tennis. Same thing. It's an overhead sport to some extent with serving. And it's not the day to go ahead and play, you know, three hours of tennis when you haven't been out there for a while. So I think it's really important is the warmup playing a reasonable amount, especially in the early parts of the seasons. Giving yourself enough recovery time, including hydration and nutrition and you know, listening to your body, if you're really sore from a day's activities from the day before, maybe the next day you should do something different and not try to beat the soreness and think it's going to be okay. You're just potentially asking yourself for a little bit of trouble.

Host: Well, certainly in one of the big issues people find now when they're walking or running or golfing or playing tennis are knee injuries and, certainly as our knees and our hips get older, Dr. Brennan, they tend to break down, get a little osteoarthritic. So what do you want us to know about hopefully preventing? You've given us some really good advice about not going too strong on your first day in and you know, not doing too much, knowing your limitations, but some of those lower body injuries are insidious and chronic. And is there a way that we can prevent them? And while you're talking about that, let's talk about what we do when we start to feel them.

Dr. Brennan Jr.: Well, I think the biggest thing, like we say with weight loss, the best way to lose weight is never to gain weight, right? That's the number one thing. And for things like osteoarthritis, there's certainly some people that there's a genetic predisposition. You know, everybody in the family had arthritis at an early age or a moderate age. We used to think, you know, and people would say, well, I'm not going to be a runner because I know that running causes arthritis in your knees. And that's actually, as you know, as an exercise physiologist, has been proven not to be true actually, there's a less incidence of arthritis and runners. Now if you have a torn cartilage or knee at an early age and you continue to run, that may predispose you to getting arthritis earlier. But in general, things like running have been shown over and over again not to cause arthritis.

So for arthritis of the weight bearing joints, like the hips and the knees and the ankles, the best way to prevent that, two things. One is to stay active and you know, do not become an inactive person. And the second thing is to keep your weight down because we know the number one risk factor for developing arthritis in our joints is not being a runner. It's not playing basketball when we were in our teens and twenties, it's actually letting ourselves get overweight to the point where we’re overloading our joints on an everyday basis. So the best advice I would say, and it's not easy, trust me, I fight the fight as well is to keep your weight down. Because once you start creeping up on your weight that starts to predispose you to developing arthritis much sooner than you would if you kept your weight down.

Host: And then what about if we have injured ourselves? Are you an ice man? Heat, bracing, wrapping, what do you like us to do? If we start to feel some of those things from tennis, golf, walking, whatever it is, and we start to feel little aches and pains. What do you like us to do?

Dr. Brennan Jr.: Yeah so, you know, when you look at the evidence, there is not as far as, you know, what's better, heat or ice or that type of thing. I think most of us in sports medicine for these things say, you know, use what works for you. So in general, an acute injury, you fall, you bruise something, it swells up. For the most part. I think people will recommend for the first three to five days ice to keep down inflammation. As time goes on, if you have something that's more of a chronic or recurrent problem people tend to go more with heat, warm packs and things of that nature. But there's no golden rule because there are some people that ice really makes things hurt more when they flare something up and they feel better when they put heat on it. So I usually tell people, listen, our general recommendation is icing for the more acute things. Like you fall off your bike and hurt your wrist or your shin starts to hurt after you start running. But everybody's a little bit different. And then so we use what works for you. And the same thing with the over the counter medications like Tylenol and ibuprofen and Naproxen.

Those are all things that certainly as long as you don't have a lot of other medical conditions that say you shouldn't take those like kidney problems or history of ulcers for these people taking these anti-inflammatories you can certainly try those short term. We don't recommend long-term use for those things because you can get into those troubles we talked about like ulcers and raises your blood pressure. But certainly to try, you know, for a few days up to a week or two an anti-inflammatory if things are getting a little angry. But remember that, you know, when you become sore and things start to ache, it's again, your body has given you a message saying that, you know what, maybe today I should do another activity. If my knees are hurting me, maybe I should do something more upper body related and give yourself a couple of days to recover. And if it still continues to bother you and it's not getting better with ice or heat or an anti-inflammatory, again, short term, then it may be worth saying, you know, maybe something else is going on. This is taking longer than I thought it would to get better and maybe I should go see, you know, my physician or provider to make sure there's nothing more going on than just an overuse inflammation.

Host: That's great advice, Dr. Brennan, as we wrap up, best advice for common injuries in active adults and what you want us to know about preventing them in the first place.

Dr. Brennan Jr.: So it's sort of what we alluded to before. If you haven't been doing something and you want to start being active again first of all, make sure you have the right equipment. If you're going to go walking, for example, that's going to be your new activity. You know, don't be wearing high heels or your work dress shoes. You should be wearing proper walking sneakers, be well-hydrated, and make sure you get plenty of rest the night before. Go ahead and start off slowly, gradually build yourself up in activity over four to six weeks, gradually progressing the weight, gradually progressing the distance. But take your time, make it fun, make it enjoyable and then make sure you're listening to your body that if something is feeling a little sore, achy or swells up, that you do take some time off to let your body recover for a few days to let that go down. And it's not the time to say, Hey doc, I need a couple of Percocet’s to make the pain go away so I can exercise more. It's not the right answer. Your body is telling you, slow down for a couple of days and let's go ahead and work our way back up again when the, when the discomfort goes away. So I think that's the biggest thing is listen to your body. Start off slow, gradual and have fun. Enjoy it. It's really supposed to be, you know, activity is supposed to be something that's fun for you and healthy for you and you don't want to overdo it, hurt yourself and then say, this is no fun, I'm not doing this anymore because then in the long-term it's not going to be good for your health.

Host: Dr. Brennan, that was absolutely great information. Thank you so much for all the good advice that you gave us about common injuries in active adults and ways to prevent them. Thank you again. To learn more about BayCare's Primary Care services, please visit BayCare.org And that concludes this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips like these great ones here, please follow us on your social channels. I'm Melanie Cole.