Musculoskeletal Health - Springfield Clinic


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Protect Your Framework: Musculoskeletal Health, presented by Diane Hillard-Sembell MD, Orthopaedic Surgery, Springfield Clinic.

Originally presented at Springfield Clinic Me 1st Women's Health Event, May 2010 - All information and images provided by presenter.

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Musculoskeletal Health - Springfield Clinic

  1. 1. Framework: Maintaining Musculoskeletal Health Diane Hillard-Sembell, MD Orthopaedic Surgeon, Knee Specialist Springfield Clinic Medical Director, AthletiCare Sportsmedicine
  2. 2. Fitness Family/ House- hold Career Friends
  3. 3. <ul><li>Time is the major </li></ul><ul><li>obstacle preventing </li></ul><ul><li>women from regular </li></ul><ul><li>physical activity. </li></ul>
  4. 4. WHY EXERCISE? <ul><li>Fitness is your cheapest </li></ul><ul><li>health insurance!! </li></ul>
  5. 5. WHY EXERCISE? Medical benefits <ul><li>Exercise may prevent/reduce/ease: </li></ul><ul><li>Coronary artery disease </li></ul><ul><li>Stroke </li></ul><ul><li>Obesity </li></ul><ul><li>Hypertension </li></ul><ul><li>Diabetes </li></ul>
  6. 6. WHY EXERCISE? Medical Benefits <ul><li>Exercise may prevent/reduce/ease: </li></ul><ul><li>High cholesterol </li></ul><ul><li>Cancer </li></ul><ul><li>Back pain </li></ul><ul><li>Arthritis </li></ul><ul><li>Osteoporosis </li></ul>
  8. 9. Effects of aging <ul><li>Degenerative changes </li></ul><ul><li> flexibility </li></ul><ul><li> strength </li></ul><ul><ul><li>40 to 50% loss in muscle mass between ages of 25 and 80 </li></ul></ul><ul><li> endurance </li></ul><ul><li> reaction time </li></ul>
  9. 11. Sarcopenia – No one is immune! <ul><li>Loss of muscle tissue </li></ul><ul><ul><li>Sarcopenia defined as 2 SD below mean of young healthy counterparts </li></ul></ul><ul><ul><li>23% women, 27% men 64-92 </li></ul></ul><ul><ul><li>If greater than 80, 31% woman, 53% men </li></ul></ul>
  10. 12. <ul><li>Must differentiate physiology of AGING versus physiology of DISUSE! </li></ul>
  11. 15. YOUNGER NEXT YEAR <ul><li>By Chris Crowley & Henry Lodge </li></ul><ul><li>Workman Publishing </li></ul><ul><li>2004,2005,2007 </li></ul>
  12. 16. Harry’s Rules <ul><li>Exercise 6 days a week </li></ul><ul><li>Do serious aerobic exercise 4X/week </li></ul><ul><li>Do serious strength training 2X/week </li></ul><ul><li>Spend less than you make </li></ul><ul><li>Quit eating crap! </li></ul><ul><li>Care </li></ul><ul><li>Connect and commit </li></ul>
  13. 17. <ul><li>Exercise for Successful Aging </li></ul>
  14. 18. <ul><li>“Skeletal muscle is the largest organ in the body and is intricately tied with protein turnover … Activating skeletal muscle has many important health benefits we are only beginning to understand.” </li></ul><ul><li>~ Steven Blair, PhD </li></ul><ul><li>Cooper Institute for Aerobics </li></ul>
  15. 19. Exercise <ul><li>Unfit forty year olds regardless of weight have higher death rates than fit 40 year olds </li></ul><ul><ul><li>Those who become fit reduce their mortality risk by 44% </li></ul></ul><ul><ul><li>Each 1 min increase in time on treadmill at maximal effort associated with 8% decrease mortality </li></ul></ul>
  16. 20. Stay Active, Not Just Thin To Live Longer Woman Men Fit-not fat 0% 0% Unfit-not fat 30% 25% Fit-fat 32% 44% Unfit-fat 57% 49%
  17. 21. Physiological Benefits of Exercise <ul><li>Reduces risk of: </li></ul><ul><ul><li>Coronary artery disease </li></ul></ul><ul><ul><li>Serum lipid abnormalities </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Osteoporosis </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Colon cancer </li></ul></ul>
  18. 22. Musculoskeletal Benefits of Exercise <ul><li>Improved muscle strength </li></ul><ul><li>Increased bone mass </li></ul><ul><li>Improved joint mobility </li></ul>
  19. 23. Fitness starts with setting goals <ul><li>Realistic </li></ul><ul><li>Achievable </li></ul>
  20. 24. Getting Started <ul><li>Enjoyable </li></ul><ul><li>Sustainable </li></ul>
  21. 25. In the Bleachers <ul><li>“I give her a week, </li></ul><ul><li>then she will be </li></ul><ul><li>back in here with </li></ul><ul><li>us and that </li></ul><ul><li>treadmill will be </li></ul><ul><li>gone in the next </li></ul><ul><li>garage sale.” </li></ul>
  22. 26. MYTH <ul><li>Weight loss means I’m getting in </li></ul><ul><li>better shape. </li></ul>
  23. 27. MYTH <ul><li>…”just five minutes a day, you can do </li></ul><ul><li>this on the couch watching TV…” </li></ul>
  24. 28. MYTH <ul><li>Fitness is an all-or-nothing proposition. </li></ul>
  25. 29. MYTH <ul><li>Metabolism can be “rev-ed up” by special </li></ul><ul><li>diet, pills, powders, or thermogenic herbs. </li></ul>
  26. 30. MYTH <ul><li>Weight training will make me muscle- </li></ul><ul><li>bound. </li></ul>
  27. 31. FITNESS COMPONENTS <ul><li>Cardiovascular </li></ul><ul><li>Strength </li></ul><ul><li>Flexibility </li></ul>
  28. 32. CARDIOVASCULAR Guidelines <ul><li>Minimum 30 minutes aerobic exercise 3X/week (recommend 4-5X/wk) </li></ul><ul><li>60-90% maximum heart rate </li></ul><ul><li>Target heart rate(THR) </li></ul>
  29. 33. A Wealth of Options <ul><li>Personal trainer </li></ul><ul><li>Classes </li></ul><ul><li>Machines/free weights </li></ul><ul><li>Club/home </li></ul>
  30. 34. GETTING STARTED <ul><li>Build physical activity into your daily routine </li></ul><ul><li>Do the same activities more often </li></ul><ul><li>Walk whenever and wherever possible </li></ul>
  31. 35. Getting Started (cont) <ul><li>Start slowly with easy stretching </li></ul><ul><li>Move around frequently </li></ul><ul><li>Take the stairs instead of the elevator </li></ul><ul><li>Carry home the groceries </li></ul><ul><li>Find activities that you enjoy </li></ul><ul><li>Try out a class in your community </li></ul>
  32. 37. WHY STRENGTH TRAIN <ul><li>Keep muscles and bones strong </li></ul><ul><li>Less likely to fall or to have accidents that will cause injury </li></ul><ul><li>Improve balance and posture </li></ul><ul><li>Reduce bone loss </li></ul><ul><li>Know your personal limits </li></ul>
  33. 38. CARDIORESPIRATORY BENEFITS <ul><li>Cardiovascular endurance increase: </li></ul><ul><li>Requires pulse to 65-85% of max. </li></ul><ul><li>Sustained more than 10 minutes </li></ul><ul><li>At least 3x/week </li></ul><ul><li>Strength training can maintain heart rate increase as long as the interval between exercises is brief. </li></ul>
  34. 39. SARCOPENIA <ul><li>Sarcopenia is the loss of muscle mass. </li></ul><ul><li>This occurs with aging. </li></ul><ul><li>Strength training rebuilds the muscle and maintains mass. </li></ul>
  35. 40. DAILY ACTIVITIES <ul><li>Shopping </li></ul><ul><li>Gardening </li></ul><ul><li>House cleaning </li></ul><ul><li>Grandchildren </li></ul><ul><li>All require a minimum strength to perform effectively and safely. </li></ul>
  36. 41. JOINT STABILITY <ul><li>Is increased by co-contraction of muscles around a joint. </li></ul><ul><li>Reduces joint injury with common tasks. </li></ul><ul><li>Reduces pain of arthritis. </li></ul><ul><li>Benefits from free weights. </li></ul>
  37. 43. RESTING METABOLIC RATE <ul><li>Increases with greater muscle mass. </li></ul><ul><li>Burns calories. </li></ul><ul><li>Increases for some time after exercise. </li></ul>
  38. 44. STRENGTH TRAINING MYTHS <ul><li>Strength training will slow you down. </li></ul><ul><li>It takes too much time. </li></ul><ul><li>If it hurts stop! </li></ul><ul><li>Muscle gains turn to fat when you stop training. </li></ul><ul><li>You will get muscle bound. </li></ul><ul><li>Increased risk of coronary artery disease. </li></ul><ul><li>Dangerous for those with high blood pressure. </li></ul><ul><li>You will look like Arnie Schwarzenegger </li></ul>
  39. 45. SAFETY TIPS <ul><li>Start slowly-but challenge your muscles </li></ul><ul><li>Learn proper technique to protect your back and joints </li></ul><ul><li>Use weights that you can lift 10 times before they become too heavy </li></ul><ul><li>Breath naturally-don’t hold your breath </li></ul>
  40. 46. GUIDELINES - Beginner <ul><li>2 times per week </li></ul><ul><li>10 repetitions of each exercise </li></ul><ul><li>2 sets of each exercise </li></ul><ul><li>Use machines in beginning to help stabilize body </li></ul><ul><li>Strength train large muscle groups </li></ul>
  41. 47. GUIDELINES - Advanced <ul><li>4 times per week </li></ul><ul><li>12-15 repetitions of each exercise </li></ul><ul><li>3 sets of each exercise </li></ul><ul><li>Add free weights </li></ul><ul><li>Add small muscle groups </li></ul>
  42. 61. FLEXIBILITY Guidelines <ul><li>Slow, static(passive) </li></ul><ul><li>Minimum 30 seconds stretch for each muscle group </li></ul><ul><li>Repeat three times </li></ul>
  43. 63. Exercise
  44. 64. <ul><li>Always take time to warm up and stretch before physical activity and cool down and stretch after activity. </li></ul>
  45. 65. Osteoporosis <ul><li>“ The Silent Thief” </li></ul>
  46. 66. <ul><li>Osteoporosis affects more than 25 million U.S. citizens. </li></ul><ul><li>More that 1.5 million fractures occur each year. </li></ul>
  47. 67. “ Fragile Bone Disease” <ul><li>osteo = bone </li></ul><ul><li>porosis = porous </li></ul>
  48. 68. OSTEOPOROSIS <ul><li>Loss of minerals, particularly calcium. </li></ul><ul><li>When 30% loss, bones break easily. </li></ul><ul><li>Bones are undergoing continual replacement, and respond to stresses </li></ul>
  49. 70. OSTEOPOROSIS <ul><li>Commonly compression fracture spine. 33% up to 75% </li></ul><ul><li>Hip fracture </li></ul><ul><li>Wrist/rib fractures </li></ul><ul><li>Stress fractures (Exercise does not prevent demineralization due to estrogen lack.) </li></ul><ul><li>Controllable factors </li></ul><ul><li>Low calcium intake </li></ul><ul><li>Smoking </li></ul><ul><li>Medications </li></ul><ul><li>Alcohol </li></ul><ul><li>Caffeine </li></ul><ul><li>Lack of weight bearing exercise </li></ul><ul><li>Excessive use of antacids and laxatives </li></ul>
  50. 71. PEAK BONE MASS
  51. 72. Will your bones live as long as you do?
  52. 73. <ul><li>Bone Mineral Density (BMD) </li></ul>
  53. 74. <ul><li>Normal X-Rays cannot detect bone </li></ul><ul><li>loss until at least 30% of bone mass </li></ul><ul><li>is lost! </li></ul>
  54. 75. “ Weight-bearing” <ul><li>Walking </li></ul><ul><li>running </li></ul><ul><li>aerobics </li></ul><ul><li>tennis </li></ul><ul><li>strength-training </li></ul>
  55. 76. <ul><li>Osteoporosis is NOT an inevitable part of menopause or aging. </li></ul>
  56. 77. <ul><li>Exercise has a positive effect on bone mass. </li></ul>
  57. 78. Treatment <ul><li>Calcium </li></ul><ul><li>Vitamin D </li></ul><ul><li>Weight-bearing exercise </li></ul><ul><li>Medications </li></ul>
  58. 79. <ul><li>Baby Boomers 1946 to 1964 </li></ul>
  59. 81. <ul><li>JOCK vs. CLOCK </li></ul>
  60. 82. BOOMERITIS <ul><li>Nicholas A. DiNubile, MD </li></ul><ul><li>American Academy of Orthopaedic Surgeons </li></ul>
  61. 83. <ul><li>“ FIX-ME-ITIS” </li></ul>
  62. 84. <ul><li>Use the “10 percent rule” TWICE </li></ul>
  63. 85. Exercise for Arthritis Management
  64. 87. Knee Joint <ul><li>Healthy knee joint </li></ul>Arthritic knee joint
  65. 88. Causes of Osteoarthritis <ul><li>Genetics </li></ul><ul><li>Joint injury </li></ul><ul><li>Obesity </li></ul><ul><li>Age </li></ul><ul><li>Sex </li></ul>
  66. 89. Weight Loss
  67. 90. Weight Loss <ul><li>Losing small amounts of weight can have a dramatic impact on knee OA development </li></ul><ul><ul><li>Loss of 10 LBS. over 10 years has been shown to decrease the risk of symptomatic knee OA in women by more than 50% </li></ul></ul><ul><li>Also-> 6.3kg loss over 6 months significantly decreased symptomatic knee pain in women >50% over IBW </li></ul>
  68. 91. Weight Loss <ul><li>If we could go from: </li></ul><ul><li>Obese  overweight </li></ul><ul><li>Overweight  normal weight </li></ul><ul><ul><li>This would prevent 33% of all knee OA in women and 20% in men </li></ul></ul>
  69. 92. Treatment
  70. 94. <ul><li>BMI=wt(kg)/ht(m)2 </li></ul><ul><li>Calories burned > Calories consumed </li></ul>
  71. 98. <ul><li>Exercise does NOT cause arthritis! In fact, physiologic loading is necessary for cartilage health. </li></ul>
  72. 99. Goals of Exercise Program for Arthritis <ul><li>Preserve or restore ROM/flexibility </li></ul><ul><li>Increase muscle strength </li></ul><ul><li>Improve aerobic conditioning </li></ul>
  73. 100. Exercise Adaptations for People with Arthritis <ul><li>Begin slowly and progress gradually </li></ul><ul><li>Avoid rapid or repetitive movements </li></ul><ul><li>Adapt physical activity to the individual </li></ul>~ American College of Sportsmedicine
  74. 101. Exercise alternatives <ul><li>Walking on concrete </li></ul><ul><ul><li>2-6x body weight </li></ul></ul><ul><li>Cycling </li></ul><ul><ul><li>equipment, safety/balance, environment </li></ul></ul><ul><li>Running </li></ul><ul><ul><li>12x body weight </li></ul></ul>
  75. 104. <ul><li>MOVE IT OR LOSE IT! </li></ul>
  76. 105. ATHLETIC INJURIES Female <ul><li>Shoulder impingement </li></ul><ul><li>Hip bursitis </li></ul><ul><li>Patellar pain </li></ul><ul><li>ACL tears </li></ul>
  77. 108. ACL Injury: Female vs Male <ul><li>4-8 times higher incidence </li></ul><ul><li>Non-contact ACL injury rates higher </li></ul>
  78. 111. NCAA Surveillance Study <ul><li>Arendt E, Dick R: Knee injury patterns </li></ul><ul><li>among men and women in collegiate </li></ul><ul><li>basketball and soccer. NCAA Data and </li></ul><ul><li>Review of the Literature. </li></ul><ul><li>AM J Sports Med 23:694-701, 1995 </li></ul>
  79. 115. Theories <ul><li>Anatomy </li></ul><ul><li>Alignment </li></ul><ul><li>Hormonal influence </li></ul><ul><li>Training factors </li></ul>
  80. 118. <ul><li>Can we prevent the epidemic? </li></ul>
  81. 119. We CANNOT Control <ul><li>ACL size </li></ul><ul><li>Notch width </li></ul><ul><li>Pelvis shape </li></ul><ul><li>Knee and foot position </li></ul>
  82. 120. We CAN Control <ul><li>Strength </li></ul><ul><li>Landing mechanics </li></ul><ul><li>Muscle recruitment </li></ul>
  83. 122. Plyometric Training in Female Athletes <ul><li>Decreased peak landing forces 22% </li></ul><ul><li>Decreased medial-lateral motion 50% </li></ul><ul><li>Increased hamstring muscle power 44% </li></ul><ul><li>Improved jump height </li></ul><ul><li>Hewett, 1996 </li></ul>
  84. 123. ACL Injury Prevention <ul><li>Neuromuscular Training Techniques </li></ul><ul><li>Strong Athletic Positioning </li></ul><ul><li>Good body control </li></ul><ul><li>Light/quiet landing dissipates force </li></ul><ul><li>Flexed “ready” position </li></ul>
  85. 124. Sportsmetrics© ACL Prevention <ul><li>Dynamic Warm-up </li></ul><ul><li>Jump/Plyometric Exercises </li></ul><ul><li>Strength Training </li></ul><ul><li>Stretching </li></ul><ul><li>* Cincinnati Research & Education Foundation </li></ul>
  86. 125. Sportsmetrics Guidelines <ul><li>Quality over quantity </li></ul><ul><li>Correct technique of utmost importance </li></ul><ul><li>Minimum of 6 weeks (3 x 2 wk phases) </li></ul><ul><li>45-60 minutes per session </li></ul><ul><li>3 times per week </li></ul>
  87. 127. Preventing Sports Injury <ul><li>Be in proper physical condition </li></ul><ul><li>Get proper instruction </li></ul><ul><li>Gradual progression & cross-training </li></ul><ul><li>Warm up and cool down </li></ul><ul><li>Get adequate rest </li></ul><ul><li>Remember fuel and hydration </li></ul>
  88. 128. What Will 20 Years Do To You?
  89. 129. Embrace the seasons of your life!