So while we should be grateful our schools are open for after-hours play, we also are mindful that our community faces its own barriers and challenges to promoting active, healthy lifestyles.
You may have heard of the Mayor’s Fitness Council, on which I serve, but you may be less familiar with the related Active Living Council of San Antonio.

The job of the Active Living Council, on which I also serve, is to create and help implement the Active Living Plan for a Healthier San Antonio. This public-private collaborative recommends policies and strategies to increase physical activity in all segments of the population in the Alamo City area. In doing so, we know the health and wellness of individuals will improve.

So we’re talking about trying to move the needle toward a more active community for more than 1 million people. To have any chance to achieve this kind of mammoth undertaking, we look at a broad spectrum of sectors to influence – business and industry, education (including after-school programs and early childhood), healthcare, mass media, parks and recreation, fitness and sports, public health, transportation and community design and volunteers and non-profit.

There’s a lot to consider, so let’s talk about one event coming up in just a couple of months that offers community-wide potential for getting healthy – Siclovia. Twice a year San Antonio shuts down major downtown streets and creates a fun route for cycling, walking, skateboarding, roller blading or just plain ambling.
On Sunday, April 7, from 10 am to 3 pm, most of Broadway from north of Brackenridge Park to Alamo Plaza will be closed for this free, fun and healthy event. That’s a 2-mile stretch of the central city with lots of fun “reclovias” or stops along the route that will feature Zumba, yoga, dancing and much more. There’s no pressure to “finish” because Siclovia is not a race, merely a play day for the community.

And while getting out for an event like this once or twice a year won’t alone change the health of our community, it provides an opportunity to get people out and can motivate them to do more on their own.
Considering the problems of obesity and health-related issues such as diabetes that plague not only our community but also the entire nation, events like these are critical to making our city a healthier, better place to live.

To learn more about Siclovia visit their website at www.siclovia.org. I’ll offer a more detailed look at this exciting event in an upcoming column.
Get out there and have fun!

Research about this very cutting-edge method to heal the body without the use of surgery was presented at a conference I recently attended at theUniversityofWisconsin, one of the global leaders in regenerative injection therapy training and research.

Like Plasma-rich Platelet injections, stem cell injections use the body’s own material to promote healing. Adult stem cells are located in our fat or adipose tissue.  They have the potential to regenerate into healthy bone, muscle, ligaments, and cartilage.  Just like removing platelets from blood, we remove stem cells from fat tissue.

This may sound a little like liposuction but it isn’t. When I tell my patients I will soon be able to bring this procedure to my practice, some have half-jokingly asked if they I can remove a few pounds of fat. We’ll take about 60cc’s of fat tissue from an area like the belly, maybe a quarter pound, and isolate out about 15cc’s of stem cells for the injection through a centrifuge or other filter system.

Stem cells are like a blank canvas. So if they are injected into a knee that’s missing cartilage, they can actually build new cartilage – easing pain and increasing function. The same holds true for other injuries, like muscle tears or tendon and ligament injuries. The introduction of stem cells to the damaged area can re-grow healthy tissue.

This adult stem cell therapy injection method should not be confused with the use of fetal stem cells, which are somewhat controversial.

This type of therapy moves toward the pinnacle of a stair step approach to musculoskeletal healing. If prolotherapy or Plasma-rich Platelet Injections aren’t getting the job done or if a physician believes a more aggressive healing process is necessary, stem cell therapy injections may be combined with the regenerative injections to optimize the body’s healing process and offer a solution before surgery.

There are other differences between adult stem cell injections and other types of regenerative injection therapies. Prolotherapy requires maybe 6-8 injections or more to be effective in helping the body to heal itself. Stem cell injections may have the same impact in one or two treatments.

I’ve been excited about my training in this area. I started learning about stem cell therapy more than a year ago and have been through several very detailed training sessions lasting anywhere from two to four days.  Physicians from all over the world are using stem cell therapy to treat musculoskeletal injuries.

Surgeons have been using adult stem cell therapy in grafts like lumbar fusions in the back, but no one inSouth Texashas utilized this method to treat musculoskeletal injuries such as muscle, ligament or tendon damage. I expect to be the first to offer it here using techniques approved by the FDA and I hope I won’t be the last.  I believe the potential for this non-surgical procedure to be a game changer for athletes and everyday patients is limitless.

Stay healthy!

As a reminder, regenerative injections offer a non-surgical way of treating many common injuries including low back pain, shoulder injuries, tendinitis, tennis elbow and even degenerative joints of the knee, hips and ankles.  TheUniversityofWisconsinis one of the premier institutions in the world on the cutting edge of regenerative injection therapy training.

At the conference, we heard from researchers who presented more of the mounting evidence about the effectiveness of these therapies. I’m going to focus today on prolotherapy and platelet-rich plasma injections, and we’ll delve into the promising field of adult stem cell injections in the next column.

Prolotherapy involves a solution of dextrose – essentially a high concentration of glucose (sugar) with lidocaine.  The solution is injected into the injured area, which may be a ligament, tendon, muscle or and bone joint.

Now here’s where it gets tricky. This injection is designed to stimulate inflammation of the injured tissue which is the body’s signal to stimulate repair. In the past, anti-inflammatories or inflammation suppressants like cortisone have been used to treat the pain of the injury, but did little to promote repair. By inflaming the injured tissue, we trick the body into producing a healing response that can strengthen the weak tissue. A series of injections over weeks or months can result in permanent repair.

Platelet-rich Plasma Injections are another method of getting to the same reaction. We take the patient’s own blood and put it into a centrifuge – essentially a high-tech blender on super high speed. The blood separates out the plasma-rich platelets which are removed and re-injected into the injured area of the body. The platelets then do what they were designed to do in the body – they stimulate growth of healthy tissue.

The platelets put your body’s repair system into hyper drive and can cut recovery time by almost one third. So an acute injury that might take three months to heal might be repaired in two months.

For professional athletes, this is an obvious advantage. These injection therapies have been used to treat pulled muscles and hamstring injuries on athletes such as Kobe Bryant, Tiger Woods and many other pro football and baseball players.

But the treatment isn’t just for world-class athletes. At the conference my fellow physicians and I learned about rotator cuff injuries, knee injuries and even osteoarthritis improving after prolotherapy injections. Evidence-based research showed improve functionality and proven repair of muscles and ligaments using image scanning.

The growing evidence about regenerative injection therapies will, hopefully, make it a more common approach for treating musculoskeletal injuries.

Next week, we’ll talk about another cutting edge procedure for treating pain and injury without surgery – adult stem cell injections.

And there’s good reason to be concerned. Football is a sport where concussions are reported at a rate twice that of the next most concussive sports — girls soccer and boys lacrosse, according to a study in the American Journal of Sports Medicine. What’s more, the study found concussion rates increased in several high school team sports every year from 1997-2008.

Concussions, also known as traumatic brain injuries, were reported in everything from wrestling, volleyball, cheerleading, baseball and softball.  The fact is that concussions can happen in even non-contact sports, such as skateboarding, skiing, BMX racing or surfing.

There are a lot of warning signs for a concussion, such as losing consciousness or becoming confused. For example, Troy Aikman suffered too many concussions during his storied career as a Super Bowl-winning quarterback for the Dallas Cowboys. In one game against the Washington Redskins, Troy was hauled off to the hospital in an ambulance after he answered a question wrong following a particularly jarring sack.

The question? What team are you playing against? His answer? Henrietta. As in Oklahoma. As in high school. Troy was hit so hard he was literally knocked back into his high school playing days.

That story may get a laugh, but it’s not funny when you or someone you know is the person dealing with a concussion. The danger in team sports is that a player with a concussion may not appear to have the obvious symptoms of a traumatic brain injury – such as being knocked unconscious, dizziness or temporary amnesia. The athlete may be allowed to continue to play, which could be catastrophic. The athlete could suffer a more serious brain injury or aggravate the concussion, leading to more serious brain trauma.

This is why it is important for coaches, athletic trainers and even student assistants pay close attention and monitor for signs of a concussion. If a player blacks out on the field, that’s an obvious sign something has gone wrong. But what if they appear fine and seem to just fall asleep on the bus ride home? Are they asleep or has the concussion finally caused them to lose consciousness?

It is almost impossible to die from a concussion, yet repeated exposure to mild head injuries can cause serious problems later in life – increased risk of Parkinson’s disease and dementia, for example.  Football players who suffer three or more concussions are at greater risk for clinical depression versus players who never had one, according to a 2007 article published in Neurosurgery.

Even a simple fall can lead cause a concussion. After a fall or other type of forceful impact, jolt or collision, consider whether the athlete is:

• Confused or unsure of their surroundings
• Answering questions slowly
• Moving slowly
• Showing mood swings or personality changes
• Nauseous
• Sensitive to light or noise
• Unable to remember what happened before and/or after a collision
• Unconscious

There are no guarantees but by having informed and vigilant staff, trainers and coaches, teams can reduce the danger posed by concussions.

Have fun. Play hard. And let’s all watch out for each other on the field.

His name has been removed from the record books and Armstrong has been banned from professional cycling. Athletic clothing and footwear company Nike — which did not drop Tiger Woods from its list of sponsored athletes after the golfer was unmasked as a multiple philanderer — severed its longstanding endorsement deal with Armstrong estimated to be worth more than $7.5 million a year. Other sponsors also cut ties to Armstrong and he voluntarily stepped down as head of the Lance Armstrong Foundation, also known as Livestrong, the cancer charity he founded in the mid-1990s.

Armstrong has never publicly admitted to doping – to gaining an athletic or performance advantage by using banned substances. But he also chose not to fight the allegations in the 1,000-page dossier that provided exacting details alleging when, how and where Armstrong cheated.

Cheat. Not world-class athlete. Not champion. Not inspirational cancer survivor. Cheat is the term that more than likely will haunt Armstrong for the rest of his days.

Yet despite the consequences, and despite the crackdown by all professional sports and the NCAA, the lure of quick results and shortcuts is tempting athletes in what should be one of the most pure areas of all competition – high school.

According to a study by Texas A&M University nearly one-third (32 percent) of high school seniors and juniors reported they had purchased performance-enhancing drugs. Nearly 2.3 percent of high school athletes are using those drugs — a figure the study’s researchers believe is underreported.

As a pain management physician I work with a lot of young athletes, helping them to recover from injuries hopefully without the need for surgery. I know the pressure many of them feel to be bigger, better, faster and stronger at an age when their bodies just aren’t developed to compete at the level they want.

Sometimes they push themselves. Other times they are pushed by coaches or family members. And they all want an edge.  Proper diet, exercise and commitment to a training regimen just aren’t enough for some of them. They scour the Internet looking for tips on what drugs will give them the results they desire, and they can get tips from other cheaters on how to make it work to its maximum effect.

Some young athletes think they are playing by the rules but still wind up cheating. Plant extracts and so-called “all-natural” supplements may contain banned hormones that can get you into trouble. Yet these dietary supplements aren’t all-too-often unregulated. Just because you can get it in a health store doesn’t mean it’s safe, effective or legal for a competitive athlete.

We all cheer the winners but forget about the honor and integrity it takes to be a fair and good loser. The athlete who comes in last after giving it his or her all deserves as much adulation as the one who broke the tape at the finish line.

Which brings us back to Lance Armstrong. If the allegations are true, he knew full well he was breaking the rules to win. He may have tried to justify it to himself because, reportedly, doping is rampant in professional cycling (as it may be in too many other pro sports). Yet even if none of the allegations ever surfaced, he would know he didn’t win based on his God-given physical talent, strength of mind and strength of character.

Some people can live with that knowledge. I just don’t know how they do it.

On a totally different note, I’m happy to have been asked to once again serve as Tournament Physician for the 2012 USTA National Women’s Intersectional Team Event. I have been honored to volunteer my services for the past two years and am looking forward to being part of this year’s event.

Some of the best women tennis players ranging in age from 35-89 will square off at McFarlin Tennis Center (1503 San Pedro) from Nov. 12-18 for this Hardcourt Championship. Proceeds from the tournament will benefit the non-profit Texas Tennis and Education Association, which promotes health and education through tennis in Texas.

I hope to see you there.

November 2012 San Antonio Rock N’Roll “Bike Tour”; starting at sunrise and riding the 26 mile marathon course through downtown SA, King Williams, and the Missions before the runners took off.

It’s clever marketing. The commercial opens on scenes of foods with little or no nutritional value – a vendor machine pastry,
a half-eaten chili cheese dog tossed onto a playground, and a soft-serve waffle cone with rainbow sprinkles.

The idea is that between competitions, it’s important to stay focused and to make sure your body is getting what it needs
for the next round. So when you step off the court, you are in the 5^th quarter, preparing yourself for the start of the next game.

The commercials are promoting a new hard candy-type supplement from Gatorade. Prominent athletes are seen carefully placing the candy in their mouth in the locker room or before they hit the field.

Now, Gatorade and Powerade and other makers of sports drinks are out to make money. Sports drinks represent one of the
fastest-growing segments of the beverage market. And the sports drinks, in moderation and at the right time, are a fairly good product. Many sports drinks not only help you get re-hydrated after a workout or during a competition, they
also have essential electrolytes that have been lost during the workout that your body needs to replenish.

However, keep in mind that we as a society have become hard-wired for sweet tasting foods and drinks. The proliferation of corn
syrup in so much of our processed foods (although not in sports drinks) can attest to this fact.

So if you’ll look at the label of just about any sports drink, you’ll see they are high in carbohydrates and sugars. Some
carbohydrates are good for you to restore energy reserves, but you shouldn’t have to get them out of a sports drink.

If you’ve worked out for 45 minutes to an hour, then downing a sports drink can be a smart move to re-hydrate and replenish. But
just buying one at the corner store before you come home from work is about as healthy as buying a sugary soda.

Which brings us back to the “candy” energy supplement. There are some vitamins in there, but nothing you can’t get from eating a few strawberries or an apple.

It’s not just this product from Gatorade – energy bars, gels and other “nutritional” supplements are often loaded with sugar and
carbs. You might get the same energy boost from six sugar cubes – it will get you going, but you will pay for it later with a crash and burn.

Eating smart throughout the day is the key. Think about carrying around a couple of apples for mid-morning or afternoon snacks. Or a small bag of carrots. Or have a handful of nuts in a sandwich bag or container. This will keep our fuel cells charged for the “5^th
Quarter.”

As with anything, sports drinks are OK in moderation, and they have their place in helping athletes stay “in the game.”  But they are not a magic elixir.

One final note: Don’t mistake sports drinks for so-called “energy drinks.” These drinks are little more than a solution of
caffeine and water, marketed to students up studying late, people who are working late or who go out for a night of dancing. Energy drinks won’t help you train and can be detrimental to keeping you energized throughout the day.

The 5^th Quarter is important. Just think about how you are keeping your body prepared for the next round.

The gold medal success of the Women’s Gymnastics Team, the championship three-peat of beach volleyball greats Misty May Treanor and Kerri Walsh, the introduction of women’s boxing to the Olympics with a middleweight gold medal going to American teen-ager Claressa Shields, and the dominance of women speedsters like Austin’s Sandra Richards Ross gave Americans
everywhere reason to cheer and celebrate sport and competition.

Of course, with all the events at the Summer Olympics, many sports were relegated to little or no prime-time coverage (team
handball and synchronized swimming, for example) whether they featured women or not. One sport growing in popularity every year is BMX racing, which became an Olympic medal sport in 2008.

You may not have caught it at the Olympics, but I see many teens and young adults in my practice who take part in this form of
off-road bicycling known for its speed, jumps and, all-too-often, injuries. Girls and young women in particular are taking up the sport, as evidenced by the number of BMX riders who come, sometimes limping, into the office.

BMX rider Arielle Martin of Utah sustained life-threatening injuries in a training that prevented her from competing in
the London Olympics, where she was considered a favorite to medal. She had three surgeries to treat a collapsed lung and severely lacerated liver she suffered in an accident when her chain broke during an Olympic qualifying training run in Chula Vista, Calif.

That may have been a “freak” accident but injuries come with the territory for BMX riders. It’s a traumatic sport punctuated by
falls and crashes, and which demands upper-body strength. For girls, the dangers of BMX racing may be even more prevalent because muscles needed to really be in control in competitive off-road bicycling are often underdeveloped.

So if you are a girl or young women involved in BMX racing, there are some parts of the body you should really work out to help you control your vehicle and minimize risk of injury.

Dislocated shoulders are a common injury so I would emphasize exercises that strengthen that area. The scapular stabilizers are an excellent place to start. The scapula stabilizers keep the shoulder joints and shoulder blades here they are supposed
to be while moving your arms and torso. Rotator cuffs, connective tissues that hold the shoulder joints and muscles together and rhomboids are all part of this area.

These are small muscles but very important. Many exercises for strengthening the scapular stabilizers don’t require much more
than resistance bands, although you may be more comfortable working out with dumbbells or machines.

• Shoulder shrugs

• Prone rowing or bench rows

• Seated rows with scapular pinch

• Low row

• Push-ups with a plus: wall, table-top, floor

• Bench with a plus

• Chair press-ups

• Sitting or standing fly’s

• Lat pull downs

You should start with very light weights and a lot
of repetitions to build up the strength and endurance. After a couple of weeks
of steady workouts (3 times a week) you can increase the weight and lower the
number of reps to build strength.

The exercise ball also can be used to help
strengthen the scapular stabilizers. Lie face down on the ball with small
weights in your hands and lift up pinching the shoulder blades. Three sets of
10 reps with little more than 1-3 pound weights will do the trick.

Leg exercises also are very important to build the
quads. We will go into detail about some of those areas in the next column.

BMX riders are a fearless lot who seemingly don’t
feel pain. But you can keep the sport exciting and fun if you work on
maintaining the real machine – your body – and putting it in the best shape
possible for injury-free riding.

Have fun!

By Annette M. Zaharoff, MD (2/1/04)
Exercise is an important component in maintaining and improving your physical fitness level. Feeling good from your exercise program is important but often becomes difficult if an injury occurs. Exercising with an injury may lead to worsening of your original problem and a longer recovery time. Recognizing when to see a sports medicine physician and appropriately treating your injury will lead to a faster and safer return to the activities you enjoy. The following information will provide a few general guidelines for common problems with the foot and knee.
The Foot
There are several common injuries that do not require medical attention, such as mild ankle sprains, blisters, heel bruise and mild tendonitis. To treat mild injuries, and prevent mild injuries from becoming more severe, you should:
minor.
1) Apply ice and compression with an ace bandage, even if swelling is only
2)    Take aspirin or an over the counter anti-inflammatory medication such as ibuprofen, provided you are not allergic to such medication.
3)    Stay off the foot as much as possible for a least the first day after an injury.
4)    Ease back into walking or your chosen athletic activity. 5)    Do not push through pain.
Signs and symptoms of injuries that do indicate that you need to see a physician include: severe swelling, severe pain, severe bruising, numbness and tingling, inability to move the foot or intense pain with movement, persistent pain that lasts for more than 5 to 7 days after an injury.
These symptoms may be signs of common injuries that do require medical attention, such as: Achilles tendonitis or tendon rupture, fractures, bursitis, and ligament or tendon tears.
The Knee There are several common injuries of the knee that do not necessarily require medical attention, such as: mild, temporary kneecap soreness related to a new activity or overexertion, and mild ligament or tendon strains. To treat mild injuries and prevent further damage, you should:
1)    Apply ice even in the absence of major swelling.
2)    Take aspirin or an over the counter anti-inflammatory
3)    Apply compression with an ace bandage or elastic knee brace with a cut out for the kneecap
4)    Ease up on activity causing any pain or discomfort
Do not exercise through pain Return to full activity only when the pain is completely gone Add exercise to strengthen the thigh muscles above the knee.
Common knee injuries that do require medical attention are torn or ruptured tendons or ligaments, torn cartilage or fractures, and dislocation of the kneecap.
The symptoms of injuries that do require medical attention include: an injury in which a “popping” was heard or felt at the time the knee was injured, instability of the knee joint, sudden and intense pain, rapid swelling, numbness and tingling, inability to bear weight on the leg, bruising or discoloration, buckling and locking sensations of the knee joint.
Remember, you are the best expert on your own body. If something just “doesn’t feel right” do not hesitate to contact your sports medicine physician for a consultation. Early intervention may shorten your recovery time and prevent a more serious injury from occurring.

1. Weak muscles and or muscle imbalance around the shoulder,
elbow, and wrist.

2. Playing excessively in racket sports or using the forearm too
much in everyday activities like the computer.

3. Poor technique –too much wrist action, poor ball control.

4. Improper equipment-incorrect grip size, tight strings, or too
stiff a racket.
Pain is usually located on the outside (thumb side) of the elbow. Initially, pain may be present only during the sport activity. As the injury progresses however, pain may occur with simple activities such as opening a door, lifting a briefcase, and shaking hands.
Treatment begins by modifying your activities to prevent further aggravation of your injury. Ice should be applied three times daily for ten to fifteen minutes. Medication for inflammation may be used. Discuss this with your sports medicine physician. Occasionally, a localized cortisone injection may be necessary for more intense anti-inflammatory effects.
Appropriate physical therapy prescribed by your physician may be very beneficial. A variety of anti-inflammatory treatments may be applied by the therapist. A safe progression into therapeutic exercises for stretching and strengthening the forearm muscles may then be instituted. Your sports medicine will re-evaluate you to determine your treatment steps.
A brace may help to support the tendon area. It may be worn during all activities early on. Later, it may be necessary to wear during your sports activities until your rehabilitation is complete.
When your physician has cleared you to return to your sport, you should start slowly. In tennis, rally for short periods. Take a lesson from your pro to assess your strokes and equipment. Avoid competition until the elbow is completed healed.
If you are experiencing any pain around the elbow, the sooner you find out what is causing it, the sooner you can begin an appropriate treatment plan and get back to the court. For specific questions about your problem, contact your sports medicine physician for help.