Meniscal Injuries

Another knee article? What is left to talk about in the knee? The meniscus is a piece of cartilage and has a number of important responsibilities.

First, it is a shock absorber. It is not hard like bone, but softer like the discs in our back. When we walk, run and jump, the bones transfer force up the limb and the meniscus help decrease the impact when the force is transferred from bone to bone.

Second, it helps with stabilization. The knee joint is a stable joint by design with the ligaments and muscles, but not because of the bone structure. It is not a deep socket like the hip but much flatter joint surface like our fingers. The meniscus is thicker on the outside of the knee than the inside, so it helps deepen the rather shallow knee joint.

Third, it reduces arthritis to the articular cartilage, the smooth lining of the ends of the knee bones. Without the meniscus there is more bone to bone contact which leads to quicker breakdown of the smooth lining. For this reason, orthopedic surgeons always attempt to repair a meniscus if able, rather that taking it out. The articular cartilage actually does not have pain receptors in it, so the reason why articular damage hurts is because of the bone structure under the articular cartilage that does have pain receptors.

The meniscus can get damaged two ways. First, is trauma. Meniscal damage is very common when ACL tears occur. The ACL injury occurs generally with twisting and twisting with compression also shears the meniscus potentially causing a tear. The second way is with degeneration and general wear and tear. As we age, our body tissues get dehydrated. I am not talking about whether you drink enough water --although everyone should stay hydrated and yes, that level does affect cartilagenous tissues in our body--but just like foam around handles and rubber seals around car doors shrink and breakdown, so do these types of cartilage. This lack of hydration leads to increased potential for meniscus breakdown.

There are a number of signs of meniscal issues. First, joint line pain is generally present. The pain though can be deeper though. Second, catching or locking. If the tear causes a big flap, the flap can get folded over and block the knee bones from moving in a certain direction. Either of these symptoms warrant a discussion with your primary care physician and or orthopedist.

Meniscal tears can heal, but where the tear is located is a very important part of this determination. If the tear is in a place that can heal, a surgeon can repair it with staples or stitches. If is located on the more inside of the knee, where circulation is poor, it will not heal and more than likely, the surgeon will remove the torn portion. Although a repair of a meniscus will require a number of weeks with crutches while removal of the menicus will have no weight bearing restrictions, the weight bearing limitations of the repair are worth the benefits in the long run.

There are non-surgical options that may be considered prior to undergoing the knife, and yes, physical therapy is one of them. Physical therapy focuses on improving the circulation to the knee joint with low resistance cyclical motion, improving the strength around the knee and assuring good alignment with the hip and foot.

To avoid mensical damage, avoid deep knee squats and lifts is the main prevention point. While activity will increase wear and tear, not performing physical activity to "save" your meniscus is not a good alternative! If you knee is limiting your physical activity, please consult your primary care, orthopedist or physical therapist, so you can get back to your favorite sport, recreational activity or simply back to getting around the house. Do not let knee pain hinder you getting benefits for your heart and other joints.

Ankle Injuries Article for Southern Standard

Although the UT-Knoxville Volunteers shut out the UT-Martin Shyhawks, 50-0, it was not without a little suffering. In addition to other injuries, two Volunteers suffered from ankle injuries. While Jarrod Shaw, offensive lineman, and Denarius Moore, wide receiver, were questionable, they played against Oregon.

The University of Tennessee Department of Sports Medicine does not release specific injury reports or more specificity beyond: Out, Questionable, Probable, or Active, so lets speculate what injuries these athletes could have sustained.

The most common ankle injury is a “sprain” resulting from a twist in the ankle. The most common are call inversion ankle sprains and is when the heel and bottom of the foot roll inwards. This can happen when a player steps on another foot, the player cuts but the player’s weight is on the outside of the foot, or when the player gets tackled low. Another name for these sprains is lateral ankle sprains. Lateral means outside, most of the damage with ankle sprains is on the outside of the ankle.

Inversion or Lateral ankle sprains have three grades of severity. The severity is dependent on how many ligaments are damaged. If you make the “OK” sign with you hand and then place it on the outside of you ankle with palm in and fingers down, your three fingers are roughly in the places of the three outside ligaments. For any future anatomists out there they are call (from front to back): the anterior talofibular ligament, calcaneal fibular ligament, and posterior talofibular ligament.

There are a couple grading systems for ankle sprains, but for simplicity, grade 1 is when the front ligament is injured, grade 2 is when the front two are injured, and grade 3 is when all three are injured.

Often athletes can get back in the game with a grade 1 ankle sprain, but grade 2 ankle sprains require more time off due to the increased instability. Acute treatment for ankle sprains, whether you are a Volunteer on the field or a Volunteer fan that stepped off the tailgate wrong, is RICE: Rest, Ice, Compression, and Elevation. The next step is getting motion and mobility back. Specific training of the outside muscles with strengthening and balance exercises are crucial to increasing the bodies ability to protect the damaged ankle.

Ligaments unfortunately do not shrink once stretched, so often the strengthening and balance is the most important to prevention and is often overlooked because it is generally after the pain has diminished and people return to general activity.

A couple newspapers reported that Denarius Moore was using a walking boot, a big bulky immobilizer that covers the entire foot and shin, but can be used with walking. This is a form of rest. By allowing the ankle not to have to control shifting while walking, there is decreased stress to the ankle joints.

Although ankle sprains generally pull all at the ligaments on the outside to cause the damage, the inside of the ankle can often have damage because of the compression, which results in swelling and bruising, but does not hurt the stability of the inside of the ankle.

Two other somewhat common results can occur with a lateral ankle sprain: a fracture of the fibula, the outside bone at the ankle, or a “high” ankle sprain. The fracture of the fibula will require cast immobilization or a surgical fixation.

The high ankle sprain is a tear in the ligament between the two bones of the lower leg, the tibia and the fibula. While these bones do spread as our ankle moves, too much will cause a tear. High ankle sprains generally occur with grade 2 or 3 ankle sprains and will require a much longer healing time. If the high ankle sprain is very unstable, it is not uncommon for an orthopedist to place a temporary screw to hold the two bones together to allow for healing.

Because of the quick return to active status, as a spectator in the peanut gallery, I assume that the ankle injuries sustained by Jarrod Shaw and Denarius Moore were grade 1 or 2 with no high ankle sprain involvement.

The Volunteers will see many more ankle injuries this year, lets just hope that they don’t make the grading scale and they get back to the field ASAP. Go Vols!

Zach Sutton, PT
Doctor of Physical Therapy
Master of Exercise Science
Board Certified Orthopaedic Specialist
Certified Athletic Trainer

Prenatal and Postpartum Exercise

On the first weekend of college football, you may ask, why in the world is there an article on prenatal and postpartum women in this week's sports medicine moment? Well, last week I became a proud father of a little baby girl, who was born at River Park Hospital’s awesome Family Birth Center.

To my wife and all mothers, you have my respect and admiration and therefore this sports medicine moment is dedicated to you.

I think it is obvious that I a proponent of exercise, and the benefits of exercise do not skip prenatal and postpartum women. During these times, exercise helps decrease low back and pelvic pain, maintain appropriate weight and increase Endorphins that lower risk of depression.

Recreational exercise such as walking, running and swimming can be continued throughout the prenatal period, but women should check with their OB specialist before beginning any new exercise program. Weight lifting for “toning” can often be continued during the first two trimesters. Team sports and recreational activities that have a higher risk for trauma, such as softball and bicycling, should be limited, but are best if avoided.

Robin Bell, a certified nurse midwife with Innovative Women's Health and Dr. Rene del Valle, endorses exercise, but states that exercise should be avoided if you experience extreme fatigue, have been placed on bed rest or have poorly controlled disorders such as blood pressure, diabetes, or seizures.

Recent medical literature links unnecessary pregnancy weight gain to childhood obesity. The Kaiser Foundation estimates that 36% of all children in Tennessee are overweight or obese. Childhood obesity increases many medical risk factors including diabetes, premature joint pain, and cardiovascular diseases.

Robin Bell states that she individually determines for her patients what amount of weight gain is necessary for a healthy baby utilizing a Body Mass Index (BMI) calculation. Generally, if a person is overweight prior to the pregnancy, less weight gain is necessary and but more weight gain may be recommended for someone who is underweight.

Low back pain is a common complaint due to the increased looseness of the pelvic bones from the hormone called Relaxin. Relaxin increases as early as 14 weeks and can remain into postpartum as long as breastfeeding is occurring.

Christi Gilliam, PT, who specializes in orthopedics and women's health at River Park Hospital, recommends an evaluation with a women's health physical therapist for women who experience pelvic or low back pain during the prenatal or postpartum period. She states that specific pelvic exercises during prenatal and postpartum can help control these episodes of back pain.

If you are expecting, talk with your OB specialist because prenatal and postpartum exercise could play a major role in the health and well being of you and your baby!

Zach Sutton, DPT, MS, OCS

Osteoarthritis

Osteoarthritis

What is osteoarthritis? Osteoarthritis is literally arthritic inflammation of the bone. Our bones are highly structural, but are quite rough, so there is covering layer at the ends of all our bones called cartilage. This cartilaginous covering normally wears away in all of us throughout our lives, but some quicker than others.

There are some new procedures like hyalgine injections and glucosamine and chondrotine sulfate that attempt to improve the layer, but ultimately this layer is not replaceable.

People with osteoarthritis often feel limited, wanting to exercise but are concerned about experiencing more pain or causing more damage. This double edge sword situation can be challenging and often leads people to consider knee and hip replacements.

This limitation, avoiding weight-bearing exercise, often limits people in their ability to exercise, which affects not just their muscle strength and bone integrity, but also lung and heart function. Do not let osteoarthritis keep you avoiding exercise because it will affect your entire body, your health, and your lifespan.

Starting an exercise regime with osteoarthritis should focus on ways to increase the pounding of your heart rate without the pounding on the joints. Water exercise and aerobics is a wonderful alternative because of the buoyancy eliminates the pounding on your joints, but the water also gives resistance for strengthening.

You do not need to know how to swim, you can do all these exercises standing up and in the shallow end of a pool! The Civic Center has instructors certified to assist you, so why wait!

Alternatives to running, walking and water programs are the elliptical, bicycling, and the rowing, the later two can be performed in the gym or out in nature. There is a great benefit to joints with cyclical motions that are performed with the bicycle and the elliptical. Our joints actually get very little circulation and blood flow and rely on movement to get nutrients into the joint and inflammation out of the joint. Do you ever wonder why your joints are so stiff after sleeping or sitting for along time? Not moving is the reason. I frequently use the analogy of a pond with my patients to explain how cyclical motion improves joints. Ponds that are stagnant with little movement of the water become very thick with algae. Ponds that have movement of the water from a spring or stream stay clear and do not get bogged down. So find a way to keep moving!

Strength training can also provide benefit to decrease pain with osteoarthritis. By increasing muscle around the arthritic joint, the muscle will increase its sock absorption ability causing less stress to the joint bones.

There are many exercise professionals and facilities in Warren County. The Civic Center does not require a membership, so you can pay as go. So if you have osteoarthritis, do not eliminate all exercise, just work with a healthcare professional to determine the right exercises to help your condition.

Zach Sutton, DPT, MS, OCS

Osteoporosis

Osteoarthritis is often confused with osteoporosis. Both of these conditions deal with the breakdown of bone, but just in difference places.

Osteoporosis deals with the major part of the bone and osteoarthritis deals with the covering at the end of the bones that make up a joint.

Specifically, osteoporosis is a thinning of the bone that structural part of the bone.

These conditions also have different outward signs and symptoms. Osteoarthritis is painful, particularly with weight-bearing activities such as running and walking. Osteoporosis often does not cause pain, and people can often have it without knowing. Although osteoporosis does not frequently hurt, people with osteoporosis are more likely to experience stress fractures in their lower legs, compression fractures in their backs and hip fractures with falls. People with osteoporosis are twice to three times more likely to experience a fracture than someone with normal bone density.

Osteoporosis can be prevented with early detection, proper nutrition and exercise. Females are more likely than males to have issues with osteoporosis, but males do experience this condition too.

Generally, the risk of osteoporosis increases with age, but even teenagers can show signs of osteoporosis, frequent stress fractures are a red flag. A fancy, two-beam x-ray of common thinning areas such as the hip and spine is the way radiologists and your primary care physician will determine if you have osteoporosis. Proper nutrition to prevent osteoporosis starts at a young age. Your peak bone mass occurs in our twenties, so calcium intake with yogurt, cheese, and milk are very important in our youth.

Unfortunately, these items often compete with teenager’s preference for sodas and chips. Vitamin D is crucial for the absorption of the calcium for bone formation. Folic acid is an important vitamin involved in the formation of bone.

Although bone mass will slowly decrease after our twenties, continuing good diet and particular exercises programs can slow this process! There are other aspects that increase risk for osteoporosis including smoking, chronic alcohol use, and excessive caffeine.

Weight bearing exercise like walking and running is great for osteoporosis. When stressed our body responds by increased bone density. Weightlifting is great to maintaining bone density to reduce or avoid the effects of osteoporosis. For those affected by both Osteoporosis and Osteoarthritis, weightlifting is a great way to improve both of these conditions.

Increasing muscle mass increases bone density to help osteoarthritis and increases sock absorption to help osteoporosis. If you have any concerns about diagnosing osteoporosis, please consult your primary care physician. For women, gynecologists can often play a role in this too. If you wish to prevent or improve your bone density, do not hesitate to seek an exercise specialist such as a certified personal trainer or physical therapist.

Fun Run

Let the count down begin! I am not talking about the start of the college football season, but for those interested, that count is at 87 days until UT plays their season opener against UT-Martin, but I am not counting or anything. No, I am talking about the count down to the 4th of July Fun Run and Walk put on by the Rotary Club. The 4th of July Fun Run and Walk is a perfect event to bring family and friends together, but also a goal for those starting exercise programs!

But why exercise? My recent articles have involved on how not to get injured, but are you getting injured by not exercising? I mean, is it dangerous to be a “couch potato?” Before I answer that question, I wish to ask one to you. What is the hardest position for your low back: sitting, standing, or lying down? Give up? Sitting is the most damaging to your back! The pressure on our discs, the padding between each bone in the spine experiences twice the amount of pressure in sitting than standing. Think of a jelly donut and adding twice the amount of weight to the top of the donut…the jelly is going to spill out. While sitting with lumbar support and avoiding prolonged “slumped” positions can help reduce the sitting risk, most all exercises involve the trunk muscles. So by exercising, you not only get out of the sitting position so much, but also improve the trunk muscles that support your back.

So if you decide to spend less time on the couch and get ready for the upcoming 4th of July Fun Run and Walk, I applaud you! If you are new to exercise, don’t forget that you have many resources in the area to help you safely set exercise goals such as certified physical trainers, certified athletic trainers and licensed physical therapists.

Zach Sutton, DPT, MS, OCS

Cardiac Screening

Every week I sit down and write about getting off the couch and exercising. However, as we begin the football season, I am reminded of the risk of vigorous exercise, particularly in a sport such as football that adds heavy, often suffocating pads to a hot environment mixed with a high risk for trauma.

General awareness regarding sudden death in young athletes has increased over the past few years. Medscape Medical estimates the risk for sudden cardiac death to be 1:100,000 for high schoolers and 1:65,000 for college athletes. While that does not seem like a lot, it is actually about 90 athletes per year in the U.S.

While the risk is very low, the loss of one of our young athletes would be tragic.

Tim McIntosh, ATC, LAT, Warren County High School's Head Athletic Trainer, has an Emergency Action Plan that includes annual training of emergency situations. In addition to being certified by the National Athletic Trainers Association and Licensed in the State of Tennessee, he is certified in Cardiopulmonary Resuscitation (CPR) and keeps an Automated External Defibrillator (AED) at hand. He stresses that the AED is a life-saving device, but its success is dependent on administering the AED within 5 minutes of the cardiac event.

Dr. Robert Benson, MD, Warren County's only resident cardiologist, reports that the majority of these cases are completely sudden with no history of medical problems until the cardiac arrest occurs. While routine physicals are crucial, the only way to detect the cardiac conditions that place a young athlete at risk is with an evaluation with a cardiologist. Cardiologists use an Electrocardiogram (EKG), as a non-invasive, monitoring system to read the signals given off by the heart for a few minutes. This screening tool allows cardiologist to determine if any abnormal signs are present in the heart. If any concerning signs are noticed, cardiologists will often perform additional tests like an echocardiogram, heart catheter, or cardiac MRI to make an accurate diagnosis. A trained cardiologist, such as Dr. Benson, is able to detect conditions such as hypertrophic cardiomyopathy, the common cause of sudden cardiac death in high school athletes, that cannot be detected in a routine physical examination. Once tested, the results should last throughout the young athlete's sports career.

An article in The Journal of the American Medical Association in 2006, confirmed the value of EKG screening, but this is still not yet a common practice nationally. The Sun Sentinel reported in March that mandatory EKG testing reduced sudden cardiac death by 89% in Italy in athletes between 14 and 35 years old. Since these results were published the European Society of Cardiology and the International Olympic Committee now recommend EKG screening of all competitive athletes. The University of Tennessee-Knoxville's Department of Sports Medicine is on the cutting edge and started utilizing EKG screens with all their student athletes three years ago. The American Heart Association has not taken the same stance yet, continuing only to recommend a medical history and physical examination at this time. Therefore, EKG screening is still on a voluntary basis in Warren County.

The major limitation is the cost of the EKG and the Cardiologist visit, however, I was pleased to find that the majority of insurances will approve a one-time wellness visit to a cardiologist. Being a cutting edge cardiologist, Dr. Benson is offering to accept the highest risk athletes, the Warren County Football players, for a cardiac wellness visit this Fall. Warren County football player parents can schedule a cardiac wellness appointment for their child with Dr. Benson at 931-815-4770.

With Tim McIntosh's and Dr. Benson's help, it is my hope that our young athletes are safer than the national statistics. Go Pioneers!

Zach Sutton, DPT, MS, OCS

Achilles Heel

Football session is here and so are the injuries. The Tennessee Vols have been plagued with the no so typical football injury. We commonly think about football injuries such as knee sprains, stingers to the shoulder, and turf toe, but Ben Martin and Marlon Walls of the University of Tennessee football team are both out for a prolonged period of time due to Achilles injuries. Coach Derek Dooley was quoted on utsports.com saying, "Our Achilles heel so far has been our Achilles heel."

The Achilles, also know as the "calf", is made up of two muscles, the gastrocnemius and the soleus. They are responsible for pushing your toes down, kind of like the action of pushing down on a gas pedal. These two muscles attach around the knee and on the back of the calf in two different areas but merge together close to the ankle becoming a tendon that attaches on the back of the heel.

These injuries were non-contact and often the mechanism of injury can be as simple as a missed step, stepping into a hole during non-athletic sports, or explosive push off when running. These injuries are generally caused when there is significant "eccentric" force on the muscle attempting to control the upward pressure on the foot that the Achilles tears. The main action of this muscle points your toes, but when you are on your toes, it is the muscle that controls your heel slowly coming to the floor, and this is the "eccentric" phase of the muscle.

Interestingly enough, pain with this type of injury is a good sign. "What? This guy must be mean," you may be thinking to yourself right now. However, a painful Achilles injury means that the tendon is still partially intact. A complete rupture will tear and visibly ball/roll up in the upper part of the calf, and because there are no pain fibers to pull on any longer, complete tears are relatively reasonable with pain. Obviously, partial tears have quicker recovery, but because the pain receptors are still relatively intact, it is not pleasant to walk.

Jason McVeigh, MS, PT, ATC, LAT, the Director of Sports Medicine for the University of Tennessee Volunteers, reports that Achilles tendon ruptures are a relatively uncommon sports injury in collegiate athletics resulting from an overload of the tendon to the point of rupture. As with most major injuries, the severity, location, and prior history of injury can influence the long term outcome. At times they may require a surgical repair and extensive rehabilitation, and athletes commonly are able to return to participation in sport.

Dr. Jeffrey Peterson, of Advanced Orthopaedics and Sports Medicine, explains that there are generally two treatment options for complete Achilles ruptures: Non-surgical cast immobilization for a minimum of 6-10 weeks or open surgical repair of the rupture. The main difference between the two is that the non-surgical group has a higher chance of re-rupture and patients may complain of less strength after treatment whereas the surgical group generally has a lower re-rupture risk but assumes the risks of surgery. In athletes, the surgical route is most common due to their activity level, while lower demand and older patients may be do well with the non-surgical path. Whichever route is taken the recovery time averages around 6 months and physical rehabilitation will usually be required.

The season for the Vols will go on, injuries are part of the game. Two weeks until the season opener!

Zach Sutton, DPT, MS, OCS

Happy Paddling

Attention all water sport enthusiast, now is the time to dust off the canoes and kayaks. The Breakfast Rotary club of McMinnville just completed a clean up of part of the Barren Fork, from the dam to the River Watch next to the Water Treatment Plant off of 56.

Literally, a ton of trash was combed from the banks, the river bottom, and trees by Rotarians, Interact, and additional volunteers who embarked in thirty plus canoes, kayaks and rafts last Saturday from the dam concluding at the River Watch.

This section of river is very pretty with small rapids, fish, bird watching; 2 big cranes live in this area! Both sections of the river have easy area for loading and unloading. The start is at the park at Route 55(S. Chancery St) and Old Morrison Road. One take out is at The Rotary Club’s River Watch Park. To get there by car, take Route 56(Beersheba Highway), making a left on East End Drive. Drive straight at the stop sign and this gravel road will bring you to the ramp after passing the baseball field and playground. Floating to this take out from the dam is approximately 1 hour. For a much longer float, you can continue down the Barren Fork River for approximately an additional 3 hours, arriving at the Ramp of the VFW, located on the East Side of the 70S (Sparta Highway).

Paddling sports, particularly kayaking, can really work the muscles of the trunk and upper extremity. Not using trunk muscles during this activity decreases the ability to transfer power to the arms. Also in the kayak, the hip portion of the trunk helps balance and change "center of gravity" when going through rapids and "digging" into turns, so you may be surprised to find sore hip muscles after this activity.

Obviously there are some safety items that are important to use to prevent injury or death such as life jackets, a whistle, sunscreen, and drinking water. The humidity of the summer is still among us and this will cause us to sweat even when paddling in the water, so remember to stay hydrated!

Another risk for injury that can be prevented is the slumped positioning that can occur due to the design of most boat seats, or lack there of design. Just as couch potato slumping can lead to herniated discs, so can slumping while paddling. Always try to position yourself with good posture at the beginning of the trip, before you being to feel pain from the prolonged poor posture. If you wait until pain presents itself, some damage and/or irritation has already occurred.

If you already have bulging disc issues, consider adapting a backrest with lumbar support on the canoe. You may be surprised that may kayaks actually have very good lumbar support and support for the trunk.

Another position which is common for whitewater canoeing is to kneel on pads with your bottom resting on the edge of the seat. Lowering your knees below your hips naturally places your back in a good posture.

Taking frequent standing breaks on the banks every 30 minutes or so can help as well by getting into a standing or extended position.

Thanks again to all the volunteers led by The Breakfast Rotary. Happy paddling!

Zach Sutton, DPT, MS, OCS

Careers in Sports Medicine

It is almost time for our young adults to pack up their rooms again and head back to college. The question, what should I major always tends to be a challenging question to answer, sometimes even when they are about to graduate! I often get parents and patients asking about how do you get into sports medicine, what degree does my son/daughter need, will they be able to get a job?

There are many ways to participate in sports medicine. I started as a cross country and wrestling coach and realized that coaches play a very important part on adjusting the level of demands during recovery or injury recognition particularly with less acute and more chronic issues like tendinitis of the knee, ankle, elbow, or shoulder. Coaches are very important part of the sports medicine team, even though they might not be formally trained!

Once an injury has been recognize, often our athletes will be assessed by a certified athletic trainer or A.T.C. ATCs assess injuries on the field or in the field house, give immediate care to stabilize, determine triage if additional emergency services are required or formal physician referral is required. ATCs often start exercises, modalities such as ice, heat, ultrasound, and electrical stimulation, and are the experts in sports medicine for taping unstable joints. ATCs are formally trained with a bachelor's degree, certified by the National Athletic Trainers Association's Board of Certification. More information regarding becoming an Athletic Trainer and schools with athletic training programs in Tennessee can be found at www.nata.org. In Tennessee, athletic trainers are also required to be licensed by the Board of Medicine.

ATCs have close relationships with primary care physicians and orthopedic physicians, but cardiologists and pulmonologist can be involved as well. Particularly with contact sports such as football, ATCs work closely with EMTs and Paramedics when head, spine, or fracture injuries are suspected. When more in-depth rehabilitation occur, physical therapists become an active part in the athletes recover and return to sport. Physical therapist are also licensed in the state of Tennessee after completing a three year post-graduate degree. More information on becoming a physical therapist and the schools in Tennessee can be found at www.apta.org. Often Athletic Trainers and Physical Therapists are dually trained. The way to do this is complete an undergraduate degree in Athletic Training and then attend post-graduate work in Physical Therapy.

Athletic Trainers need to be able to work independently and think on their feet. In emergency situations, the ATC is most often the most qualified sports medicine particianer. The day of the ATC can go from 0 to 60 very quickly. Somedays are completely uneventful, where others are very busy. Most Athletic Trainers work with school systems at the high school or college level and therefore, the are able to get some recovery time when the school sessions are out. Schools with football, however, often have pre-season practices that can be very intense. The University of Tennessee will begin their "two-a-day" practices in the coming weeks and this will start with administrative physicals, drug screening, and breakfast as early as 6am, so that means the athletic trainers will be up earlier! During these practices, the team physician and the team orthopedics will be present every evening to help the ATC attend to the injuries of the day, so often the day is not concluded until o'dark thirty.

Particularly with two-a-days and hot weather sports, the ATC is responsible to coordinating hydration for the athletes, but also determining if the temperature and the humidity permit practice to occur. So you can note that the ATC wears many hats of responsibility.

There are many opportunities in Sports Medicine from Coaches to Doctors, Athletic Trainers and Physical Therapists to Parents.

Warren County is luck to have Tim Macintosh, ATC to cover our athletic training needs at Warren County High School. I hope that all parents and coaches will support him in his efforts and expertise to keep our athletes on the field.

Zach Sutton, DPT, MS, OCS

Exercising in the heat of the Summer

The hot humid days of August are upon us. During these hot summer days, I would like again to caution everyone on a couple good practice habits to play it safe in this heat.

Do not stop your exercise routine because of the heat, but consider alternatives to accomplish. If your routine involves the outdoors, perform this activity just after the sunrises in the morning and take advantage of the coolest daylight weather. The coolest weather of the day is not at midnight, but just before the sunrises since it has had more time to cool off from the heat of the day.

The hottest time of the day is around 4pm, but even though you can avoid direct sunlight perform your routine later in the evening, the earth, particularly blacktop surfaces, will continue to give off heat from the direct sunlight for many hours.

Therefore, I encourage morning workout when at all possible.

The Civic Center is a great alternative since the environmental temperature and humidity are controlled, so you can run on the treadmill, around the gym. Or cross train! Hang up the running shoes and throw on some swimming trunks. The Gilley Pool offers regular scheduled hours, but also some specific lap swimming times too. You could consider taking an indoor exercise class like Yoga or weight training.

If you are a walker, consider the Three Star Mall. Although this is not an “exercise facility” and running is not permitted, but walking in this controlled temperature and humidity environment is a superb alternative to beating the heat.

Everyone that is outside is susceptible to dehydration even if you are not participating in an active activity. I caution sitting outdoors too. Not that you should not do it, but sweating is sweating, so rehydrating is necessary even if your activity was just sitting.

Making wise choices about the types of fluid you drink can also reduce the risk of dehydration. Caffeinated drinks such as coffee, sodas, and tea. In order to balance hydration from a 12 oz soda, one must drink 18 oz of water. Athletes working out in this weather can take a pre and post exercise routine weight on a scale. 1 pound of weight loss equals 16 ounces of fluid that needs to be replaced into the body.

Dr. Sabo, the nephrology specialist at Middle Tennessee Nephrology, states that people who are taking medications for high blood pressure are especially at risk for complications of dehydration. He advises that people who have questions regarding their medications and risk of dehydration contact their primary care physicians. It is possible that adjustment of medications during periods of hot, humid weather may be the best bet.

Emergency Rooms see an increase in Kidney Stones this time of the year which is often caused by episodes of dehydration. Kidney stones cause severe pain, so keep watch on the weather and play it safe in the heat and humidity!

Zach Sutton, DPT, MS, OCS

SilverSneakers

Over the past month, I have discussed osteoarthritis, osteoporosis, and other general health topics. I have explored differing types of exercise and their pros and cons for these conditions, but if you are still uncertain or nervous about initiating a program, I have an opportunity for you!

I am very excited to talk about a great opportunity that Melanie Brock offers at the McMinnville Civic Center called SilverSneakers. SilverSneakers is customized class designed exclusively for older adults who want to improve their strength, flexibility, balance and endurance. Melanie Brock is a specially trained Senior AdvisorSM at the fitness center and can introduce you to SilverSneakers and help you get started.

The only major requirement is approval from your physician. The great part about this program is that you do not need to be in any particular physical shape prior to starting. You may be in a wheelchair and that is ok! Brock specially tailors the exercise program to the current level of each individual and progresses the individual as she sees improvement in tolerance. She tells me that she has helped many individuals progress from basic seated exercises to the full standing exercise routine.

There are many benefits of this program for many conditions.

For osteoarthritis, this is a low impact, easy motion program, and when it comes to arthritis, 'motion is the lotion'. Recall that osteoarthritis is the break down of the lining of our bones at the joints. These joints do not receive much direct circulation and rely on movement to push nutrients into the joint.

For osteoporosis, this program integrates upper extremity and lower extremity strengthening exercises with resistance types such as gravity, free weights and rubber bands. Remember that osteoporosis is the thinning of the shafts of our bones and that stressing the muscles around the bones increases our body's building and maintenance of the bone shafts.

One of the biggest risks with osteoporosis is breaking a bone when a fall occurs, so preventing falls is a very important part of staying healthy! This program incorporates differing levels of balance and coordination that Brock, as our local certified Senior Advisor, will specifically chose for your safety.

This program has many other health-related benefits that can influence high blood pressure, cholesterol, diabetes, obesity, pain, and general well-being.

Brock is an energetic and experienced instructor that delivers a great exercise program in a fun, supportive environment. This is not a "no pain, no gain" program.

This class meets on Monday, Wednesday, and Friday at 915 a.m. at the Civic Center. The sessions last approximately 45-60 minutes. The program cost is $3 per session, however, you may qualify to have this fee waived! The SilverSneakers Fitness Program is offered by leading Medicare health plans and Medicare Supplement carriers. Specifically in Tennessee the following offer SilverSneakers: AARP MedicareComplete® from SecureHorizons, AARP® Medicare Supplement Insurance Plan, Amerigroup, HealthSpring, and Humana.

A reliable source at the Civic Center tells me too, that they often give free gifts away to regular attendees like t-shirts, water bottles, backpacks, etc.

Zach Sutton, DPT, MS, OCS

I am off the couch, now what?

Ok, I am off the couch. I am washing the car, mowing the lawn, maybe even pulling a few weeds, do these activities count towards my physical activity goals? What about evening strolls around the civic center? Yes, yes, and yes. All of these activities promote calory burning activity, muscle use, and heart rate increases.


You can be active throughout the day and give yourself a pat on the back. All activities have a health benefit! A church friend mentioned to me the other day, "I just feel better the more I walk, even my knee that has had surgery and my arthritic hips feel better too.". She enjoys the opportunity to walk on the trips that she takes, but she also uses a pedometer to track her activity level when she is home and maybe not as active. Utilizing a pedometer is a great and inexpensive way to track how active you are when just doing normal activities. A pedometer is a little device you put on the waist of your pants and it tracks how many steps you take, which then can be converted into calories or miles.

This can be a great way to increase activity be tracking it through the day and all these steps can be calculated into calories burned. According to David Bassett, Professor of Exercise Science at University of Tennessee-Knoxville, the average American take 5,000 steps per day. He contrasts this to an Amish community that walked greater than 10,000 steps on Sunday, the day of rest, and greater that 17,000 steps on regular weekdays. The Amish show a dramatically lower prevelance of heart conditions, diabetes, obesity, and other medical conditions. So the Amish are great examples of how regular activity can improve health and that you do not necessarily need a gym, a Chuck Norris or Dennis Austin workout, although these are fine, to be actively healthy.

Another aspect to the Amish is that their diets do not include drinks high in sugar like soda and foods high in saturated fat like French fries.

So is there reason to have a regular exercise regime to increase heart rate for 30 minutes even if I get 10,000 steps a day. 10,000 steps is a great goal, but yes, consulting with your primary care physician and cardiologist about regular exercise is important too.

Have you ever wondered why we always hear about 30 minutes of continuous exercise? This is where we get the biggest benefits for improving the condition of our heart. For the first 20 minutes of heart pumping exercise, our body burns quick fuel like sugar and it is not until after 20 minutes that our body begins to burn fat.

So my recommendation is to get active, with or without a regular routine. Track your daily activity with a pedometer, available for less than 10 dollars at Wal-Mart, and embark on a regular exercise routine to increase your heart rate.

Over the weekend there was an advertisement for River Park Hospital's new cardiac rehab department. For those with recent or significant history of cardiac issues, the Cardiac Rehab Department may be a great resource for education and a safe place to start.

Zach Sutton, DPT, MS, OCS

Tour de France

It is that time of year again! Yes, the Stars and Stripes Fun Run is over, baseball season has concluded, TSSAA is in a dead period, the City Pool has been open for over a month now and we still have 54 days until the Vols football season opener. “What else is there?” you might be asking.

Actually, there is something else, though it isn’t happening in our country. The bicycle race of all bicycle races, the annual Tour de France, is now in action. This 21-day bike ride totals 2200 miles in its entirety. Riders travel an average of 100 miles per day, climb some of the steepest mountains in France and have to be on guard constantly to avoid crashing with 100 other riders.

While most of us will not be pumping up the tires, putting on brightly-colored spandex, making the trip overseas and riding up and down the French Pyrenees Mountains, some of you might be inspired to start riding locally for exercise.

There are some great health benefits to bicycling. A couple of weeks ago I mentioned that bicycling is a good alternative for people with osteoarthritis of the knees and hips. It’s a low impact activity, great on the joints and helps build the quad muscle on the front of the thigh, which helps absorb impact around the knee. Biking is also a great cardiovascular exercise that elevates the heart rate and improves endurance. You can begin burning fat after 20 minutes of riding. Additionally, riding a bike improves balance and strengthens the core muscles.

Before hopping on the saddle, there are a few risks that everyone should consider. The bike should be in good shape with tires pumped up and a good brake system. Seat height is very important for both safety and comfort. If the seat is too low, it will place significant pressure between the knee cap and the upper leg bones. The seat should be high enough to decrease knee pressure with the leg slightly bent at the knee when the pedal is fully down. Most importantly, you should always be able to safely dismount at stop signs or in any event where caution is needed.

Most bikes require leaning forward to the handle bars. If you have low back pain with sitting, there is a high risk that bicycling will increase this pain. Squeezing your shoulder blades together and bringing your chest forward can improve posture and help you avoid the back pain. Bike stores can raise the “stem” that connects the handle bars to the bike, which can also help to avoid the bent forward position.

Always remember to wear a helmet; helmets save lives. Be sure that your bike has reflectors but try to avoid night riding, as well as when the sun is rising or setting. Pick routes that do not have blind turns.

So, even if Lance Armstrong does not win his 8th Tour de France this year, you can win the race against obesity, diabetes, arthritis, and cardiopulmonary conditions with bicycling as part of your regular physical activity routine.

Zach Sutton DPT, MS, OCS

Is Cheerleading a real sport?

Is cheerleading a real sport? Ok, before you answer, hear me out.

I was surprised to find headlines on the internet this week that there is currently a law suit in Hartford, Connecticut that is investigating whether colleges can include cheerleading as a sport and cheerleaders as sports participants. This all started last year when Connecticut's Quinnipiac University cut the women's volleyball team, and as a result, the coach and five team members sued the school. Title IX was an education amendment enacted in 1972, the goal of which was and is to assure that all students have the opportunity to play a sport, a very important part of health, learning teamwork, and building individual confidence.

The amendment states that "No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance..."
-United States Code Section 20

Quinnipiac University utilizes cheerleading as part of their Title IX compliance because they have a coach, regular practices, and in addition to their role to support other sports, they have an annual championship competition that defines the season. At this point though, the competition is not recognized by the NCAA, the National Collegiate Athletic Association, so an official ruling in this court case could prove to elevate the official status of Cheerleading or worse judicially declare it not a sport. Either way, the outcome of this case will certainly change cheerleading.

So do I think cheerleading is a sport in the physical perspective?

I would imagine that Nascar is now accepted as a sport because of the intensity of driving at high speeds, the risk of injury, and fatigue that is inevitable with the duration of the race. Furthermore, the winners often do a backflip off the window of their car. Colleagite cheerleaders perform backflips with their feet on the ground.

Michael Jordon's average air time is 0.98 seconds and Lebron James has a vertical leap of just less than 4 feet. A cheerleader tossed in the air by their teammates competes with Jordon's air time and some cheerleaders can jump and do the splits in mid air with a vertical space from the ground of about 4 feet competing with Lebron James.

Can anyone tell me any other team sport that uses their hands like feet? Exactly. While gymnists are similar to cheerleaders, cheerleading truly turns gymnastics into a team sport. The stunts that are performed as a team truly require all present for the safe and masterful accomplishment of flinging into the air and returning to earth with no harm and ready to run and backflip again.

The weight of objects thrown in sports: baseball is 5 ounces, football is 15 ounces, discus is 2.2-4.4 pounds, shot put is 8-16 pounds, a cheerleader is >50 pounds. Number of potential positions on a cheerleading squad, 7, but like football there can be more than on of many of those positions.

US All Star Federation is the governing body of cheerleading who partners with ESPN to show cheerleading competitions International competition: US has held the gold in every event except International all-girl level 6 which Chile won in 2009, but US took back in 2010. Other medal winners include China, Mexico, U.K., Japan, Canada, Columbia,

There are over 4 million cheerleaders in the world. Although 97% of them are female, at the collegiate level, 50% of them are male according to about.com

So now that we have hopefully established that cheerleaders are quite extraordinary athletes, what injuries are common with them.

Cheerleaders have a high risk for both traumatic and overuse injuries to multiple areas of the body.
Traumatic injuries are high risk at the ankle, arm, and head. Overuse injuries are prevent in the back, shoulder, and wrist. The traumatic injuries obviously come from the high level jumps and tosses. Sprained ankles and sometimes fractures can occur with landings, particularly if the cheerleader lands on their catching partners foot, forcing it to roll inward. Head trauma and concussions are another risk, do you recall the signs of a concussion from the football article written by Rudie Thomsen, PTA a month ago? The signs of a concussion are....

Ultimately safety and proper form are most important to prevent cheerleading injuries, but general strength training can also reduce the risk for the overuse injuries. Coaches and athletic trainers are integral to keeping our cheerleaders supporting our teams and competing at their very high levels for their own championships.

Although the debate in the judicial system is ongoing, most all major universities, such as the University of Tennessee, recognize cheerleading as a sport with a defined championship and offer not only athletic training services, but also weight training services.



Zach Sutton, DPT, MS, OCS