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Dr. Michael Smith (Host):  It’s a very good thing that more and more people today are exercising. We know that it’s important to stay active throughout our entire lives. But a lot of us, most of us really, are non-professional athletes. We may not be as conditioned as we should, maybe we are not stretching as much as we should before we exercise. And we are encountering more and more injuries. Welcome to The GW HealthCast. I’m Dr. Mike Smith and today’s topic is Prevention and Treatment of Common Injuries Suffered by the Nonprofessional Athlete. My guest is Dr. Teresa Doerre. She is the Assistant Professor at the George Washington University School of Medicine and Health Sciences and is affiliated with The George Washington University Hospital. Dr. Doerre welcome to the show.

Teresa Doerre, MD (Guest):  Hi, thank you for having me.

Host:  I’m one of those nonprofessional athletes who does maybe a little bit too much and I end up hurting myself a lot, so this is a great topic for me. I want to start with maybe not so much the specific injuries that we will get into. We are going to talk about the top three. I want to first talk about pain. More and more people as you know, are exercising which is a good thing. We, as I said in the teaser there staying active is so important. But a lot of us do have that post exercise pain. When should somebody actually seek out professional help when it comes to pain after exercise?

Dr. Doerre:  Yeah, this is actually a very common question that a lot of people have. I think it’s very helpful to understand that there is some pain that it’s okay to work through and I think that’s typically soreness. It’s okay to have some soreness after a workout, soreness that even lingers to the next day, but as long as it’s resolving with conservative measures of ice and elevation and the soreness goes away within a day or so of working out; I think that’s the kind of pain that’s okay to work through and that let’s you know that you – you have actually done a tough workout, your body is recovering and that’s okay.

When I tell people to get checked out; it’s usually for pain that’s lingering and pain that’s preventing them from doing the activities that they want to do. And often, if this pain is associated with things like swelling of a joint and it’s really inhibiting them from doing what they want to do and it’s not just a gentle soreness from a workout that they’ve done; it’s something that’s lingering. It’s something that’s repetitive in the same spot and causing persistent problems; that’s when I think it’s important to get checked out and even if people aren’t sure whether or not it’s something to get checked out, I never think there is anything wrong in having more education about injuries and about workouts and about all those kinds of things. So, I think that’s a good general guide. But I never think there’s- I really sort of subscribe to the fact that there’s not like a stupid question when it comes to when injuries should get checked out.

Host:  Yeah. I think most people are familiar with the idea of what you just said. A little soreness is fine but if it’s lingering, if it’s two-or three-days post now and if it’s stopping you from doing your normal daily routine; that’s a good indication that maybe you need to seek some help. So, let’s talk about that nonprofessional athlete. Right, we know more people or at least I hope more people are understanding the importance of staying active and I think injuries are common in this nonprofessional athlete group. Why is it? Why is someone like me, I’m in that group; why am I more prone to injuries of say the shoulder, the hip, the knee?

Dr. Doerre:  I think people end up being injury prone when sometimes - especially I think it’s great that there are a lot of leagues that are available and people are participating in more recreational sports and even when they are doing activities on their own more like individual type activities such as running and training and swimming; I think these things are great. Sometimes I think people try to kick it from zero to sixty very quickly and I think on a number of fronts that can cause problems.

One is just before any workout it’s important to stretch and it’s important to have stretching just as a part of an overall routine because the more flexible you are, the more you are going to be able to prevent injuries. I think another thing that’s crucial to this is that you gradually work up to what you want to be doing. I think it’s great to have goals. I think it’s great to join a league. I think it is important to prepare so while it’s good to go out and play in a tournament; sometimes that’s a significant amount of activity compared to what someone does on a regular basis. And I think if you know you have an event coming up or you know you want to work up to a certain activity level; I think it’s important just to put in some of the time to work up to that and to practice beforehand and to get some reps in for whatever activity you want to be doing and just build up to that because I think that’s the thing that helps people prevent a lot of injuries. And obviously, that’s not always doable with everyone’s hectic schedule. So, I think it’s just important to listen to your body when you do go out to participate in sports. Because it is great. It’s great to push it. It’s great to get your heart rate up, but at the same time, you want to stay safe and you don’t want to cause yourself problems from being active.

Host:  Yeah, it’s interesting because I have a lot of friends. I used to fall into the same category as the weekend exercise warrior, right. I didn’t really do anything during the week and then come the weekend I’m playing tennis, playing golf, jogging, doing all of that and I know for me when I was more consistent with exercise throughout the week; that helped me with some of the pain and it seemed to help with some of the injuries that I was prone to which is really in my right knee. So, that weekend warrior thing, that might be an issue for some people.

Dr. Doerre:  It can be but I mean even if you don’t have time to consistently workout during the week; I think if you are going to be participating in sports on the weekend, just stretching before you go out and also doing a light warmup activity whether it’s just going for a quick jog before you get started playing tennis; it’s going to help you feel a lot better when you go to do more explosive movements later on. And so, I think just warming up really does help in terms of injury prevention as well. And I do think it is good to keep in mind though how much activity you are doing especially with things like throwing exercises and throwing sports. It can be very easy to quickly overdo it in terms of sort of straining your shoulder. But just keeping in mind how much you are doing and how you feel and then again, I can’t over-emphasize icing and just sort of symptomatic management.

Host:  Yeah. So, let’s talk about the top three injuries that happen in this nonprofessional athlete group and I know that through some quick research the knee, the shoulder, the hip very common areas of injury. I’d like to start with the knee if that’s okay Dr. Doerre because that’s the one that I always get. So, this is being kind of selfish here but, so when it comes to the knee; what is that most common injury? How do we prevent it and if it does happen, how do we treat it?

Dr. Doerre:  Yeah, I think the most common thing I see is what is referred to as patellofemoral syndrome or anterior knee pain. What happens is it’s a type of overuse injury where the cartilage underneath the kneecap becomes irritated from repetitive use and what ends up happening is it sort of causes this cycle of inflammation and pain and soreness and it can make it difficult to do sports and it can make it difficult to do daily activities.

The way to really tackle this and to prevent it is actually having good muscle control and good mechanics is actually one of the best injury prevention tools for this kind of pain. Having good core strength, having good hip strength and having good strength in your quads really helps control the movement of your knees and control the stress that goes through the joint. So, when I see people that have this kind of pain; I talk to them about sort of the things that we can do to help prevent the injury in the future and what we can do to help with the symptoms that they are experiencing at the time. And typically, anti-inflammatories, rest and a little bit of activity modification is enough to clear up the symptoms.

But just as important as getting rid of the symptoms now is preventing the recurrence of this pain in the future. And so, whether it’s though a home exercise program or formal physical therapy; I talk to them about the importance of strengthening and having that as a diverse part of a workout plan in order to prevent injuries down the road. And that’s very helpful for most people in terms of dealing with this injury and preventing it. And I also talk to them about a gradual progression and building up to more high impact activity in the future.

Typically, I have them start with low impact exercise just to get back into the swing of things and get back to activities and then we talk about building up over time to help prevent just falling into this pattern of dealing with this more chronic injury. The other thing that can lead to it is now with how CrossFit and a couple of other workout programs are pretty common; a lot of people do squats and deep squats can definitely add to some stress across the patellofemoral joint. Open Chain exercises can also put some stress there. So, when I see athletes that are dealing with these issues; I talk to them specifically about some of the things to avoid and it’s not that they can never participate in those things again; but just getting them symptom-free, getting them strong and then slowly working back into those kinds of exercises.

Host:  Yeah, that sounds like great advice. You mentioned something interesting that I do want to briefly talk about and then we will get into – we will just move up the body. We will go up to the hip and then to the shoulder. But you said something about core strength and we are hearing more and more about how important that is. Tell us a little bit about what that is. What core strength really means and how does that help with preventing some of these injuries?

Dr. Doerre:  Yeah, I mean I think the most important thing in what I tell patients is you can’t consider any injury or any body part in a vacuum. It is connected to the rest of your body. And a lot of people do talk about this concept of the kinetic chain where everything is tied together. So, having good core strength, having good strength in your low back, in your hips, your knees; these things are all tied together in terms of preventing injuries throughout the rest of the body. And often especially for hip injuries; identifying any weaknesses in the core are really important in terms of helping to prevent injuries in the future and addressing any current injuries as well.

Host:  Yeah, let’s go ahead and move up the body. So, we talked about the knee, let’s get into the hip. What are some of the – or what is the most common hip injury? How can we prevent it and if it happens, how do we treat it?

Dr. Doerre:  Sure. I mean I think – I don’t necessarily see as many people in the office for this, but having covered sports teams; I think just muscle strains about the hip are pretty much the most common kind of hip injury and so, not just one muscle group, but I mean the hamstrings, the quadriceps, the adductors, things that people think of being as like “groin pull”; these are the things that I see people commonly on the field as having injuries that are limiting them during a game. But the good thing is for the most part, these injuries are typically low grade meaning that it’s something that can be managed without surgery. It can be managed conservatively and just requires some rest, anti-inflammatory medications, gentle stretching and then a gradual increase in strengthening; but they can be really acutely painful. They can stop you from being able to continue to play during a particular event and it’s just important to manage it appropriately and to wait until your symptoms resolve until you go back and try to go full swing into activities again.

Host:  Yeah, so, when people say groin pull, I think that’s the common lay person phrase for this, right, but it could be really any of those main muscles supporting the hip. Is that right?

Dr. Doerre:  Yeah, I mean I think people sometimes use the term groin pull is a little bit of a grab bag term. Typically, we are talking about an adductor strain, the muscles that are on the inner part of your thigh, but people can sort of localize some of these feelings, whether it’s from the quadriceps or the hamstrings, kind of that part of the leg and they will feel pain when they have been working out and it will feel pretty sore the next few days. But the good thing is with just some of the conservative measures we are usually able to get people past it pretty quickly. Sometimes hamstring injuries can linger a little bit longer, but I think just having good education on it and knowing what to do really helps people get past most of it.

Host:  So, let’s just kind of continue going up. We got the knee, we got the hip, now we got the shoulder. What’s the most common injury there, how do we prevent it, how do we treat it?

Dr. Doerre:  So, the most common injury I see in the shoulder is kind of a continuum of injuries which is a strain of the rotator cuff which can cause pain in and of itself, but occasionally there’s a bursa which is a lubricating surface above the rotator cuff and this can actually become inflamed and that can cause what’s called bursitis. Those are definitely the most common things I see whether it’s people that are doing sports that require throwing or just a lot of overhead motion. It’s not uncommon to see people come in with pain that they feel in the front of the shoulder, down the side of the shoulder, sometimes even in the back of the shoulder and in terms of prevention, again, just circling back to some of the points about stretching, warming up and keeping track of how much activity you are doing especially if it's repetitive activity and icing after sports. That can definitely help prevent it.

If you notice some pain that’s lingering, anti-inflammatory medications can definitely help the inflammation from bursitis and that can be really useful, but I think another common thing that gets overlooked a little bit is to have a good rotator cuff conditioning program. And the rotator cuff muscles are small muscles around the shoulder, but they act as a compressive force over the humeral head and this actually gives really great dynamic control over your shoulder. So, if you do a good job of conditioning of the rotator cuff, just in general, you have better control of your shoulder and that definitely goes a long way to preventing injuries.

And sort of in the same vein of thinking, your periscapular muscles which control your shoulder blades; all these things are linked together and so having good conditioning of the periscapular muscles and the rotator cuff; these sorts of exercises that target these muscles. These aren’t heavy weights that we are using. But it’s for conditioning and it helps you have good posture and good form and it goes a long way for injury prevention.

Host:  You mentioned icing. I think a lot of people in this group, this nonprofessional athlete group; they think of icing as something you do if you had an injury, if there was an acute pain episode while you were playing tennis or something, that’s when they ice. Do you suggest that we should be icing our knees, our shoulders depending on what the exercise was, all the time after we work out or is it just when you have pain?

Dr. Doerre:  I think if you know you are prone to pain in a particular area; I think it’s good to ice it all the time. I think especially if you do a lot of overhead activity or a lot of throwing, I think icing your shoulders is definitely a good idea. I mean I think it’s hard to tell, sometimes you feel great like immediately after the workout and things are sore the next day. I don’t think you are necessarily losing anything by icing when it’s in response to pain but I think if you know that you have a problematic area; even if you are not feeling pain at that time; I think it’s good to do it a little bit preemptively to really help with any swelling and inflammation. And it’s definitely useful.

Host:  So, Dr. Doerre you gave us a lot of great advice for common injuries, knee, moving up hip and then into the shoulder. I liked what you said about core strength. I think that’s really important and of course warming up, stretching, very important. Lastly, what would you like people to know about exercise and some of these common injuries?

Dr. Doerre:  I think the most important thing is to find an activity you enjoy. I think finding out information and being educated on injury prevention and having good warm up and conditioning programs. I think those are really important. I think if you are going to embark on a training program or you have a new fitness goal whether it’s something that’s part of a team or if it’s an individual goal such as running a marathon; I think doing a little bit of research and having a training program is really helpful. There’s a lot of information out there and it’s always hard to know on the internet what information is the correct information.

But I can’t stress enough the conversation I have with so many athletes; is really just building up and doing a progression and letting your symptoms and any symptoms you have, really knowing your body and letting any symptoms guide your progression as you build up to whatever your fitness goal is. And as long as you feel good and there’s just a little bit of soreness, it’s okay to work past those things. But if you are running into some problems and things aren’t getting better and it’s becoming a little bit of a roadblock then it’s a good time to get checked out and I think that we are here and we are happy to manage these kinds of injuries and happy to work with athletes and happy to help people meet their goals. So, I think working together we can keep everyone healthy and still get them to meet the goals that they want to achieve.

Host: You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Doerre or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.