Musculoskeletal Health - Springfield Clinic

Framework: Maintaining Musculoskeletal Health Diane Hillard-Sembell, MD Orthopaedic Surgeon, Knee Specialist Springfield Clinic Medical Director, AthletiCare Sportsmedicine

Fitness Family/ House- hold Career Friends

Time is the major
obstacle preventing
women from regular
physical activity.

WHY EXERCISE?
Fitness is your cheapest
health insurance!!

WHY EXERCISE? Medical benefits
Exercise may prevent/reduce/ease:
Coronary artery disease
Stroke
Obesity
Hypertension
Diabetes

WHY EXERCISE? Medical Benefits
Exercise may prevent/reduce/ease:
High cholesterol
Cancer
Back pain
Arthritis
Osteoporosis

EXERCISE REDUCES STRESS! EXERCISE REDUCES STRESS!

Effects of aging
Degenerative changes
 flexibility
 strength
40 to 50% loss in muscle mass between ages of 25 and 80
 endurance
 reaction time

Sarcopenia – No one is immune!
Loss of muscle tissue
Sarcopenia defined as 2 SD below mean of young healthy counterparts
23% women, 27% men 64-92
If greater than 80, 31% woman, 53% men

Must differentiate physiology of AGING versus physiology of DISUSE!

YOUNGER NEXT YEAR
By Chris Crowley & Henry Lodge
Workman Publishing
2004,2005,2007

Harry’s Rules
Exercise 6 days a week
Do serious aerobic exercise 4X/week
Do serious strength training 2X/week
Spend less than you make
Quit eating crap!
Care
Connect and commit

Exercise for Successful Aging

“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.”
~ Steven Blair, PhD
Cooper Institute for Aerobics

Exercise
Unfit forty year olds regardless of weight have higher death rates than fit 40 year olds
Those who become fit reduce their mortality risk by 44%
Each 1 min increase in time on treadmill at maximal effort associated with 8% decrease mortality

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%

Physiological Benefits of Exercise
Reduces risk of:
Coronary artery disease
Serum lipid abnormalities
Hypertension
Diabetes
Osteoporosis
Obesity
Colon cancer

Musculoskeletal Benefits of Exercise
Improved muscle strength
Increased bone mass
Improved joint mobility

Fitness starts with setting goals
Realistic
Achievable

Getting Started
Enjoyable
Sustainable

In the Bleachers
“I give her a week,
then she will be
back in here with
us and that
treadmill will be
gone in the next
garage sale.”

MYTH
Weight loss means I’m getting in
better shape.

MYTH
…”just five minutes a day, you can do
this on the couch watching TV…”

MYTH
Fitness is an all-or-nothing proposition.

MYTH
Metabolism can be “rev-ed up” by special
diet, pills, powders, or thermogenic herbs.

MYTH
Weight training will make me muscle-
bound.

FITNESS COMPONENTS
Cardiovascular
Strength
Flexibility

CARDIOVASCULAR Guidelines
Minimum 30 minutes aerobic exercise 3X/week (recommend 4-5X/wk)
60-90% maximum heart rate
Target heart rate(THR)

A Wealth of Options
Personal trainer
Classes
Machines/free weights
Club/home

GETTING STARTED
Build physical activity into your daily routine
Do the same activities more often
Walk whenever and wherever possible

Getting Started (cont)
Start slowly with easy stretching
Move around frequently
Take the stairs instead of the elevator
Carry home the groceries
Find activities that you enjoy
Try out a class in your community

WHY STRENGTH TRAIN
Keep muscles and bones strong
Less likely to fall or to have accidents that will cause injury
Improve balance and posture
Reduce bone loss
Know your personal limits

CARDIORESPIRATORY BENEFITS
Cardiovascular endurance increase:
Requires pulse to 65-85% of max.
Sustained more than 10 minutes
At least 3x/week
Strength training can maintain heart rate increase as long as the interval between exercises is brief.

SARCOPENIA
Sarcopenia is the loss of muscle mass.
This occurs with aging.
Strength training rebuilds the muscle and maintains mass.

DAILY ACTIVITIES
Shopping
Gardening
House cleaning
Grandchildren
All require a minimum strength to perform effectively and safely.

JOINT STABILITY
Is increased by co-contraction of muscles around a joint.
Reduces joint injury with common tasks.
Reduces pain of arthritis.
Benefits from free weights.

RESTING METABOLIC RATE
Increases with greater muscle mass.
Burns calories.
Increases for some time after exercise.

STRENGTH TRAINING MYTHS
Strength training will slow you down.
It takes too much time.
If it hurts stop!
Muscle gains turn to fat when you stop training.
You will get muscle bound.
Increased risk of coronary artery disease.
Dangerous for those with high blood pressure.
You will look like Arnie Schwarzenegger

SAFETY TIPS
Start slowly-but challenge your muscles
Learn proper technique to protect your back and joints
Use weights that you can lift 10 times before they become too heavy
Breath naturally-don’t hold your breath

GUIDELINES - Beginner
2 times per week
10 repetitions of each exercise
2 sets of each exercise
Use machines in beginning to help stabilize body
Strength train large muscle groups

GUIDELINES - Advanced
4 times per week
12-15 repetitions of each exercise
3 sets of each exercise
Add free weights
Add small muscle groups

FLEXIBILITY Guidelines
Slow, static(passive)
Minimum 30 seconds stretch for each muscle group
Repeat three times

Exercise

Always take time to warm up and stretch before physical activity and cool down and stretch after activity.

Osteoporosis
“ The Silent Thief”

Osteoporosis affects more than 25 million U.S. citizens.
More that 1.5 million fractures occur each year.

“ Fragile Bone Disease”
osteo = bone
porosis = porous

OSTEOPOROSIS
Loss of minerals, particularly calcium.
When 30% loss, bones break easily.
Bones are undergoing continual replacement, and respond to stresses

OSTEOPOROSIS
Commonly compression fracture spine. 33% up to 75%
Hip fracture
Wrist/rib fractures
Stress fractures (Exercise does not prevent demineralization due to estrogen lack.)
Controllable factors
Low calcium intake
Smoking
Medications
Alcohol
Caffeine
Lack of weight bearing exercise
Excessive use of antacids and laxatives

PEAK BONE MASS

Will your bones live as long as you do?

Bone Mineral Density (BMD)

Normal X-Rays cannot detect bone
loss until at least 30% of bone mass
is lost!

“ Weight-bearing”
Walking
running
aerobics
tennis
strength-training

Osteoporosis is NOT an inevitable part of menopause or aging.

Exercise has a positive effect on bone mass.

Treatment
Calcium
Vitamin D
Weight-bearing exercise
Medications

Baby Boomers 1946 to 1964

JOCK vs. CLOCK

BOOMERITIS
Nicholas A. DiNubile, MD
American Academy of Orthopaedic Surgeons

“ FIX-ME-ITIS”

Use the “10 percent rule” TWICE

Exercise for Arthritis Management

Knee Joint
Healthy knee joint
Arthritic knee joint

Causes of Osteoarthritis
Genetics
Joint injury
Obesity
Age
Sex

Weight Loss

Weight Loss
Losing small amounts of weight can have a dramatic impact on knee OA development
Loss of 10 LBS. over 10 years has been shown to decrease the risk of symptomatic knee OA in women by more than 50%
Also-> 6.3kg loss over 6 months significantly decreased symptomatic knee pain in women >50% over IBW

Weight Loss
If we could go from:
Obese  overweight
Overweight  normal weight
This would prevent 33% of all knee OA in women and 20% in men

Treatment

BMI=wt(kg)/ht(m)2
Calories burned > Calories consumed

Exercise does NOT cause arthritis! In fact, physiologic loading is necessary for cartilage health.

Goals of Exercise Program for Arthritis
Preserve or restore ROM/flexibility
Increase muscle strength
Improve aerobic conditioning

Exercise Adaptations for People with Arthritis
Begin slowly and progress gradually
Avoid rapid or repetitive movements
Adapt physical activity to the individual
~ American College of Sportsmedicine

Exercise alternatives
Walking on concrete
2-6x body weight
Cycling
equipment, safety/balance, environment
Running
12x body weight

MOVE IT OR LOSE IT!

ATHLETIC INJURIES Female
Shoulder impingement
Hip bursitis
Patellar pain
ACL tears

ACL Injury: Female vs Male
4-8 times higher incidence
Non-contact ACL injury rates higher

NCAA Surveillance Study
Arendt E, Dick R: Knee injury patterns
among men and women in collegiate
basketball and soccer. NCAA Data and
Review of the Literature.
AM J Sports Med 23:694-701, 1995

Theories
Anatomy
Alignment
Hormonal influence
Training factors

Can we prevent the epidemic?

We CANNOT Control
ACL size
Notch width
Pelvis shape
Knee and foot position

We CAN Control
Strength
Landing mechanics
Muscle recruitment

Plyometric Training in Female Athletes
Decreased peak landing forces 22%
Decreased medial-lateral motion 50%
Increased hamstring muscle power 44%
Improved jump height
Hewett, 1996

ACL Injury Prevention
Neuromuscular Training Techniques
Strong Athletic Positioning
Good body control
Light/quiet landing dissipates force
Flexed “ready” position

Sportsmetrics© ACL Prevention
Dynamic Warm-up
Jump/Plyometric Exercises
Strength Training
Stretching
* Cincinnati Research & Education Foundation

Sportsmetrics Guidelines
Quality over quantity
Correct technique of utmost importance
Minimum of 6 weeks (3 x 2 wk phases)
45-60 minutes per session
3 times per week

Preventing Sports Injury
Be in proper physical condition
Get proper instruction
Gradual progression & cross-training
Warm up and cool down
Get adequate rest
Remember fuel and hydration

What Will 20 Years Do To You?

Embrace the seasons of your life!

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Musculoskeletal Health - Springfield Clinic

by Springfield Clinic on May 07, 2010

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