Beating Pain

Thanks to our year-round warm climate, Southwest Florida attracts an unusual number of energetic residents.

"This is a vibrant community," says Dr. James Guerra of Collier Sports Medicine and Orthopedic Center. "We have a very active, more seasoned athletic population here. They want to play golf and tennis forever."

On the downside, all that activity, combined with normal degeneration of aging tissues, puts many at increased risk for injuries. Licensed physical therapist Mike Willett, co-owner of Pelican Sports Rehabilitation and Body Balance for Performance in north Naples, estimates that up to 70 percent of golfers here experience lower-back problems. Guerra says he sees about 500 shoulder injuries each year.

Fortunately, says Guerra, advances in surgical and rehabilitative techniques can fix most injuries and put active Floridians back in action.

shoulder problems

Ask local orthopedic surgeons or therapists about common injuries here, and you'll usually hear about shoulder problems. "We have almost an epidemic of these problems," says Guerra.

There are several reasons why. Many active residents prefer sports that involve repetitive shoulder movement, like golf and tennis. Normal decline in tissue elasticity as we age makes the shoulder more prone to tearing. And many people don't realize that staying active beneath the hot Florida sun can cause dehydration, which makes connective tissue more vulnerable to injury.

One of the most-seen injuries is a torn rotator cuff, involving the four muscles and the cuff of tissue that surround the ball-and-socket shoulder joint. Attritional changes can weaken the tissues and lead to small tears that can be addressed with physical therapy; more acute tears may require surgery. Either way, the condition can be painful, especially at night, says Guerra. And it can impinge upon range of motion. Often sufferers can't raise their arms above shoulder height.

Therapy may involve ultrasound treatments (deep heat), electrical stimulation of muscles and nerves, or cortisone injections. A therapist may also incorporate exercises to help build flexibility and strength.

More severe cases could require surgery, which may not be as dire as it sounds. Advances in arthroscopic techniques in the last five years have made the process minimally invasive in many cases.

Using general anesthesia, usually, surgeons can reattach the torn tissue to the bone in outpatient surgery that lasts about an hour. There may be some pain or discomfort for a couple of days, and a sling is required for two to four weeks, but patients can quickly resume normal activities.

Brought to the Knees

Shock-absorbing cartilage in the knee-called the meniscus-also loses integrity with age. Sudden twisting motions-as with skiing, or a golf or a tennis swing, for example-can cause it to tear, as can a traumatic injury, like being hit in the side of the knee.

X-rays or an MRI may be used to diagnose the problem, and a doctor may recommend cryotherapy (icing the knee), anti-inflammatory pain medications and bracing of the knee. Most important is to stop using the knee to give the area a chance to heal. As with most injuries, at the first sign of pain, stop what you're doing and get the problem addressed-otherwise you risk further damage.

Rehabilitation of a minor tear can often be handled with physical therapy, using exercises to strengthen quadriceps and hamstrings, restore flexibility and encourage proper form in sports activities. More serious tears could require surgery.

Though the outpatient surgery takes a mere 20 minutes, full recovery can take anywhere from four weeks to several months. But with rehab and proper care, says Guerra, "those patients really, really do great."

Other Complaints

Lower-back injury is especially common for golf and tennis players because of the sports' repetitive twisting and swinging motions.

Treatment often involves exercises to help increase flexibility in the back, hips and hamstrings, and strengthening exercises for abdominal muscles and lower thighs. Therapy may also call for ultrasound, electrical stimulation treatment and ice or heat therapy.

Golfers so often suffer from this problem that Pelican Sports' PT Willett has created Body Balance for Performance with co-owner Mike Via. Body Balance includes post-rehab and general wellness in golf fitness, carried out and supervised by physical therapists to help golfers recover from and avoid injuries.

Tendinitis, or inflammation of the tendons, is another common complaint among local athletes. "The muscle can deal with repetitive motion, but the connective tissue can't," says Anthony F. Hansen, licensed massage therapist and owner of Absolute Health and Therapeutic Massage in Naples.

Elbows, knees and feet are just a few of the areas prone to this type of injury due to overuse. As with many such injuries, age can be a contributing factor. Most patients find relief through therapy that may involve rest, massage, non-steroid anti-inflammatory drugs, cryotherapy and stretching exercises. Surgery generally is a last resort.

Preventive Measures

An ounce of prevention really may be worth a pound of cure, with sports injuries. "A lot of injuries that occur in people who are very active occur due to either poor posture or poor body mechanics," says Willett. That's why so much of his practice focuses on prevention.

A frequent mistake many people make is skipping a warm-up. "People don't stretch, they don't warm up, and then they're tight and sore," says Hansen. Just five or 10 minutes of stretching before strenuous physical activity can prepare the body for exertion and allow greater flexibility and less chance of injury.

Drinking more water also can help. Hansen likens the body to an automobile's radiator-without enough water, tissue loses elasticity, and can't heal itself. He also points out that poor nutrition can cause problems.

"Part of rehabilitation is not necessarily body manipulation, but has to do with changing their lifestyle," Hansen says of his clients. "Our idea is not just to fix the injury, but let's get to the cause."