Health & Fitness

Head to toe: How to avoid overuse injury during sports

Frankie Telfort, an exercise physiologist and personal trainer, demonstrates a lower-extremity warmup at the Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida in Coral Gables.
Frankie Telfort, an exercise physiologist and personal trainer, demonstrates a lower-extremity warmup at the Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida in Coral Gables. FOR THE MIAMI HERALD

Clint Bridges has been lifting weights and working out since he can remember, and wrestling alligators since he was 6.

“I learned how to wrestle gators before I knew how to ride a bike,” he said.

Bridges, 39, has severed his Achilles tendon twice, and more recently had major shoulder surgery. His injuries have come from years of lifting weights and playing sports.

Overuse injuries, from the ankles to the shoulders, are usually the result of incorrect stretching, poor form and excessive pressure, doctors say. The key to a healthy recovery? Depending on the injury, rest, physical therapy and listening to your body.

Bridges suffered from a SLAP (Superior Labrum Anterior and Posterior) tear. He had surgery in October to repair the tear and completed physical therapy two weeks ago. He works out six days a week.

“In the beginning [after surgery], I really had to limit myself. It was very humbling,” said Bridges, who with his family mans the Everglades Holiday Park concessions. “I’m someone who’s lifted an eighth of a ton and had to go back to five- to 10-pound dumbbells.

Dr. Michael Baraga, an assistant professor of clinical orthopedics at the University of Miami Miller School of Medicine and surgeon at UHealth Sports Medicine, treated Bridges for his shoulder. Baraga said that the first step to injury prevention is a good warmup. Cold stretching can lead to injuries such as pulling a hamstring.

Baraga treats acute injuries, many of which affect “weekend warriors.”

“The typical weekend warrior was probably a competitive athlete at some point, and they cram in what they used to do in one longer weekly session. It’s not the best form for injury prevention,” he said.

To recover, he recommends ice, compression, elevation and rest. If it doesn’t improve within two days, seek medical attention.

Charlie Rhodes, 66, had to stop playing tennis after suffering from a hip adductor strain in the groin muscles. Rhodes, a tennis player since high school, said he was focused on preventing back pain when he injured himself and went to Dr. Ivette Guttmann, an assistant professor of orthopedics at UM medical school and a primary care sports physician at UHealth Sports Medicine.

His recovery consisted of steroids, rest, and eventually, modified exercise. Within a few weeks, his pain subsided significantly. Playing on hard surfaces, when he was used to clay, contributed to his injury.

“I thought it was my hips. I was not resting properly and I was constantly re-injuring myself,” said Rhodes, who now rests more between playing.

Rhodes went to Guttmann six weeks after the initial injury. She treats tendonitis, rotator cuff and elbow injuries, noting that chronic injuries usually affect seasoned athletes when they continue to overload soft tissue such as tendons. Tendors are the tough fibers that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee and ankle.

“Tendon injuries account more or less for 30 to 50 percent of all sports injuries,” she said.

Tendon injuries, known as tendinopathy, are caused by repeated strains and micro traumas, just under the threshold of tendon tears or ruptures.

“Asking your muscles to do just under injury for a prolonged period of time can cause tendinopathy,” she said.

Eccentric exercises help patients recover from tendon-related injuries because they lengthen muscles, compared with concentric exercises, which shorten muscles. An example of an eccentric exercise is lowering a weight slowly after picking it up. The concentric part would be bringing the weight toward your shoulder.

Weekend warriors and athletes alike make the mistake of doing too much, too fast and too often, said Dr. Michael Swartzon, a sports medicine physician with the Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida in Coral Gables.

“There’s a load the body can handle,” he said. “You may not feel it, but you can’t overload the muscles and tendons.”

Swartzon described anterior knee pain, often associated with runner’s knee, as a gnawing, aching dull pain in front of the knee caused by overuse. He said it responds well to rest, anti-inflammatory medication and physical therapy.

He recommends that athletes take one day off a week, and one month off every six, especially when it comes to student athletes.

“I think that needs to be said to parents and coaches,” Swartzon said.

Telling patients they need to take off, whether they’re professional or student athletes, or training for a marathon, is difficult. He works with Miami Marathon participants, and also provides medical care for Miami-Dade County Schools high school sports programs.

“About 10 percent of cases I see need surgery. A vast majority need guidance and physical therapy,” he said.

Often, Swartzon recommends that patients use braces to support ligaments that have been stressed or damaged.

“The idea is the brace supports the recovery and that the patient is going through some form of organized therapy,” he said.

Tennis elbow is a misnomer, he said. The pain is in the elbow, but it comes from overuse of the wrist.

“What’s causing it is the overhead movement of the wrist, so, grasping, doing pull-ups, holding a steering wheel is difficult,” he said. “I have patients wear a wrist brace all-night long because we sleep through those pains and end up re-injuring ourselves.”

Bad technique contributes to injuries as well. In the weeks leading up to the Miami Marathon, he’s flooded with injured patients, sometimes telling people they can’t run.

“For people who are training for months, it’s such a huge letdown. Running involves a person’s feet, ankles, hips, knees, back, neck, shoulders, heart and lungs. There’s a lot that needs to be thought of,” he said.

Swartzon recommends getting a running coach or joining a running club if you’re a novice.

“If you’ve never run or are not a runner, it may take a year of training. If you’re reasonably fit and in good shape, it could take three months [to prepare],” he said.

Swartzon stressed the importance of listening to your body and realizing it has its limitations. Most of the time, muscle soreness is safe. Most doctors said “no pain, no gain” is usually not the case, and powering through an injury will make it worse.

Maurice Kemp, 24, is an example of overuse and misdiagnoses. Kemp, a professional basketball player, was misdiagnosed with shin splints last year while playing overseas. In reality, he had three stress fractures in his lower left tibia and required surgery so he could return to the sport.

“I was in a lot of pain. [Doctors] told me it was shin splints but it felt a lot worse, and I’d had shin splints before,” he said.

After playing basketball continuously for a year, in college and abroad, Kemp met with Dr. Chris Hodgkins, an orthopedic surgeon at the Miami Orthopedics and Sports Medicine Institute, on a Friday. He had surgery the following Monday.

Despite being cleared to play basketball in November, he waited until January to sign with the Cleveland Cavaliers development league team.

“Being an athlete, it’s kind of hard to stop doing something you’ve been doing all your life,” Kemp said. “I took a while to rehab.”

Poor conditioning, incorrect form and age make some more susceptible to suffer from ankle injuries.

“Even simple athletic sprains can lead to serious injuries,” Hodgkins said.

Hodgkins said many patients go through rehab and still require surgical reconstruction of the ligament in the ankle.

“The ankle sprain is probably the one of the most misdiagnosed injuries in the U.S.,” he said.

Hodgkins specializes in the misdiagnosis and mistreatment of plantar fasciitis, which occurs when the flat band of connective tissue stretching between the toes and heel bone becomes strained, causing severe heel pain. It affects a range of athletes and weekend warriors, including runners.

Ankle sprains, ligament ruptures and tendon ruptures have different recovery periods and treatment plans.

Sprains are the least serious and require rest, ice, compression and elevation. Patients can often return to sports within a couple weeks. Ligament ruptures can require a boot or brace, and can take up anywhere from six to 12 weeks for recovery. Tendon ruptures are often misdiagnosed and often require surgery.

Achilles tendon ruptures are more common in men, he said, but one gender isn’t more predisposed than another.

The right shoes, proper warm-ups and cool downs can help minimize the risk of these injuries.

Dr. Thomas San Giovanni and exercise physiologist Frankie Telfort are changing how people do their warm-ups and recovery through a routine they developed. The five- to 10-minute routine targets the lower extremities and incorporates the entire body.

San Giovanni, an orthopedic surgeon with the Miami Orthopedics and Sports Medicine Institute, played Division 1 soccer at Boston College until he tore his hamstring, ending his athletic career.

Telfort, a Miami native and Gulliver Preparatory graduate, won a scholarship to play football for the University of Southern California in 2008. A year later, he learned he had a heart condition, hypertrophic cardiomyopathy, dashing his dream of playing football at USC or professionally.

Telfort began working with USC’s football team, then the Seattle Seahawks. He now works with Equinox, the fitness club that has facilities in Coral Gables, South Beach, Brickell and Aventura, and is developing the training videos with San Giovanni.

“When people aren’t conditioned well, the motion they have becomes dysfunctional,” San Giovanni said. “That’s when injuries occur.”

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