Returning to sports and exercise during Covid19.

Restarting your normal exercise routine is important for your health. While many people are focused on the covid risk aspects, this video/blog focuses on your musculoskeletal issues that may arise when restarting exercise, and optimizing your health and wellness.

Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. It’s August 19th, 2020. Welcome to our weekly live broadcast. I’m excited to have everyone here. I hope everyone is having a great day, great week. It’s really, we’re kinda, we’re still in the middle of summer, but we’re starting to wind down and it’s August 19th. Before I start, I would be remiss if I did not say happy birthday to my mother. I won’t mention how old she is. She is still incredibly youthful and young looking, and happy birthday to her.

So around this time of year, there is so much going on from a sports standpoint, whether that is the US Open Tennis, football season is starting. And right now, obviously with COVID, you even have baseball and the NBA sort of in full swing and hockey as well. In particular, I am a huge football fan. I grew up in Western New York. And so I am a Buffalo Bills fan, and very excited about their season this year. The NFL has a number of interesting things that they’re trying to do in terms of dealing with COVID, stuff I’m not going to really talk about today, but just a whole enterprise of trying to manage their whole COVID protection prevention kind of program is mind boggling, quite frankly, and given all the circumstances, it’s probably the best that they can do if they’re trying to play. They even have some interesting ways that they’re trying to protect players while they’re actually playing with a special type of mask that they’re going to wear now. It’s a lot of interesting stuff that kind of connects public health and sports together. But it kinda makes me think about how for the rest of us as we start to reincorporate physical activity, things that you should be thinking about.

In my case, I happen to play tennis. I also swim. All stuff that I have not been really able to do in any significant degree in the last few months during COVID, but it’s stuff that I’m starting to look forward to reincorporating relatively soon in hopefully a safe and low risk manner. And over the summer, I mean, the things I’ve been doing to stay physically active have included a lot of body weight related exercises, spinning as well at home. And so things that are keeping me physically active, but as I try to reincorporate certain activities that are a bit more sports specific in particular for me overhead activity, including tennis and swimming, there are a number of things that you should be thinking about when it comes back to reincorporating physical activity.

So first and foremost, you need have a really clear on a sense for where your own physical vulnerabilities, weakness, injuries are. If you already know that, fantastic. You’re ahead of the game. If you don’t know that in any significant degree, probably worthwhile assessing yourself. For that kind of assessment, physical therapy tends to be really good. Most physicians don’t typically do a really dedicated exam to properly kinda figure that aspect out, but you really want to be kinda checked out head to toe to get a sense for where you have asymmetry, weakness, imbalances, instability, maybe some chronic inflammation signs. Those are the kinda things you want to be aware of because it’ll affect how you start to reincorporate physical activity. And what’s interesting is if you have, let’s say a shoulder issue, you need to know if you also may have some issues in the neck, whether it’s arthritic issue, instability issue, posture related issue, maybe some weaknesses from one set of muscles to another set of muscles. You want to be aware of that because that’s how you’re going to protect yourself and actually get better as well. So first and foremost, assessing yourself.

Number two is technique. I think having had some time off from physical activity, like formal sports related physical activity, that’s a great chance to kinda reevaluate technique related issues so that you are optimizing and putting yourself in the best position to not only function at a high level in that physical activity, but that you’re also doing things at their most optimal sort of technique so that you’re putting yourself at lower risk as well. So this is really relevant for me for a couple of reasons. Number one, as a tennis player, I do have some very mild rotator cuff tendinopathy in my shoulder. That’s something I’ve had probably since I was a teenager because it’s something that I first recognized about 12 years ago when I started using musculoskeletal ultrasound to look at joints and tendons. And that’s important because, well, why do I have a little bit of rotator cuff tendinopathy? Understanding sort of how I may have a little bit of asymmetry right to left, how my posture might be a little bit off, how my technique might be throwing things off as well. That’s stuff that I need to work on. And in my case, I made a really pretty strong effort a few years ago to really correct some technique related issues when it comes to serving and that’s kind of an ongoing process and something that I should always be thinking about. Another example of that for me was when I reincorporated swimming, I went out of my way to take some time to improve my technique, partly because it’s much harder to reincorporate an activity like that compared to when you’re a teenager. But number two, I know that having a mild shoulder issue, that can be something that can be at risk as I start to incorporate other types of overhead activity. So improving technique, a huge part of getting back into physical activity even if you are an amateur athlete. You don’t need to be a professional level athlete to be working on your technique. If you’re someone that does an activity once, twice per week, or even a couple of times per month, you should be thinking about technique obsessively. That’s how you protect yourself.

Then as you start to reincorporate physical activity, if you ever have any sort of an injury, pain, anything that seems off, I would recommend instead of just grinning and bearing it, which is what most people do, which is what we all do realistically, that you should be looking in terms of getting evaluated sooner rather than later. And the reason why is because if you have something at an early stage that can be improved upon, improve it. Do what you can so it doesn’t become something worse. It always strikes me as incredible that when it comes to things like diabetes and blood pressure in the past, nobody did anything about it until they actually had a heart disease or a stroke. But now it’s common medical wisdom that you need to do something about it. Diet, exercise, maybe medication, to treat that in an early stage so that you don’t have those kinds of bad consequences, like heart attacks and kidney failure. Well, it’s the same thing when it comes to your joints. If you have a little bit of knee pain, rather than sitting on it and just grinning and bearing it, icing it after playing or taking some anti-inflammatory meds, you really should be evaluating what’s going on here. Do I have a problem here? Is there something I can fix? Is there something with my back, my knee, my ankle? Like what’s going on here that needs to be corrected so I can actually fix this? My own brother who has started playing tennis pretty aggressively in his early 40s routinely tells me that he’s got pain in his elbow, or his shoulders, or his back, and he’s icing himself down after playing. And routinely I tell him “You really need to get that checked out because that’s probably not a good thing if you’re just icing yourself down and taking anti-inflammatory meds. That’s really not the right way to be treating this. Figure out what’s going on and fix it, or at least put yourself in the most optimal position so that you don’t need to deal with this chronically or that it gets worse.

So evaluation early makes sense. You want to get evaluated by somebody who knows what they’re doing here. Realistically, the vast majority of physicians don’t know how to evaluate musculoskeletal issues properly or competently. That’s a problem because they may be focused on other problems like diabetes, blood pressure, when you really should be focused on how to handle this in a more competent way. One issue if you’re seeing a surgeon for these kind of issues rather than someone who’s got expertise on a nonsurgical end, is that they’re looking at it from the lens of how bad is this? Does it need surgery now? It’s very likely if you have something early, you may have something that can be treated non-surgically early on so that you don’t need to be thinking about surgery. So you need someone who knows what they’re doing. They need to be able to do a proper examination.

In my own clinic, diagnostic musculoskeletal ultrasound for a lot of those types of injuries, whether it’s arthritis, tendonitis, or injuries is very helpful in terms of figuring out why do you have pain? Is there instability? Is something that’s developing? A really great way at very quickly making a diagnosis. If you have a overuse injury, the reality is that X-rays, they’ll show you some arthritic issues, but they’re not going to necessarily, they’re not going to show any of the soft tissue issues. And frequently you don’t need an actual MRI, but an ultrasound can help make that diagnosis. So your physician should be able to do that if they’ve got that expertise to help make that kind of diagnosis for you quickly.

And then making some changes early on so that you can improve things, whether it’s getting back into the right kinda strengthening exercises, correcting technique as well. Something that I’m very well aware of is that for my own shoulder, if I’m not doing the right kind of upper back kind of exercises, scapula stabilizing exercises, I’m putting my shoulder at risk longterm as well. So that’s stuff I need to be focused on chronically. And certainly if you have an injury or developing problem as you reincorporate your athletic activities, make sure that you’re doing the right kind of rehab or exercises to strengthen the muscles and put yourself in the best position to be protected. And then if you’re not getting better with that basic kind of approach, then consider a regenerative medicine treatment sooner rather than later.

So this is relevant and sort of nuanced in a couple of ways. Number one is if you have a mild to moderate injury, you may be fine with just using your own platelets or prolotherapy. If you have something that’s a little bit more than that, then using your own bone marrow derived stem cells would be helpful. But on top of that, you have to also think about timing. If you’re someone who’s playing at a more competitive level where you have sort of a dedicated season, then understand that some of these treatments will actually sort of prevent you from doing that kind of physical level of activity for the first couple of weeks or so. So if you have something like platelet rich plasma, or your own bone marrow derived stem cells in the middle of season, you would have to expect that you’re really kinda shutting it down for the first two weeks in terms of that sort of sporting activity. And as you reincorporate that activity, you’d be starting at maybe 25-30% of your normal level of the next few weeks after that, and then slowly ramping up. So that may be something that’s better off if you’re willing to kinda take some time off, let’s say a month or so after treatment or something that’s outside of your normal competitive season. The other way to look at it is if you have a milder injury, that’s more of a soft tissue strain, you’re doing the right kind of physical therapy, you’re still having discomfort, you have something that doesn’t necessarily require platelet rich plasma or your own stem cells, then utilizing a treatment like neuro prolotherapy to reduce the pain, to reduce some of the neural agitation that’s causing the pain, myofascial related pain, is a great option to help shut down some of that pain quickly, keep you at a high level of function, as well as keep you physically active and keep you active during your actual sporting league season as well, during your competitive season as well. So there’s different sort of levels to how to approach that and treat that and with the right kind of approach, you can not only stay at a high level, you can recover from an injury. You can also kinda keep going at a high level even in the middle of your competitive season as well.

So exciting times for those of us who are trying to get back into physical activity, more sporting related activity, be smart about it in terms of assessing yourself before you get back into it, improving technique, making sure you get evaluated if you’re starting to develop pain or dysfunction as you kinda reincorporate things, and understanding how to incorporate some of the more modern regenerate medicine treatment options if needed when required.

Well, thank you very much. I hope everyone’s doing well. As a reminder, I’m doing this live every Monday and Wednesday. You can catch the replay as it’s been sort of edited and captioned after the next couple of days. And until our next broadcast, have a good day, and live well. Bye bye.

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***About this video***In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses returning to sports and exercise during Covid.