Written by Lauren B. Johnson
Photographs by Sarah Westmoreland
Embrace it! Longer days and mild temps are enticing us all to get active outdoors. Read on for how to lean into that oh-so healthy inclination while keeping your muscles and joints free of pain
A good outdoor workout during the Lowcountry spring is hard to beat. The fresh air filling your lungs isn’t yet sagging under summer’s humidity. Your muscles feel loose in the warm sunshine. And as you survey the radiant landscape, feel-good endorphins flood your brain. Whether you’re biking or hiking, hitting the links or swimming laps, the exhilaration of finding your springtime stride after weeks of winter can make you feel unstoppable.
While exercise keeps our bodies fired up—it is, in fact, one of the greatest controllable factors in preventing disease—upping our physical activity also poses the potential to generate some pesky pains in our muscles and joints. The following pages will give you the rundown on a range of favorite warm-weather pastimes—tennis, running, golfing, cycling and swimming—breaking down both their health benefits and potential orthopaedic pitfalls. Roper St. Francis Healthcare affiliated orthopaedic surgeon Robert Schoderbek and sports medicine manager Kyle Prothro weigh in on the best course of action for treating these musculoskeletal trip-ups, and share tips for warding off pain before it strikes.
The Benefits Package
It’s common knowledge that exercise reduces stress, builds muscle and lowers body fat, but did you know that logging the recommended 150 weekly minutes of aerobic activity may also reduce your mortality risk by as much as 32 percent? (So found research from the American Medical Association.) In fact, the CDC reports that netting adequate exercise could prevent one out of every 12 deaths in the nation. A regular workout routine can also improve brain health and mood, lower rates of chronic disease, help maintain mobility as you age and reduce inflammation throughout the body.
This mild season is the perfect time to shift your aerobic activity outdoors, which in itself can yield increased activity levels. A study published in the International Journal of Behavioral Nutrition and Physical Activity reports that exercising outside increased participants’ activity output by an average of 30 minutes per week.
FEELING SLUGGISH? Skip the afternoon latte or energy drink and head outside. Research shows that being in nature boosts energy levels among nine out of 10 people.
When Injuries Strike
All those health benefits should have you pumped to get your heart pumping again, but take care not to let your enthusiasm run away with you. After a sedentary season, diving back into a sport too quickly can set you up for a variety of orthopaedic woes, from sprains and strains to ligament injuries. “Rest is a great thing for our bodies, but it also results in loss of flexibility and strength, increased body fat and decreased cardiorespiratory endurance,” says Prothro. Dr. Schoderbek adds, “When our bodies are stationary for long periods, the muscles and tendons shorten and tighten, becoming more prone to tearing if not properly stretched.”
Even if you’ve remained active throughout the winter, a spring in your step may cause you to push harder than usual. Perhaps you’re signed up for the Charleston Sprint Triathlon Series (runs May 31-August 9) or have set your sights on swimming the Charleston Harbor during the Lowcountry Splash (May 16), and the warm weather inspires you to step up the pace or frequency of training. “If your body isn’t conditioned for the duration or intensity at which you are trying to perform, you’re more prone to strains and sprains,” says Prothro. Both injuries refer to the stretching or tearing of tissue; strains involve muscles or tendons (the latter of which are tissues that attach muscle to bone), while sprains involve joint ligaments (the tissues that connect two bones).
Don’t let that hold you back, though; the health benefits of participating in your favorite sport nearly always outweigh the risk of orthopaedic injury. The key is to take preventive steps beforehand (keep reading for those) and to know how to respond should pain crop up. Toward that end, Dr. Schoderbek and Prothro have shared the most-common ailments associated with our favorite spring activities.
If you’ve cheered from the grandstands of the Volvo Car Open, now Credit One Charleston Open, you’re familiar with the ace athleticism derived from a regular tennis practice. The game’s fast pace and constant volley build cardiovascular strength, improve mental alertness and boost agility and flexibility. However, its explosive nature can also take a swing at joints in both the upper and lower limbs. “Among tennis players, we commonly see overuse injuries in the wrists, elbows, shoulders, hips, knees and ankles,” says Prothro.
Watch out for…
- Lateral epicondylitis or “tennis elbow”: inflammation of the tendons joining the forearm muscles to bone, resulting in outer arm pain near the elbow and decreased grip strength
- Rotator cuff tear: partial fraying or complete detachment of the muscles or tendons of the shoulder, signaled by pain and weakness, trouble reaching overhead and inability to swing a racket
- Bicep tendonitis: inflammation of the tendons connecting the bicep muscle to the front of the arm, indicated by shoulder pain or pain with an overhead swing
- Meniscus tear: tearing of the cartilage found on top of the tibia in the knee, leading to knee pain, swelling, popping or giving way
- Anterior cruciate ligament (ACL) tear: partial or complete tear of the ligament running diagonally through the knee, signaled by knee instability, pain and swelling
Agnes Pomata, 68
Her pain: After a long weekend of heavy yardwork in mid-October 2019, Agnes, a Wadmalaw Island resident, felt shooting, debilitating pain in her right arm when playing tennis. She took a weeklong break from the sport and tried the RICE method, but when she hit the courts again the pain returned.
Her diagnosis: Rupture of the right distal biceps tendon, diagnosed by Roper St. Francis Healthcare affiliated orthopaedic surgeon Heather McIntosh by way of a physical exam and MRI.
Her recovery: Agnes underwent upper extremity tendon surgery in December 2019 followed by six weeks of physical therapy. In mid-February 2020—much sooner than expected, she notes—Agnes was able to resume her favorite sport.
GET SEEN THE SAME DAY! While many specialists have a two-week lead-time, Roper St. Francis Healthcare offers same-day appointments with more than 40 orthopaedic specialists across the Lowcountry. “In an emergency situation, delaying treatment can worsen the condition,” says sports medicine manager Kyle Prothro. “Seeing patients as soon as an injury occurs allows us to get them back on their feet that much quicker.” No referral is needed unless your insurance requires it. Call (843) 203-2266 or schedule an appointment.
A team of surgeons from the Barrow Neurological Institute Recently dubbed golf a “contact sport,” asserting that the powerful swings practiced by modern golfers exert as much compressive force on the spine as a football block.
With its social nature and beautiful environs, golf’s greatest benefits may be more mental than physical. However, golfers who forego a cart and walk the course get their heart pumping, as well, and net an average of 10,000 steps. While golf may have a reputation as a mild sport, players aren’t free from potential injury. “We don’t engage the muscles required for a golf swing with the power and intensity of a swing on an everyday basis,” says Prothro, noting that increased flexibility and upper-body strength can reduce a player’s risk for injury (as well as their score).
Watch out for…
- Medial epicondylitis or “golfer’s elbow”: inflammation of the tendons connecting the forearm muscle to the inner elbow, characterized by pain along the palm-side of the forearm from wrist to elbow
- Lower back pain: soreness and trigger points (AKA “knots”) caused by overstretching or inflammation in the soft muscle tissue
- Spinal torsion: pressure and twisting within the spine that, when repeated, can lead to chronic lower back pain
- Shoulder tendonitis: inflammation of the rotator cuff or bicep tendon resulting from repeatedly moving the arm overhead
- Meniscus tear: (see tennis)
- ACL tear: (see tennis)
Biking offers similar cardiovascular benefits and leg strengthening as running, only with a reduced jolt to the joints. Outdoor cycling burns more energy than an indoor spin class thanks to wind drag, meaning you could burn some 4,000 calories during Coastal Cyclists’ annual 100-Mile Spring Century ride. While this low-impact sport doesn’t trigger many orthopaedic problems, repeated pedaling can result in overuse pain, and the potential for bike accidents puts head injuries in the risk mix.
Watch out for…
- Iliotibial (IT) band syndrome: rubbing of the connective tissue against the thighbone caused by repeated bending of the knee; indicated by pain and tenderness in the outer thigh, especially above the knee joint
- Achilles tendonitis: inflammation of the tendon connecting heel to calf behind the ankle, increasing the risk of an Achilles tendon tear; tendonitis may also develop in the hip, knee or ankle
- Concussion: a traumatic brain injury resulting from an impact to the head that causes the brain to jostle rapidly back and forth, leading to headache, nausea, blurred vision, memory loss/confusion, balance/coordination problems and neck pain; if symptoms appear after a fall, head straight to the ER
If you’ve hit the pavement for a 5K, 10K or longer, you know the perks of long-distance running. The sport revs cardiorespiratory endurance, promotes weight loss and provides stress relief while also reducing resting heart rate and blood pressure. And according to the Journal of Sports Sciences, running outdoors expends more energy than jogging on a treadmill, making spring the perfect time to step up your routine. “Running is one of the best exercises for overall physical fitness, but it’s not always kind to your joints,” says Dr. Schoderbek, a sports medicine specialist. The high-impact sport most frequently stresses muscles and joints in the legs and lower back.
Flat feet or high arches kick up the risk for shin splints, so wear supportive, shock-absorbing footwear (your best bet is to be fitted at a running shoe-specific shop) and replace your sneakers every 350 to 500 miles.
Watch out for…
- Sprained ankle: stretching or tearing of the ankle ligament due to rolling or twisting and resulting in pain and swelling of the joint or inability to bear weight
- Medial tibial stress syndrome or “shin splints”: repetitive stress to the shin bone and surrounding musculature caused by a sharp increase in exercise intensity/duration, leading to swelling and tenderness along the inside lower leg
- Stress fracture: severe bruising or small crack in a bone, leading to site-specific pain; typically heals on its own, but doctors may prescribe rest for up to eight weeks followed by physical therapy
- Herniated disk: bulge, protrusion or rupture of the cushioning between vertebrae, causing leg and lower back pain (AKA “sciatica”); usually self resolves, but shooting pain down the leg, especially below the knee, is a red flag to see the orthopaedist
- Iliotibial (IT) band syndrome: (see cycling)
Will Ramsey, 33
His pain: Eight miles into the run portion of Maryland’s Eagleman 70.3 triathlon in June 2019, James Island resident Will experienced severe pain along the outside of his right knee. He finished the race, but for months afterward felt the same sharp pain whenever he ran.
His diagnosis: IT band syndrome—a common overuse injury among long-distance runners and cyclists. He ran California’s hilly Big Sur Marathon five weeks before the triathlon and admits that he did not give his body adequate rest between the two races.
His recovery: Dr. Robert Schoderbek recommended multiple months of rest from running and a regular physical therapy regimen focused on strength training throughout his lower body. Will picked his jogging routine back up in January and is on track to compete in Ironman Chattanooga 70.3 this May.
Studies show that time spent in and around water boosts our mental health, delivering some of the same mind-calming effects as meditation. Diving in and propelling your body through that H20 kicks your physical health up a notch, too—torching calories, strengthening muscles (your heart included) and improving lung capacity, all without putting stress on your joints. And with local water temps quickly rising, open-water swimming becomes more viable this season, offering the extra challenge of monitoring currents and maneuvering waves. Swimming is quite low-risk when it comes to injury, making it an especially smart sport for people with arthritis and limited mobility. Even so, improper form or overtraining can cause pain in the upper body, especially within one of the body’s largest joints: the shoulder.
Watch out for…
- Shoulder impingement syndrome: a condition that occurs when the rotator cuff tendons and bursa (fluid-filled sacs that reduce joint friction) get pinched in the bones, causing swelling and inflammation; signaled by difficulty reaching up behind the back, shoulder weakness and pain with overhead movement
- Shoulder tendonitis: (see golf)
- Rotator cup tear: (see tennis)
- Bicep tendonitis: (see tennis)
Treat the Pain
No matter the sport that caused them, most minor sprains, strains and cases of inflammation can be treated at home using basic first aid. Our experts suggest pairing the RICE method (rest, ice, compression, elevation) with an over-the-counter nonsteroidal anti-inflammatory such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve) to reduce swelling and discomfort. “Ice promotes vasoconstriction [a narrowing of the blood vessels] to reduce swelling in the joint. Just don’t apply it for too long, or the blood vessels may start to dilate,” explains Dr. Schoderbek, who recommends icing in half-hour increments every two to three hours.
More extreme ailments warrant a visit to the doc. “If RICE doesn’t reduce symptoms within 48 to 72 hours, or if the pain is unbearable at any point, it’s time to see your primary care doctor or orthopaedist,” says Prothro. X-rays and/or MRIs may be taken to rule out a stress fracture, tear or dislocation. Depending on the severity of the injury, doctors may prescribe high-strength anti-inflammatories, cortisone injections, PT or even surgery. And don’t be surprised to find yourself sporting an immobilizer such as a brace, boot or sling for a few weeks.
Prime your Body
Whether you’re logging miles or matches, swings or strokes, it’s important to increase activity slowly, especially if you cut back on exercise over the winter. “Don’t go out with the expectation that you’re capable of the same level of intensity that you were before taking time off,” says Prothro. “Ramp up gradually and rest when your body gets fatigued. It’s okay to take a day off.”
Another piece of the injury-prevention puzzle is strength training. A Danish study of more than 26,000 adults found that a regular full-body strength regimen reduced one’s risk of injury from another form of exercise by 68 percent. “Not only do resistance exercises add muscle mass and improve bone strength, they also help prevent muscle imbalances, improve balance and body alignment and strengthen the ligaments and tendons that surround joints—all of which can help prevent orthopaedic injury,” says Dr. Schoderbek. The U.S. Department of Health and Human Services recommends that adults perform moderate to high-intensity muscle-strengthening exercises that engage the whole body at least twice a week. That doesn’t have to look like a CrossFit class: body-weight exercises or those with light weights or resistance bands are enough to keep your musculoskeletal system stable.
While it may not be as exciting as cresting the peak of the Ravenel or sinking a birdie, a quick stretch routine can ward off pain, as well. “Stretching before and after exercise can help prevent muscle tears,” says Dr. Schoderbek. “Strong, limber muscles equal happier, better protected joints.”
It’s also key to prep from the inside out. “Hydration is critical for nearly every vital function and acts like coolant in a car for your body,” says Prothro. Especially when you’re exercising for extended periods outside in the sun, it’s essential that you hydrate in advance, take water breaks throughout the activity and replace fluids lost afterward. “Proper hydration is essential before any long run,” says Dr. Schoderbek, who tended to three times as many runners as usual in the med tent at this January’s unseasonably warm Charleston Half Marathon. “A bottle of water won’t get you through 13 miles. Pre-hydrate a week in advance and make sure to balance electrolytes during and after a big endurance event.” Eating water-filled foods helps toward hydration, as well (think watermelon, cucumber, cantaloupe, lettuce). And consuming a nutrient-rich diet helps keep your body functioning at its best across the board.
Don’t hesitate to enlist an expert, especially if you’re inspired to take on an endurance event like a half or full marathon, long-distance swim or triathlon, or are trying to up your game on the court or course. “Discuss your goals with your primary care doctor, an athletic trainer, physical therapist or a coach, who can help you devise a plan to safely increase your activity levels,” says Prothro. And if small but pesky pains do crop up, consider working with a physical therapist or athletic trainer, who can identify and resolve any strength imbalances or postural issues before they cause a major problem. Lastly: “Always listen to your body,” says Prothro. “There’s a big difference between discomfort and pain,” adds Dr. Schoderbek. “Discomfort is expected when pushing your body to new limits, but pain should never be ignored.”
FIELDING YOUTH SPORTS
Springtime also kicks off adolescent sports such as soccer, baseball, lacrosse and track. Play offense when it comes to overuse injuries by ensuring that teen and adolescent athletes have appropriate equipment, take in lots of water and nutritious food and get plenty of rest. “Overuse is a big problem with youth sports, especially when the child becomes sport specific,” says Dr. Schoderbek. “Too much of a single activity can stress the growth plates at the end of developing bones.” The orthopaedic surgeon encourages parents to instead involve their children in a variety of sports across the seasons.
Henry Maloney, 18
His pain: In mid-March 2019, Wando High School lacrosse player Henry was hit from his left side during a game, sending his left leg across his body and bending his knee unnaturally. An orthopaedic expert on the field evaluated him and suspected a torn ACL, which Dr. Robert Schoderbek later confirmed based on a physical exam and the results of an MRI.
His diagnosis: Anterior cruciate ligament (ACL) tear in his left leg and a small tear in his left meniscus
His recovery: In April 2019, Dr. Schoderbek performed anterior cruciate ligament reconstruction patellar tendon surgery—during which a portion of Henry’s patellar tendon (which connects the kneecap to the shinbone) was used to rebuild his ACL. He also stitched up the meniscus tear. Following surgery, he underwent 30 days of physical therapy then continued with PT, strength training and agility exercises at home throughout the summer and fall. In February 2020, he hit the field again.
Here, find a roundup of our favorite spots for outdoor exercising in the Lowcountry’s scenic backyard
- Hampton Park (Peninsula) offers rollers and strollers alike paths winding through 60 acres of lush gardens and around ponds, as well as resistance exercise stations.
- The Arthur Ravenel Jr. Bridge (Mount Pleasant/Peninsula), spanning 2.5 miles one way, has one of the Lowcountry’s only inclines, peaking at a 5.6 percent grade. On the Mount Pleasant side, Waterfront Park has DIY workout stations and grassy spaces for stretching.
- West Ashley Greenway lays out more than 10 scenic miles of mostly paved, flat trail for runners, walkers and bikers.
- Beaches like those on Sullivan’s Island, Isle of Palms, Kiawah Island and Folly Beach offer breathtaking views and endless stretches of firm sand for running or pedaling. The Atlantic also provides miles worth of ocean for open-water swims.
- Charleston Municipal Golf Course (James Island), affectionately called “The Muni,” allows residents of any level to play 18 holes for under $25. The walk-able public course is currently in the midst of a $3 million renovation so will soon be nicer than ever.
- Sawmill Branch Trail (Summerville) affords joggers and cyclists wide, paved paths paralleling a small creek for roughly seven miles.
- Wannamaker North Trail (Goose Creek) challenges mountain bikers and trail hikers with 13 miles of forested, off-road terrain studded by steep hills, sharp curves and an elevated ridge.
- The tennis backboard at Sullivan’s Island’s J. Marshall Stith Park and the easy-on-the-knees clay courts at Mount Pleasant Tennis Complex and James Island’s Maybank Tennis Center rally to be favorites among plenty of public court options.
Photographs by (Will & Henry) Sarah Westmoreland; (Dr. Schoderbek, Kyle Prothro, & Agnes) Samantha Jean Becker; (golfer) courtesy of Wild Dunes Resort; & (biker) Brian Fancher
* NOTE: Dates mentioned throughout may have changed due to COVID-19. Please see the events’ websites for the most accurate scheduling information.