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Experts share their advice on ways to avoid getting hurt. By Dora Grote
There's no room for injury when training for a fall run. Photograph via Shutterstock.

1. Follow the Rule of Ten

If you want to push yourself, build up slowly: Run 10 percent farther than you did last week, or add 10 percent more weight than you lifted last week, says Dr. Rajeev Pandarinath, an assistant professor at the George Washington University School of Medicine & Health Sciences.


2. Don’t Lift Above the Shoulders

Our bodies aren’t built to lift heavy weight over our shoulders, says Dr. Kenneth Fine of the Orthopaedic Center in Rockville. When you’re holding your arms out at a 90-degree angle from your body, the weight shouldn’t go above that.

Says Fine: “The irony is that shoulder presses are not important for the human body, and many elite athletes do not do this exercise, whereas amateur athletes often do. An overhead press puts too much unhealthy stress on the rotator cuff.”


3. Cross-Train

Exercising for several hours a day can be healthy, but it’s best to mix the types of exercise. “Limit any particular activity to one hour a day,” Fine says.


4. Warm Up

Light cardio exercises to warm up your muscles, followed by gentle stretching, can help prevent injuries. More dynamic stretching, such as walking lunges and high knees, can help prepare you for high-intensity workouts such as CrossFit, Pandarinath says.

5. Listen to Your Body

“We like to think we’re still in our twenties, so we train with a lot of gusto and cross a line and start having shoulder and knee pain,” says Dr. Chris Annunziata of Commonwealth Orthopaedics in Arlington.

As more runs and marathons have cropped up, people are “diving in too quickly,” causing injuries, says Dr. Daniel Pereles of Montgomery Orthopaedics. CrossFit and Tough Mudders, among other workouts, can lead to rotator-cuff tendinitis (from lifting weight overhead) as well as knee tendinitis and stress fractures (both from repeatedly jumping).

It’s fine to challenge yourself, but don’t ignore your body’s messages.


Not sure if you're over-exercising? Read more about when to consult a specialist and therapy treatments that could help relieve your aches and pains here.

This article appears in our October 2014 issue of Washingtonian.

Posted at 03:00 PM/ET, 10/20/2014 | Permalink | Comments ()
As CrossFit, Tough Mudders, and marathons become more popular, Washingtonians are suffering more sports injuries. Here’s how to avoid overdoing it—plus good treatment options if you do hurt yourself. By Dora Grote
To avoid injury, Dr. Kenneth Fine suggests limiting any one exercise to an hour a day. Photograph by Jeff Elkins.

Beth McCann was jogging on the W&OD Trail in Arlington a few years back when severe pain literally stopped her in her tracks.

A registered nurse at the George Washington University Medical Faculty Associates, McCann had been an almost daily jogger for 30 years. When training for a marathon (she runs about one a year), she can log nearly 50 miles in a week.

On this October day—she had been training for the Marine Corps Marathon—she barely managed to walk home. A visit to a sports-medicine specialist revealed a stress fracture in her lower back. She ended up on crutches for six weeks and was unable to run for a year.

The specialist McCann saw was Kenneth Fine of the Orthopaedic Center, which has locations in DC and Rockville. Dr. Fine, she says, made her realize the importance of rest (she hadn’t been sleeping well before her injury but continued to be on the go) and of listening to her body during exercise (she had ignored aches and pains before the fracture).

McCann started getting deep-tissue massages every two to four weeks to help with circulation to the injured area. During the year she couldn’t run, she took spinning classes and lifted weights; now that she’s able to run again, she still takes days off from jogging to spin and weightlift.

“I’m a push-the-envelope kind of athlete, and that will get you in trouble, as I have found out,” says the 54-year-old Arlington resident.

It’s a common problem in Washington. As CrossFit, Tough Mudder competitions, and marathons are becoming increasingly popular, overuse injuries are taking a toll.

“Washington has a high number of people who are very motivated and disciplined, sometimes to the point of being obsessive, which can lead to over-exercising,” Fine says. While he notes that exercise is important in managing or staving off stress and illness, an obsession with exercise “leads to our area having a very high fitness level but to more overuse injuries. You will see the orthopedic surgeon more often, but you’ll see other doctors less often.”


When to Consult a Specialist

As the name suggests, sports-medicine doctors study and treat athletic injuries such as ligament and cartilage tears, stress fractures, and muscle and tendon strains.

The basic treatment for minor or moderate sports injuries has remained the same for years—ice for the first 48 hours paired with 72 hours of rest and elevation. How do you know when an injury is severe enough to see a doctor? One key sign is if you can’t bear weight on the affected area.

“If it hurts you a little bit to walk, it’s okay to wait and protect yourself and not exercise,” says Dr. Chris Annunziata of Commonwealth Orthopaedics in Arlington. “Give it up to a week and you should be getting better with ice, elevation, and rest. If it doesn’t get better, go to the doctor.”

While physicians not trained in sports medicine might treat just the acute injury, a sports-medicine specialist will also try to determine what led to the injury—and then to correct any problems with the goal of maximizing future performance.

“If someone is a long-distance runner, do they have inflexibility of their muscles or an imbalance of strength?” Annunziata says. “We try to direct care to affect those causes.”

Sports-medicine specialists are trained to get you back on your feet as safely and as soon as possible and to keep you moving even during treatment.

Says Annunziata: “If a runner comes in with knee irritation, we will allow them to do swimming, elliptical training, and cycling to improve lower-extremity flexibility around the knee and hip.”


From Dry Needling to Plasma

A sports-medicine doctor usually will do one of several things to treat an injury. He or she may prescribe anti-inflammatory pills or give an anti-inflammatory shot. If trained as an orthopedist—many othopedists have experience with sports-related injuries—the doctor will perform any necessary surgery.

Depending on the injury, a sports-medicine doctor may send you to physical therapy. Some physical therapists are also certified in sports medicine. As with any sports specialist, their aim is first to identify the reason the injury may have occurred.

“I look at how you are moving—are you having neck pain when you turn your head?—and try to figure out the source of your pain,” says Stacy King, owner of Aspire PT & Wellness in Bethesda, who is an orthopedic clinical specialist.

Once the problem is identified, a physical therapist will, among other things, give a patient stretches and corrective exercises to improve flexibility and strength.

Dry needling is a new trend in therapy that, like acupuncture, involves inserting needles into the body. While acupuncture follows a set of points and meridians, dry needling targets trigger points in muscles that are causing pain. The goal is to get a twitch response, which feels like a muscle cramp and which ultimately relaxes the muscle.

“It’s a faster form of treating trigger points,” King says. “The patient often feels the benefits quickly—some feel results immediately.” The average number of treatments is four, and side effects can include muscle soreness and bruising.

A physical therapist must be trained to do dry needling, through an organization such as Kinetacore, and this treatment isn’t for everyone. Someone who is in the first trimester of pregnancy, has a clotting disorder, or is within six weeks of having surgery shouldn’t receive dry needling.

Other therapies are on the horizon for treating serious or lingering sports injuries—including those that rely on the human body, such as plasma and stem cells, to accelerate healing.

PRP, or platelet-rich plasma, therapy is one such treatment. A patient’s own blood is centrifuged, separating it into layers. The platelet-rich layer, full of growth factors, is then injected back into the patient.

Although the American Academy of Orthopaedic Surgeons hasn’t yet validated PRP as a scientifically proven method of treatment—it’s being studied—Fine says he and other doctors are using it.

“I have used it in cases such as elbow tendinitis and plantar fascitis where patients have not improved with standard treatments,” he says. “The pros are that it makes intuitive sense to inject growth factors to try to stimulate tissue to heal, and there are some studies showing its benefits. The cons are that we really don’t know at what concentration they would work best. There are many studies that show no improvement from PRP.”

While Fine says he hasn’t seen serious negative side effects, possible ones include infection, blood clots, nerve pain or injury, skin discoloration, and worsening of symptoms.

Other treatments in the experimental stages include stem-cell therapy and human-growth-hormone injections into joints. “Stem cells are being used, but they are in the very early stages, so there really are no good scientific articles,” Fine says.


Choosing a Doctor

Many family physicians now are very well versed in sports medicine; you might check if your primary-care doctor is board-certified in the field. Other medical specialties allow physicians to get a Certificate of Added Qualifications in sports medicine. Orthopedic surgeons, for example, can do a fellowship and take a written test through the American Board of Orthopaedic Surgery to become certified in sports medicine. The American Board of Family Medicine offers a similar test for family doctors. Licensed physical therapists—who don’t have an MD—can also become board-certified through the American Board of Physical Therapy Specialities.

“It’s a sexy thing to tell your patients you’re a sports-medicine specialist,” Fine says, “but not everyone is certified.”

Want to see a sports-medicine practitioner? You can find certified specialists at certificationmatters.org.

To find recommended sports-medicine specialists, orthopedists, and rehabilitation doctors, see our Top Doctors list.


This article appears in the October 2014 issue of Washingtonian.

Posted at 12:50 PM/ET, 10/08/2014 | Permalink | Comments ()
Sports psychologist Dr. Keith Kaufman explains the tricky difference between ritual and routine and which one actually aids in performance. By Melissa Romero
Olympian Sanya Richards-Ross, who won a gold medal in the 400-meter race this year, always wears a bullet necklace her mother gave her while competing. But do superstitions really help athletic performance? Photographs courtesy of Wiki Commons.

Before a race, local marathon runner Dorothy Beal absolutely needs her race hair.

No, “race hair” does not involve Beal donning a wig or hair extensions during competition. Rather, the night before every event she washes, blow-dries, and straightens her hair. “All of my [personal records] have happened when I had race hair,” she explains. “I don’t know why, but it feels faster to me than messy, wavy hair.”

On the Olympic level, 400-meter gold medalist Sanya Richards-Ross wears a necklace her mom gave her during every race. Michael Phelps swings his arms and slaps his back three times before every swim, and heptathlon winner Jessica Ennis uses her lucky measuring tape during competition.

What all these athletes have in common is their reliance on what they believe are superstitions, says local sports psychologist Dr. Keith Kaufman. The thing is, some of those habits aren’t actually superstitions—and many of them don’t actually help athletes win. “In sports psychology, we think of rituals and superstitions in similar terms, but we differentiate them from routines.”

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Posted at 12:40 PM/ET, 08/09/2012 | Permalink | Comments ()
The National Park Service denied the required permit for the third annual race. By Melissa Romero

The third annual Washington DC Triathlon, scheduled to take place on June 17, has been canceled.

DC Tri made the announcement on its website this afternoon, saying the event was denied the required Park Service permit. The triathlon takes place on National Park Service property and in the Potomac River, and ends on Pennsylvania Avenue near the US Capitol Building.

While in past years the triathlon was held in June, this year the National Park Service wasn’t able to accommodate the event, says National Park Service public information officer Carol Johnson. “There’s a period between Memorial Day and the Fourth of July where we don’t issue permits for runs, simply because we have all kinds of other things going on,” she explains. “In the past we’ve had some exemptions for the event, but this year we just couldn’t permit it.”

Those who registered for the sold-out race have until March 28 to get a refund or transfer the fee to a new event. Click here for more information.

The Nation’s Triathlon is still scheduled to take place on September 9.

Posted at 01:48 PM/ET, 03/14/2012 | Permalink | Comments ()
An organization that will host a national competition this March hopes yoga will be recognized as an Olympic sport. By Melissa Romero

Who does it better? USA Yoga will host the 2012 National Championships for yoga in March. The organization hopes yoga will become an Olympic sport. Photographs courtesy of Flickr user Ron Sombilon Gallery.

Yoga, the back-bending, leg-twisting ancient practice that prides itself on being a personal, spiritual discipline, is putting on its game face.

Some of the best yogis out there are heading to New York City in a few days to compete in the 2012 National Yoga Championship for youths and adults, an event hosted by the United States Yoga Federation. Each participant is required to perform seven yoga postures in three minutes. The judges will rate each pose based on strength, flexibility, timing, and appropriate breathing in postures.

According to its website, USA Yoga’s mission is to join other countries to form an international yoga federation and to qualify yoga as an Olympic sport. It has already applied to the United States Olympic Committee.

But does adding a competitive edge take away the introspective, know-your-own-body aspects of yoga? Mary Catherine Starr, a local yoga instructor, says yes.

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Posted at 12:08 PM/ET, 02/29/2012 | Permalink | Comments ()
These ladies log miles upon miles by foot and bike and in the water every week to train for grueling triathlons each year. By Melissa Romero

DC has one of the highest concentrations of triathletes in the country. And every year, thousands of athletes from all over the world descend upon the District for two popular triathlons: The DC Tri and the Nation’s Tri. These five female local women live and breathe the Washington triathlete culture, and you can read all about their training, competitions, successes, and failures on their personal blogs.

• • •

Katie Ingram
Run This Amazing Day

Why you should read her blog: This triathlon newbie is a firecracker. You’d never guess from her hilarious posts and tweets that during her 9-to-5 she’s the director of information of technology for a law firm. Warning: You’re likely to stifle a snort at your desk while reading her updates on everything from training and races to her adorable pups, Graham and Molly.

Where she trains: “I love cycling at Hains Point for short workouts, but for longer workouts I’ll head out to Reston, Virginia, or Potomac, Maryland, or even Skyline Drive for some gorgeous and hilly rides. I mostly run on the Mount Vernon trail, the Four-Mile Run trail, the Capital Crescent trail, or in the city itself. I swim at my local gym pool.”

Favorite post-workout food: “I’m usually not very hungry immediately after a triathlon, but I love a burrito after a good, hard workout!”

How many hours a day she trains: “Two to three hours a day, but weekend workouts can last up to seven or eight hours.”

• • •

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Posted at 09:25 AM/ET, 01/30/2012 | Permalink | Comments ()
Seven-year-old Timmy Tyrrell of Manassas is racing around the track to raise money for children suffering from cancer. By Laura Wainman

Mini poses with his friend Ella Day, who was diagnosed with brain cancer in 2010. Photographs courtesy of Tina Tyrrell.

At first glance, Timmy “Mini” Tyrrell of Manassas is no different from your average seven-year-old. His parents are his heroes, and the family dog is like a brother to him. He loves running around outside, and anything with wheels that lets him go fast; he dreams of one day becoming a doctor. But spend just a few minutes with Mini, a nickname derived from the fact that he is his father’s “mini me,” and he will tell you all about his greatest passion: raising money for children with cancer through go-kart racing.

Mini—who, upon meeting me shook my hand, looked me in the eye, and welcomed me by name to his home—has raised more than $28,000 to date for the Jeffrey Virostek Fund, and has no plans of stopping there. The pint-size driver is racing toward his goal of raising $50,000 for pediatric cancer patients and their families before May 13, 2012.

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Posted at 01:30 PM/ET, 01/18/2012 | Permalink | Comments ()
US Soccer Foundation and DC United Women team up at event to help end child obesity in urban areas. By Mary Yarrison

The US Soccer Foundation's Soccer for Success program aims to combat childhood obesity in urban areas. DC has one of the highest rates of childhood obesity in the nation. Photograph courtesy of the US Soccer Foundation's Facebook page.

NBC4 held its annual Health and Fitness Expo this past weekend at the Washington Convention Center, bringing in more than 3,500 health-care providers, nonprofits, and other businesses to answer Washingtonians’ health-related questions for free. For many, particularly the uninsured, the expo provided a valuable opportunity for free health screenings: Vendors offered everything from blood-pressure checks to HIV screenings and memory assessments. Locals and their kids joined in by the trainload—more than 85,000 attended, according to NBC4—for these screenings, and for updates on current health-care issues like autism treatment and childhood obesity prevention, which was of particular interest.

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Posted at 02:28 PM/ET, 01/17/2012 | Permalink | Comments ()
A local physical therapist explains what causes these common injuries and how to avoid them. By Melissa Romero

Got shin splints? You may need to switch up your running route. Photograph courtesy of Flickr user Roby Ferrari.

If you’re anything like me, the sound of people pounding on the treadmill is almost as painful to my ears as nails on a chalkboard. But while you’re wincing now, the pain they’ll soon feel in their legs from shin splints may be enough of a scolding.

Shin splints are one of the most common injuries that occur among athletes, especially among runners. They cause a dull, nagging ache along your shins, which become painful to the touch. If not treated properly—and often they are not—they can lead to even more serious injuries like stress fractures.

We asked Maryland-based physical therapist Dr. Jamey Schrier of Schrier Physical Therapy for his expert advice on preventing and treating every runner’s nemesis.

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Posted at 02:49 PM/ET, 01/12/2012 | Permalink | Comments ()
These 11 exercises will help you build explosive power and speed By Melissa Romero

If you caught the NBA All-Star Slam Dunk Contest last week, you probably saw Los Angeles Clippers power forward Blake Griffin jump over a car. Chalk it up to pure talent if you want, but chances are he has spent some serious time at the gym improving his hops.

Athletes like Griffin who want to improve their explosiveness usually turn to plyometrics, a training regimen that combines strength and speed for maximum power. It’s not for the faint of heart: The National Strength and Conditioning Association says you should be able to squat more than 1½ times your body weight before incorporating plyometric exercises into your workout. And high-school athletes should avoid plyometrics altogether; it can damage growth plates in their bones.

Whitney Maymon, a trainer at Evolution, a personal-training studio near Thomas Circle, says it’s safe to incorporate one to two plyometric exercises into your routine once a week, but only after you’ve started a strength-training program. Here are 11 exercises to try if you want to be the next Blake Griffin.

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Posted at 04:14 PM/ET, 12/02/2011 | Permalink | Comments ()