Getting back into exercise after months on the sidelines? Don’t jump the gun! Hear why it’s important to take it easy and avoid injuries from a doctor who treats elite pro athletes as well as weekend warriors. Host, Dr. Jonathan Fialkow welcomes Dr. John Uribe, chief medical executive with Miami Orthopedics & Sports Medicine Institute, and head team physician for the NFL’s Miami Dolphins and NHL’s Florida Panthers.
Getting back into exercise after months on the sidelines? Don’t jump the gun! Hear why it’s important to take it easy and avoid injuries from a doctor who treats elite pro athletes as well as weekend warriors. Host, Dr. Jonathan Fialkow welcomes Dr. John Uribe, chief medical executive with Miami Orthopedics & Sports Medicine Institute, and head team physician for the NFL’s Miami Dolphins and NHL’s Florida Panthers.
Announcer:
At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist HealthTalk Podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life. Getting back into training after months on the sidelines? Don't jump the gun, get expert advice from a sports team doctor on this episode of Baptist HealthTalk.
Dr. Jonathan Fialkow:
Welcome back, Baptist HealthTalk Podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a practicing preventative cardiologist and lipidologist at the Miami Cardiac and Vascular Institute at Baptist Health South Florida, as well as Chief Population Health Officer at Baptist Health. As more businesses and recreational facilities open after months of closure due to the coronavirus pandemic, athletes, whether it's an everyday person to students to pros, are starting to resume their personal fitness programs. While it may be tempting to throw yourself back into training full force and catch up for your weeks to months of lost activity, this can actually be a recipe for disaster.
Dr. Jonathan Fialkow:
We'll talk about what to do and what not to do to make sure you stay healthy while working out with a colleague of mine who spent many years working with elite athletes. I'm happy to welcome John Uribe, MD. Chief Medical Executive with Miami Orthopedics and Sports Medicine Institute. Dr. Uribe is the Head Team Physician for the Miami Dolphins and the Florida Panthers. Welcome to the podcast, John.
Dr. John Uribe:
Well, thank you very much, Jonathan. A real privilege to be here with you.
Dr. Jonathan Fialkow:
So appreciating your time as well, I think if we break the conversation up into a couple of components, just to let the podcast listeners know what's coming. First, we'll talk about some general benefits of physical activity and health. And then we'll talk about the amateur athlete, the weekend warrior, so to speak, and what they can be doing, should be doing, and should be not doing in terms of protecting themselves. And then I'd love to share your experiences with the pro athletes that you deal with and we deal with in our relationships between Baptist Health and some of the pro teams. So to get that started, let's just talk about general health routines with returning to fitness. So what kind of things should someone who is getting back into that activity level be following and concerned with?
Dr. John Uribe:
Well, it's been an interesting time, obviously, where our parks have been closed. I love tennis and I can tell you to start out, when they opened up the tennis courts, for example, it was basically singles only. And so I thought, "Okay, this is great. I can go back out and play tennis." So I went out and tried to play singles. And sure enough, as soon as I went for a drop shot, I pulled a hamstring. So the bottom line ... And that really is what happens. It's very interesting because when you asked me to do this, I thought, "That was really stupid." The bottom line is obviously to stay healthy, exercise is critical. And getting back into a competitive environment is great. But the main thing there, I think, is you break down that sport into its components before you compete and truly start warming up and get your exercise program down for that sport.
Dr. Jonathan Fialkow:
So was your personal push to get back and do what you were doing before conscious? Were you thinking, "I just want to resume my normal life?" Or was it with just lack of thought of warming up? What do you think contributed to your personal ... I had a similar thing. I started running again and next thing you know, my calf is pulled. And so [crosstalk 00:00:03:46].
Dr. John Uribe:
And that's what happens. Absolutely, that's exactly what happens. And you get into it. You've been locked up so long and you just want to go back to things you enjoy. And the bottom line is that our muscles and our muscle memory isn't up to it. And so the real key there was to break it down into, you can go hit and practice a little bit, but in tennis, for example, you have to be able to sprint, you have to be able to jump, you're using your upper extremities. So there, you get into a program where you do interval stuff, you can start jogging and then sprint a little bit, or you warm up on the court and just jog around the court a few times. Make sure your body temperature is, your core temperature's up. And then you stretch and then you stretch, and then you slowly hit. You get your strokes down a little bit and you back up. And then you hit a little more.
Dr. John Uribe:
And particularly, depending on whether you've had issues with your shoulders or whatever, because that's where rotator cuff tears come in from not warming up and trying to hit the ball too hard overhead. So you break the sport up into components, the same thing with soccer or any sport where you're really going to have to push yourself, basketball, whatever.
Dr. Jonathan Fialkow:
So it's planning it, obviously, building up slowly, taking care of your body. How about can you speak about being aware of your body or having your body talk to you? What are the kind of things that people shouldn't push through or they should be looking forward to say, "Hey, wait a minute. I better back off, or ostensibly, not exercise."
Dr. John Uribe:
Right. Like you just said, I mean, you really listen to your ... You truly listen to your body. And again, in sports where you have multiple parts of your body working, it's like if you go out and ride a bike, it's a little bit easier because you can just start pedaling, you can push it, and get going. And you're not doing any truly ballistic movements right away. But in other sports, for example, basketball or the tennis, or you're going out and you're going to play some soccer or something where you're stop and go and that kind of thing, the main thing is, like you felt, when you started to feel your leg tighten up, then that's a real common thing with runners is that's where you stop and you slow down and you walk, you stretch, and then pick it back up. Because that's what the muscle's telling you, that it's pulling on that tendon and it needs to be relaxed, it needs to be stretched.
Dr. Jonathan Fialkow:
Oh, I learned my lesson. So a couple things you just mentioned, let's pick up on. Let's stretching. Again, weekend warrior, amateur athletes, pro athletes, where does stretching come into play? What would you recommend people? And obviously, we're talking about different activities. So what's the role of stretching? And how much time should one stretch based on how much exercise or activity they plan to perform?
Dr. John Uribe:
So again, it's obviously sport dependent. But for example, anything that requires you to really stop and go, a sprint, for example, that kind of thing. The best thing to do is to warm up. You can actually just jog or ride a bike, do something where you start warming your legs, your joints. And that's after you've reached a core temperature elevation where your body is warm. That's the best time to really stop and stretch. And then there are different, obviously, stretching maneuvers for the hamstrings, for your adductors, the muscles that pull your thigh in. Because they're the ones that are most commonly stretched, your calf muscles. Even some of the muscles in your feet that they can actually stretch themselves out and they can tear. So those are very important. And your lower back. Once you reach that core temperature, your muscles are much more malleable though. They're easier to stretch and they'll sustain that. Whereas if you stretch cold, it really doesn't help that much.
Dr. Jonathan Fialkow:
Interesting. Okay. And similarly, something to plan, something that people have to really anticipate if they're going to exercise. They don't just get out and run, "Oh, I should have stretched." It has to be part of their armamentarium. A couple of specifics then. Now, gyms just starting to open up. People might be going back to the gym, whether it be resistance training or lifting weights or things like that. Any particular concerns in that? Those people with those activities?
Dr. John Uribe:
It's interesting because with this COVID and the lockdown where we've been home, we've seen some very interesting injuries due to people trying to work out at home without perhaps the weights that they're used to. And so they've used trying to move appliances or do certain things that-
Dr. Jonathan Fialkow:
For exercise? They're doing that for exercise?
Dr. John Uribe:
Yeah, yeah, for exercises or just pushing their body beyond what they're used to because they're home. And so-
Dr. Jonathan Fialkow:
I got some trees that need to be cut. So if anyone wants to do some exercise, I can give them my address.
Dr. John Uribe:
[crosstalk 00:09:23] I'll see, for example, the biceps tendon where it attaches to the elbow, we'll see maybe, in my practice, I'll see three or four a year. And so far, just in this three month period, I've had 12. And so it just is ... It's been very interesting. So when you go back to the gym, if you haven't been lifting, that's where, and maybe not even a gym rat, but that's where you start with a good rule of thumb is to just see how much ... For example, if you're doing a leg extension or a leg press or a bench press, just see what you are comfortable with doing one time maximally, and then cutting that in half. And that can be your base weight. And something reasonable like three sets of 10 with that is very good. And then you just gradually increase the weight as your training permits. But as opposed to going in and just trying to see what you can do in the gym. That's where you tear your peck and you can tear your biceps, you can tear your rotator cuff.
Dr. Jonathan Fialkow:
So again, for the third or fourth time, and maybe a half a dozen times more, people should not feel they have to catch up by getting right back where they were when they stopped the regular exercise. It should build into it gradually and as their body lets them.
Dr. John Uribe:
Yeah. That's a great way to put it. That's exactly right.
Dr. Jonathan Fialkow:
You mentioned the biceps tendon. Just from curiosity, were those 12 cases or so, again, were these amateur athletes, professional athletes, people at home? What was the mix of the people who were doing that?
Dr. John Uribe:
They were people at home. And it's very interesting because those are what we call ... The way tendons really tear, it's called an eccentric load where the muscle is reacting not in the way, for example, a biceps you would think is ... It actually is a supinator [inaudible 00:11:31] that turns the hand up, but it's also an elbow flexor where it bends the elbow. And so the way you tear a tendon is instead of you pulling up something, it won't pop there. But if you're trying to catch something from falling, for example, you catch yourself falling down and your elbow, and the elbow is trying to be kept from bending, that's that's the way it tears. Or an Achilles tendon is more like as you come down. Not pushing up, but it's more coming down where you're trying to keep the heel from striking the ground hard. That's where you tear the tendons. And that's why it's so critical to really stretch things out because when they're taut, that's when they're more likely to pop.
Dr. Jonathan Fialkow:
And just appreciate that. So in addition to that, I presume you and doctors in the Miami Orthopedics and Sports Medicine suite are seeing more of these types of injuries over the last couple of weeks, certainly since the pandemic started. Can you speak to some of the other more common ones you're seeing, both you personally and others in the group?
Dr. John Uribe:
Yeah. I think that the rotator cuff has become a very, very common injury, which wasn't so common in the past. Maybe we weren't diagnosing them as well, but because individuals are exercising to a greater extent as they age and the rotator cuff has a limited or has a diminished vascular supply in certain parts of the tendon, as people get older and they're doing more, say, weightlifting or throwing a ball or doing overhead activities, exercises that really stress the rotator cuff muscles, we're just seeing a lot more rotator cuff tears. And there are very specific exercises that you can do to maintain the health of that rotator cuff. So, yeah, that's become a very common part of our practice, which in the past wasn't so common.
Dr. Jonathan Fialkow:
Definitely seeing trends with this new situation. I do apologize, this is just some background noises, this is live from home podcast communications, and something that we're all have gotten used to regularly. John, now we're entering the summer in Miami, which is an unfortunate part of the year. Speak a little bit again, the amateurs getting out there and like you said, playing tennis, et cetera. Got to have precautions regarding the heat, other types of things that they should be aware of. So what would you recommend people, again, be very conscious of and not just [crosstalk 00:14:34] doing?
Dr. John Uribe:
Yeah, absolutely. I mean, obviously hydration plays a huge role. And it's incredible how quickly, with the high humidity, that you sweat so profusely. And because of the incidents, for example, in football that we've had in the past ... When I first started with the Hurricanes years ago, IVs, for example, were not very common. The only place we would give an IV, for example, was in a hospital. You had to bring the player to the emergency room to hydrate them up with an IV. And we've become much, much more aware of hydration. And the simplest way is just to look at your urine and see the color. And that will give you a good hint. But just the fact of playing tennis or running or what, you should just take your natural breaks and try to keep up with your water intake.
Dr. Jonathan Fialkow:
So if you're urinating less or the urine is dark and concentrated, that's a sign that your body is starving for water you need to hydrate. Yeah.
Dr. John Uribe:
Absolutely. Right. Like the players, we make them and bring the urine and we look at it and just ... And we'll do specific [inaudible 00:15:56] to actually see how-
Dr. Jonathan Fialkow:
How it is, how hydrated they are.
Dr. John Uribe:
How concentrated it is. And so, a little more sophisticated, but that's the easiest way.
Dr. Jonathan Fialkow:
Well, I'm glad we were able to work in the urine color into our conversations for our listeners benefit. But it's of great value. A couple of other things, let's talk about the difference between, as you've alluded to, patients resuming activities or exercise or athletic competition quickly versus overuse injuries. Can you speak a little bit? Obviously, they're related. But similarly, what would we consider overuse injuries? What are you starting to see? What should athletes or people who are working out change their workouts? Should they do the same thing regularly? What would you recommend you're telling people in terms of they want a good workout, but not to overuse?
Dr. John Uribe:
Yeah. I mean, the most common overuse injuries are to the tendons that are producing the movement of the joint. Particularly, for example, your Achilles, your kneecap tendon, your patellar tendon. In tennis and golf, the inside or the outside elbow tendons, the ligaments. Because what happens is when you start just overusing ... And what that is, and it's not obviously a specific number, it's different from everybody. Because a lot of times, it's the way they're used. They may not be appropriately used. In tennis, for example, the outside tendons or ligaments of the elbow and where the extensor tendons were, the tendons that raise your wrist and your fingers, they attach to the elbow. So if you have a long lever arm, which is a tennis racket, and instead of hitting with your elbow and your wrist fixed, and you try to wrist a ball, that creates a huge stress on that elbow, on that tendon that attaches. And then you get these micro-tears and that's an overuse. And the same thing with a throw or that's throwing to the rotator cuff.
Dr. John Uribe:
So as you alluded to before, when you start feeling it tighten up, that's when you stop, you stretch, you rub it, and you try to prevent that. And particularly, as you know your body, as you know when it comes. After pitchers, that's why we have pitch counts. And golfers is the same thing. On the inside of the elbow, as they flex their wrists or hit fat, that tendon that bends the wrist attaches to the inside and they start breaking down that joint. And the jumper's knee in basketball players where the kneecap tendon hooks into your knee cap, they start feeling that and they play through it. And all of a sudden, they can't jump anymore and it takes a long time to recover.
Dr. Jonathan Fialkow:
So we have warming up, we have stretching. We have building up to your previous level of activity. Hydration is important. And then listening to your body for any sense of overuse or injury, I think are so far the take home points.
Dr. John Uribe:
Yeah. And the other is when you feel it too, after your workouts, if you've had issues with that, just ice it down. And the ice truly helps. And it decreases the inflammation there locally. I mean, when you exercise, you develop this nitric oxide that dilates your muscles or dilates your vessels, and you get more oxygen in there. But then at the end of your exercise, you really want to decrease the inflammation. And for those areas where you're sore, the best thing is to ice it down and then massage it.
Dr. Jonathan Fialkow:
How long should someone put ice on an area that might be sore or potentially injured? Let's get specific.
Dr. John Uribe:
Yeah. So the usual is about 10 to 15 minutes. You certainly don't want to put ice on your skin for more than about 15 minutes, and particularly around the knee because there's a nerve that actually lifts your foot that runs to the outside of your knee. And we actually had one of our professional football players, one of our starters actually put the ice pack on and just forgot. And I don't know how you forget because that hurts. But he took the ice pack off and basically, he iced the nerve down and it took almost six weeks to come back.
Dr. Jonathan Fialkow:
Oh boy.
Dr. John Uribe:
Yeah, he had a foot drop for six weeks.
Dr. Jonathan Fialkow:
10, 15 minutes. More in the 10 minutes, more in the 10 minutes. Okay. All right. So a couple of final things, and I don't want to take you away too long because obviously you're getting paged quite a bit. That's life.
Dr. John Uribe:
I'm trying to turn it off and I don't know how.
Dr. Jonathan Fialkow:
That's all right. Don't dazzle us with your technical acumen. You're the Head Team Physician for the Dolphins and the Panthers. How have the pro athletes been dealing with both coming back to training a layoff, and from an interest level, are they training a little differently given the COVID-19 pandemic? It's not just a matter of we haven't practiced for a couple months, now we're practicing. It's also what are you seeing in terms of the new environment that they're dealing with?
Dr. John Uribe:
So it's been very tough. I'll tell you, a lot of it is for perception. And we want to be as safe as possible for the players and create an environment which puts nobody at any increased risk. But obviously, it's tough. Especially in football, you're going to have 100 guys coming in, into that facility, and it's going to be difficult. So the NFL has created this pretty extensive workload for us in terms of testing these players and all the staff. And right now, what's being done is basically virtual training. The coaches are in contact with ... Boy, I'm trying to turn this off, but I don't know.
Dr. Jonathan Fialkow:
That's okay.
Dr. John Uribe:
Coaches are working with the players virtually to try, and the strength coaches, to have them go, most of them have a home gym or something like that. But it's been tough for them. And what we don't know is what level of fitness they'll have. And that'll be the first thing that's tested is what is their level of fitness when they arrive in camp? I think they're arriving camp in 47 days.
Dr. Jonathan Fialkow:
Wow. So that's-
Dr. John Uribe:
And the NHL now, they're actually skating. But we're not allowed to test them or examine them until they get the facility totally cleaned up and right for us to go back in.
Dr. Jonathan Fialkow:
So certainly no aspect of our society that hasn't been impacted in some way with the pandemic. Something to be conscious of. Well, look, I really appreciate your time or certainly your expertise and your leadership in the Baptist Health system with [inaudible 00:00:23:41]. You gave us great information and really brought home a lot of important points. And again, personally, as well as what I see in others, we do need to be patient as we resume our activities and take care of ourself and listen to our bodies, as we said a couple times. And thanks for sharing some of the experiences with the high end or amateur athletes, as well as the professional athletes that you deal with.
Dr. John Uribe:
[crosstalk 00:24:04].
Dr. Jonathan Fialkow:
Yeah. Anything you'd like to add? Any points you'd like to make that we missed in the conversation?
Dr. John Uribe:
No, I think nutrition's really important too. I think the sleep is very important. I think we all tend to work pretty hard, and you don't realize how critical that is for your overall health and fitness and make your activities actually better. So I think that breaking down your sport before you go compete and work on the breakdown, the important parts of that sport, before you go competing actively, I think will really help prevent injuries. And good nutrition and sleep. That's it.
Dr. Jonathan Fialkow:
Speaking in my language. And I appreciate those points, which were missing bringing up. And again, Dr. John Uribe, I really appreciate your time spent with us on the podcast. And to our listeners, as always, any thoughts, ideas for topics or any other things you'd like to bring to our attention, feel free to write to us at baptisthealthtalk@baptisthealth.net. And once again, thanks for listening and stay safe.
Announcer:
Find additional valuable health and wellness information on our resource blog at baptisthealth.net/news. And be sure to interact with us on our social media channels for live and upcoming events. This podcast is brought to you by Baptist Health South Florida, healthcare that cares.