Archive for the Sports Medicine/Injuries Category

The “perfect” patient – a bodybuilder

Posted in Sports Medicine/Injuries with tags , on February 15, 2008 by Dr. CJ

In contrast to the morbidly obese child I talked about yesterday, I had the ultimate patient later in the day yesterday – perfect for discussion of a few points.

25-year-old guy with a shoulder problem, big-time weightlifter/bodybuilder, noticed that his one arm just couldn’t do as many reps of dumbbell military presses as his usually-weaker opposite arm.


First off (vital signs being “vital”, after all), his BMI was a terrible reflection of his body composition. He had a BMI of 32.  This is a perfect example of the limitations of measuring BMI, for this guy was nothing but muscle.  Since the BMI is blind to body composition, it appears on paper that he is “obese”, but nothing could be further from the truth. 

Secondly, even in the setting of an apparent injury, he is capable of far more physical strength than any other patient I have on their best days.  Only because he is so “in tune” to his body’s capabilities was he aware that there was indeed a problem.

Finally, he is motivated to fix this on his own; he simply needed advice as to what the problem was and how to go about fixing it.  He did indeed have a problem in the shoulder, something that would respond to either physical therapy/strengthening or possibly an injection.  Presented with the options, he much preferred fixing it by himself with progressive strengthening, so I spelled out a regimen for him to perform in the gym. 

In contrast, the majority of patients I see want the “quick fix”, citing all sorts of excuses as to why they can’t participate in physical therapy or even do the exercises at home on their own.  Athletes don’t want any setbacks in their regimen and are more than willing to accommodate an injury by altering their activity rather than avoiding activity or opting for a “quick fix” which has potential for significant adverse effects.  I knew he wouldn’t accept a recommendation to stop weightlifting until his shoulder felt better – that would be ludicrous to a guy like this who is in the gym every day.

This was certainly a refreshing patient encounter after wanting to beat my head against a wall about the “fat kid” with a neglectful guardian.  I don’t expect everyone to be like this, but I do believe that people need to be more proactive about their health by aiming to fix the underlying problem rather than asking for that “Band-Aid” solution to cover-up their pain. 


I love DOMS (Delayed-Onset Muscle Soreness)

Posted in Sports Medicine/Injuries, Transformation on January 7, 2008 by Dr. CJ

I did some squats last night – after a long hiatus, mind you. I didn’t get a full leg workout in last night, butDOMS I made sure to get three sets of squats in before I had to quit. Then, about noon today, I started getting that sweet muscle burn in the thighs – that reminder that I pushed my legs beyond their normal comfort zone, a little pain with each step, gradually worsening throughout the day. Quite possibly among the best feelings in the world. It’s especially sweet when I don’t get it after a few workouts in a row, then I finally push myself hard enough to get it again. I would love to get it after every workout, but some times I just don’t have the energy to push it that hard. I’m going for that again tonight with my chest and triceps. Oh, how I want to hurt by tomorrow afternoon!

The image to the right is an MRI of the upper arm showing increased signal of the biceps one day after a biceps workout. It is a common, well-recognized phenomenon – usually occurs 1/2 to 2 days after exercise, peaks at 1-3 days, and may last hours to weeks. The pain certainly responds well to non-steroidal anti-inflammatory drugs (e.g. ibuprofen, acetaminophen), but why bother with the poisons when not truly necessary. Headache – yes; muscle soreness – let it be. Bring on the natural high.