see the video: http://vimeo.com/61096362

Jason Rudolph:
The aging athlete. Here we all are. Everybody wants to be able to run wind sprints after your 80s and along with wind sprints after 80s come injuries. This is one of my favorite pictures. This is my ultimate aging athlete. Nolan Ryan, if anybody remembers this 20 years ago or so. He was 46 or so and this young buck named Robin Ventura decided to charge the mound and he clocked him, knocked him unconscious and that was the end of that. The aging athlete, I think, can still be a… yeah…pretty aggressive athlete. Quickly about me. I’m an orthopedic surgeon who specializes in foot and ankle trauma and all sports medicine type injuries. I’ve been in the area for the past 12 years. Board certified in orthopedic surgery. I do live locally and I try to treat all my patients like I would treat my friends and neighbors. I did play football like Gary mentioned. I have either suffered, am suffering and certainly will be suffering the repercussions of that so I kind of know exactly what a lot of the injuries are like and how to recover and what it’s like to be injured. A quick outline. We’re going to try to move through things relatively quickly and [inaudible] time in the end to ask any questions. I broke it down into two kinds of injuries. You got the overuse injuries and the acute injuries. Acute means something that literally just happened; overuse is more of a wear and tear chronic problem. Definition of an overuse injury: inflammation of a body part due to too much stress on either a normal area or normal stress on an abnormal area. I try to describe that like almost like a repetitive type of injury in certain spots. If you have a normal Achilles tendon but you just over do it, that tendon could become injured. Then again, you can have abnormal area like maybe you have a little thin bone or osteoporotic bone, you have normal activities creating injury to that abnormal area. Repetitive activities to a specific body part can include lots of things. Deciding you’re going to install a roof in one day, doing the entire P90X video, or one of these crazy videos, the first day. I got it in the mail for Christmas, I’m going to do the whole thing today. Or deciding to take up jogging cause you jogged 30 years ago so you go for a nice and easy 10 mile run. [inaudible] Tendonitis. This is all sort of definition stuff so that we can move through some of these problems later. Tendons are the piece of anatomic material, let’s say, that connects a muscle to a bone. One tendon everybody knows is your Achilles. That connects your calf muscles to your heel bone. Bursitis. Another one of these overuse things we’re going to hear on. So what’s a bursa? Bursae are these fluid filled sacks that occur somewhere between, usually between the skin and the underlying bone. The concept is, you have these to decrease friction. We all have them under out elbows. When you’re resting on your elbows, your elbow moves normally. You have them on the sides of your hips. When you lay on your side the skin doesn’t rub into a bone. These are normal things we have but there are areas where we can get overuse injuries. A stress fracture. Again, this is what I was just describing as an overuse injury specifically to the bone. I see a lot of these. [inaudible]. It’s an increased stress [inaudible]. Classic there is the army recruit, joins the army and does too much walking that first day and he gets a stress fracture. The other one is normal activity but abnormal bone, such as osteoporosis. That’s described as a “paperclip concept”. If you take a paperclip and you bend it, you bend it, you bend it, it starts getting hot, keep at it and you get little cracks in it and that’s kind of what a stress fracture is.

The first topic is trochanteric bursitis. A very common problem we see a lot of time here. Greater Trochanter is this big, hard bone you can feel inside of your hip. Some people call that a hip bone. It is but that really is a femur. And that spot is called your Greater Trochanter. It has attached a lot of the muscles; the muscles that help you stand up straight, the muscles that stop you from waddling or waddling as you’re walking. Symptom of Trochanteric Bursitis is pain directly on that big bump on the side of your hip. Sometimes the pain will radiate all the way down the outside of your knee, sometimes it’s worse at night, sometimes it’s worse when going up and down stairs. Risk factors for developing this problem: repetitive activity, like you’re going to see for all of these overuse injuries the first thing I’d say is repetitive activity. Biking, stair climbing, running. You’re also going to get this from direct trauma right to the side of the hip where that bursa fills with fluid. This is a picture, a cartoon of your hip. These are the muscles I was describing that are coming down, another band of muscles that are going this way and that red hotspot right there is where this bursa is located. This other side is the same picture without the muscles attached, and this bump is the Greater Trochanter that we’re talking about. How do you treat this? Again, most of these things, these overuse injuries, are treated nonsurgically. Simplest thing – modify the activities. If you hit yourself in the tight with the sledgehammer, stop hitting yourself with a sledgehammer. Second thing we try, NSAIDs, fancy name, basically what we’re talking about is ibuprofen or Naprosyn, the anti-inflammatory kind of medications. Cortisone injections work really well. Its’ a quick way to put the anti-inflammatory rate where you want it to be. Although it is a shot, we’re taking that shot and putting it right where we want it to be rather than taking a pill where the medicine goes throughout whole body. Physical therapy. Sometimes this helps, sometimes it doesn’t. Most of the time we go to therapy when the simpler things like [inaudible] are not working. Surgery is extremely rare for this problem. Has been described that people who just simply don’t get better within 6 months to a year of conservative management in which case what we do is go and remove the bursa. We are talking either an incision or sometimes now we can go through tiny little holes and use a camera and slip an orthoscopic type of surgery. Next problem – Patella Tendonitis. Again we are talking about the tendon. This particular tendon is the one that connects the kneecap to your leg. Your knee cap or your patella bone to the tibia bone. It is very important in the activities that require running, jumping, kicking sports. Symptoms are pain directly along the length of the tendon. The pain may be intermittent, meaning it’s not there all the time but as it gets worse it can progress to being present throughout the day. Another cartoon of the patellar tendon. This is a thigh bone. This white band is your quadriceps tendons, your quadriceps; your big thigh muscles are on top. They connect to this patella or your knee cap. And all that force goes right down through this big, patellar tendon. There’s all these big, huge thigh muscles you have really go right through this one little band of tissue and that’s what help you or your tibia or your leg bone move. Causes again, like I’ve said, it’s a very common overuse injury. Repetitive stress to the patella. Same concept we’re talking about when we’re doing more and more activities to one spot and cause this inflammation. In Patella Tendonitis, since this is not a bursa, this is a real tendon, the cause is multiple, tiny small tears that occur in that tendon. Those small tears hurt. Normally when your body has these tiny, small tears in tendon, you can naturally heal them on your own unless of course you keep doing it repetitively over and over again where your body can’t catch up. Then tears either don’t heal or progress to a point where they can’t heal cause the tears are too big. Risk factors for Patella Tendonitis, the same thing. High intensity or high frequency of specific activities. If you suddenly increase activity, I see this a lot in runners where they have a half-marathon they are training for so this week I’m going to build from 1 mile to 10 miles. Again, same problem is these overuse injuries. Overweight, again, the simple concept that if you’re putting more force across a tendon, you’re going to increase the likelihood that that tendon is going to hurt. Tight quadriceps muscles or muscle imbalance, these kind of go together. When we find you’re into weight training and you’re overdoing one side of the leg, let’s say doing a lot of hamstring work and ignoring your quadriceps. Then all of a sudden your hamstrings are going to get stronger while quadriceps might tighten up. That tightening up can cause more stress across the patellar tendon. This comes into play when we talk about how to treat patella tendonitis. Treatment, same thing I’m going to say this over and over and over. Rest. Doesn’t mean there’s no physical activity. Doesn’t mean you runners have to completely give up on activities. Just give up the high stress activities. If you’re having pain from high intensity running, there’s elliptical, there’s bicycle, there’s swimming. There’s other ways to keep your cardiovascular up while the painful tendonitis heals on its own. Physical therapy comes into play a lot with patella tendonitis.

Again, the stretching we were just talking about, the strengthening of certain muscles, the adjusting of your body mechanics. This is something that physical therapists are very astute at and great at helping out. Because just because you think [inaudible] quadriceps strong by doing light extensions doesn’t mean there aren’t ten other exercises that are better to get that muscle stronger. I’ve mentioned in this, phonophoresis and iontophoresis, big fancy names for ways of getting steroids into inflamed area. Phonophoresis is where the therapist will use an ultrasound to kind of drive some steroid cream into the area that’s inflamed. Iontophoresis, same concept but they use electrical stimulation. These are all things that you might be treated with when it comes to physical therapy. Same thing. Surgery is very rarely indicated in patella tendonitis. Most of the time it gets better with simple things we’ve talked about in the nonoperative treatment. If the symptoms haven’t gotten better in 12 months usually that’s when you might talk surgery for this. Another tendonitis, Achilles Tendonitis. This is something that I see, like I’ve talked about, I see a lot of foot and ankle injuries in a lot of athletes. The Achilles tendon is the large tendon that connects the calf muscles to the heel bone. It’s the largest tendon in your legs. The blood supply to your tendon becomes important. I’ll show you a picture of this in a second. There’s great blood supply that comes from the muscles above. There’s great blood supply that comes from the heel bone below. But now you’re in this middle portion that really has kind of a lousy blood supply. That narrow portion is [inaudible] problem. That’s almost always where, if somebody ruptures the Achilles tendon that’s where it occurs, but also these overuse injuries, these tendonitis problems also occur in that area that has a poor blood supply. Symptoms, again, pain directly either along entire Achilles tendon, you can also have pain where the Achilles tendon inserts onto the heel bone which is a little bit different problem but we can see both of those. Usually the symptoms are worse directly after exercise. While you’re stretched out and running and using it, sometimes it doesn’t hurt as much until it starts to cramp up, get tight, become more inflamed. We’ll see that pain after exercise or many times in the morning. Risk factors are very similar. Once again repetitive injury, overuse activity. This is a big runner, basketball player, volleyball player, running and jogging sports. Again it causes the same microscopic tearing we’ve talked about. In the area that doesn’t have a good blood supply your body can’t get the stuff into that area to help it heal so that’s the area these microscopic tears may not heal. When things don’t heal the tendon becomes now a starved and thickened tendon that gets an even fancier name here, tendonosis we call it, which essentially is a chronic thickening of the tendon where now it’s at a point where your body simply can’t heal it and now it’s just a thick, scarred piece of tendon.