We all know that exercise can help athletes reach peak performance and help you lose weight. But did you know that it could also increase longevity. There has been an increasing amount of research on what humans can do to maximize lifespan or longevity.

AT 85-YEARS OLD, Bob Delmonteque runs marathons, cycles 120 miles and bench presses over 250 pounds. Delmonteque has trained astronauts and actors over the past 50 years, and is one of America’s most visible longevity personalities.

The discovery of the fountain of youth through exercise is now being evidenced with mounting facts that exercise can reverse aging and extend longevity. Prior to this finding, much of the research in anti-aging has been on the effects of starving rats and the direct correlation of caloric restriction by eating less and living longer.

However, if starving yourself is not all that appealing, you may want to seek another method to maximize or extend your life.  Fortunately, it has been discovered that, with the right kind of exercise routine, you achieve this worthy accomplishment.

Genetics Play Important Role
To understand the effects of exercise on longevity, it is important to understand a few basics of why and how aging occurs.  Genetics and who your parents are play an important role in our longevity and how fast we age.

Researchers, generally agree that genetics account for up to about 35 percent of the variation of why some people live longer than others.  There are specific genes or what’s in our DNA that makes up these genes, which help some people live longer than others.

This component of aging is caused by certain genes changes and their ability to switch on and off over time. The switching on and off of genes, in many ways, controls the risk of developing age related diseases like high blood pressure, diabetes, cancers, dementia, and much more. So if we can’t pick our parents, it may make you feel a little helpless on your fate of achieving maximum longevity.

Deep Within Your DNA
However, there is good news.  Exercise has been proven to help control this inheritable out of control circumstance. Regular exercise literally gets deep within your DNA and in many beneficial ways may help you live longer.

The process of how this occurs continues to be studied with research showing that people who exercise actually have younger appearing and healthier genes that function better than their non-exercising same aged peers. In fact, a recent study has revealed that these genes can be made to appear and function up to nine years younger with regular exercise.
Why is making your genes appear and function in a more youthful manner important? Well it is believed that within your body’s DNA there are continual complex biochemical reactions that occur.

The older appearing and functioning genes are more likely to produce reactions that cause cell damage and ultimately age the body. The younger genes perform better to ward off this damage and prevent illness and disease.

THE DISCOVERY of the fountain of youth through exercise is now being evidenced with mounting facts that exercise can reverse aging and extend longevity.

Increased  Immunity
Besides the benefits of exercise on our genes, there are many other ways that exercise can increase our longevity.  It has beneficial effects on our bones by strengthening them and helping to prevent fractures that can lead to premature death.

Maintaining good cardiac and lung function through exercise can prevent sudden death and lead to a more productive quality of life. Among many other benefits, exercise also has been proven to keep your brain and immune systems healthier and functioning better.

Regular Moderate Activity Best
So now that we know that lifestyle changes such as exercise plays a key role in maximizing longevity, what exercise is the best for our DNA?
The research that has shown the benefits of exercise on longevity, has generally proven that moderate exercise, enough to make you sweat for at least three hours a week, is sufficient. Therefore, an aerobic exercise routine such as biking, running, brisk walk or swimming for at least 45 minutes four times a week should do the trick.
Now, you can look at exercise as not only a way to change the outer you, but also the inner you, down to the smallest core molecule that makes up our genetic blueprint for life: DNA.
As the first days of summer near,  don’t think of only working out but imagine “working-in” on the bodies DNA to reverse aging and maximize your potential longevity.

Dr. Badolato

ABOUT THE AUTHOR

A Florida native, Dr. Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents’ Medical Center in Jacksonville. Dr. Badolato is Board Certified and has fellowship training in sports Medicine with a specialization in non-operative musculaskeletal medicine. Formerly a team physicians at Ohio State University, he was also the medical director for the world-renowned IMG Bollettieri Sports Academy in Bradenton, Florida. You can reach Dr. Badolato at 321-253-2169.

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When student athletes from Oveido’s Hagerty High School are in action, chances are you’ll find Titusville resident and certified athletic trainer Sarah Lufcy on the sidelines, helping to keep players hydrated and conditioned, plus standing ready if there’s an emergency.

Certified athletic trainer Sarah Lufcy assesses a football player’s knee at Hagerty High School in Oviedo.

“We’re the first line of defense when an injury occurs,” explains Lufcy, who got her bachelor’s degree in athletic training from UCF’s College of Health and Public Affairs (COHPA) in 2005, going on to get a master’s in health services administration two years later. She now works as one of three athletic trainers at the central Florida high school, where she also teaches biology.

“There’s a misconception that athletic trainers are personal trainers. People don’t understand the time that goes into getting your degree and becoming board certified,” adds Lufcy.

“Think of me as an athletic therapist. I can treat all kinds of athletic injuries and do all kinds of rehabilitation for anything that doesn’t require surgery.”

Fastest Growing Profession

Athletic training is one of the fastest growing professions in the nation, with the federal government predicting this allied health career will jump 37 percent by 2018, much faster than average for all occupations.

ATHLETIC TRAINING students practice assessments in the program’s teaching lab at UCF. Photo By Thomas Alan Smilie/COHPA/UCF

The UCF program at COHPA is one of the largest, if not the largest in the country, with 56 students working toward the bachelor’s of science degree.

“It’s a profession that combines medicine, which a lot of people like, with helping people, which a lot of people like and sports which a ton of people like,” says Kristen Schellhase, who directs the popular athletic training program at UCF.

“Another reason it’s growing is litigation. With everybody suing everybody there are some states now that have made laws that you cannot have an athletic program unless you have medical coverage and some of those specify a certified athletic trainer.”

Schellhase

The profession is relatively young, tracing its roots to the 1950s and not taking off until the late 1970s. Schellhase was inspired to pursue the career in the late 1980s when her high school employed a full-time, female athletic trainer, rare for a woman in those days.

She’s proud that her students now gain experience working alongside professional female athletic trainers who are leaders with the university’s football and basketball teams, but says the profession is growing beyond the sports world.

“We have athletic trainers in the military, in car plants in Michigan. I have a friend who is the athletic trainer for the US Airways flight attendant training program,” says Schellhase.

“Kennedy Space Center has three full time athletic trainers who work with people hurt doing manual labor. That’s the newest field and we have not scratched the surface. We have to start exposing students to these different things.”

First Line of Defense

Because of the misconceptions about the profession, the college requires prospective students to spend 100 hours observing a practicing athletic trainer, who is responsible for an athlete’s emergency care, including CPR and the split second decisions of an initial first aid response.

“You don’t know what it’s like to be on a field in 98 degree sweltering heat, hauling water, being screamed at by coaches, and dealing with sweaty, dirty people unless you’ve been there. That’s the extreme example, but if they don’t get that they’re going to quit in the first week and they’ve taken a spot from someone else,” she says.

Athletic trainers are experts in assessing orthopedic injuries and will often follow an injured athlete through surgery, recovery and rehabilitation. Preventing re-injury is a big part of their job, as well as overseeing an athlete’s overall well being.

“We handle a lot of psycho-social issues such as recognition of eating disorders and drug problems. We’re the first line of defense for recognition because the player is not going to go to the coach and announce they have an eating disorder and they’re not going to tell their parents, but the athletic trainer will pick up on it because of the signs they see,” explains Schellhase.

Jenkins

UCF graduate Erin Jenkins got her athletic training degree at UCF and then added a physical therapy degree and is now finishing a doctorate in that field. She works as a PT at Florida Sports & Rehab in Viera and Wuesthoff Home Care and says she often combines the two specialties when working with injured athletes.

“Typically an athlete might come in with an injury or something more chronic that’s progressed over a period of time,” says Jenkins.

“Regardless, they need rehabilitation. A great deal of athletic training is prevention because it’s one thing to get them back to standard functioning, back to walking and being pain free, but it’s a whole other thing to get them back to being able to safely play the sport they love.”

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LEFT TO RIGHT: Steve Gober, Dr. Bruce Thomas (MIMA Sports Medicine), Mike McGowan, Dr. James Andrews (American Sports Medicine Institute of Birmingham), Lee Kuntz, Dr. Wiemi Douoguih (Head Team Physician for the Washington National) and Dr. Craig Miller. MIMA Sports Medicine physicians have been providing care to Brevard’s professional baseball teams since 1993.

BREVARD COUNTY, FLORIDA (Feb. 25, 2010) – MIMA Sports Medicine Drs. Schuyler DeJong and Bruce Thomas are once again taking care of the medical needs of the Washington Nationals. The Nationals are back in town for Spring Training to prepare for the 2010 Major League season with 15 home dates at Space Coast Stadium.

Before the major and minor league players hit the field, Dr. Thomas and Dr. DeJong will administer their preseason physicals. The Nationals’ pitchers and catchers received their physicals last Saturday, with position players getting checked out today.  The Nationals minor league players will get their exams early next month.

Dr. Bruce Thomas examines Drew Storen, pitcher with the Washington Nationals.

Drs. DeJong and Thomas have worked Spring Training with the Nationals since the team’s move to D.C. in 2005.  Prior to that the doctors served as the Spring Training physicians for the Montreal Expos and Florida Marlins.

Dr. Thomas also served as the Expos’ and Nationals’ Head Team Physician from 2003-2006, and split his time between the big league team and his MIMA practice in Melbourne, Florida.

“Brevard is fortunate to have a Major League baseball team in the community,” said Dr. Thomas.

“This is a wonderful entertainment asset to our community. It is also fabulous to see the Nationals’ dedication to our local community by choosing to have their health care needs served right here in Brevard.”

For more information about MIMA Sports Medicine, call 725-4500 ext. 7818, or CLICK HERE.

For Washington Nationals ticket information, CLICK HERE.

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Dr. Steve Badolato

THE NUMBER of golfers in the United States and especially Brevard County continue to increase in recent years. A recent study estimated that there are over 15 million participants in this country alone.  With this increase wave in participation comes the swell of injuries related to the sport.  One such ailment is medial epicondylitis, commonly referred to as “Golfer’s Elbow.”

Golfer’s Elbow is characterized by inflammation and pain on the inner side of the elbow. The pain occurs where the tendons of your flexor muscles of the forearm attach to the bony region of the inside of the elbow.  This should not be confused with a similar condition of “Tennis Elbow” known as lateral epicondylits, which occurs on the outside of the elbow.  Golfer’s Elbow is not limited to just golfers, in fact, it occurs commonly in throwing and racquet sports such as baseball and tennis.

Causes

GOLFER’S ELBOW is characterized by inflammation and pain on the inner side of the elbow. The pain occurs where the tendons of your flexor muscles of the forearm attach to the bony region of the inside of the elbow.

Golfer’s Elbow is caused by damage to the muscles and tendons that control your wrist and fingers. The damage is typically related to excess or repetitive stress — especially forceful wrist and finger motions. These stresses cause damage to the muscle and tendons of the forearm which attach to the medial (inside) aspect of the elbow and upper arm.    Sometimes golfer’s elbow begins after a sudden force to the elbow or wrist.

It is most common in men between the ages of 20-50, but can occur in women and athletes and non-athletes of all ages.  Many times sports injuries are a result of faulty technique, and with proper attention to proper form and conditioning can be prevented.

In golf and racquet sports, special awareness to swing mechanics with adjustments, if necessary, are very important. For the more avid player, it is beneficial to see a golf pro/instructor for a swing and club evaluation. Golfers should also have their clubs sized properly, including the grip size of the club which plays a significant role in development of golfer’s elbow.

Signs and Symptoms

Symptoms can be insidious or sudden in onset and can be made worse by shaking hands, gripping a golf club, turning a doorknob, or any movement that involves flexing your wrist towards your forearm.

• Pain and tenderness on the inner side of the elbow which can extend into the forearm
• Stiffness of the elbow and pain when making a fist
• As it worsens, it can cause numbness and tingling into the ring and little finger
• Can evolve into weakness of the hand and wrist

Diagnosis/Treatment

GOLFER’S ELBOW is usually self-limited. However, the pain may hang on for many months, even if you take it easy and follow your doctor’s orders.

An accurate diagnosis is usually easily made based on medical history and physical exam. An X-ray may be performed to rule out other causes of pain including but not limited to a fracture or arthritis. Early diagnosis and treatment will allow you to return to your sport or activity sooner. The following are the key components of treatment:

• Rest: Stop the repetitive activities causing pain
• Over the counter pain relievers can help alleviate the pain
• Ice applied to the region of the elbow for 15-20 minutes, three to four times a day
• Stretching and strengthening the affected area is very important and a trial of physical therapy may be necessary
• Forearm strap if used properly can reduce the strain on the inside of the elbow
• Cortisone injection is a reasonable option if conservative treatment fails
• Gradual return to play when the pain has resolved and full function restored

Golfer’s elbow is usually self-limited.  However, the pain may hang on for many months, even if you take it easy and follow your doctor’s orders.  During the recovery period, it is important to rest and avoid the temptation of sneaking in a round of golf.  When you’re no longer in pain, begin to practice the arm motions of your sport. Review your golf swing with an instructor, make adjustments if needed, and have a great time playing the game that you love.

A Florida native, Dr. Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents' Medical Center in Jacksonville. Dr. Badolato is Board Certified and has fellowship training in sports Medicine with a specialization in non-operative musculaskeletal medicine. Formerly a team physicians at Ohio State University, he was also the medical director for the world-renowned IMG Bollettieri Sports Academy in Bradenton, Florida. You can reach Dr. Badolato at 321-253-2169, or log on to PremierUrgentCare.com

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Dr. Anthony Allotta

To Beat Shoulder Pain, Prevention is Key

THE SHOULDER is one the most amazing joints in the human body. Unlike other joints, the shoulder has a seemingly limitless range of motion. Because of this amazing range of motion, the shoulder is also very susceptible to injury.

Types of Injuries
Acute injuries have a definite cause, and it is usually evident exactly when they occur. Because the shoulder moves almost without restriction, it has a greater propensity to dislocate, and  makes up half of all joint dislocations. AC separation, which is known commonly as simply “shoulder separation,” is also due to acute traumatic shoulder injury. These two injuries are commonly confused, but they are very different conditions.

The shoulder joint is located at the junction of three different bones: the clavicle, the scapula, and the humerus. In a shoulder separation, the junction of the clavicle and scapula is disrupted. In a shoulder dislocation, the humerus (arm bone) is displaced from the socket. Not only are the injuries different in anatomic terms, but the implications for treatment, recovery, and complications are also different.

Fractures of this area may involve the clavicle, scapula, or humerus. Because of the complex anatomy and functional mobility of the shoulder it is difficult to mobilize the shoulder in a cast, and fractures sometimes require surgical intervention.

Soft tissue injuries
Traumatic soft tissue injuries of the shoulder include cartilage and tendon injury. A labral tear involves a cuff of cartilage called the labrum, which circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for its very wide range of movements.

Fortunately, Most labral tears do not require surgery; however, in patients who have persistent symptoms despite more conservative treatments, surgery may be necessary.

Tears or rupture of tendons associated with the muscles of the rotator cuff or bicep are common findings in traumatic shoulder injuries, and are treated based on the severity of disruption and the functional goals of he patient.

SHOULDER PROBLEMS, including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body, but it’s an unstable joint because of the range of motion allowed. It’s easily subject to injury because the ball of the upper arm is larger than the shoulder socket that holds it.

Chronic injuries
No matter what your activity of choice, with proper training, you do not need to suffer through most overuse injuries.

Arthritis of the glenohumeral joint generally causes pain with activity, loss of passive motion and stiffness. Some patients may complain of nighttime pain. Multiple joint involvement is suggestive of rheumatoid arthritis.

Rotator cuff tendonitis is commonly seen when there is a muscular imbalance in the shoulder and one of the four rotator cuff muscles is unevenly stressed, subsequently leading to inflammation.

Of the injuries in this class, impingement syndrome is the most common. This occurs when the uppermost muscle of the rotator cuff is impinged on the bone that sits above it, the acromion. Pain results when the arm is lifted away from the body. If these problems persist, it can lead to a condition in which the capsule that sits around the shoulder joint becomes inflamed and freezes up. This condition is commonly known as frozen shoulder or adhesive capsulitis.

Prevention
To prevent overuse injuries there are two main factors to consider: Flexibility and core stability.

• Flexibility allows freedom of movement. This needs to be present in all parts of the body. In the shoulder, balance of the forces of the rotator cuff is essential. It is more critical that these muscles are equally flexible than how flexible they are. Too much flexibility can be dangerous and lead to injury. Stretching before physical activity is important to ensure increased blood flow, temperature, and elasticity of the soft tissues. Stretching should be done in short durations. Stretching for 20 seconds or more per muscle group is done to increase flexibility only and should not be done immediately prior to vigorous exercise.
• Core stability is also very important. To avoid injury one must focus on postural skeletal structure and musculature including the lumbar spine (low back), the cervical spine (neck), the scapulothoracic joint (upper back), trapezius and serratus anterior muscles.

These skeletal structures and muscles hold the scapula in neutral position. If these areas are unstable the excess strain and workload get passed on to the shoulder. Deficiencies in muscle strength and core postural stability are frequently found in conjunction with chronic shoulder pain and injuries.  To beat shoulder pain, prevention is the key.

Dr. Allotta is board certified in Family Medicine and fellowship trained in Sports Medicine. He is a graduate of Touro University College of Osteopathic Medicine in Vallejo, California. He practices in Port St. John, Florida as a member of Premier Orthopedics and can be reached at 321-433-1439.

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Dr. Patricia Baumann

TENNIS ELBOW presents with pain on the lateral (outside) part of the elbow over the bony region known as the lateral epicondyle.  The epicondyle is the place of origin of the extensor tendons of the wrist.  When there is chronic overuse of these tendons, the tendon degenerates and pain persists.   Most patients are between the ages of 30 and 50, however tennis elbow may occur in any age group.  Most patients with tennis elbow do not play racquet sports, but do participate in repetitive activities at work or play that require vigorous use of their forearm muscles.

Most patients present to the orthopedic office with complaints of severe, burning pain on the outside portion of their elbow.  Usually the pain progressively worsens over time and becomes worse with certain activities, such as carrying and lifting heavy items, or even lifting light items.  Diagnostic examination involves direct palpation or pressing firmly on the lateral epicondyle which, if tennis elbow is present, reproduces the patient’s pain.  The pain can be exacerbated by resisting extension of the wrist by the examining physician with the elbow flexed.  Radiographs (xrays) rarely show any changes, as the injury is associated with tendon, not bone.

A TENNIS ELBOW brace is designed to apply pressure over the muscle belly of the extensor muscles, which is why it is worn below the elbow and not over the elbow. The brace is designed to “trick” the tendon origin as the tendon now acts as though it starts at the brace and not at the elbow.

• In most cases (85-90 percent) non-surgical treatment will lead to resolution of the symptoms.  Pain relief is the initial goal followed by decreasing the inflammation so the tendon can heal. Non-steroidal anti-inflammatories (NSAIDS), such as Ibuprofen, are effective in both decreasing pain and inflammation.  If NSAIDs are contraindicated due to reflux disease, a history of stomach ulcers or anti-coagulation therapy, acetaminophen (Tylenol) may be taken instead.  Ice to the elbow will decease inflammation and decrease pain.  A tennis elbow brace may be beneficial.  This brace is designed to apply pressure over the muscle belly of the extensor muscles, which is why it is worn below the elbow and not over the elbow.  The brace is designed to “trick” the tendon origin as the tendon now acts as though it starts at the brace and not at the elbow.  This allows the extensor muscles and the tendon to rest.  A wrist brace may be worn to prevent extension of the wrist, again allowing the extensor tendons to rest.
• Physical therapy in conjunction with bracing is frequently recommended, and many modalities such as ultrasound can be used to decrease inflammation at the tendon origin.  The therapist will also work on stretching the extensor tendons to relieve the pain at the elbow.
• A corticosteroid injection may also be used at the lateral epicondyle to allow for local decrease in inflammation. Corticosteroid injections should be limited in their numbers because too many injections into the tendon can cause degeneration and rupture of the tendon.  (Usually, the maximum number of injections is 2-3).
• Casting to rest both the elbow and the wrist may be used to further avoid surgery – as a last resort.
• • Activity modification is essential.  A tennis player would need to rest from tennis while completing the course of physical therapy.  Returning to sports should be worked in gradually upon resolution of the symptoms.
• Surgical treatment is reserved for cases that have failed all non-surgical treatment options and the symptoms have persisted beyond six months.  The surgery is an outpatient procedure, meaning the patient goes home on the day of surgery.  The surgery consists of cleaning (debriding) the degenerated tendon and reattaching the fresh edges of the tendon to the epicondyle.  The patient is placed in a splint that holds the elbow at 90 degrees for 1-3 weeks.  After the splinting, the patient is again placed in physical therapy to first work to regain range of motion of the elbow then strengthening of the arm begins about 6-8 weeks after the surgery.  If the patient participates in tennis, they are allowed to return to their sport 4-6 months after surgery.  Tennis elbow surgery is successful about 80 percent of the time.

UNLIKE TENNIS ELBOW, Golfer’s elbow is painful on the medial epicondyle (inside of the elbow). The medial epicondyle is the origin of the flexor muscle of the wrist. Golfer’s elbow is caused by the pull of the flexor tendons of the wrist on the origin of the tendon at the elbow.

Golfer’s Elbow (medial epicondylitis)
Golfer’s elbow presents with pain on the medial epicondyle (inside of the elbow).  The medial epicondyle is the origin of the flexor muscle of the wrist. Golfer’s elbow is caused by the pull of the flexor tendons of the wrist on the origin of the tendon at the elbow.  Golfer’s elbow is also caused by repetitive motion of the arm, specifically with wrist flexion.  Golfer’s elbow is less common than tennis elbow.

Most patients will present to the orthopedic office with complaints of pain on the inside portion of their elbow.  The orthopedic surgeon will examine the patient and the pain is usually reproduced when the doctor palpates (presses on) the inside bony area of the elbow.  The pain is also reproduced when the doctor resists flexion of the wrist with the elbow flexed (bent) at 90 degrees.  Radiographs most commonly are negative for boney abnormalities.

The treatments are very similar to tennis elbow.  Most cases of golfer’s elbow will resolve without surgery.  NSAIDS can be prescribed for those patients who do not have any contra-indications for the medicine.  Physical therapy to stretch the flexor muscles combined with modalities such as ultrasound are effective.   A tennis elbow brace may also be used but the brace would be placed over the flexor muscles, again designed to trick the tendon and relieve the inflammation.  Corticosteroid injections are rarely used in this area due to the close proximity of the ulna nerve on the inside portion of the elbow.

Activity modification is essential.  Golfers must take a break from the game in order to allow the tendon to rest and heal.  Once resolution of symptoms occurs, returning to the game is done gradually. Surgery is rarely considered in golfer’s elbow due to the 95-100 percent resolution of symptoms with non-surgical treatments.

Dr. Baumann is fellowship trained in adult reconstructive total joint replacements, which is a subspecialty of orthopedic surgery.  She is Board Certified.  Her practice, Premier Orthopedics is located in Port St. John and she is on staff at Parrish Medical Center and Cape Canaveral Hospital. Please call 321-433-1439 for information.

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Dr. Steve Badolato

RUNNER'S KNEE is a very common condition that affects not only runners, but others who train and compete in various activities and sports. Runner’s knee is also known in medical terms as patellofemoral pain syndrome or dysfunction (PFD).

As the name infers, patellofemoral dysfunction is an injury that occurs at the articulation between the patella, commonly known as the kneecap, and the underlying large bone of the thigh called the femur. Anatomically, the patella is a diamond-shaped bone which lies in a correspondingly shaped groove in the front of the femur, and is designed to function as a pulley, assisting the quadriceps by providing a mechanical advantage for added strength.

ONE OF THE MOST COMMON INJURIES among runners, runner’s knee most often strikes as runners approach 40 miles per week for the first time. The pain often feels worst when running downhill or walking down stairs.

PDF occurs under one of two broad circumstances – either when the patella is forced with excessive pressure against the underlying femur or when it tracks excessively on one side or other of the groove. In either case, this would cause irritation and abrasion of the cartilage of the patella, resulting in inflammation and pain.

Runners are not the only ones that experience this condition which is present in up to 50 percent of all patients that present with the complaint of knee pain.  PFD is characterized by diffuse, aching anterior knee pain that increases with activities such as running, climbing up or down stairs, kneeling, and squatting, all of which place additional loads across the patellofemoral joint.  Just sitting down for a prolonged period of time and then standing up can illicit symptoms of pain or tightness around the knee cap area which is outside the region of the major knee joint.

Clinical Symptoms Include:

• Pain behind the kneecap
• Pain worse after prolonged sitting
• Climbing stairs, particularly downstairs
• Jumping or squatting
• A feeling of instability or catching sensation of the kneecap
• Sensation of feeling or hearing snapping, popping, or grinding in the knee
• Occasional swelling around the knee cap

PFD typically results from overuse of the knee in sports and activities such as running, walking, jumping, weight training, or bicycling, and is commonly first noticed after a new workout routine or quick change in a short time in amount/duration and increased intensity of training.

The initial diagnostic evaluation should include a complete history focused on the knee which includes current and previous pain and/or problems. A comprehensive knee exam helps to rule out conditions which can mimic PFD, such as patellar tendonitis, patellar osteoarthritis, and quadriceps tendonitis, and X-rays of the knee can identify bony abnormalities, mal-alignment conditions and arthritis.

An initial conservative treatment approach to patients with PFD should focus on modifying the training/program that resulted in causing the condition with special attention to the biomechanics, and include the following measures: (1) relative rest with consideration of a temporary change to no-impact aerobic activity; (2) quadriceps strengthening; (3) evaluation of footwear; and (4) icing, especially after activity.

SHERNETTE HYATT is a 26-year old world class sprinter who was diagnosed with PDF. She underwent therapy at Beachside Physical Therapy in Indian Harbor Beach, Florida with focus on quadriceps strengthening and hamstring stretching. Shernette excelled in track at St. Johns University.

Definitive treatment should be individualized and concentrate on quadriceps strengthening and hamstring flexibility with an ultimate goal of returning to usual sport or activity. The addition of hip strengthening and stretching or stretching of the iliotibial band, hamstrings and calves should be based on a physical examination. Consideration should also be given to use of over-the-counter or custom orthotics. Also, utilization of a simple knee sleeve with a patellar cutout or strap may help.

NSAIDS (non-steroidal anti-inflammatory drugs) and Tylenol may be recommended.  Patient education is essential, and patients need to be given realistic treatment expectations. Most patients do well with conservative treatment, particularly if they maintain a disciplined approach.

Before Returning to Sport  or Full Activity

• Full painless range of motion
• Normal strength compared to other leg
• Able to jog and sprint without pain or limping
• Able to do 20 yard figure of eight runs
• Able to jump on both legs and injured leg without pain

Prevention of PDF centers around maintenance of optimal biomechanic function through appropriate shoe gear and foot orthoses as needed.  Maintenance of thigh (quadriceps) strength, especially the inside part of this muscle group, hamstring (back of thigh) flexibility and proper shoe wear with good arch support are imperative in preventing PDF.

Activities that involve repetitive and excessive patellofemoral joint compressive forces should be avoided. Squats, lunges, leg extensions and leg presses are all activities that apply considerable stress to the patellofemoral articulation, since they couple quadricep-intense resistance work with high degrees of knee flexion.

When the athlete’s specific sport or event requires that these types of exercises be performed (i.e. football lineman), they should be done carefully, and the athlete should be closely monitored to ensure optimal technique with regard to alignment and selection of specific strengthening parameters (repetitions, frequency and intensity). Overtraining, abrupt changes in training, or beginning a training regimen too vigorously in a short period of time should be avoided.

A Florida native, Dr. Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents' Medical Center in Jacksonville. Dr. Badolato is Board Certified and has fellowship training in sports Medicine with a specialization in non-operative musculaskeletal medicine. Formerly a team physicians at Ohio State University, he was also the medical director for the world-renowned IMG Bollettieri Sports Academy in Bradenton, Florida. You can reach Dr. Badolato at 321-253-2169, or log on to PremierUrgentCare.com

Related posts:

1. Osteoarthritis Most Common Form of Knee Arthritis
2. ‘Country Club’ Sports Tough on Elbows
3. ‘Golfer’s Elbow’ Characterized By Pain on Inner Side of Elbow

Dr. Steve Badolato

Surfing Injuries

SURFING IS A SPORT that has been growing rapidly in popularity in all age groups.  Brevard County, Florida offers many of the best surfing locations on the East Coast of the United States.

Although surfing is often perceived as a very dangerous sport, a recent study suggests just the opposite.  In this study, which appeared in The American Journal of Sports Medicine, it was discovered that surfing was safer than football, basketball, and even soccer.  Injury rates of various sports were studied with football reporting about 33 injuries per 1,000 hours of play, soccer about 19,, basketball about nine, and surprisingly, surfing had only about six and a half significant injuries per 1,000 hours of surfing.

On average the risk of significant injury with surfing is relatively low. With that said, the diverse aspects of the sport create a wide variety of related health issues and risks unique to the sport that all surfers should acknowledge and try to prevent.

STAND UP GUYS: Dr. Lance Maki (top), and surfing Hall of Famer Skip Savage, do some stand up paddling off Cocoa Beach, Florida. Stand up paddle surfing, or SUP, is a surface water sport, a variant of surfing where the surfer uses a paddle to move through the water while standing on a surfboard.

Common Surfing Injuries
The most common significant surfing injuries are run-of-the-mill sprains and strains, followed by cuts, bruises, and broken bones.  The impact with the surfboard or the ocean floor, and the force generated by large waves, cause most traumatic injuries.

More advanced surfers who surf larger waves under more extreme conditions have more severe injuries (even drownings) when compared to less experienced surfers under safer conditions. Many of the injuries sustained are the direct result of the surfboard itself. The leash is a line that is attached from the surfer’s ankle to the board and can cause and prevent injury. It can reduce injury by preventing a loose board from hitting others but can also cause a recoil injury to the surfer.

Shark Attacks
I have managed many surf related injuries, including, on more than one occasion, a surfer that was bitten by a shark.  Recently, a patient presented with a large bite to the foot (photo below) resulting in a noteworthy injury with complications requiring stitches, surgery, and antibiotics.

This patient’s encounter was fairly typical of most shark bites while surfing.  In most situations the shark’s reputation is far worse than his bite.  About half of all unprovoked shark attacks worldwide involve surfers.

According to the International Shark Attack File, by far the most common bites on surfers are “hit and run” attacks which typically occur in the surf zone.  The victim rarely sees the shark, and after inflicting a single bite or slash wound it usually will not return.  These attacks are frequently the case of mistaken identity.  It is suspected that upon biting, the shark quickly realizes the surfer is a foreign meal and immediately releases. Shark bites are rare, and, as in this case, the injuries are mostly confined to the leg below the knee and seldom life threatening.

Marine Hazards

• Jellyfish: These marine invertebrates have tentacles with venom filled cells (Nemocyst) that can inject toxins (envenomation) into the skin causing burning, redness, swelling, and rashes.  If a surfer comes in contact with these animals, the goal should be to remove the tentacles, soak the affected area in hot water with immediate washing of the area with vinegar, ethanol, or even urine to provide relief of symptoms. The use of an antihistamine such as benadryl is also helpful.  Individuals with severe symptoms or contact with several jellyfish should seek immediate medical attention.
• Stingrays: These bottom dwelling creatures are encountered while surfers are entering or exiting the water. Their tail has a sharp spine that can penetrate skin causing a puncture wound or laceration with severe pain out of proportion to the appearance of the wound.  Initial treatment with hot water immersion inactivates the toxin injected during the assault.  One recommendation made to me by Cocoa Beach resident, and Hall of Fame Surfer Skip Savage, is to shuffle your feet while entering and exiting the water to scare the stingrays away.
• Ear Problems: Outer ear infections are relatively common with surfers. These are caused by chronic exposure to moisture. If infection occurs, treatment with antibiotics is necessary. Prevention includes use of earplugs while surfing and routine use of isopropyl alcohol/vinegar mix in the outer ear canal after. Eardrum rupture may occur when a surfer is struck by a strong wave or hits the water with sufficient force after a fall.  Most ruptures heal spontaneously.
• Sun Exposure: Surfers have increased risk for skin cancer which can be mitagated by the routine use of sunscreen and protective clothing. Regular skin cancer screening by a physician is also valuable for early detection of cancerous lesions.

In summary, with attention to these surf related health risks, the sport of surfing can be a great source of healthy fun, exercise and life long recreation.

A Florida native, Dr. Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents' Medical Center in Jacksonville. Dr. Badolato is Board Certified and has fellowship training in sports Medicine with a specialization in non-operative musculaskeletal medicine. Formerly a team physicians at Ohio State University, he was also the medical director for the world-renowned IMG Bollettieri Sports Academy in Bradenton, Florida. You can reach Dr. Badolato at 321-253-2169, or log on to PremierUrgentCare.com

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Dr. Steve Badolato

Strength training is an essential part of any fitness program.

IT IS IMPORTANT to virtually every man and woman regardless of age.  Long gone are the days when strength training was only for the muscle-bound bodybuilder, power lifter, or football player. Today, strength training is for everyone from the teenager trying out for the high school football team, to the baby-boomer wanting to look and feel young again, to the senior in a nursing home as part of a program to prevent falls.

Think you’re too old to start a strength training program? Well think again! Strength training is just what your body needs to fight loss of bone mass, muscle mass, and strength that comes with the dreaded aging process.

Everyone, no matter how young or old should be engaged in some form of regular strength training program.  The setting can be at a fitness center, gym, or even at home using very little equipment. Aside from the typical machines, dumbbells, and barbells, you can use resistance bands and balls or even your own bodyweight can be used in designing a weight training program.

KARYN BRANTLEY, a personal trainer, practices what she preaches. Today, strength training is for everyone from the teenager trying out for the football team, to the baby-boomer wanting to look and feel young again, to the senior in a nursing home.

Benefits of Strength Training
So what is the point? If you never participated in a strength training program in your life, why start now?  A strength training program will make a significant difference in your quality of life, besides just making you look good in a bathing suit at the beach, it does much more:
• Build muscle strength: Adults lose an average of 5 pounds of muscle every decade after age 20. Strength training will help prevent this loss and rebuild what you have already lost.
• Decrease risk of osteoporosis: Inactivity and aging can lead to decrease bone density.  Studies have shown that strength training can increase bone density and help prevent osteoporosis.
• Reduces blood pressure:  Strength training can be beneficial for the prevention and treatment of high blood pressure.
• Weight Loss/Fat Loss: Strength training increases the body’s metabolic rate, causing the body to burn more calories throughout the day. This results in a decrease of fat and increased lean muscle mass.
• Improved Balance and Stability: Increased strength and coordination obtained as a result of strength training improves balance and stability. This helps keep you safe by decreasing risk of falls or accidents during daily activities.
• Decreased risk of back injuries and back pain: Studies have shown that proper  strength training will actually decrease risk of back injuries and alleviate certain sources of back pain.
• Decreased risk of developing certain diseases: Studies have shown that strength training can improve glucose (sugar) tolerance associated with development of     diabetes and cause positive effects on lipid (cholesterol) profiles for individuals who participate in a regular strength training program.
• Psychological benefits: Not a surprise, studies have shown that  people who strength train regularly report improved body image, greater self esteem, elevated confidence, and a significant improvement in mood.
The above are just a handful of beneficial effects of strength training. The time spent at the gym or home can literally help you turn back the clock to look and feel younger each day.

Getting Started
Before starting any type of strength training program it is best, especially for beginners, to seek information, guidance and expert advice. The internet is an excellent place to start for a fundamental knowledge of strength training. The development of a strength program by a professional trainer is optimum for best results. Certified fitness/strength training professionals are available through memberships in local gym/fitness centers or as independent personal trainers.

Identifying a friend or family member to join you as a workout “buddy” provides mutual support and peer pressure to maintain a regular workout routine and schedule, and an even more compelling incentive to meet your goals.

General Tips for Beginners:

• Remember to warm-up. This gives the body a chance to deliver nutrient rich blood to areas to be exercised.
• Stretch to increase or maintain muscle flexibility
• During the first two weeks of starting a program, keep it light. Pay important attention to technique and good body mechanics and slowly work up to heavier resistance/weights.

JACK ALLEN, a retired New York City police officer, trains regularly with weights. Strength training is what your body needs to fight loss of bone mass, muscle mass, and strength that comes with the dreaded aging process.

• Go through the complete range of motion; focus on breathing properly and never sacrifice form to add more weight or repetitions.
• Strength training sessions are generally recommended to last one hour or less.
• The intensity of your workout depends on a number of factors, including number     of sets and repetitions, the overall weight lifted, and rest between sets.  You can vary the intensity of your workouts to fit your activity level and goals.
n As a general rule, each muscle that you train should be rested one to two days  before being exercised further in order for the fatigued muscles to rebuild.
• The minimum amount of strength training recommended by the American College of Sports Medicine is 8-12 repetitions (reps) of 8-10 exercises, at a     moderate intensity, two days a week. You will get more overall gains with more days per week, sets and resistance, but the progression should be individualized.
• “No pain, no gain” is a false statement and can be dangerous. Your body will adapt to strength training, and will have reduced body soreness each time you     workout.
• Listen to your body; your intensity and duration of exercise should be based on your sense of exertion for the particular body part you are training.

These general tips are primarily for beginners. For some novice and most advanced strength trainers these tips may seem routine. However, these guidelines should be recognized by beginners as a foundation upon which to build.

Medical Clearance for a Strength Training Program
Before starting a strength training program, some people should be given clearance by their doctor.  The best time to get started is now. Do it for your health, for your fitness and for a new you.  The next time you feel like picking up a can of beer, a donut or the TV remote, pick up a dumbbell instead. Your body and mind will be happier you did.

A Florida native, Dr. Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents' Medical Center in Jacksonville. Dr. Badolato is Board Certified and has fellowship training in sports Medicine with a specialization in non-operative musculaskeletal medicine. Formerly a team physicians at Ohio State University, he was also the medical director for the world-renowned IMG Bollettieri Sports Academy in Bradenton, Florida. You can reach Dr. Badolato at 321-253-2169, or log on to PremierUrgentCare.com

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Plantar fasciitis (PF) is a painful inflammation of the bottom of the heel of the foot.

There are many causes of plantar fasciitis including:

• Weight gain,
• Excessive standing and walking ,
• Stair climbing,
• Wearing high heels,
• Runners who increase mileage or frequency of workouts,
• Biomechanical foot conditions such as flat footed or high arches,
• Pregnancy as a result of weight gain,
• Improper shoes with poor arch support,
• Arthritis of the foot.

These and many other causes of PF can cause the tough tissue on the bottom of the foot, which is tendon-like and covered by fascia, to become shorter.   Pain occurs when this shortened fascia is stretched.  This classically occurs in the morning when you first wake up and walk barefoot. These first few steps can cause severe heel pain, which typically improves as you continue to walk.

PLANTAR FASCIITIS was formerly called “a dog’s heel” in the United Kingdom. It is sometimes known as “flip-flop disease” among US podiatrists. The condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.

• Sharp pain in the inside part of the bottom of the heel bone (calcaneous bone),
• Heel pain after exercise,
• Pain after standing a long time or getting up from a seated position,
• Commonly heel pain first thing in the morning with your first few steps.

Plantar fasciitis usually occurs gradually overtime with increasing pain as the condition worsens. For example, an individual who just started a jogging exercise routine may experience some heel discomfort upon awaking in the morning. After increasing the amount of running distance and/or frequency he or she may then begin to experience a knife-like sensation in the heel in the morning, frequently throughout the day, and at the beginning and end of their runs.

How is PF Diagnosed?
Typically the diagnosis is easily made based on the patient's history and physical findings.  A history of heel pain with weight bearing, especially upon awakening, tenderness at the medial (inside) aspect of the bottom of the heel bone, and pain elicited by stretching the bottom of the foot, are typical findings of this condition.

Commonly, a foot X-ray is performed which may show a bone spur of the bottom of the heel (calcaneous) bone which projects forward.  In the past, and still on occasion now, these bone spurs may be blamed for the heel pain and unnecessarily operated on to correct the problem.  The symptoms are actually the result of inflammation of the tissue attached to the spur and the muscles fascia of the foot, not from the bone spur itself.  Therefore, surgery to remove these bone spurs should rarely if ever be performed.

How is PF treated?

• Anti-inflammatory medication as directed by your physician
• Proper shoes with attention to good arch supports and heel cushions
• Stretching and icing the bottom of foot first thing in morning, which is best accomplished with a frozen bottle of water, placing your foot on it and rolling it on the ground
• Night splints keep the foot and ankle in a neutral position at night allowing for a constant stretch of the fascia while sleeping
• Physical therapy is sometimes required with the goal of stretching the plantar fascia and strengthening the muscles of the lower leg to support the heel
• Injection of cortisone into the inflamed tissue of the heel is sometimes necessary to treat severe inflammation
• Very rarely is surgery necessary.

PF may take a couple of weeks, up to months to treat, and resolution depends on the duration and severity of symptoms prior to seeking medical consultation.

How is PF prevented?
The best way to prevent PF is to maintain a healthy weight, and wear proper shoes with arch supports and heel cushions if needed. Avoid repeated pounding to the heel if PF symptoms are present.  Thorough stretching, and a focus on maintaining flexibility and strength of the muscles of the foot and ankle are critical to preventing plantar fascia shortening. Prompt treatment by a physician can prevent long debilitation from PF and help to ensure a speedy return to pain-free activity and exercise.

A Florida native, Dr. Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents' Medical Center in Jacksonville. Dr. Badolato is Board Certified and has fellowship training in sports Medicine with a specialization in non-operative musculaskeletal medicine. Formerly a team physicians at Ohio State University, he was also the medical director for the world-renowned IMG Bollettieri Sports Academy in Bradenton, Florida. You can reach Dr. Badolato at 321-253-2169 or log on to Premierurgentcare.com

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Dr. Steve Badolato

Elevated Body Temperature Occurs Quickly in Florida Heat

STAYING COOL and well-hydrated while exercising is very important. Brevard County, Florida, with its average high temperatures of 90 degrees and its high relative humidity resulting in "feels like" temperatures topping 100 degrees, can make this a difficult task.

Heat illness as a result of elevated body temperature or hyperthermia can occur in a very short period of time in these conditions.  There are various forms of heat illness, which can potentially harm or even be deadly for individuals exercising outdoors.

What are Heat Cramps?
Heat cramps are painful muscle cramps that can occur in the legs, arms, and abdominal muscles.  The cause is generally believed to be caused by fluid loss and inadequate consumption of fluids and/or electrolytes.  This form of heat illness, although quite painful, will not cause prolonged or permanent health problems.  The remedy for this condition is simple rest in a cool environment, stretch/massage of the affected muscles, and rehydration with a water/electrolyte (sports) drink.

ACCLIMATIZATION to heat, which is the process of physiologic adaptation to a new environment is important to athletes and those from cold weather environments that suddenly begin training in the warmer weather conditions of Florida.

What is Heat Exhaustion?
Heat exhaustion develops after extended periods of exposure to high temperature while exercising.  This may or may not be preceded by heat cramps and is characterized by excessive sweating, electrolyte imbalance especially sodium and potassium, and weakness. Prolonged exposure may lead to dizziness, headaches, nausea, vomiting, and pale, clammy skin.

This situation is common in children and can occur quicker as a result of their decreased body surface area available to dissipate heat while exercising.  Urgent rest in a cool environment, water/electrolyte drink, cool mist fan, elevation of legs, and in some cases even intravenous fluids may be required. Core body temperature of 100.4 F to 104.9 F is the norm for heat exhaustion and, if exercise and exposure continue unabated, this condition can progress to the potentially fatal form of heat illness known as heat stroke.

What is Heat Stroke?
Heat stroke is the most advanced state of hyperthermia.  It occurs when the body absorbs more heat than it can dissipate. A core body temperature typically greater than 104.9 F, which is over 6 F higher than human's average normal temperature of 98.6 F, distinguishes this condition.

Heat stroke results from overload and failure of the body's cooling mechanism, is a medical emergency, and is manifested by mental status changes, irritability, hot dry skin, physical collapse, and cardiovascular shock.  Emergent transport via emergency medical system to the emergency room for intravenous fluids, ice packs to armpits, groin and neck or water immersion is necessary.

Prevention of Heat Illness
Fluid hydration prior to and during exercise is the cornerstone of preventing heat illness.  The following are basic general guidelines prior to hot weather exercise:

• Drink about 16 ounces (5-8 percent carbohydrate sports drink with sodium) two hours before exercise.
• If exercising for a prolonged period of time, attempt to match fluid losses from sweating; replacement fluids can range from 5-10 ounces of cool fluids every 15 minutes depending on your size or about 5 ounces every 30 minutes during exercise for an 80 pound child.
• Post exercise rehydration is important and the required amount of fluids can be determined by measuring pre-exercise and post-exercise body weight; generally replacement of 16 ounces of water for every pound of weight lost is required.
• The time of day you exercise is also important in preventing heat illness. Choosing to exercise in the cooler early morning or late evening hours can greatly reduce your risk of developing heat illness. Exercise apparel should be light and loose fitting to allow for quicker and more efficient cool-down.

Acclimatization Important
Proper conditioning is essential and can be attained with initial exercise sessions being shorter and less intense and then building to higher levels, depending on your level of fitness.

Acclimatization to heat, which is the process of physiologic adaptation to a new environment, is also very important. This process is particularly important to individuals from cold weather environments that suddenly begin training in the warmer weather conditions of Florida. Total adaptation typically requires about two weeks, with the majority adaptation occurring by five days.

Beware the Heat Index
Humidity, temperature, and heat index play a big role in the risk of developing heat illness.  High humidity reduces your body's ability to get rid of excess heat by sweating. At any given temperature, the higher the relative humidity -  which is the water vapor in the air -  the higher the apparent temperature, which is referred to as the heat index ("feels like temperature").   For example, if the air temperature is 86  F and the humidity is 50 percent, the heat index is 88 F. However, at the same temperature of 86  F with the relative humidity of 90 percent, which is not uncommon in Brevard County, the heat index or "feels like" temperature is 105 F.  In other words, your body will have to sweat as much to get rid of extra heat at 86 F with 90 percent humidity in Florida as you would in a dry desert at 105F.

Be careful trying to beat the heat, but if you must, recognition of the early trouble signs and symptoms of heat illness are essential. Remember prevention and know when to say "no" when exercising in hot and humid weather.  A little common sense and education can make exercise and sports during the summertime on the sunny Space Coast safe and enjoyable.

A Florida native, Dr. Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents' Medical Center in Jacksonville. Dr. Badolato is Board Certified and has fellowship training in sports Medicine with a specialization in non-operative musculaskeletal medicine. Formerly a team physicians at Ohio State University, he was also the medical director for the world-renowned IMG Bollettieri Sports Academy in Bradenton, Florida. You can reach Dr. Badolato at 321-253-2169, or log on to PremierUrgentCare.com

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