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Competitive Edge Summer 2013


Staying Healthy as a Senior Athlete

By AJ Cianflocco, MD

This summer, seniors from around the country will descend on Cleveland for the National Senior Games. At venues throughout the city, athletes age 50 and older will compete in 19 events, from archery and shuffleboard to tennis and volleyball. This major sporting event began in 1987 and has grown to 14,000 senior athletes.

The number of seniors participating in competitive sports — both individual and team sports — has been increasing in recent years. As we age, it takes greater effort to keep up one’s athletic performance, particularly after age 60. The growing Senior Games shows that many are continuing to be athletic throughout their lives. The good news is that staying physically active as we age can prevent and even reverse many of the physiological changes that happen. For athletes and active seniors, the keys are having days of rest to recover and modifying our activities. It is also important to avoid total inactivity for any length of time as this can lead to a loss of flexibility, strength and bone mass as well as cardiac deconditioning.

As we age, it’s a matter of understanding our body’s cues and following some preventive measures. For seniors, the basics of injury prevention include:

  • Proper warm-up with adequate cool down after every activity
  • Avoidance of abrupt changes in frequency, duration and intensity of activity
  • Allowance for adequate recovery time by alternating days of intense activity with less strenuous days
  • Attention to environmental conditions such as temperature and humidity
  • Maintaining proper nutrition and hydration to promote good health and optimal athletic performance
What to watch for

Aging affects multiple organ systems, from the heart and lungs to our bones and metabolism. Of all the changes, musculoskeletal changes often have the most impact on the aging senior’s sport. These changes include an overall decrease in muscle and bone mass, stiffening of muscles, and weakening of ligaments and cartilage.

Risk factors for injury include previous joint injuries, underlying osteoarthritis, and vision and/or hearing impairment. Overuse injuries in seniors are also more common due to the requirement for longer recovery time.

Degenerative meniscal tears and osteoarthritis of the knee are commonly seen together. This type of meniscal tear can occur with minimal trauma in the arthritic knee, just as a prior injury may lead to the future development of arthritis.

To avoid chronic problems and longer rehabilitation times, treatment for musculoskeletal, sports-related injuries should not be delayed for seniors. Initial care consists of protection, rest, ice, compression and elevation. This should be followed up by a guided and progressive rehabilitation program. Physical therapy should also focus on range of motion, flexibility and strength. Alternative training methods should be incorporated for a safe and timely return to activity.

Other issues to consider

Older athletes must also pay closer attention to temperature-related illness. Heat illness can occur due to the increased risk of dehydration, decreased sweat gland function and impaired blood flow in response to elevated core temperatures. Sometimes medications, such as beta-blockers and diuretics, can create additional issues and may increase risk of heat illness.

By applying many of the same guidelines used by younger athletes for training, injury management and injury prevention, and by being more aware of the physical changes that occur as part of the maturation process, the senior athlete can stay active for a lifetime.

If you are a senior, be sure to consult a medical professional if you are planning to start an exercise routine or if you are a senior athlete experiencing physical changes.

AJ Cianflocco, MD, is a sports medicine physician. He provides care at Cleveland Clinic’s Euclid Hospital and Sports Health Center in Garfield Heights. For an appointment with Dr. Cianflocco or any of our primary care sports medicine doctors, call 877.440.TEAM.

Getting Started with Exercise

Regular activity helps maintain good health and physical independence as we age. The following are recommended:

  • Low-impact aerobic or endurance exercises such as walking, swimming and dancing
  • Strengthening exercises (after medical clearance) such as weight machines or elastic bands. Consider a personal trainer for proper technique if you have not done this recently.
  • For balance, strength, flexibility try tai chi or senior yoga

A Good Gait Can Make All the Difference for a Runner

By Amanda Gordon, MPT

Marathon runners can drop their time by two minutes and everyday runners can avoid injury just by improving their efficiency. If you are a runner, you can do this simply by having a gait analysis performed.

The definition of gait is “the manner or style of walking/running,” and people have many different patterns. Gait analysis is an assessment of your body mechanics, and it can help you make changes that can do the following:

  • Improve your running efficiency
  • Prevent injury
  • Determine the cause of an injury

Both injured and uninjured athletes can benefit from gait analysis by a physical therapist. If you are injured from running, you could benefit from learning about your running style and foot strike and finding out if your shoe wear or a muscle imbalance are contributors to the injury.

As noted, a proper gait analysis may help prevent an injury when you run, and it can make you more efficient. It’s all about proper mechanics. For example, excessive foot pronation, short or long strides, or excessive arm movements can cause increased energy expenditure and decreased efficiency.

A physical therapist can assess the following during an analysis:

  • Running history
  • Training goals
  • Foot placement
  • Shoe wear
  • Strength and flexibility
  • Heel strike
  • Arm swing
  • Hip, knee and foot mechanics

After a full assessment, you will learn strength and flexibility exercises, personal body mechanics issues, and ways to change or improve your gait pattern to be more efficient and potentially prevent injury.

Cleveland Clinic’s Run Smart Program offers gait analysis. Physical therapists and exercise physiologists assess multiple aspects of a runner’s gait through both direct observation and by analyzing video.

Amanda Gordon, MPT, is a senior physical therapist who specializes in gait analysis. For more information or to make an appointment, please call 877.440.TEAM.


Going the Distance with Energy Gels

Athletes are starting to use energy gels, but are they good for you? Find out in this Q&A with Cleveland Clinic dietitian Katherine Patton, MEd, RD, CSSD, LD, and Nutrition Therapy intern and endurance runner Cortney Staruch.

What are energy gels?

Energy gels are carbohydrate gels that provide energy for exercise and promote recovery. They are made from a blend of sugars, most often maltodextrin and fructose. They offer high levels of glucose to provide fuel for endurance athletes. Most energy gels come in 1- to 1.5-ounce packets, which makes them convenient to take along on a long-distance event. Most energy gels have no fat, fiber or protein, so they can be digested quickly.

What are the pros and cons of energy gels?

Runners, swimmers, cyclists or anyone exercising for more than 60 minutes should fuel their body. Research shows consuming carbohydrates during exercise that lasts longer than an hour improves metabolic response and athletic performance. With energy gels, athletes get a convenient source of energy without consuming a lot of fluid or a heavy meal during a long-distance event.

However, because energy gels contain a concentrated amount of sugar, taking them too quickly could cause an upset stomach. To prevent this from occurring, wash down your energy gel with sips of water.

What is the final analysis? Should athletes use them?

Energy gels provide a great option for fueling during long-distance events. During long-distance events, we need to give our bodies more fuel to prevent glycogen depletion. The American College of Sports Medicine recommends consuming about 30-60 grams of carbohydrates per hour. Most energy gels pack 23-27 grams of carbohydrates while an 8-ounce sports drink provides 14 grams of carbohydrates.

Though energy gels provide fuel for those on the go, remember that what works for one athlete might not work for another. Plan a fueling strategy and practice it during long training sessions to determine what works best for you. Good training, proper fueling and adequate hydration provide the foundation for achieving a personal best!


Ohio Law Aims for Greater Protections for Young Athletes

What you need to know about revised concussion regulations

From professional sports to youth athletics, sports teams are beginning to take a closer look at concussions. A new Ohio law is aimed at keeping kids safer after suffering from this typically short-lived brain injury that is caused by a bump, blow or jolt to the head. Concussions can lead to headaches, nausea, blurry vision, dizziness, trouble focusing and concentrating, mental “fatigue,” depression, or a change in sleep patterns, to name a few symptoms.

Ohio House Bill 143, signed into law in February, is designed to keep kids safe. Forty-eight states have now passed youth concussion legislation designed to protect young athletes. It is part of the cultural shift to pay closer attention to sports concussions.

The new law does the following:

  • Mandates that parents and athletes submit a signed letter stating they received and reviewed a concussion information sheet.
  • Requires that an athlete be removed immediately from play by coaches, referees or officials if he or she displays any signs or symptoms of a concussion during practice or a game.
  • Prohibits student-athletes who are removed from a game for a suspected concussion from returning to play on the same day.
  • States that athletes cannot return to play until they are properly evaluated and receive written clearance from a physician or other licensed healthcare provider.
  • Requires that coaches and referees involved in interscholastic sports hold a pupil activity permit (PAP) from the Ohio Department of Education. The PAP includes a mandatory training program for concussion and concussion recognition.

This new law ensures that if there is a suspected concussion, the young athlete is immediately pulled out of play. It also ensures proper evaluation by a healthcare professional prior to returning to play.

“There is growing evidence that undiagnosed, unrecognized or poorly treated concussions can significantly prolong the recovery period. This can take anywhere from the expected short, one- to two-week recovery to months or possibly even longer,” says Richard Figler, MD, a Cleveland Clinic primary care sports medicine physician and concussion specialist. “This new law is meant to protect the athlete.”

He adds, “If you are playing sports, know the signs and symptoms of concussion. When in doubt, sit it out. You only get one brain — protect it.”

The new Ohio law went into effect on April 26.


Q&A: Meet Two of Our Team Members

Jason A. Genin, DO, and Zenos Vangelos, DO, recently brought their sports health practices from Cleveland Clinic’s Lorain Institute to Cleveland Clinic Sports Health locations in Cuyahoga County. Dr. Vangelos also continues to see patients in Lorain County at the Richard E. Jacobs Health Center. Both are primary care sports medicine physicians who see adults, adolescents and children.

dr genin

Jason A Genin, DO

Jason A Genin, DO

Primary Care Sports Medicine Cleveland Clinic Sports Health
Assistant Director, Osteopathic Sports Medicine Fellowship
Clinical Professor, Ohio University School of Osteopathic Medicine

Why did you choose a career in medicine?
I enjoy the interaction with patients and the challenge in helping them improve their quality of life. I like learning from my patients daily.

What is your favorite thing about being a sports medicine physician?
I like helping athletes faced with injury. Every day, I counsel athletes about injury, which is part of sports. Expect it. How you recover from it and grow from the experience helps define people as adults.

What types of patients do you see?
My specialty interests are sports medicine, adult arthritis, concussion in the athlete, ultrasound and regenerative medicine.

What advice do you offer athletes faced with injury?
Patients (or parents) should know that our goal is to return them (or their child) to the field of play as quickly and as safely as possible. Every athlete and every visit is unique.

Tell us more about yourself.
While playing college football, I sustained a career-ending and lifelong injury. This recovery from and insight into injury helped me choose the path of sports medicine. Today, I can better relate to my injured patients.

Jason Genin, DO, is a sports medicine physician who sees patients at Cleveland Clinic’s Garfield Heights, Middleburg Heights and Westlake Medical Campus sites. To schedule an appointment with him, please call 877.440.TEAM.

dr sabik

Zenos Vangelos, DO

Zenos Vangelos, DO

Primary Care Sports Medicine
Cleveland Clinic Sports Health
Director, Osteopathic Sports Medicine Fellowship
Team Physician, Cleveland Indians and AFC Cleveland (soccer)

Why did you choose a career in medicine?
I was fascinated by the way the human body functions, and as an athlete, I had a keen interest in sports medicine in particular.

What types of patients do you see?
My specialty interests are soccer athletes, throwing athletes, athletic back pain, platelet-rich plasma injections, prolotherapy and musculoskeletal ultrasound. I treat all athletes from weekend warriors to professional athletes with the same level of care.

What advice to you offer athletes faced with injury?
Respect and treat your injury like professional athletes do.

Tell us more about yourself.
I have participated in and enjoyed multiple sports with a focus on soccer. I recently became the team physician for the professional soccer team AFC Cleveland. For the past 20 years, I have been the team physician for the Cleveland Indians. In 1994, I started the osteopathic sports medicine fellowship program, which trains two physicians a year.

Zenos Vangelos, DO, is a sports medicine physician who sees patients at Cleveland Clinic’s Westlake Medical Campus and Richard E. Jacobs Health Center locations. To schedule an appointment with him, please call 877.440.TEAM.


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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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