Except for zealous fitness buffs, most people either slow down their exercise pace or (the shame!) drop their outdoor routine altogether as the days get shorter and colder. Though we had a fairly mild winter, many people are just now getting back into the full swing of things regarding their exercise regimens. And now that we’re in the throes of baseball season, kids and teens are eager to get back into the swing of things, too.
We spoke to Christopher S. Ahmad, MD, head team physician for the New York Yankees, about the safest ways to get your fitness regimen back on track without injuring yourself. In addition to his work with the Yankees, Ahmad, who practices at ColumbiaDoctors Tarrytown, specializes in knee ACL, meniscus, and cartilage injuries; shoulder instability and labral tears; rotator-cuff pathology; Tommy John surgery; and advanced arthroscopic surgical techniques for sports-related injuries of the knee, shoulder, and elbow.
What general advice do you have for the average person just getting back into a fitness routine after a few winter months of minimal exercise?
Spring is a great time to motivate and get back in shape. Injuries, however, can derail the most motivated people wishing to engage in a new fitness routine. The most common mistake that can be avoided is training too quickly and with too much intensity.
The best advice I can give to anyone who wishes to begin an exercise program or play sports is to: 1) develop a steady habit of exercise, 2) have a slow progression, and 3) diversify exercises and sports to avoid overuse injuries. Writing down goals is effective. Working with a trainer or an exercise group with similar goals and understanding injury-prevention can be extremely effective. Finally, remember to sleep and eat well and to have fun.
How does preventive care change as one ages? For instance, what should a person in his or her 40s and 50s do to prevent joint injury vs. someone in his or her 20s and 30s?
Age and existing level of conditioning influence the risk of overuse injuries. As we age, and particularly with disuse, our tissues such as tendons, muscles, and ligaments become more fragile to stress. Older patients and/or patients who have not exercised for some time need a slow progression in the intensity of the exercise and training programs to avoid tissue breakdown and injury.
What are the most common sports injuries you see in your practice?
I see patients who play a variety of sports, from soccer and lacrosse to gymnastics and baseball, and at different competitive levels, from coaches to developing youth athletes. The injuries span from ACL tears in professional soccer players to Tommy John injuries in baseball pitchers. I currently am head team physician for the Yankees and also for the New York City Football Club, and many patients seek out the same level of care that I provide to professional athletes. Athletes from all over the country come for treatment that will give them the best chances of getting back on the field, baseball diamond, or soccer pitch.
How important is warming up and what should a good warm-up entail?
A great message with regard to baseball is, ‘warm up to throw, don’t throw to warm up.’ For any sport or exercise program, warm-up is essential to injury-prevention and also athletic performance. Warm-ups should be conducted to get your heart rate and your muscle groups active. Low-stress exercise such as jogging in place is typical for a warm-up. This should be followed by a stretching routine. Following a warm-up and stretching, the intensity of exercise can be increased more safely.
What should a person do first if he or she twists an ankle, knee, or other joint?
Injuries happen within a spectrum of severity. At one extreme, a very small sprain to an ankle can occur while walking in the street and some mild soreness may resolve on its own within days, but, at the other extreme, a twisting injury to a knee could result in major ligament damage and require surgery. As a general principle, if the pain in the injured extremity is to the degree that you’re unable to walk normally and without a limp, then you should seek medical evaluation.
How does one know when or for which kinds of injuries to apply heat/ice or alternate between both?
Generally speaking, acute injuries should be treated with ice. Heat is often used for stiffness issues such as can occur in the neck or lower back.
Do you see a lot of kids and teens being injured when playing baseball and what do you think accounts for these injuries?
I have witnessed a tremendous rise in youth injuries over the past several years. In fact, I just published and article on the rise of Tommy John surgeries over the last 10 years and the age group that has seen the greatest increase in injuries is our young adolescent athletes. The factors are related to early sports specialization and training intensity. Baseball is a sport that, unfortunately, has inherent risk for shoulder and elbow injuries. Over the past several years, younger kids are throwing harder, more often, and without adequate rest and recovery periods. Often, these young athletes have numerous coaches and play on numerous teams. Their young bodies and arms are in need of recovery periods and when they do not have rest periods, they sustain injuries such as shoulder, rotator cuff, and labral tears, as well as elbow-ligament tears and growth-plate injuries.
Have you seen any research about baseball injuries in kids and teens?
I have conducted several research studies to better understand the injury risk in young baseball players. First, many players and families have limited knowledge of the fact that overuse is a major risk for injury. One recent study found that approximately 30 percent of coaches and 25 percent of parents were unaware that overuse could cause injury. A second major study found that as many as 75 percent of kids playing baseball experience arm pain and 50 percent were encouraged to play through the pain. Kids who play with arm pain are at great risk for injury.
How can the number of injuries be reduced?
Education is a simple and effective way to reduce injury in our young athletes. I have co-founded an organization called Baseball Health Network www.baseballhealthnetwork.com, which has a mission to enhance the safety of youth baseball players through education. The educational material is unique in that it allows for baseball performance to fully develop but with safe principles to reduce injury. The material was developed by a team with a variety of expertise, including physicians, sports-medicine specialists, baseball coaches, athletic trainers, and strength and conditioning experts.
What does your role as head team physician for the Yankees entail?
The responsibilities as a head team physician for any team are enormous and the Yankees present even greater challenges. I manage all aspects of medical care for the team, including the players, coaching staff, and, often, their family members. I have a team of medical specialists including two internists—William Turner, MD, and Paul Lee, MD—who make up the dream team of healthcare for the Major League club. In addition, we have physicians that assist me by taking care of the Yankees minor league affiliate teams. My phone is on 24 hours a day, seven days a week to manage any injury or issues that occur in a major or minor league players any time of the season or offseason. In addition, I attend spring training in Tampa, Florida, and perform physical examinations on the players prior to their first day of practice. Finally, I perform medical and orthopedic evaluations for potential Yankees players who are acquired through the draft, free agency, or trades.
During the season, I attend each of the 81 home games at Yankee Stadium and care for player injuries that occur during play, and I travel with the team during post-season play. A typical day at the stadium would entail evaluating several players with insidious injuries such as a starting pitcher who developed some shoulder soreness following his pitching the day prior. I also evaluate players with more serious injuries, such as when Derek Jeter fractured his ankle in 2012 or when Ivan Nova tore his ulnar collateral ligament of his elbow.