Young at sport

Apparently, Chico’s youthful vibe is contagious. Plenty of students lead active lifestyles, and they’re joined by a large number of middle-aged and elderly adults who are jumping on bikes, jogging on trails or satisfying competitive drives with team sports.

Orthopedists and physical therapists have taken note. So has Enloe Medical Center, which is hosting an informational event on Sept. 26 called “Your Life … Back in Action: Solutions for Injuries Related to an Active Life.” Scheduled presenters include Dr. Nicholas Komas, a local orthopedic surgeon, and Jeff Zelenski, a physical therapist who manages Enloe’s Outpatient Rehabilitation Services department. Both spoke with the CN&R over the phone about the prevention and treatment of sports-related ailments.

“What I see probably most in the area of preventable injuries is patients between their 40s and 60s who are getting more active and are probably going at it a little too quickly,” said Komas, who used the term “boomeritis” to refer to the phenomenon of later-in-life athletics.

“They get involved in programs that [take them] from being completely sedentary to trying to do high-level fitness without ramping up slowly, and then they get injuries—usually the shoulder or knee.

“As a sports physician who [also] takes care of high-school kids and college kids, really the majority of sports injuries I see are in the older athletes,” he continued. “We’re taking care of the mature athlete who is doing these things with a body that’s not designed to do them. Our natural history is not to be athletes at 50 years old; that’s not our evolution. But some people are doing it.”

Komas recommends a “reasonable” approach of gradually building up to improved conditioning, flexibility and core strength.

Zelenski agrees. He said there isn’t one set of exercises that works for everyone, but in general it’s best to maintain an optimum weight (to ease stress on the joints), and to stretch before demanding activities—sensible advice for people of all ages.

He also stressed the importance of consulting professionals.

“A lot of times, I think, [athletes] underutilize the medical field and/or physical therapy,” he said. “As [people] get older and they do sports for a while, they think it’s OK to hurt—‘I’m a weekend warrior—my back hurts, my shoulder hurts. That’s normal.’

“That is not the case. If they get evaluated, they can be treated or set up on a prescriptive exercise program to really help prevent some of those wear-and-tear injuries down the road.”

Currently, physical therapy is almost exclusively for the rehabilitation of injuries diagnosed by a physician. Indeed, Zelenski doesn’t get much of an opportunity to work with people before they’re hurt. That may change, he said, noting that his profession is moving toward a more preventative model.

For now, he encourages active adults to work with doctors and trainers.

Even with a sensible exercise plan, injuries happen. Advances in treatment and rehabilitation have decreased recovery times while increasing positive outcomes.

“The more and more we learn, the quicker we can rehab people, and people are returning to sports quicker,” Zelenski said. “We mirror the physicians, how they’ve gotten quicker, better, faster.”

Komas said orthopedists haven’t added a lot of new treatments, but rather have done a lot of refinements, particularly in arthroscopic procedures. Those operations, in which the surgeon inserts a scope through a small incision to repair damage, are now commonly used for dislocated or unstable shoulders, injured rotator cuffs and torn knee ligaments.

For many shoulder and knee procedures, the recovery time is around six months—a vast improvement from the 12-month period that used to be commonplace, particularly for ligament tears in the knee. Indeed, NFL players Adrian Peterson and Robert Griffin III have become poster boys for rapid recovery from such injuries.

But quick comebacks aren’t strictly the domain of professional athletes. Though sports stars may have more intensive rehabilitations and access to top-tier athletic trainers, they undergo the same procedures as Komas’ patients, he said.

Both Komas and Zelenski face the challenge of making sure patients don’t do too much too soon following surgery. There’s a dangerous point in the recovery period when the patient starts to feel better—less pain, more strength—and feels inclined to push him- or herself. That feeling can be deceptive.

“A lot of the return to function from those injuries is really based on biology,” Komas said. “When you put a graft in there, it has to heal, and we know from studies that there’s a period of time when that graft is more vulnerable to rupture.

“A lot of it is letting nature take its course.”

Physical therapists like Zelenski take cues from doctors’ orders, and some procedures call for rehabilitation to begin within hours or days of surgery. That’s right, hours—for total joint replacements, physical therapists come to the hospital and may get patients on their feet the day of their operation.

Zelenski, like Komas, treats patients young and old. He’s found a lot of his adult patients get injured by pushing themselves too hard, such as entering too many competitive events.

Still, he doesn’t want to dissuade people from leading more active lives. Rather, he promotes preventative steps that can help reduce the odds of injury.

“Motion is lotion,” Zelenski said. Or, to put it another way: Stay young at heart by getting the old heart pumping.