Skin and bones neuspta 2011

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  • You need to be healthy to do your job, without a healthy body you can’t do what you enjoy and need to do to make a living, support your family and have fun………
  • Up to 70% of tennis players………have shoulder complaints…..
  • Talk about acromion, humerus, rotator cuff impingement
  • 40-50% of recreational tennis players have had tennis elbow
  • Sun protection factor = amount of comparable time it takes to cause sunburn in un-coated vs coated skin area. Only refers to UVB protection
  • Decrease of only 3% body water
  • Skin and bones neuspta 2011

    1. 1. A presentation to the New England USPTA Winter Conference 01/15/2011 Stephan Esser MD www.esserhealth.com
    2. 2. Skin and BonesStaying Healthy on the Court Stephan Esser USPTA, MD Harvard/Spaulding
    3. 3. Intro
    4. 4. Topics• Common Health Concerns –Musculoskeletal –Skin Care –Hydration on Court
    5. 5. Learning Points• Get to know your body – Basic Anatomy – What can go wrong• Know what yo u can do – Preventing problems – Basic Treatment• When to see a doctor
    6. 6. Why it Matters?
    7. 7. BackPain
    8. 8. Back Pain Stats• > 80 % of Americans in a lifetime• ≈ 30 % at any given time• 2nd leading reason to see a doctor• Spending in 2005 = $85.9 billion• Among Athletes highest rates: – Football, gymnastics, wrestling etc.
    9. 9. 80% 10%
    10. 10. Preventing Back Pain• Maintain healthy Posture – Awareness • “Ergonomics” – Core Strength – Flexibility & Balance – Ideal Body Weight• Muscle Balance – Weight training – Cross-Training
    11. 11. Ergonomics
    12. 12. Core Strength• Defined – Abdominals: Rectus, Obliques – Back Musculature: Extensors• Function – Provide spinal stability – Improve spinal circulation – Look Good – Ball defense
    13. 13. Flexibility• Maintain – Hamstrings – Quadriceps – Lower Back – Upper Back and Shoulders – Abs
    14. 14. Preventing Back Pain• Cross-Training: – Challenge “Tissue” in different ways – Develops complementary muscles – Engages the nerves and brain• Maintain Muscle Balance
    15. 15. Preventing Back Pain
    16. 16. Back Pain• You can handle it: – Mid-Low Back pain that improves with rest, ice NSAID’s and core work – Pain with a clear cause: eg: Inc. serving, played a tournament now with some mild LBP• Self Treating – 1-5 days of ’d activity: Soft-Brace, Ice, NSAID’s, maintain light activity (stationary bike) – 1-3 weeks of intensive core strengthening, stretching
    17. 17. More Stats.• Back Pain Free – 50% of people in 1 week – 75 % of people in 1 month – 95% of people in 3 months Regardless of Treatment or no Treatment
    18. 18. Back Pain• See your Doc’: – Extreme Pain – Pain that fails to improve with “conservative” management in 3-7 days – Pain with associated symptoms: • weight loss, fevers, chills, skin rash, night sweats – Pain with numbness, tingling or weakness down the legs – Change in bowel or bladder habits – Numbness in the groin area
    19. 19. Back Pain Wrap-Up• Back Arthritis and degeneration is a normal part of aging, but how we experience it varies• 90% of back pain is “safe pain”• You CAN do a lot to reduce the intensity, frequency and duration of back pain• You CAN manage most back pain on your own• There are times when you NEED to be evaluated by a Doc
    20. 20. Shoulder Pain
    21. 21. Shoulder Pain
    22. 22. Shoulder Pain• Common Causes: – Muscle Strain – Bursitis – “Rotator Cuff” tendinopathy or tear – Arthritis – Neck problems
    23. 23. Risks• Age• Family History• Overuse/Mis-Use• Trauma• Other: – Diabetes, Liver Problems, Nerve dysfunction
    24. 24. Why
    25. 25. Preventing Shoulder pain• Muscle Balance – Maintain “cuff balance” – Avoid excess overhead weight-lifting (military press, delt raises etc)• Technique – Serve, Forehand• Graduated training• Diet?• Smoking?
    26. 26. Treating Shoulder Pain• You CAN handle it – Mild to moderate discomfort in the shoulder after an increase in training – Pain that improves in 1-7 days with “conservative” measures – Mild chronic pain which you have previously had diagnosed and is well controlled
    27. 27. Treating Shoulder Pain• Call your “Doc” – Pain that doesn’t improve with a 1-4 days of conservative care – Pain with weakness, numbness or tingling – Pain with associated neck pain – Pain with all the “red flags” from back pain section – Dislocation, persistent clicking, popping, grinding, swelling, instability
    28. 28. What to do?• Relative Rest: Day: 1-7• ICE 2-4 x’s/ day• Maintain Range of Motion – Pendulums, Wall Walks etc.• If improving: Band workout: Day 4-14• +/- 7-10 days of NSAID’s
    29. 29. 4 Simple Tests• Neck ROM – Pain reproduced, worsened, etc• Shoulder ROM• Strength Tests• Empty Can Test
    30. 30. Shoulder Wrap Up• Maintain Flexibility and Strength – cuff, shoulder, biceps, triceps• Avoid Excess Overhead Cross-Training• Get it Checked out: – New Pain – Persistent Pain – New clicking, popping, catching, grinding, instability – With Associated Neck pain, numbness, tingling, weakness
    31. 31. Elbow Pain
    32. 32. Elbow Pain
    33. 33. Elbow Pain• Causes: – Tennis Elbow / Lateral Epicondylitis – Golfers Elbow / Medial Epicondylitis – Trauma – Ligaments – Nerve Injury/ Arthritis/Gout
    34. 34. Risks for Tennis Elbow• Technique• Muscle Strength and Balance• Frequency of Play• Change• String Tension• Racquet Stiffness• Grip Size
    35. 35. Preventing Elbow Pain• Technique• Technique• Technique• Avoid Sudden Variation: – Play Frequency / Racquet Width, Weight, Length / String Type and Tension• Conditioning• Flexibility
    36. 36. Lateral Epicondylitis• Treatment – Modify Technique – RICE – NSAIDs – Stretching and range of motion – Strengthening – Adjust Equipment – Elbow band etc
    37. 37. Lateral Epicondylitis• Non-Responsive: – Acupuncture – Cortisone Injections – Platelet Rich Plasma – Surgical Debridement
    38. 38. Elbow Wrap Up• Adjust Technique• Maintain Strength and Flexibility• RICE etc.• Modify Equipment• Visit your Doc if failure to improve
    39. 39. Knee Pain
    40. 40. Knee Pain
    41. 41. Knee Pain• Common Pre-disposing Factors: – Genetics, Family History, Obesity, Trauma – Muscular De-conditioning / Imbalance• Causes: – Arthritis – Cartilage (Meniscal) Injury – Ligament Injury: ACL, PCL etc – Muscle Imbalance eg: Patello-femoral Syndrome
    42. 42. Knee Pain• Things you can handle: – Mild Intermittent Discomfort – Previously Diagnosed low grade discomfort• You need a Doc: – Acute Trauma – Moderate to Extreme Persistent Pain – Swelling – Catching, Popping, Clicking, Locking, Grinding, Instability without a diagnosis
    43. 43. Knee Pain• Prevention: – Maximize Muscle Balance – Maintain Hamstring and Quadricep Flexibility – Exercise Form – Balance Work – Achieve “Ideal Body Weight” – Diet?
    44. 44. Knee Pain• Treatment: – RICE – Strengthening and Muscle Balance – Guided or personal Physical Therapy Program – NSAIDs – Cortisone injections – Cartilage Supplementation to the joint – Platelet Rich Plasma – Surgery
    45. 45. Knee Pain Wrap Up• Maximize Muscle Balance• Improve and Maintain flexibility• Follow up with a “Doc” for evaluation of new or persistent pain, popping, grinding, swelling or instability• Staying active does NOT worsen knee arthritis but may cause pain if you have known arthritis or other common proble
    46. 46. Foot Pain
    47. 47. Foot Pain
    48. 48. Foot Pain• Common Causes: – Trauma –Ankle Sprains – Plantar Fasciitis – Stress Fractures – Corns – Bunions
    49. 49. Prevention• Strength and Range of Motion• Flexibility• Proprioception / Balance• Appropriate Equipment• Diet: Consistent Caloric Consumption – Vitamin D, Calcium• Avoid excessive repetitive training
    50. 50. Treatment• Sprains/Strains: – RICE / Rehab / NSAIDs• Plantar Fasciitis – Stretching, Ice Rolling, Tennis Ball Work – Splinting, Physical Therapy, Cortisone, Surgery
    51. 51. Foot Pain• You can handle it: – Ankle Sprain you can walk on right away – Mild discomfort with a known diagnosis• Time to see a Doc: – Acute injury with immediate swelling, bruising, extreme pain, inability to walk – Persistent pain, swelling, clicking, popping, grinding or instability – Numbness, tingling, weakness in the foot
    52. 52. Foot Pain Wrap Up• Maintain leg strength, balance and flexibility• Appropriate equipment• Any traumatic event with persistent symptoms get it checked out• Remember RICE
    53. 53. Skin
    54. 54. Skin• Largest Organ in the body• Function: – Protect – Maintain hydration – Detoxify – Thermoregulation – Activate Vitamin D – Sex Appeal or Repellent
    55. 55. Skin• What Can go Wrong: – Sunburn – Skin Cancer: • Squamous Cell • Basal Cell • Melanoma
    56. 56. Quick Stats• Most common of all cancers• 1:5 Americans in a lifetime• Non-Melanoma: 2 million cases/yr – Inc. of 300% since 1994• Melanoma: 68, 000 cases /yr
    57. 57. Skin
    58. 58. Risks• Unprotected and/or excessive exposure to ultraviolet (UV) radiation• Fair complexion/ Family History• Occupational exposures to chemicals• History of multiple or atypical moles• Severe sunburns as a child• Dietary intake• Smoking exposure
    59. 59. Skin Care• Prevention: – Avoid Excess Exposure • Sunscreen • Clothing • Scheduling • Location: Court Side – Internal Sunscreen: 20-30% Cancer Risk • Quit Smoking • Avoid excess oxidizers • Fill up with the good stuff: Colorful fruits and veggies – Yearly Doctor Skin Check – Monthly Home Skin Check
    60. 60. Sunscreen• Broad Spectrum: UVA & UVB• ≥ SPF 30• Apply 15-30 minutes before exposure• Re-apply every 2 hours if sweating/in water• Don’t Forget: – Hands, ears, neck, back of legs, lips
    61. 61. Skin Care• Prevention: – Avoid Excess Exposure • Sunscreen • Clothing • Scheduling • Location: Court Side – Internal Sunscreen: 20-30% Cancer Risk • Quit Smoking • Avoid excess oxidizers • Fill up with the good stuff: Colorful fruits and veggies – Yearly Doctor Skin Check – Monthly Home Skin Check
    62. 62. Sun-Protective Clothing
    63. 63. Skin Care• Prevention: – Avoid Excess Exposure • Sunscreen • Clothing • Scheduling • Location: Court Side – Internal Sunscreen: 20-30% Cancer Risk • Quit Smoking • Avoid excess oxidizers • Fill up with the good stuff: Colorful fruits and veggies – Yearly Doctor Skin Check – Monthly Home Skin Check
    64. 64. “Internal” Sunscreen
    65. 65. Skin Care• Prevention: – Avoid Excess Exposure • Sunscreen • Clothing • Scheduling • Location: Court Side – Internal Sunscreen: 20-30% Cancer Risk • Quit Smoking • Avoid excess oxidizers • Fill up with the good stuff: Colorful fruits and veggies – Monthly Home Skin Check – Yearly Doctor Skin Check
    66. 66. Know your ABCDE’s
    67. 67. Skin Wrap Up• Wear Sunscreen daily• Wear Sun-Protective Clothing• Fill up on colorful foods• Avoid known “cancer causers”• Do regular skin checks• Know your ABCDE’s• Follow up with your Doc’
    68. 68. 10-12 cups of Daily Reccs: water/ day• Ideal: water, fitness waters, sport beverages, club soda, mineral water, and flavored water• Very good: 100% fruit juices, lemonade, tomato and vegetable juices• Good: raw fruits and vegetables• So-so: soft drinks, decaffeinated coffee, yogurt, skim milk• Avoid: caffeine and alcoholic beverages – act as diuretics
    69. 69. Hydration• 80kg male ≈ 48 L of body water• Lose 0.5-2.5 L H20 per hour of tennis• 1-2% H20 loss before you feel “thirsty”
    70. 70. Sweat• Constituents: – H2O – Sodium – Chloride – Potassium – Magnesium
    71. 71. Risks• HypOhydration – Impaired heat control – Altered Immunity – Kidney dysfunction•  endurance ≈ 30%
    72. 72. Pre-Match• Water• Carbohydrates• Quick Sugars
    73. 73. On Court• Drink 7 to 10 oz of fluid every 10 to 15 minutes and/or every changeover• Carbohydrate Electrolyte Drink: – Provides Glucose – Replenishes Electrolyte Loss – Enhances Water absorption
    74. 74. After Play• Replenish –H20 –Carbohydrate Meal –Electrolytes –Calories
    75. 75. Hydration Wrap-Up• Prevent Hypo-hydration – Stay ahead of needs – Focus on H20 rich beverages and foods – Avoid foods that dehydrate: Alcohol, Caffeine, high protein, high fat foods• Maximize hydration throughout the day/ match• Re-hydrate post day / end of match
    76. 76. Conclusion• “The first wealth is health” RWE• There is a lot you can do to stay healthy – Get to know the basics – Make a plan – Make changes when necessary• Recognize when to seek help• Some problems need a “team approach”

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