THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Transcripts: 535-3 and 535-4

Week: 535.3 Guest: Dr. Gabe Mirkin, Sports Medicine Expert, Columnist Philadelphia Enquirer Topic: Playing Through Pain? Why you shouldn't.- Part One Producer/Host: Steve Girard

NEMA: The concept of "playing through pain" is what we want to talk about today, and sports medicine expert Dr. Gabe Mirkin...who writes for the Philadelphia Inquirer, among other publications, has been kind enough to sit in with us. It seems that there's a fine line there...that you have to try to decide whether or not you're sore from just workouts, or is there something developing that might require rest, or maybe should be looked at by a doctor. How do you tell?

MIRKIN: Well, a little bit of pain is good, because if you don't stress your body, you don't improve. Remember, all athletic training is stress and recovery, you take a hard workout on one day, you're sore the next day...and you don't take another hard workout until the soreness is gone. So, athletes are going hard, easy, easy...or hard, easy, easy, easy.... but its some variation of stress and recovery. So, some degree of discomfort is good, on the other hand, you have to learn the difference between the pain of hard training or the pain of an injury. As a general rule, the pain of hard training is symmetrical, both sides of your body are equal...when you're about to pull a muscle, you're in trouble, it'll be localized in one area. Number two: the pain gets worse as you go along with an injury, whereas it stays, the severity stays if you're training and getting the so called burn. The message is: if you get localized pain, in one area, that gets worse as you exercise, stop immediately. Because exercising through pain is like cursing in church, you just don't do that.

NEMA: Can you tell me, are there particular injuries that adults get associated with certain sports...something that you see all the time that they can kind of watch out for and say, "Up...this is something that's starting"?

MIRKIN: Absolutely, in fact, these sports related injuries are named for the sport. The most common long-term injury in runners is runners' knee....a pain behind the kneecap caused by the kneecap, the back of the kneecap rubbing against the long bone of the upper thigh behind it. Its caused by an exaggeration of a foot plant. When you run, you land on the outside bottom of your foot... you roll inward. So that causes your lower leg to twist inward while your kneecap is pulled outward. So, the treatment for runners knee in runners is to put inserts in the shoes where we limit rolling in, and we give you special exercises to strengthen the muscles on the inner upper poll of the kneecap to pull the knee cap inward. In a like manner, tennis elbow from hitting a tennis ball, is a pulling away of the tendon on the elbow, and the treatment for that is to stop playing tennis when you feel the pain, and then do strengthening exercises for the injured muscle before you go back to playing tennis again.

NEMA: It seems that a lot of these injuries start, at least with my friend in their mid 30's to mid 40's, they're getting out there, trying to do something again that they haven't done for a while, so I guess the best advice is to not get too intense too soon....

MIRKIN: That's correct, and in sports parlance, its called background before peaking. A weightlifter increases his volume out of season...he might go ten tons, twenty tons, fifty tons, sixty tons a month. And then, when they get into their season, they decrease their tonnage, forty, thirty, twenty...but they lift much heavier weights, and they work much harder. A runner does the same thing...a champion runner might build up to a hundred miles a week, but not running very fast, and as he or she gets into season, they take it down to twenty miles a week, but some of the running is done at extremely fast pace.

NEMA: Dr. Gabe Mirkin...more on re-conditioning without injury in our next program. I'm Steve Girard.

Transcripts:

Week: 535.4 Guest: Dr. Gabe Mirkin, Sports Medicine Expert, Columnist Philadelphia Enquirer Topic: Avoiding Injury While Getting in Shape- Part Two Producer/Host: Steve Girard

NEMA: Sports Medicine columnist and radio host Dr. Gabe Mirkin is with us again, as we continue our discussion on understanding pains related to workouts...and injury. And one thing that I'm particularly fond of, as a martial artist, is stretching, I'm always trying to preach the benefits of that, especially when someone gets into something they haven't done for a while....

MIRKIN: Absolutely! Long, flexible muscles do have some resistance to injury. But the major reason competitive athletes have to stretch is that it makes them better athletes. You see, the longer a tendon is, the greater the torque you can exert on a joint, so you can jump higher, lift heavier, run faster, and throw further.

NEMA: And what about the adage, "See your doctor before starting a new exercise program"...is that because your doctor knows you and your body characteristics and whether you're ready for a certain sport.?

MIRKIN: The odds are overwhelming that your doctor knows less about fitness than you do....and probably weighs more than you do, and has sloppier eating habits than you do. Yes, every doctor has to say, "Well, go see your doctor, and get an exercise cardiogram to see how much exercise your heart can take". Well, a cardiogram is almost worthless....it'll pick up only the most severe problems...that you probably know about because of being excessively short of breath, having a family history of heart attacks, or having limited endurance or having chest pain. Yes, I'm gonna tell you to go see your doctor....the tragedy is odds are he'll know less than you do about exercise.

NEMA: Why is it that so many people take up a sport or activity...even something they really like....and then just drop it?

MIRKIN: 65% of all regular exercisers drop out of their program within six weeks of starting and then don't resume their exercise at all. And the best way to prevent injury is to set up your program so that you don't exercise in your sport more than every 48 hours. You see, every time you exercise, your muscles are injured, and that's the soreness you feel the next day...and your program should be arranged so that you stress them hard enough so that they're sore the next day, but not so hard that they can't recover within 48 hours. So, your program should be: upper body exercise, say on Monday, Wednesday and Friday...and if you want to exercise consecutively, do a lower body exercise that stresses different muscle groups on Tuesday and Thursday. You could, say, do aerobic dancing lower body on Monday, Wednesday and Friday...and pull on a rowing machine, or swim - upper body, on Tuesday and Thursday. And the second rule is: which you've already alluded to....stop immediately if you feel pain.

NEMA: Thanks to Dr. Gabe Mirkin...a sports medicine expert you can hear on radio and read in the Philadelphia Inquirer. When pain speaks up, you should listen...its your body's way of telling you to slow down your attack on a new activity. If you're going to run, it may be best to ride the stationary bike, and do a program of overall fitness before you start pounding your feet, ankles and knees on the pavement. Some people have some biomechanical problems that may prevent proper motion in a certain sport, and which will cause problems down the road...be sure to check with your doctor if you have any questions on why you have soreness or restricted movement in a certain area. As Dr. Mirkin says, workout soreness is usually symmetrical, unless the sport calls for using one side over the other, like tennis or bowling... and remember, if an injury gets worse as you continue exercising... you should stop immediately. Good luck. I'm Steve Girard.