|Prescription for Life
Posts from August, 2012
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|Beating the Heat
It’s that time of year again. School is about to start and with it all of the sports for fall. But as many of us know, those sports are beginning right now with their preseason conditioning. These sports include cross country running, soccer, football and many others. To talk about training at this time of year is to also talk about the dangers of training in the heat. Why is this so important? Part of the problem regarding heat-related medical illnesses has to do with lack of acclimatization to the heat. Since most of the athletes who are training now are beginning their training, many are not acclimatized, which can lead to medical problems.
What risk factors are there to practicing in the heat? First, as mentioned before, there is the lack of acclimatization. Second, there is the increased amount of equipment worn (in the case of football in particular), there is the lack of conditioning and hydration that develops when competing.
It is important for coaches, parents, athletes and doctors to know these risk factors when assessing the situation of summer training. A combination of all or just one of these can lead to heat exhaustion or even heat stroke.
Symptoms to be concerned with when dealing with these are:
- Excessive thirst
- Fast or irregular heart rate
- Excessive sweating or, in the case of heat stroke, lack of sweating
What do you do if these symptoms occur? First and foremost, get the athlete out of the heat. Whether that is by getting him or her into the shade, inside an air-conditioned environment or in a cold pool or tub, getting out of the heat can do wonders for the body when trying to rid itself of excessive heat. Other things that can be done are more preventative in nature. Keep the athlete as hydrated as possible. A lack of hydration leads to an inability of the body to rid itself of the heat appropriately through sweating. Take frequent breaks – this allows the body to cool adequately. Wear less gear – sometimes wearing less pads (especially in football) for a period of time can allow for practice to continue without problems on hotter days. Practice at cooler times of the day. Practicing in early morning or later evening when the heat of the day is not at its height is a way to avoid heat exhaustion.
Even when using all of these preventive measures, it is possible for problems with heat to occur in athletes. It is important that an athletic trainer or medical personnel be available at all practices and games to monitor the situation.
Some faster treatments involve cool water or ice to the armpits, back of the neck or groin. Immersion in a pool of cool water is usually the best way to treat if an athlete is showing signs of heat exhaustion.
Please make sure to be careful when practicing and training in this hot weather. It is important to teach an athlete the ability to endure in trying environments, but it is equally important to teach them to be smart about their health. Have a great season!
Michael Messmer, DO, CAQSM, is a sports medicine physician at St. Francis Family Medicine at Hunter’s Ridge. Always check with your doctor before beginning any exercise regimen.
Posted by MMessmer on 08/13/2012 at 11:45 AM
|The Iliotibial Bane
Ah, IT band syndrome. This is the most commonly injured tendon in a runner. In my clinic, I see this probably once a day and more often during running season.
But what is it? The Iliotibial band is a long tract of tendon that begins at the upper portion of the leg and goes along the outside of the leg all the way to the outside of the knee. The muscle that controls that tendon is on the outside of the hip. The IT band has multiple functions. Its main function is the abduction (lifting the leg to the outside) of the leg. Its secondary functions include helping in squatting, standing and running/walking when putting weight on that leg so as to keep your leg steady.
What many don’t know is that when walking and running, there is a slight amount of abduction that occurs with each stride. Couple that with the consistent amount of repetitive weight-bearing strain, and you can see why it’s so commonly overstrained and injured to walkers/runners.
Some common symptoms of IT band syndrome include hip pain on the outside of the hip after standing/walking/running, outside knee pain after standing/walking/running, shooting pains down the outside of the leg, snapping sensation on the outside of the hip or knee and occasional swelling on the outside of the knee that gets better when resting.
The good news is that very rarely does one need to stop exercising when this is strained. Admittedly, I’ve told a few runners to stop for a few weeks to let it rest (which is the best treatment for it in the end), but that is only temporary, and they are able to get back to their activity fairly quickly.
It also has many different methods of treatment. Let’s look at some:
1) Cross frictional massage – rub the knee portion of the IT band perpendicular to the fibers of the IT band
2) Ice massage – take a small cup and freezing water in it. Then rubbing that frozen water on the area of pain for 10 to 15 minutes
3) Stretching after a warm up and during a cool down
4) IT band straps – wrap around the leg and put pressure just above the area of pain when running to take some pressure off the tendon
5) Foam rollers/hand rollers – they break up adhesions/scar tissue that forms with tendonitis, as well as work out lactic acid buildup and help loosen the muscle fibers.
There are a few more, but if anyone starts getting symptoms like IT band syndrome, I would first recommend trying these tried and true methods of treatment at home. If they don’t work, then it’s time to see your physician for further recommendations.
There are other options, including corticosteroid injections, PRP injections, prolotherapy injections and physical therapy that can help, but see your physician before considering these. Many times a biomechanical issue of the lower extremities needs to be corrected to prevent further strain on the tendon.
All in all, this injury is more of a nuisance than anything else. It is correctable, but it is also important to start the home treatments early and often if you feel it coming on. It is also important to know your limits and when to see your physician. Good luck and happy running!
Michael Messmer, DO, is a sports medicine physician at St. Francis Family Medicine at Hunter’s Ridge. Always check with your doctor before beginning any exercise regimen.
Posted by MMessmer on 06/08/2012 at 9:57 AM
Concussions are a very hot topic in the media and a topic that has become heavily debated in regard to treatment protocols and, for the athlete, returning to play. As many know, the NFL has changed its policies on concussions in light of the growing research behind the long-term morbidity and mortality. The long-term outcomes of improperly diagnosed or improperly treated concussions can be very severe and should not be taken lightly.
It is important to realize that while a majority of concussions occur in sports, they can, and do, also occur in the workplace. The treatment is the same no matter the cause of the concussion.
First, what is a concussion?
The 2009 Zurich conference on concussions defined concussions as:
Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include:
1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ''impulsive'' force transmitted to the head.
2. Concussion typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously.
3. Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course; however, it is important to note that, in a small percentage of cases, post-concussive symptoms may be prolonged.
5. No abnormality on standard structural neuroimaging studies is seen in concussion.
(Taken from Clinical Journal of Sports Medicine, May 2009 Volume 19, Issue 3)
There are a multitude of symptoms associated with a concussion, and as the definition eludes to, loss of consciousness is only one of the many symptoms that may occur, but may, in fact, not be present. The severity of the concussion does not depend on loss of consciousness. In fact, symptoms of fogginess, anterograde amnesia, and confusion are some of the more predictive symptoms of a prolonged recovery. Other symptoms can include any or many of the following:
• Problems focusing
• Pressure in the head
• Neck pain
• Nausea or vomiting
• Blurred vision
• Feeling slowed down
• Light/sound sensitivity
• Difficulty concentrating/remembering
• Fatigue/low energy
• Trouble falling asleep
• Sleeping more than usual
• More emotional than usual
• Not feeling “right”
These symptoms combined with an abnormal cognitive evaluation and balance assessment all constitute a concussion and obligate the doctor to begin a treatment regimen.
The treatment itself is very complicated and very individually dependent. Factors such as previous concussions, time between previous concussion, and activity level before diagnosis can affect an individual’s return to activity. As the recent conference in Zurich discussed using the most recent studies on concussions, there is a graduated return to activity that starts with complete rest of the brain until symptoms described above resolve completely. Once this happens, a gradual increase in activity over the course of 24 hours between activity levels, coupled with no worsening of symptoms, allows the patient to return to previous level of play/work. It requires frequent follow ups on the physician’s part to assess symptoms, balance and cognition and to temper activity levels if symptoms develop in the meantime.
There have been some technological advances in the diagnosis of concussion to prevent the patient from falsifying information and to assess improvement. These are, however, only tools and should not be used in place of a physician’s discretion regarding return to play.
The most important change in the guidelines is related to the time of removal from activity. There are no set times anymore, and the grading of concussions is no longer done. A concussion can take anywhere between five days to six weeks to recover, and in many cases with multiple concussions, can lead to post-concussive syndrome, which requires long-term management like vestibular rehabilitation, neuropsychological evaluation and treatment, and medical management over the course of six weeks to years.
The bottom line is that the management of concussions has changed dramatically. It is recommended that you see a qualified doctor if you think you have suffered a concussion.
Posted by MMessmer on 04/04/2012 at 3:37 PM
|Spring is here
It’s a new season. Spring is here! The weather is starting to improve, it’s getting warmer, and most of us are beginning to get that urge to go out hiking some trails or running some roads. This is an excellent urge, and one I would encourage all to follow if your doctor has told you it’s appropriate for you to exercise.
A couple of hints though, remember the sky and sunlight can be deceptive when indoors when it comes to warmth. There are many times when I will think it looks beautiful only to walk outside and realize it’s absolutely freezing! Remember to dress appropriately. I tell runners to wear one less layer of clothing when jogging then you would if you were going outside to stand for 1-2 hours. Different people can tolerate different amounts of cold/heat, so this is a judgment call on your part. Also, remember that as the earth around us begins to warm up the ground can be very went and hence, very loose. This time of year I see quite a bit of ankle sprains and foot injuries in runners and hikers in my clinic.
Make sure to watch your step and be aware of the terrain you will be hiking and running on before you go out so you can wear the appropriate footwear.
The outdoors is a wonderful place to spend your time, enjoy the new weather, and keep up the activity!
Dr. Michael Messmer
Sports Medicine Physician
St. Francis Health Center Hunter’s Ridge
Posted by Pat on 03/01/2012 at 8:42 AM
|Running Through Pain
Running season is about to begin. Then again, does it ever really end? We had a successful half marathon from Topeka to Auburn, and it looks like people trained very hard for it.
Let’s talk about running through pain. This is a subject near and dear to my own heart because I deal with this conflict in my own head being a runner and a sports medicine physician at the same time. I think this is a subject that most runners grapple with at least once during their careers, and I also believe there is no one protocol to follow when dealing with pain during running.
So when do we stop? When do we keep going? Those are the fundamental questions we pose to ourselves on a regular basis during training. What kind of pain is bad? When can we run through the pain? Are there certain areas on the body that we should immediately stop if we feel them?
There are certain examples that are obvious. If we are running and feel a sharp pain followed by inability to bear weight and swelling in an area after a significant injury during the run (i.e. a rolled ankle), or there is chest pain and shortness of breath during the run, this is an obvious indicator that we should stop and see our doctor or head to the emergency room. But what about the smaller, more nagging pains?
I have a general rule as a physician, which is if pain gets worse during the course of a run, stop. If pain stays the same during a run, slow down, if still present, stop. If pain goes away during a run, keep going.
This may seem pretty generic to some, and I’m sure many can think of times when this rule wouldn’t have helped. But remember, it is a general guideline to use that always has exceptions.
Nagging injuries to runners can become more severe injuries if left alone or ignored. I usually tell my runners to adjust how they run when they are dealing with smaller injuries. There is no need to stop unless it violates the first part of the general rule. However, the worst thing we, as runners, can do is to not adjust our running schedule to help our injury. This can be done by simply giving more rest days during the week, using cross training more often instead of run days (i.e. biking, swimming, elliptical), decreasing speed of runs or decreasing distance of runs. If none of these help the pain, then it is time to see your physician for further help.
The last thing to talk about is the type of pain. This is a difficult part of pain to understand, and there is no solid answer to which pain is worse because people interpret pain in their own bodies differently. Once again, I turn to my general guideline, and no matter what the pain feels like, if we follow those rules, we should know when to keep going and when to stop.
I hope you all find this helpful, and I wish you all a happy running season. See you out on the trail!
Dr. Michael Messmer
Sports Medicine Physician
St. Francis Health Center
Posted by MMessmer on 01/30/2012 at 10:57 AM
|Blog Owner Profile
Michael Messmer, D.O.
Sports Medicine Physician
Dr. Messmer, board certified in family practice and sports medicine, is a physician at St. Francis Family Medicine at Hunter's Ridge. He enjoys martial arts, hockey, sucba diving, weight lifting, backpacking and camping. He also speaks Spanish.