From biking and jogging to playing golf, tennis and weekend basketball, millions of us regularly enjoy athletics. As we all know, there are many benefits to participating in sports, but to do it safely, it is important to take precautions. Otherwise, we run the risk of incurring injuries that not only cause us pain and inconvenience but also cost us financially in terms of medical expenses and lost productivity.
I encourage virtually all of my patients to engage in regular, physical exercise to improve their health. Time and time again, however, I’ve found that most people can benefit from learning more about how to exercise properly — the goal being to gain strength and flexibility while avoiding injury.
Whether you are a competitive athlete or just starting a new exercise routine, here are 6 tips that everyone who is physically active should consider adopting:
1. Customize your workout to achieve your personal fitness goals. Whether your goal is to improve your cardiovascular health, body composition (including the ratio of muscle to fat), strength, endurance, or your position and motion awareness, not all exercise is the same, and more is definitely not necessarily better!
- To improve your cardiovascular health: You will need to get your heart rate up to 70-85% of its maximal rate for at least 30 minutes per day, three days a week. To determine your maximal heart rate, subtract your age from 220. (e.g. The maximal heart rate for a 50-year-old is 170 (220 – 50 years = 170), so his or her target heart rate will be 70 to 85 percent of 170, or between 120 and 145.)
- To improve your body composition (ratio of fat to muscle) and to optimize your body’s fat-burning capacity: You will want to exercise in a way that gets your heart rate up to 40-60% of your maximum heart rate.
- To increase your muscle power and endurance: To maximize muscle power, you should engage in a lower number of total exercise repetitions at a higher level of weight/resistance, whereas to improve muscle endurance, you’ll need a higher number of repetitions at a lower weight/resistance. For example, athletes wanting to develop power might design a program where they perform 2-3 sets of 10 repetitions, with each lift set at 70% of their single-repetition, maximum weight. On the other hand, to develop endurance, the same athlete should perform 2-3 sets of 20-30 repetitions, with each lift set at 30-50% of their single-repetition, maximum weight. Your single-repetition, maximum weight is how much weight you can lift one time using the maximum effort that you can safely exert. Be very careful not to push past your maximum limit when you test yourself – you don’t want to get injured before you get started!
- To improve your motion awareness and bone strength: Consider cross-training with soccer, basketball, tennis, or other activities that encourage more side-to-side movement and speed changes. Research has shown that pure long-distance runners, particularly women, can actually be more at risk for stress fractures because the straight-line movement of running only strengthens bones in one plane, whereas cross-training strengthens bones in a more complete, multi-directional fashion.
2. Ditch the myth about stretching prior to exercise to prevent injury. Contrary to popular belief, recent scientific reviews indicate that stretching only before and after intense exercise does little to prevent injury. What does matter is your baseline level of flexibility. In other words, if you are already flexible, you have some reduced risk of muscle injury even if you do not stretch much before you exercise. But if you are not very flexible, doing a bunch of stretching just before exercise is unlikely to prevent muscle injury. Therefore, you need to stretch regularly over a period of time, and not just as a method of warming up before exercise.
- To stretch correctly: Hold each position for a minimum of 30 seconds. If the stretch is not held long enough, then the muscle fibers will simply return to their pre-stretch length after you stop, and your stretching will be of minimal benefit. Once a muscle is properly stretched, the effect lasts for about six hours. Therefore, to improve flexibility most efficiently, one should stretch three times per day, for at least 30 seconds per muscle stretched.
- Be aware that having too much flexibility can be as much of a problem as having too little. For example, with increased flexibility, the ligaments holding our joints together can become more vulnerable to being overstretched and sprained. How flexible is too flexible? The Beighton Hypermobility Score, which is easily located on the Internet, provides a quick method to rate joint hyperflexibility. If you already are very flexible, then stretching may not be in your best interest. Instead, focus on strengthening and balancing your muscles, which will help stabilize and protect your joints and ligaments.
- When strengthening: Work with a qualified and experienced physical therapist, personal trainer, or athletic trainer so that you can develop proper form and safe sports-motion habits early on. Give yourself a day between exercise sessions to allow for muscle cell repair and growth, for example, doing upper body strengthening on Mondays, Wednesdays, and Fridays, and lower body strengthening on the other days. When increasing your exercise intensity, a generally safe approach is to increase your weight/resistance level by no more than 10% every 2 weeks.
3. Be cautious about taking anti-inflammatory medications if you sustain an injury. Although inflammation has a bad reputation for causing many painful conditions, it’s essential to the process of healing. After an acute injury, healing occurs in three complex phases over a long period of time, during which new connective tissue is created that replaces and reinforces the injured tissue. The first of these phases is inflammation, which causes pain in order to restrict our range of movement to protect the area from further injury. Perhaps even more importantly, the inflammation triggers cellular activity that initiates healing of the damaged tissue. The inflammatory phase typically lasts 4-6 days.
Although clinical research has shown that taking an anti-inflammatory after an acute injury can speed one’s return to activity by decreasing pain, several studies also have demonstrated that using an anti-inflammatory immediately after being injured can reduce tendon and ligament strength during healing. In sum, taking anti-inflammatory medication can interrupt the inflammatory process and thereby reduce the potential, maximal healing of the injured area.
I tell my patients to try to avoid using anti-inflammatories, such as Aspirin (unless you are taking it for heart protection), ibuprofen (a.k.a. Motrin, Advil, Nuprin) and naproxen (a.k.a. Aleve, Naprosyn) for at least the first few days after injury. Instead, I recommend taking acetaminophen (a.k.a. Tylenol) up to 4000 mg. per day, as long as you do not have any liver problems and are taking it for less than a two-week period. In cases of more severe pain, you should consider seeing your doctor for a check-up and, if appropriate, obtaining a prescription for a muscle relaxant or other pain medication that you can take for a few days until the pain from inflammation subsides.
4. Be diligent about getting regular physicals to address significant or persistent injuries. Routine physical exams are very important for identifying conditions that may affect your ability to exercise safely, such as certain heart and lung problems or uncontrolled high blood pressure. Let your primary-care doctor know about any concerns you have regarding your exercise regimen. It’s also a good idea to see your physician if you are experiencing any of the following:
- An inability to bear weight on an injured limb due to severe pain;
- Pain that persists for more than 3 or 4 weeks without improvement;
- New or progressive numbness, tingling or — especially — weakness in your arms or legs; or
- Persistent dizziness or light-headedness during or after exercise.
- Head, neck or back injuries that are causing deterioration of your balance, problems with your mental faculties, or changes in your bladder and/or bowel function (any of these symptoms could indicate a rare but urgent medical emergency!).
5. Consider innovative treatment options. Musculoskeletal injuries are extremely common; in fact, it is estimated that over 100 million injuries occur every year worldwide. Of these, 30-50% involve ligament and tendon injuries. Fortunately, there are some exciting, new options available to treat these conditions, including platelet-rich plasma (PRP) therapy and prolotherapy, which enhance the body’s own healing capability to repair damaged tissue. A growing body of medical research has demonstrated the effectiveness of these therapies in treating various painful conditions of the neck, shoulder, elbow, hand, low back, hip, knee, and ankle.
- PRP therapy involves taking a patient’s blood, centrifuging it to concentrate the platelets — which contain numerous growth factors responsible for tissue healing as well as blood-clotting factors — and then injecting it into the injured area to promote healing. This process has successfully helped such athletes as golfer Tiger Woods and football wide-receiver Hines Ward, among others, to recover from their injuries and return to play more quickly.
- Prolotherapy is another injection method, which uses simple, fluid solutions other than blood for treating injured tendons, ligaments, and joints.
6. Don’t be shy about checking a physician’s credentials. If you have sustained a particularly difficult injury or if you participate in elite/competitive sports, I recommend consulting with a physician who is board-certified in either Sports Medicine or Physical Medicine and Rehabilitation. Although patients often turn to an orthopedic surgeon when their medical problem is exercise-related, many orthopedic surgeons specialize in areas other than sports medicine and thus may have limited experience in providing non-surgical care for athletes. For the best results, you need a medical specialist who can not only comprehensively assess your musculoskeletal system, but also provide you with the widest range of treatment options, from the least to the more invasive procedures.
By David Wang, D.O.