Search for tag: "fitness"

Interviewer: You've decided you want to eat healthier, maybe become more physically active, or quit an unhealthy habit. The next step is to take action.

But Dr. Jennwood Chen says to succeed, don't try to change too much at once.

Dr. Chen: That intention to make a change needs to be realistic. And for some people cutting a whole liter of soda out of their daily routine is not that realistic. So cutting it down to a half liter a day for a while and then weaning yourself off it is a more realistic thing.

Interviewer: Dr. Chen says making even small changes when adopting new health habits can be hard. You will slip up, but strive for progress, not perfection. And be sure to celebrate when you do make progress.

Dr. Chen: You've got to pat yourself on the back and you should, you know, tell your family, you should tell your friends, and you should be proud of yourself really, you know. And that's how we just do . . . that's how we stay on the path.

Interviewer: So during the summer months, temperatures are rising, people are getting out more, and you might be getting a little concerned about heat exposure and how it might be impacting your health.

We're here with emergency room physician, Dr. Troy Madsen. And Dr. Madsen, when it comes to heat exposure, what do people need to be concerned about?

Dr. Madsen: Well, the biggest thing with heat exposure is just your body overheating. That's where you really start to see issues not just with feeling uncomfortable, but potentially having even a life-threatening situation. Some people . . . you know, you may be familiar with just being out in the heat, you've been hiking or on your bike, or you know, whatever you might be doing, and you're probably familiar with that feeling of just feeling thirsty and tired and maybe a little bit nauseous and maybe a little bit of a headache. Well, at that point, you may be experiencing what we call heat exhaustion. But the big risk becomes when you move beyond that, and your body temperature continues to rise. And then you can experience what's called heatstroke. And that becomes a much more serious thing.

In those situations, your body temperature is often very high. You can have damage to the organs in your body, meaning damage to the kidneys, even potentially the heart, the brain. And in some of those situations, when you hear about these stories of people in places where there is just extreme heat and people are dying of the heat, it is often because of heat stroke that that's happening.

Interviewer: Yeah, we hear about these deadly heat waves and things on the news. And it's, you know, what does that even mean? We're talking like organ damage. Like the heat is getting so high that . . . are you talking brain? Are you talking heart? Who is at risk, and what is it actually doing to the body?

Dr. Madsen: It's exactly that. The body is getting so hot that it is leading to damage and breakdown of the tissues in the brain, the heart, the kidneys. Sometimes part of that is dehydration that's contributing to that as well where that's affecting your kidney function. But in terms of risk, there are a few groups who are really at risk of this. Number one is people who are experiencing homelessness, who may be out in the heat, aren't in a cool place. Other people who are out doing outdoor activities. And maybe you find yourself in a situation where you're out, you're exposed, you know, there's no way to really cool down, maybe you didn't bring enough water along on your hike or your bike ride.

But then there are also certain groups that are really at risk. And these are the very young and the very old. So young babies, infants, and then older people have a tougher time regulating their body temperature. So you might be out, and let's say you take your baby, you know, in a stroller, you're out on a walk, or you go to the zoo or something and you're feeling okay, or maybe you're feeling just a little bit of a headache or a little bit hot. Your baby could be experiencing very severe symptoms in that situation. So if you live with the very young or the very old, just be aware that if you're not feeling great, they're probably experiencing a whole lot more of the heat and much worse effects than you are.

Interviewer: So it sounds like heat exposure affects basically anyone and everyone if you don't, you know, take the right steps. What are some of the ways that a person can, say, prevent heat exhaustion and then later heat stroke?

Dr. Madsen: Well, the biggest thing, you know, is to try and be in a situation where you can cool down. If you're out on a hike or you're out somewhere in the outdoors, try to go in shaded areas, ideally areas that have a water source, something where you can cool down if you need to. Carry plenty of water, you want to make sure you have lots of water with you. The general rule of thumb is 16 ounces of water per hour. I tell people start with at least eight ounces if you're just doing moderate activities. Sixteen ounces can be a lot to carry if you're out on several hours, but try and do that if you can, or at least know where you can get some water.

The big thing I would suggest too is if you have elderly parents, relatives, friends, neighbors, check in on them. One of the sad things that sometimes happens is older people, especially right now, may not have checked their air conditioner, may not know if it's working, or it may work and then it stops working. And sometimes a very sad thing we see is people in this situation then are either embarrassed to reach out for help or don't know who to call for help. And the house temperature gets very hot, and they experience severe symptoms with heatstroke or even death. So check on those people. If you have babies as well, just be aware that they can experience these heat symptoms much more than you may be experiencing at that same time.

Interviewer: So heatstroke, something to keep in mind, something that could be very, very dangerous. ER-worthy if it gets bad enough?

Dr. Madsen: Absolutely, yep. If it's bad enough, if you have a family member or yourself who's just confused, not feeling well, absolutely, get to the ER. Try to get cooled down quickly. Call 911 if you need immediate help.

Interviewer: Learn more about the dance clinic and how it can help you if you're a young dancer, or a dancer that's been doing it for a while. We'll talk about that next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Trina Bellendir is a physical therapist in the dance clinic at University of Utah Orthopedic Center, and today we're going to learn more about the clinic. It's a resource for you as a dancer that hopefully you'll use before to prevent injuries, and if you do have an injury, it's also a place you can go to have that taken care of. So first of all, who is the dance clinic for? Is it just for amateur, professionals, both?

Trina: It is actually for both. Anyone that has an injury or would like to prevent an injury, or they know that there's some dysfunction, or their dance instructor has told them, "You need to work on this," that's what I'm there for.

Interviewer: Okay. So that's a good trigger word, right? If your instructor says, "This is something you need to work on," and you're not able to do it, that would be something you can help them with. Tell me about a typical visit. Who is that person?

Trina: I've had a few that came in with, "You need to work on your arch supports and lifting up your arch," and them not knowing how to attain that arch. So my job is to teach them which muscles to use, how to show them their points on their feet to get those activated.

Interviewer: Got you. Can you give us some other examples?

Trina: Knees over the second toe. Dancers tend to let their knees fall in, so we'd like to have them knees always in line with their second toe to help prevent some of the chondromalacia patella and knee dysfunctions.

Interviewer: And a lot of those dysfunctions, is this true or false, are caused by some sort of a muscle strength imbalance or a flexibility imbalance that you can help with?

Trina: It is. Most of them are muscle imbalances and we just need to do some minor exercises to help them rearrange those.

Interviewer: Got you. So it's for professional dancers as well as amateurs, young and old?

Trina: Young and old. I've seen them up to 50 or 60 and as young as 8.

Interviewer: Got you. And your typical patient, I would imagine, is somebody that comes in that has hurt themselves at some point, and maybe has ignored it for a while because they're hoping it would get better. You would hope to have fewer of those and more people that are coming in more proactively. Talk me through how somebody might know that they should actually come and visit the clinic.

Trina: Any time you start getting just the basic strains, pains type of thing that doesn't go away after you've iced it and rested it for a day or two, those are the type of people I'd like to see in there, preferably before they are unable to dance and the show is tomorrow.

Interviewer: And then for those that come that actually have some sort of a chronic issue, how do you normally work them through that?

Trina: Well, I treat the chronic issue first mainly by treating, getting their symptoms under control. Then we'll look back and see what caused the issue. Not just the ankle, but does it even arrive at the hip or at the back. We need to make sure the entire body is working well together and those muscle balances are correct.

Interviewer: Do you have any sort of technology or tools that helps you analyze dancers? I've been to a runner's clinic before, and I loved the fact that they filmed me. I learned so much from that.

Trina: So I am in a fairly unique position working at the university, that we have a motion capture system that we have in the clinic. We have a force plate that is actually brand new that we can test their ground reaction forces with. We have isokinetic machines for strengthening and testing, as well as what's called a foot mat. It does the pressure sensitive areas of your foot so they know where they're putting the pressure.

Interviewer: So a lot of kind of cool tools.

Trina: We have lots of fun toys over there, yes.

Interviewer: Yeah, to really help somebody through whatever particular issue they might be facing. So if somebody comes in for a visit and they're in the situation, either I guess. Let's talk through both of these. They're looking to do something that they're not able to at this point, or they have hurt themselves and they're looking to rehabilitate. How often does somebody usually have to come back before they start noticing some results?

Trina: I like to see results after the first visit.

Interviewer: Really?

Trina: That doesn't mean that I've got them completely better, but I want to make some changes day one. So maybe not better, but at least a change, so that way we know we're heading in the right direction.

Interviewer: I see. And does insurance cover this?

Trina: Insurance covers most of it. If we take your insurance at the University Orthopedic Center, then your insurance will cover the dance clinic as well.

Interviewer: So really, I mean, it's just great insurance against hurting yourself or being able to enjoy this thing that you enjoy for a long time.

Trina: It is. It's basically your co-pay versus a new pair of dance shoes, which can run anywhere from $50 to $150, $200. So your co-pays $25, $50 even, and it's worth it. I just would prefer to have people come to me early and have me say, "Well, it's just a little strain." I'd rather have that, give you a couple of exercises, treat some of the mechanics that you're doing early, versus waiting until it's a chronic issue and then it's going to take months to get better.

Interviewer: It's a lot easier to untangle that early on, so.

Trina: It is, and I try not to take you out of dance, because telling a dancer they can't dance is awful. So we try to keep you in your sport as long as you can, unless it's too bad.

Interviewer: So really, pay attention to what your body is telling you, and it's a great resource you can take advantage of that is fairly reasonably priced if you have insurance through the U.

Trina: Absolutely.

Interviewer: What about somebody that doesn't have insurance through the U?

Trina: People that don't have insurance through the U, we do take cash pay. We try to be kind with that, and if you pay upfront, it's a 30% discount.

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Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question, on The Scope.

Interviewer: "Where should I start, diet or exercise?" This particular listener wants to get into better shape and wants to know if, you know, it's better to start with fixing your diet first and then moving on exercise, or do you exercise first and then the rest will follow. Certified exercise physiologist Britta Trepp, what do you say? Diet or exercise? What should you start first?

Britta: Both.

Interviewer: All Right. Well, I suppose we should define some terms first. So diet, what does that mean to you?

Britta: Yeah, when we say diet it doesn't mean a one-time diet, but rather a lifetime strategy of healthy eating. So most popular diets should be approached with caution you can talk to a registered dietitian to make sure that it makes sense for you, but healthy diets really aren't low carbohydrate necessarily, extremely low carbohydrate or very high protein. They're well-rounded and myplate.gov is the current recommendations for a healthy diet.

Interviewer: And that's not only healthy in the nutrients you get, but the sustainability of it too. Just being able to maintain that, I mean, it's really hard to do a low carb diet for a long time.

Britta: Right and oftentimes you will see that people will do an extreme diet, and they'll often lose the weight, but then gain it again.

Interviewer: Yeah, is that because they just can't sustain that diet and then all of a sudden, now they're bingeing on carbohydrates?

Britta: Certainly. A lot of the fad diets are low-calorie. They're not surprising when people lose weight if you're actually looking at the diet, but it isn't sustainable long term.

Interviewer: All right, and that resource again for a good diet?

Britta: myplate.gov.

Interviewer: All right. Now, let's talk about exercise. What does that mean? Does that mean I got to go to the gym and be an Olympic power lifter?

Britta: Yeah, exercise really, the American College of Sports Medicine recommends 30 minutes a day of moderate to vigorous activity. Moderate to vigorous means you can hold a conversation, but you might not be able to sing a song, okay? So that's the intensity that we're talking about. Thirty minutes, five days a week.

Interviewer: All right, so when I asked the question, "Where should I start? Diet or exercise?" I would imagine, and I can't speak for this listener, but that's making some assumptions, right? Like diet is going to be super hard so I got to really concentrate, or this exercise part is going to be super hard so I got to really just concentrate on that, but you're saying there's some moderation in there.

Britta: Right, even small tweaks make big changes.

Interviewer: All right, like what for example?

Britta: For example, I worked with a client who is working on changing his body composition, he actually cut out just added sugar for one month and lost 10 pounds of fat. So in addition, to maybe cutting out just one simple thing with a diet to become healthier, you can break up your sedentary time. So these are also small tweaks, if you are able to get up and move every hour, one to five minutes, you are able to accumulate up to 30 minutes a day.

Interviewer: Let's talk a little bit about what the ultimate goal is here. When somebody is asking the question, "Where should I start, diet or exercise?" they're probably trying to change their body composition a little bit.

Britta: Yeah, the ultimate goal is to become a healthier composition. So the numbers on the scale, how much you weigh doesn't tell the whole story. Now, you can weigh quite a bit and actually be composed of mostly muscle which is metabolically active. So we always recommend instead of looking at the scale actually doing Bod Pod body composition test so that you can look at plus or minus 2% what your actual composition ends.

Interviewer: And that's how much fat you have, excess body fat. A certain amount is healthy, but most of us are carrying around probably more than we need to.

Britta: Certainly. Males and females each have separate amounts of body fat that are essential for normal biological processes, but we can track not only where you are now and make small goals and tweaks year after year, but we can also, if you are an athlete, say, "Okay, we're performing really well at this certain body composition and that can be a goal for us moving forward."

Interviewer: Some of the, I think, mistakes that some people make though is they think that losing those numbers on the scale is, like you said, the ultimate goal where they could be really shorting themselves of calories and losing valuable muscle as well. Talk about that a little bit.

Britta: Yeah, so just as with weight loss, diet and exercise are both part of the puzzle. With exercise, cardiovascular activity as well as strengthening activity are essential. So we could act like a gerbil on a treadmill all day long and just zoom, zoom, zoom around. If we are not doing resistance training whether that's body weight exercises or standard lifting in a gym, we will lose some of our muscle mass and that is honestly very metabolically active. It is good to keep.

Interviewer: So an answer to the question, "Where should I start? Diet or exercise?" You should do both.

Britta: Yes. The research says that both are the most beneficial for weight loss.

Interviewer: Got you. And if you need some help who would you recommend somebody get in touch with?

Britta: Yeah, here at the University of Utah we have a clinic called PEAK Health and Fitness. We have registered dietitian as well as certified exercise physiologists, and they can work together to come up with a program for you so that you can get on the right track.

Interviewer: And for those that aren't in this area try to find a similar resource probably in your own community and I think probably one of the most helpful parts of that is you have a plan in front of you then.

Britta: Certainly, yeah. It's often very good to track. It'll keep you honest. So I know on my desk I have a little, it's actually a little black book, that I track my weekly exercise and I see every day, and I open it up and I know that I want to add more to it. So it's very visible in my life.

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Interviewer: Coming up next we're going to talk about a common hiking hazard and how to make sure it doesn't happen to you. That's next on The Scope.

I want you to think about it. When you go hiking, what problems do you normally run into? Maybe sore feet, tired legs, blisters. Pretty common problems, but today Dr. Emily Harold, a sports medicine specialist at University of Utah Orthopedic Clinic, is here to tell us about one of the more common hiking problems that isn't something that a lot of people really think about, and that's dehydration. And when I heard about this I'm like, "Really? Dehydration? Don't we all drink enough water? It seems like everybody's got a bottle of water."

Dr. Harold: Well, I think we all drink some water. I think that we don't all drink enough water. I mean, I think that we are blessed to live in a great state that has an amazing climate, and it's a very low humidity climate. And because it's a low humidity climate, when you're outside and it's hot outside and the sun's beating down, a lot of times your sweat dries quicker and you don't really realize how much you're sweating. And it can almost be pleasant when it's 80 degrees outside in this environment versus 80 degrees in Houston, Texas, in which case everybody knows they're sweating.

And so a lot of times people are sweating more than they realize and they're losing more water than they realize and they don't replenish enough, and that can lead to headaches, and tiredness, and in extreme forms can even lead to things like heat exhaustion, heatstroke, which can cause a lot of damage over time.

Interviewer: So if I was just going out for like an hour or two hike, do I really need to take water? Is that enough time to start getting symptoms of dehydration?

Dr. Harold: It's enough time. We would recommend at least a quart an hour. So if you're going to go out for a two-hour hike, one, we recommend probably drinking a liter before you go. And then while you're out, at least a quart an hour while you're out. More if you are running, trail running, doing activities that are more than just walking.

Interviewer: You've covered more endurance-based events like marathons and whatnot, and you say that it can really be common in those events. Explain that a little bit.

Dr. Harold: It's a common problem. A lot of times in marathons, people are out on the course for four, five, six hours. On a hot day, they don't drink enough fluid when they're out running and a lot of times when they come in after they cross the finish line, they can have some dangerously high body temperatures, 103, 104, 105. And so we really kind of institute a rapid cooling part and we try to give IV fluids for hydration, but it's very important that you drink enough water, especially when the temperature gets up above 70.

Interviewer: And when that sun's out, is it even worse?

Dr. Harold: Yeah, because the sun dries the sweat off a little quicker, and so you don't get the same cooling effect as you get when it's a little cloudier.

Interviewer: So drinking water, very easily preventable of dehydration. What about extra salt in those situations?

Dr. Harold: It is recommended that if you're out for more than an hour that you do ingest some salt.

Interviewer: Really? And above and beyond what I would normally get in my diet?

Dr. Harold: I think that's why trail mix became so popular. Because people realized if they went walking for a long time, that salt that comes from peanuts and that kind of thing can actually help to retain some of that water that you're drinking, and that helps to replenish their water stores a little easier.

Interviewer: Gotcha. And then also we're talking about kids. If you go out hiking for a couple hours with kids, that has a different effect on a kid than it might an adult.

Dr. Harold: Exactly, and if you're like my kids, you like to run ahead and you're constantly exploring. So you're not drinking water and no matter how much you tell them to drink water, by they time they're to start drinking when they're thirsty, they've already gotten a little bit dehydrated. So it gets really important just to watch your kids' water bottles. I usually recommend bringing a water bottle for each kid and having them drink from it, so you can monitor how much they're consuming.

And if you get somewhere and you realize they haven't really drunk very much water at all, then you can push their fluids a little bit just to keep them from getting dehydrated.

Interviewer: How often does heat exhaustion and heatstroke really lead to things? I mean is that not too common, more common than I might think?

Dr. Harold: I think both. I think we'll see a lot of hyperthermia or high temperatures sometimes in the emergency room. Usually if you catch them early and you cool people quickly, it doesn't lead to bad outcomes. Now if you have someone who is in Canyonlands or Moab and gets lost and wanders, that's something that can lead to heatstroke and it can lead to some, exactly, brain injury.

Interviewer: Just kind of wrap up, then, for myself or for my kids, what would I look for for symptoms to indicate they need to be drinking more water? Or is it just monitor water drinking?

Dr. Harold: I think it's easy enough to monitor water drinking. A lot of the symptoms are kind of difficult. Things like fatigue, they get that when they hike anyway. Headache is a common one. So if your child or you notice that you are starting to get a headache when you're walking, a lot of times that's because you're dehydrated. So that's the earliest one.

Interviewer: So in that instance drink water, get out of the sun for a little bit, rest for how long?

Dr. Harold: Exactly. Find a shady spot.

Interviewer: How long would you want to rest for?

Dr. Harold: Some people find a shady spot, drink some water, you want to rest for probably a good 10, 15 minutes until you start to feel better.

Interviewer: Yeah, and that will start to go away. And then you're fine to go back out again?

Dr. Harold: Absolutely.

Interviewer: I mean, this seems just like one of those topics that I don't think a lot of people think about and a lot of people don't think is really all that serious in their life.

Dr. Harold: Yeah, I think that's my final thought. It's something that I know I could do better at and most of us can do a better job of hydrating, but it is something that can lead to problems and it does make for a much more comfortable walk if you're properly hydrated.

updated: June 16, 2021
originally published: August 24, 2016

Interviewer: Olympians are some of the strongest, fastest, hardest-working athletes in the world, pushing their bodies to the limit. But what's it like for a doctor who takes care of them? That's coming up next, on The Scope.

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: I'm here with Dr. Willick, and he is a sports medicine physician at the U. He's worked with the international Olympic and Paralympic medical communities and has worked with some athletes himself. When you're working with an athlete, what kind of considerations do you have to take in when compared to, you know, just someone that hurt their leg when they're hiking, or something like that?

Dr. Willick: One special consideration with any athlete who might get tested for doping is that we have to make absolutely, 100% certain we don't make any mistakes when prescribing medications. So for every single medication that we prescribe with an athlete, we always check, double check, and triple check whether or not it is on the prohibited list to make sure the athlete doesn't inadvertently get into trouble. It turns out that a lot of anti-doping violations are actually mistakes made by healthcare providers unknowingly prescribing a prohibited substance to an athlete when they shouldn't.

Another important consideration when you're taking care of elite athletes is, what is their training and competition and travel schedules. We often have Olympic and Paralympic athletes come to clinic who may only be in town for three days. They may be in between one World Cup event and the world championships, for example. Sometimes you have to prearrange things to get a lot done in a short period of time. You have to know when their next major competition is, because that's going to affect your workup and your rehabilitation protocols. For a recreational athlete, for example a hiker, we often have more time for the workup and rehabilitation.

Interviewer: So, with these extraordinarily driven athletes and things like that, what is it like when, you know, maybe they're injured, or, do you ever come up to a situation where they want to compete, and they're going to compete, and it's against what you want, what's best for them? You're saying, "Hey, I'm your doctor, no, you shouldn't be doing this"? Do you ever run into those types of things, or, how do you deal with those?

Dr. Willick: The short answer to your question is yes, of course. We run into that with recreational athletes as well as the world's best athletes. People want to do their sport, they want to continue being active, they want to compete. Every case is taken individually. There are times when it might be okay for an athlete to compete with a particular injury, knowing that maybe it'll give them a setback, but if they have one chance to compete in the Olympics, sometimes they just have to go for it.

And that's very different than if you have one chance to compete in the next 5K that's being run in town, knowing that there's going to be another 5K a week later and another 5K a week after that or a month after that. But often, there's only one opportunity to actually compete in the Olympic or Paralympic Games and the fact of the matter is, that can be reflected in the medical decision-making. However, if it is truly unsafe or unwise for the athlete to compete, we absolutely have that discussion with the athlete, along with their coach, sometimes with their family and other members of the team.

Interviewer: So coming up, we have all these people sitting down, watching the athletes, right, and cheering for their country, their favorite athletes, watching their favorite sports and stuff like that. What is something you would want the viewers, our American listeners who are sitting and supporting their country, to know about these athletes? What is something that they should appreciate and know about these athletes?

Dr. Willick: The viewer should appreciate the thousands of hours of hard work the athletes have put in to be on TV at the Olympic or Paralympic Games for a few seconds, or a few minutes, or maybe an hour. Thousands of hours of strength training, and flexibility training, and motor skills training, and meeting with a sports nutritionist, trying to regulate their sleep, meeting with a sports psychologist, and the dozens or hundreds of support staff behind every athlete. From all the specialists, to the coaches, to the coaches they had in their earlier days, and yes, even the medical staff supporting that athlete.

Interviewer: So you'll be watching?

Dr. Willick: I will be watching, yes.

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Interviewer: Dr. Travis Maak is a sports medicine expert and the Head Orthopedic Team Physician for the Utah Jazz. He says a majority of ski injuries happen in the late afternoon, and unfortunately it's during that last run, that one more run. How did you find this out?

Dr. Maak: Part of it was from personal experience, to be honest with you. So I actually was a sort of volunteer ski patroller in my high school days here when I was growing up. It's something that is known to all ski patrollers, that basically . . . ski patrol is in large part about 90% boredom, and that happens from the beginning of the day where you literally just go out and ski yourself because you're so bored, because there's nothing else going on, to about 10% of terror.

That always happens at the end of the day, and sometimes right after lunch. But usually it's from about 3:30 to 5:00 is when everything happens. That's where you basically put your gear on and get ready, because you are going out. It's not an 'if', it's a matter of 'when.'

The reason that happens is it most likely it has to do with two things. One is it's starting to cool down so from a temperature perspective the snow is starting to get a bit harder. It loosened up. It warmed up. It was a little bit softer. During the afternoon it starts to cool down, so it gets a little bit rockier, a little bit skied out, so the terrain itself is more difficult. That's the first thing that is most likely contributing.

But the other contributor is a personal and modifiable factor. You can't change the weather, but you can change yourself. We all want to get in as much as we can, the most bang for our buck. We bought that pass. It may seem a little overpriced, but when you do it, it's fantastic and you want to keep going and get the most out of it.

Basically, it has to do with a muscle fatigue. The ligaments are the structures that hold our joints together. The main injury that we see typically is either a broken bone or a ligament tear. In particular in skiing it's the ACL. The ACL seems to be unfortunately the skier's injury. Generally, the reason it happens is the knee joint has two predominant stabilizers, the muscles, the tendons as one unit, and then the ligaments. Those are separate. The ligaments are literally like ropes. They connect the two bones together.

The muscles are the dynamic stabilizers, so they fire when they're working and you make your knee bend and straighten, and it allows you to do those bumps and do those turns in a perfect fashion. But when muscle fatigue happens, then the muscles aren't working correctly. They aren't firing correctly and they start to get weak and tired. As they get weak and tired, your mind may want them to go, but it's not going to happen because, frankly, you just can't put forth the energy.

So where does that energy go? It doesn't disappear. It goes to the ligaments, and so the ligaments end up taking more energy than they're supposed to and they end up failing and tearing. That's most likely why this happens, because the energy which is dissipated by the muscles can't be because they're tired and fatigued, and so it goes to the next step in the chain.

Interviewer: Do you find that people that are a little bit more muscularly in shape are less likely to have this happen, or at that point in the day is pretty much everybody susceptible?

Dr. Maak: Muscularly in shape is a question that a lot of people take to mean the body builder, giant muscles, and frankly that actually has nothing to do with it. In fact, a lot of people who have those fast-twitch, big muscles end up getting tired quicker. If you look at endurance athletes or athletes that are training for a specific sport, the muscles themselves have become accommodated to a long-term type of energy expenditure.

Skiers, for instance, they train in both strength, the quads, the hams, the lower body strength, but also endurance. Ultimately, that's what we're talking about is endurance. It's the fatigue of the muscle, not the ability to jump really high one time or run a sprint. It's the ability to stay and produce that power and energy over a long period of time, hence the last run of the day.

At the end of the day, it's fatigue. It's training. It's the ability to generate that force required to ski throughout the day. When that ability to generate that force disappears, that's when the injuries happen.

Interviewer: So probably your casual skiers don't have that kind of muscular endurance.

Dr. Maak: They don't. Interestingly, here at the University we've actually produced a skier's program to provide people with sort of an ability to produce that type of power and endurance over a period of time pre-ski season, so that by the time they hit the ski season, they are ready. Their quads are ready. Their hams are ready, and it's a completely different muscle set than happens over the summer when you're out running, you're out doing the type of endurance summer activities, rock climbing, etc. It's totally different for skiing. It's a different muscle group, and if you don't [inaudible] and educate your body to those muscles, you're not going to be able to do it.

Interviewer: So what's your final advice? I mean, you've laid it out that the injuries are happening in the late afternoon. Do you just not do that last run? Do you just slow it down a little bit? What would you tell a skier?

Dr. Maak: At the end of the day there's always one last run. That's unavoidable. So the message that we try to get out here is make that one last run a fun one, and not a potentially serious or a safety issue run. The way to do that, let your body be your guide. You can do all of the things that we've talked about already, which is prepare yourself for the run. Prepare yourself for skiing. Get yourself in tip-top shape as best you can. But also listen to your body.

After lunch, you're going to be a little fatigued. You let things set in. You may slow down the runs. Don't go hit the double black run right after lunch. Instead, maybe start on blues, ramp it back up a little bit. But once 2:30, 3:00 starts setting in, look at your watch, listen to your legs, listen to your body, and instead of going and hitting the double black as the last run, maybe take a groomer. Take a nice, little, smooth one down. Enjoy yourself. You don't have to be a hero at the end of the day. At the end of the day, if you do it that way, you'll be able to come back the day after.

updated: December 14, 2022
originally published: February 17, 2016

Dr. Jones: Personal trainer, athletic trainer, what is the difference and who do I want for me or my daughter? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, fitness and athletic trainers on The Scope.

Recording: Medical news and research from University of Utah physicians and specialist you can use for a happier and healthier life. You're listening to The Scope.

Dr. Jones: We're told we should move more. Women as they age are told they should get some weight training as well as cardio, all these shoulds. But who can be get to help us older ladies push those weights and adolescent girls are performing at increasing levels of athleticism on high school and college teams. Who should be directing their training to make them strong but keep them safe? Today in The Scope studio we're talking with Dr. Amy Powell, a sports medicine specialist at University of Utah Orthopedics Hospital about trainers.
Who trains them, how are they license, and who's the right person for you and your daughter the jock on the college team, or the ski team, or the basketball team, or the track team, maybe not the chess team but maybe? Welcome to The Scope, Dr. Powell.

Dr. Powell: Thank you.

Dr. Jones: So I thought personal trainers were for one person and athletic trainers are for a team but maybe that's too simplistic. So what's the difference between personal trainers and an athletic trainer?

Dr. Powell: I think the biggest difference is that athletic trainers truly are health care professionals and I think a personal trainers are more as coaches, people that can help to make you stronger, make you faster, perform better at your sport or keep you in shape as you age. But athletic trainers are truly health care professionals. They're trained in injury triage, injury management, concussion management, concussion prevention and we use them to help our athletes both stay safe on the courts and the fields and everywhere else and stay healthy.

Dr. Jones: Oh, and how about licensing? Are they licensed differently?

Dr. Powell: They are. The license requirements vary state by state but the state of Utah does have licensed athletic trainers and athletic trainers sit at the end of their four-year undergraduate degree for a board examination that's a national exam, so they're both board certified and licensed by state.

Dr. Jones: I never thought of trainers, well, of personal trainers as being have to triage injury but that's a really big deal for an athletic trainer for a team who should be continuing to get on the court and who should stay off the court.

Dr. Powell: Right. Our athletic trainers here at the University of Utah are really, really important people to help with the initial injury evaluate and we as team physicians fill in for where they need our help.

Dr. Jones: Right. What about practicing jobs? Let's say you've been thinking you're young person and you love sports and you want this to be your career. What are the differences in jobs? Let's say where does the athletic trainer get a job?

Dr. Powell: Yeah. Athletic trainers function at multiple different levels so the classic athletic trainer spot would be with a team at a university, a Division I institution. There are athletic trainers with professional teams. There are athletic trainers with ballet companies and other performing arts like Cirque du Soleil has their own athletic training staff.

Dr. Jones: Oh yeah. How cool is that!

Dr. Powell: We would love to see an athletic trainer at every high school in the state of Utah. That has not happened yet but hopefully it will at some point. Athletic trainers function as a physician extenders in some clinical settings too. So for instance at the University Orthopedic Center we have three or four athletic trainers on staff that help with initial evaluation of injured patients.

Dr. Jones: Oh, oh, maybe one of those are my husband who's kind of a single older athlete with an injury, how cool. So we at Utah are fortunate to have a program in athletic training education here in the College of Health, so how long is it?

Dr. Powell: It is actually a fairly competitive undergraduate program so it's a four-year degree.

Dr. Jones: Whoa.

Dr. Powell: And we also have a graduate program which is a master's degree and a good portion of institutions like ours. Pretty much every athletic trainer that works with our student athletes has a master's level degree.

Dr. Jones: Wow, okay, it's a career.

Dr. Powell: It's a career.

Dr. Jones: Right. So that sports teams for the girls college basketball should have a certified athletic trainer but how about of us older ladies who need help in the gym to show up and push a weight or something, who should we have?

Dr. Powell: I think on that situation a personal trainer will be a really great fit. So personal trainers have different certificates that are given by different governing bodies. One of them are commonly known ones as the American College Sports Medicine and there are different levels of personal trainer’s certifications. You can be a certified strength coach. You can be a certified personal trainer, those don't typically require a four-year degree, some do some don't. And so the level of training is a little bit more variable than the athletic trainers who go through a four-year full degree program and have a very set curriculum regardless of where you train.

Dr. Jones: Great. Now the chess team. There's a growing body of evidence that vigorous exercise makes the brain work better, for science, problem solving, and probably chess and this is true for six-year olds and 60-year olds. So maybe the chess team needs an athletic trainer? Dr. Powell, what are your thoughts on that?

Dr. Powell: Or maybe we should just send the chess team out to run a few laps before their big competitions.

Dr. Jones: Right.

Dr. Powell: That would be my suggestion first.

Dr. Jones: Okay. Stay strong, stay safe, and stay smarter and thanks for joining us on The Scope.

Recording: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.