 Hi, I'm Meredith Maher at the University of Maryland Medical Center. Today we're discussing how to exercise safely and prevent sports injuries with Dr. Ryan Rees from University of Maryland Family and Community Medicine. Thanks for being here today, Dr. Rees. Thanks for having me. And thanks to all of you for watching. We invite you to leave your questions for Dr. Rees in the comment section below and be sure to like this video to let us know you're watching. Dr. Rees, you're a primary care sports medicine physician. Can you explain what primary care sports medicine is and how does it differ from orthopedic sports medicine? Absolutely. So primary care sports medicine are physicians that are well-trained in musculoskeletal medicine similar to orthopedics, but they focus on the nonoperative management of a lot of musculoskeletal conditions. So whether that be with exercise therapy or with joint injections and a lot of primary care sports medicines are also very well-trained in ultrasound, which is another way to help diagnose and to also do ultrasound-guided injections to help manage a lot of injuries. We work with both athletes and non-athletes alike. So people that want to get back into exercise and have any type of joint problems or muscle strains, all those things were very well equipped to handle. You're also a doctor of osteopathic medicine. What is a DO? Yeah, so a DO is similar to an MD. We do the same training throughout medical school, but we have additional training in hands-on medicine. So it's something called osteopathic manipulative training. It's similar to chiropractic work where it's hands-on treatment. Works really well with primary care sports medicine to help offer a different treatment option for some muscle strains or muscle pains and checking alignment and things like that, but very similar to an MD. Like I said, requires the same medical training, medical degree and board certification just with that additional training. So since you fall under family and community medicine, what are the benefits to seeing a primary care sports medicine physician? Yeah, so being a primary care sports medicine physician, you're trained first in primary care. So I wonder what a residency in family medicine, so three years in board certified in family medicine and then an additional year for sports medicine specialization. I think that offers a unique perspective. Again, managing things non-operatively, which a lot of the vast majority of musculoskeletal problems are managed non-operatively, but also I think gives a good way to prevent injuries as well, which is sort of more of the primary care focus. So I do plenty of exercise sort of prescription or helping people get back into exercise to prevent other things like cardiovascular health, diabetes, cholesterol, so using exercise to really treat all of those. I think it really works well together. For your patients who are new to exercise and they're just newly exploring, getting back into a healthy active lifestyle or maybe they've never even really worked out before, how do you help guide those patients in order to prevent those injuries from occurring? Yeah, so we can walk through very simply. So we can sort of say what the guidelines are for exercise, which would be 150 minutes of what's called moderate intensity exercise per week, but we can really help guide through those things. So it's not going zero to 150 minutes right away, especially for someone who's been sedentary. So we can kind of go through what's almost like an exercise prescription, similar to if we were prescribing a medication, we would kind of walk you through how to start, things to expect when you start general soreness and things and what to do for that, and then kind of work our way up in intensity. So we don't want to just kind of set someone completely free, where they could set themselves up for injury or other problems. So we can help guide them through, give them certain benchmarks and activities that would be appropriate, and sort of guide how you're getting the appropriate level of exercise without sort of over or underdoing it. How do you encourage your patients to stay motivated too when they're new to exercise? Maybe it hasn't been like a lifelong passion of theirs, and what should they consider when starting a new activity or choosing a new exercise? I think the biggest thing is finding something that you actually enjoy. So I think trying different things. Whenever we talk about exercise, I think it's common to sort of think of, he wants me to go to the gym and start lifting weights or start running, but there's a ton of things that sort of fall into what would be considered exercise, whether that be dancing, doing exercise classes, even just walking throughout the neighborhood. I think a lot of people don't realize that those things count towards true exercise. I think all those, I mean, would have the same effects, basically depending on what you do. So I think really trying different things and finding something that you actually enjoy and something that you're not going to dread and know that you have to sort of just kind of check a box every day, but sort of trying different things to figure out what works for you. And how does nutrition play a role in their long-term success with not only staying motivated, but also injury prevention and just being healthy overall? And nutrition is very important. So combining the exercise with a healthy diet would be the best way for promoting things like weight loss and cardiovascular health, as we were saying, but also just preventing things like muscle soreness and cramping as you exercise. It's very important to eat plenty of fruits and vegetables and staying well hydrated throughout the day as well. It's very important. So drinking plenty of water, avoiding sugary drinks that will help kind of get you through your workout and will help reduce soreness afterwards too. So speaking of helping out with soreness, walk us through the importance of rest and recovery and what that should look like for each person. Absolutely. So it's very important for any exercise program to account for the rest and recovery portion. That first off starts with plenty of sleep. So making sure, you know, six to eight hours per night of restful sleep exercise, starting exercise program should actually help you sleep better as well. But it's very important for recovery and then making sure that you're not overdoing it. So overdoing any type of exercise could lead to muscle pains, muscle strains and injuries. So making sure that you're not doing the same if it's whether it's weight training, making sure you're not doing consecutive days of the same exercise and giving yourself, you know, two to three days probably in between training the same exercise and whether if that's more of a cardiovascular things, if you had a really hard workout, it's going to take you a couple of days to fully recover from that. You should have lighter intensity workouts probably the following day to making sure that you're fully recovered. Should patients be stretching as well? And if so, do you recommend they stretch before they begin their exercise or after or both? Stretching is very important for many different reasons. So whether that be to prevent muscle pulls or strains and also as we get older, it's very important to stay flexible because it will promote even joint wear. So very commonly we'll see if patients, particularly for the knee, if their hamstrings and everything around the knee is very tight, it's not going to wear evenly on the cartilage. So that could make things like arthritis and pains worse. So it's very important to stay flexible. And usually we would recommend to stretch warmer muscles. So not right away, but if you were to do a little bit of a warm up, say five to ten minutes of light walking or exercise bike and then stretch afterwards before more intense workout, that works very well. And then also stretching at the end will help to, it'll help promote flexibility and prevent injuries in the future. At what point should somebody see a sports medicine specialist for their concern, their pain, or even a flare up of a previous injury from years ago? I think once it fails sort of your regular treatment, so if you've been icing and you've been maybe taking an anti-inflammatory like an Advil, and it's just not getting better over the course of a couple of days, and it's still causing you pain, I think it's reasonable to then see a sports medicine doctor. Also if it's ever limiting you significantly, so you're going to the gym and you just can't do one thing because your knee is hurting so you can't really walk or exercise like you want to or you can't do a certain type of exercise because your shoulder is really hurting you or it's causing you pain or trouble. I think at that point, once it starts to really limit you from what you, from your goals, certainly reasonable to then see a sports medicine doctor. So those are for sort of the chronic problems and then anything more acute. So if you are exercising and you feel something and it causes you to stop and then you need to be out for a couple of days because the pain just hasn't gotten better, that certainly would be another opportunity to see the sports medicine doctor. And as a primary care sports medicine physician, you've mentioned that you provide non-operative treatments. What are those treatment options and if a patient needs more surgical intervention, what do you do then? So there's a multitude of non-operative treatments, whether that be starting with exercise therapy, so whether we can give you a home exercise program and things that you would be able to do on your own to help build muscle to prevent it or promote flexibility or whether that would be the point where we think it would be more appropriate to be guided by a physical therapist or occupational therapist. We would send you a referral for those and then sort of follow up after completing those therapies. Medications can also be an option and usually in conjunction with exercise therapy, so mainly anti-inflammatory medications can sometimes be appropriate. Then the ultrasound is a really good tool for primary care sports medicine doctors. So it helps both with diagnostic, so we're able to use ultrasound pro-bread in the office and sort of examine closer joints, muscles, tendons to get a better idea of exactly what's going on. We can also use that ultrasound to then guide injections if appropriate to make sure that the medicine is going in the right place and that the injection can be as effective as possible for you. We offer a variety of injections as well, so there can be corticosteroid injections, platelet-rich plasma injections or PRP. There's also gel injections, which are more appropriate for usually arthritis, so we offer really a multitude of things. If we do do things or we think we have encountered a surgical problem, at that point we can talk to our colleagues, the orthopedic surgeons, we can get you set up there for evaluation in their office. How can patients most quickly recover at home from an injury? So you've mentioned some over-the-counter pain medications, which is Advil, but in stretching, obviously rest and recovery, are there any natural supplements or any sort of specific heating and ice pattern that you recommend? Anything that you've noticed is a best practice for taking care of yourself at home. Yes, I think one of the main things if you suffer an acute injury, icing can certainly be helpful, so specifically more so in the first 48 hours or so, applying ice for 20 minutes at a time and then taking the ice off for at least 20 minutes, that can be helpful certainly in the acute injury, as well as things like you mentioned, like that Advil or ibuprofen, taking those to help reduce inflammation, and then the other things that we mentioned, so things like resting. If you did suffer an injury or your knee has been bothering you, maybe you try to modify your activity a little bit. Maybe squatting is not the best for you and maybe you can kind of adjust your training a little bit to see if that will help and see if you can work your way back up to the exercises that you want to. Do you recommend that people stop exercising completely during an injury or is there a way where they can safely resume working out while also being mindful of that injury while it heals? Yes, so it certainly depends on the injury, but in general you can usually modify your activity to still stay active. It'll usually be less intense as before, but you can still usually stay active to work through the injury. Many times that can help to make sure that it doesn't get stiff or get worse, but it certainly depends on the type of activity. We can certainly help guide you through those decisions as well. Whenever someone comes into the office, I'm sure to tell them what they're still able to do rather than usually completely shut them down. You mentioned stretching is particularly important as we age. Are there any other exercises that those who are approaching, you know, the later stage in life should concentrate their efforts on more so than others? Absolutely. So specifically in postmenopausal women, strength training is very important for bone health and it can prevent fractures and things like osteoporosis. Strength training is sort of a scary word sometimes, but really it can be light weights. The goal is not necessarily to put on muscle or block up, but the strength training itself using weights will help the bone health. So that would be very important. And really as a combination of everything is sort of the best practice. So having days where you do do cardiovascular exercise mixed in with the recommendation is two days of strength training per week. And then flexibility as we sort of discussed with stretching throughout all of your exercises. Is there anything else you think people should know about how to safely exercise, prevent injuries, or even ways to stay motivated once they find an exercise that they feel like is appropriate for them? I think really starting slow is important, especially if you're someone that was not particularly active before and you're trying to start back into activity. You don't want to go zero to 60 as we said, because it can be both discouraging and you can cause injury to get a ton of soreness after exercise. So I think setting appropriate goals and starting light with those exercises and doing what you're able to tolerate I think is the best and really listening to your body is important too. So you should not really be exercising through pain frequently. If you're currently having pain and you're having to push through it all the time, that's really usually not a safe situation and can make things worse. So at that point, it would be appropriate to make an appointment. But I think just starting slow and sort of gradually building your exercise duration and intensity is a general good rule of thumb. Should soreness be the ultimate goal with every exercise? It seems like a lot of people feel like if they weren't sweating heavily or they don't feel sore after the fact, then they think they didn't get that great of a workout in. Is that true? Yeah, that's a very common misconception. So having soreness and really going to the point of exhaustion is really not the goal for every exercise and that can predispose you to certain injuries. So as we discussed, things like walking will count towards, as long as you're going at a good pace, can count towards your cardiovascular exercise and should not leave you incredibly sore or exhausted at the end of the workout. Those are the things that can, like I said, predispose to injury. It can be very discouraging to having to think that you need to push yourself that hard every time you exercise. Great. Well, that's all the time we have today. Thank you, Dr. Reece, for speaking with us and thanks to all of you for watching. We invite you to continue leaving your questions for Dr. Reece in the comments section below. You can also send us a direct message if you feel more comfortable asking your question that way and we'll get back to you within two business days. All right. Thank you, Dr. Reece. Thank you for having me.