Low Impact Exercise

As we age past 40, our bodies lose muscle mass and bone density. So it is certainly wise to exercise in order to maintain as much muscle mass and bone density as possible.

That being said it’s important to listen to your body. In our 20’s and 30’s, the mantra for exercise is “no pain, no gain.”

I would suggest that after 40 you should listen to your body. If a certain exercise hurts, you may want to modify, decrease reps or even discontinue it altogether.

Safe low impact exercises include biking, ellipticals, rowing machines, yoga, Pilates and pretty much anything in a pool.

So try to implement some of these into your regular routine!

-Kenneth Grinspun, M.D

Female Athlete Triad: Problems Caused by Extreme Exercise and Dieting

Female Athlete Triad: Problems Caused by Extreme Exercise and Dieting

Sports and exercise are healthy activities for girls and women of all ages. Occasionally, a female athlete who focuses on being thin or lightweight may eat too little or exercise too much. Doing this can cause long-term damage to health, or even death. It can also hurt athletic performance or make it necessary to limit or stop exercise.

Three interrelated illnesses may develop when a girl or young woman goes to extremes in dieting or exercise. Together, these conditions are known as the “female athlete triad.”

The three conditions are:

  • Disordered eating
  • Abnormal eating habits (i.e., crash diets, binge eating) or excessive exercise keeps the body from getting enough nutrition.
  • Menstrual dysfunction

Females at Risk

Females in any sport can develop one or more parts of the triad. At greatest risk are those in sports that reward being thin for appearance (such as figure skating or gymnastics) or improved performance (such as distance running or rowing).

Others feel pressure to lose weight from athletic coaches or parents.

Female athletes should consider these questions:

  • Are you dissatisfied with your body?
  • Do you strive to be thin?
  • Do you continuously focus on your weight?

Female Athlete Triad

Disordered Eating

Although they usually do not realize or admit that they are ill, people with disordered eating have serious and complex disturbances in eating behaviors. They are preoccupied with body shape and weight and have poor nutritional habits.

Females are five to 10 times more likely to have disordered eating compared with males, and the problem is especially common in females who are athletic. The illness takes many forms. Some people starve themselves (anorexia nervosa) or engage in cycles of overeating and purging (bulimia).

Others severely restrict the amount of food they eat, fast for prolonged periods of time or misuse diet pills, diuretics, or laxatives. People with disordered eating may also exercise excessively to keep their weight down.

Disordered eating can cause many problems, including dehydration, muscle fatigue and weakness, an erratic heartbeat, kidney damage, and other serious conditions. Not taking in enough calcium can lead to bone loss. It is especially bad to lose bone when you are a child or teenager because that is when your body should be building bone. Hormone imbalances can lead to more bone loss through menstrual dysfunction.

Menstrual Dysfunction

Missing three or more periods in a row is cause for concern. With normal menstruation, the body produces estrogen, a hormone that helps to keep bones strong. Without a menstrual cycle (amenorrhea), the level of estrogen may be lowered, causing a loss of bone density and strength (premature osteoporosis).

If this happens during youth, it may become a serious problem later in life when the natural process of bone mineral loss begins after menopause. Amenorrhea may also cause stress fractures. Normal menstruation is necessary for pregnancy.

Doctor Examination

Recognizing the female athlete triad is the first step toward treating it. See your doctor right away if you miss several menstrual periods, get a stress fracture in sports, or think you might have disordered eating.

Give the doctor your complete medical history, including:

  • What you do for physical activity and what you eat for nutrition.
  • How old you were when you began to menstruate and whether you usually have regular periods.
  • If you are sexually active, use birth control pills, or have ever been pregnant.
  • If you have ever had stress fractures or other injuries.
  • Any changes (up or down) in your weight.

Your doctor will give you complete physical examination and may use laboratory tests to check for pregnancy, thyroid disease, and other medical conditions. In some cases, a bone density test will be recommended.


Treatment for female athlete triad often requires help from a team of medical professionals including your doctor (pediatrician, gynecologist, family physician), your athletic trainer, a nutritionist, and a psychological counselor.


Last reviewed: October 2009

Co-developed with the American Orthopaedic Society for Sports Medicine

Shawn Matsunaga, ATC


Shawn Matsunaga received his degree in Physical Education/Athletic Training from California State University Dominguez Hills in 1993. He began his career working for a prominent surgeon Dr. Karlan Michelson. In addition to working for Dr. Michelson, he also worked as an assistant athletic trainer for California State University Los Angeles from 1994-1999. He relocated to Bartlett, Tennessee and began working for the University of Tennessee at Memphis as a senior research assistant. Upon completion of the study, he became an athletic trainer for the Memphis City Schools. In 2006 he became a Certified Specialist in Health Ergonomics. That same year he started his own company called The Ideal Connection which deals with ergonomics/wellness consulting. He was able to help many different types of employees from Delta, Fedex and Accredo Pharmaceutical achieve their goals. Shawn enjoys spending time with his family, snowboarding and fishing.

Female Athletes at Increased Risk for ACL Injury

Female Athletes at Increased risk for ACL Injury

Over the past decade the speed, power and intensity displayed by female athletes has increased making them 2-10 times more likely to sustain a knee ligament injury such as an anterior cruciate ligament (ACL) injury. More aggressive styles of play has led to an increase in musculoskeletal injuries especially in female athletes who participate in jumping and pivoting sports such as soccer, basketball and volleyball.


Most ACL injuries occur by non-contact mechanisms:


  •  One-step/stop deceleration
  • Cutting movements
  •  Sudden change in direction
  •  Landing from a jump with inadequate knee and hip flexion
  •  Lapse of concentration (resulting from unanticipated change in the direction of play)

There is no easy explanation as to why female athletes are more prone to non-contact ACL injuries. Research shows that female athletes run and cut sharply in a more erect posture than men, and they bend their knees less when landing from a jump. There is also debate on the opinion that another explanation could be the anatomical and hormonal differences between men and women. Another cause is a wider pelvis. Women have a “Q” angle, which makes the thigh bone angle downward more sharply then in men. This alignment makes women’s knees bend more inward when they land which could predispose women to ACL injuries.

Recent studies tells us that the rate of ACL injuries among women can be reduced by following a proper neuromuscular training and conditioning program called Prevent Injury and Enhance Performance (PEP) ( before practices and games. The PEP program consists of a series of 19 warm-up, stretching, strengthening, plyometric, and sports specific agility exercises that can be done in 30 minutes without any specialized equipment.

In general, experts say that there are four ways to reduce the risk of ACL injuries:


  •   Proper leg muscles strength training and core training
  •   Proper neuromuscular (balance and speed) training
  •   Proper coaching on jumping and landing and avoiding any straight knee landing
  •   Proper footwear that gives optimal traction to allow peak performance in sports with cutting and stopping

Reference: American Academy of Orthopaedic Surgeons


Bob Dunaway, ATC



Bob graduated with a B.S. Degree from Memphis State University in 1988. He became a Certified Athletic Trainer January 1990, and has worked in sports medicine outreach with area high schools and college level athletics since graduation. He served as the Athletic Trainer for world basketball league Memphis Rockers for two seasons & has been with Memphis Orthopaedic Group since 2011. Bob covers St. Mary’s Episcopal School and Southwest Tennessee Community College. He is a Certified Instructor Trainer for the American Heart Association Certified Ergonomic Specialist.

Prevent Pain Throughout Your Body By Taking Care Of Your Feet

Did you know your can prevent or reduce acute and chronic pain throughout the entire body merely by taking care of your feet? Your feet are the gateway to what is known as the kinetic chain. The kinetic chain is what the National Academy of Sports Medicine defines as the relationship or connection between your nerves, muscles and bones. In other words, how you walk/run (correctly or incorrectly) determines how your muscles, bones, and nerves respond to that stress.  Since your body is linked together, your feet can be the cause of pain in your knees, hips, back, and even your neck. Approximately 24% of adults have foot ailments, and the prevalence increases with age.

The first step and most obvious way to help is your footwear. Proper footwear should: smooth out gait inefficiencies, be flexible and durable, provide shock absorption, protect and adapt to uneven terrain, control motion, and prevent injury.  When selecting footwear you should consider all of these factors, especially with store bought shoes. Footwear can be customized to the specifications and needs of the individual, often times through a foot specialist or Podiatrist. In addition to footwear, an individual should also consider getting fitted for a custom orthotic. Orthotics are shoe inserts which support and align the foot and lower extremities, and are usually formed by making a plaster mold of the foot. Non-custom orthotics can also be found in foot/shoe stores but are generally not as effective as custom made orthotics. Ideally, orthotics should improve balance, re-align anatomical structures, control bio-mechanical function, accommodate foot deformities, and re-distribute external and internal forces.

Foot pain, particularly as it relates to shoes, footwear and arthritis-related disorders may be an important modifiable factor. Emerging research suggests that there may be a significant role for foot orthotics and footwear in the treatment of rheumatoid arthritis and osteoarthritis of the hip, knee and foot. Bio-mechanical evidence indicates that foot orthotics and specialized footwear may change muscle activation (muscles we use when we walk) and gait patterns (how we walk) to reduce the stress placed on our joints.


Mac JuVette

Mac Juvette, Athletic Trainer

Union University Graduate – B.S in Athletic Training

Mac has been with Memphis Orthopaedic since 2013 where he currently serves as an ATC to LeMoyne-Owen College and local high schools in Tipton County including Munford High School. He has a passion for serving the youth and local community with a dedication to providing care and assistance to the injured and the healthy.

Sports Hydration for Health and Performance

During sporting practices and events it is imperative for athletes to stay hydrated not only for health reasons but also for maximum performance. Dehydration can lead to life threatening conditions such as heat exhaustion or heat stroke if not treated and can lead to decreased  performance at the basic level.  Heat illnesses can range from heat cramps and heat exhaustion to heat stroke that can be fatal. All types of heat illnesses need to be recognized and properly treated quickly to decrease the severity of the situation.

Signs of Minor Heat Illness:

  • -Dizziness
  • -Cramps, muscular tightening and spasms
  • -Lightheadedness, when not associated with other symptoms

Early Warning Signs of Exertional Heat Exhaustion/Heat Stroke:

  • -Headache, dizziness, confusion and disorientation
  • -Excessive Sweating and/or flushing
  • -Fatigue
  • -Nausea and/or vomiting
  • -Chills and/or goose bumps

Signs of Exertional Heat Stroke:

  • -Core body temperature of more than 105 degrees
  • -Signs of nervous system dysfunction such as confusion, aggression and loss of consciousness
  • -Increased heart rate
  • -Rapid breathing
  • -Seizures
  • -Low blood pressure

Fluids should be consumed before, during and after practices and games to help prevent any heat illness from occurring and to replace fluids lost during activity. On average athletes should consume 200-300 milliliters of fluids every day.

A good way to measure how much fluid an athlete should consume after practices is a weigh in and weigh out chart. Athletes weigh in before activity starts and then weigh out after they have concluded the activities.  For every pound lost during activity an additional 16 ounces should be consumed on top of what the athlete already is consuming. The goal is for the athlete’s weight to be back to the starting weight by the next practice. This ensures that the athlete is properly re-hydrated.

The easiest way to determine if you are properly hydrated is the color of your urine. It should be light like lemonade.

Lori Conklin, MOG Staff Athletic Trainer, graduated from Lenoir-Rhyne University (Hickory, NC) in 2006 with a B.S in Athletic Training and a B.A in K-12 Physical Education. Shortly after graduation she became Head Athletic Trainer at a local high school as part of an outreach program with Carolina’s Medical Center for 3 years before relocating to Memphis in 2008. Lori worked with Baptist Rehabilitation Germantown covering St. George’s Independent School from 2008-2010. Lori has been Head Athletic Trainer at Arlington High School for the past 5 years and has been with Memphis Orthopaedic Group since September 2013. Lori is also a part of an elite group of Athletic Trainers that covers a World Championship Cheerleading Competition that is held in Atlanta, Ga. annually.


Hey Trainer!!! Do I Have To Wear A Mouthpiece?

Hey Trainer!!! Do I Have To Wear A Mouthpiece?

My name is Jay Phillips and I am a Certified Athletic Trainer. I want to talk briefly about mouthpieces and why they should be worn. There have been numerous studies that have been done by the American Dental Association and the Academy of Sports Dentistry that reveals a reduction is oral/facial injuries when athletes use a mouthpiece. Equally the National Federation of State High School Associations (NFHS) mandates the use of these devices in football, field hockey, ice hockey, lacrosse and wrestling (for wrestlers wearing braces).

The NFHS States before there was a mandate for athletic wear of the mouthpiece, that 50% of football player injuries were facial/oral and since the mandate the number of occurrences has dropped to 1%. The TSSAA adopted resolutions in 2006 that mandates mouthpieces in all TSSAA contact sports.   Mouthpieces should protect the entire biting surface of the teeth. It is widely acknowledged that mouthpieces should be properly fitted to the individual athlete and that the one size fits all is not always the best. An athlete should be able to speak if the mouthpiece is properly fitted.

So, the answer to the question of if a mouthpiece should be worn is a resounding yes! But, it is still up to the parent and student athlete to select the correct size and type of mouthpiece.



Hey Trainer! My Helmet is Too Big!

Hey Trainer!!! My Helmet is Too Big!


My name is Jay Phillips and I am a Certified Athletic Trainer. I want to talk briefly about helmets and why it is important to make sure they fit correctly. As fall sport’s season progresses, all athletes that wear helmets must be mindful of the movement of the helmets that they wear for their sport. Here are some tips to make sure that your helmet fits correctly:

  1. Measure Head Size: Using a tape measure, measure the head from above the brow to around the temples and at around the occiput (larger back portion of the head) back to above the brow.
  2. Confirm Helmet Size based on your Measurements:
Size Hat Size Circumference
S Up to 6 1/2 Up to 20 3/8″
M 6 1/2 – 7 20 3/8 – 22″
L 7 – 7 1/2 22 – 23 1/2″
XL 7 1/2 and Up 23 1/2 and Up

3. Putting on Helmet: Place thumbs over the base of the ear pads and gently lower helmet onto head at a considerable angle so that the ear pads 1st touch the temple.

4. Adjusting Fit: Inflation of the helmet is not always needed. Only use if the helmet does not fit properly.

  • Use an inflation bulb and a proper inflation needle
  • Add air to obtain a comfy fit
  • Ear pads should be comfortably fixed next to players face

5. Checking for Proper Fit:

  • Front of helmet should be 1” above players eye brow
  • Interlock hands over helmet and firmly press down unto head. The skin of the front head should move with the front pad
  • There should be no twisting of the helmet when pressure is applied
  • Remember that the pressure of the helmet should be felt at the crown of the head not the brow
  • Never wear a helmet that rests too high on the head or too low on the head

6. Attaching Chin Strap: Make sure that the chinstrap is at the middle of the

chin and comfortable over the chin

7. Taking Off Helmet: Unlatch the bottom button of the chin strap and then

gently press thumbs into ear pad and lift helmet off.




It’s Back-to-School Time: Lighten Your Load


With a bursting school curriculum and more gadgets than before, kids today could be experiencing the effects of a heavy backpack. The American Academy of Orthopaedic Surgeons (AAOS) and the Pediatric Orthopaedic Society of North America (POSNA) urge parents and kids to consider safety first to avoid backpack-related injuries.
According to the Consumer Product Safety Commission (CPSC) more than 24,300 individuals were treated in hospitals and doctors’ offices for injuries related to backpacks in 2012, and more than 9,500 of those injuries were kids 5-18 years old.

“Backpacks are designed to distribute the weight of load among some of the body’s strongest muscles,” said orthopaedic surgeon and AAOS spokesperson Michael Wade Shrader, MD. “But, when worn incorrectly, injuries such as strains, sprains and posture problems can occur. While some of these injuries can be minor, others can have a lasting effect on kids, and follow them into adulthood.”

AAOS and POSNA recommend the following tips to help eliminate discomfort and reduce the risk of backpack-related injuries. 

  • Kids should carry no more than 15-20 percent of their body weight.
  • Use both shoulder straps to keep the weight of the backpack better distributed and adjust the shoulder straps to keep the load close to the back.
  • Remove or organize items if too heavy and pack the heavier things low and towards
    the center.
  • When lifting backpacks, bend at the knees.
  • School backpacks are for schoolwork. Carry only those items that are required for the day; if possible, leave books at home or school.
  • At home and at school, keep walkways clear of backpacks to avoid tripping.

    Parents also can help with backpack-related pain:

  • Encourage your child or teenager to tell you about numbness or tingling in the arms or legs which may indicate poor fit or too much weight being carried.
  • If the backpack seems too heavy for the child, have them remove some of the books
    and carry them in their arms to ease load on the back.
  • Purchase a backpack appropriate for the size of your child.
  • Watch your child put on or take off the backpack to see if it is a struggle.
  • Encourage your child to stop at their locker throughout the day as time permits to drop off heavier books.