Blog Archives

Blog Archives

Platelet Rich Plasma

Posted by on February 25, 2019

Platelet Rich Plasma (PRP) treatments have become an emerging trend in healing for a variety of orthopedic ailments. While social media is abuzz with the possibilities, the information being shared does not always line up with the realities of what PRP can do. The surgeons of Mid-Tennessee Bone and Joint are familiar with PRP treatments and know firsthand how they work and what the procedure is capable of.

Dr. Scott McCall has performed these specialty treatments in our office and in surgery. The procedure is relatively easy and takes approximately 10 minutes. Blood is drawn from the patient in a routine manner and put into a centrifuge to isolate the plasma. The plasma is drawn up into a new syringe and injected into the patient’s joint, much like receiving a cortisone or viscosupplement injection.

Dr. McCall says the patients who will most benefit from PRP are young and experience tendonitis or chronic inflammation in the knee, foot, elbow, or shoulder (rotator cuff). PRP has been shown to reduce inflammation in those areas and boost healing. Arthritis treatments have long benefited from steroids, such as cortisone, prednisone, and corticosteroids. PRP hasn’t been shown to be as effective in treatment of arthritis.

Even though PRP treatments have been soaring in popularity lately, the technology itself is not necessarily new. Dr. McCall has performed the treatments as part of his surgeries for the last eight years in patients with partial tendon tears. He injects the PRP intraoperatively during surgery to aid in healing and improve recovery time.

It is important to state that PRP is not proven to regrow any tissue, whether cartilage, tendons, or muscle. It also doesn’t help patients whose joints are bone on bone and could benefit instead from a total joint replacement. Additionally, PRP treatment is not a benefit that is currently covered by insurance. The cost of the procedure can vary and is paid out of pocket by the patient prior to the treatments.

Our surgeons are happy to discuss the possibilities of PRP to see how you can benefit. To schedule an appointment, call our office at 931-381-2663.

Visit our Specialties page to learn more about the various orthopedic services our physicians provide!

Cheerleading Safety

Posted by on January 23, 2019

While cheerleading once involved just leading cheers and chants with minimal tumbling and acrobatics, modern cheerleading has greatly evolved. It is much more competitive and involves a highly athletic mix of dance and gymnastic skills, as well as complex stunt and pyramid maneuvers. With these advances, the potential for severe injury has increased. Cheerleading accounts for more than 16,000 emergency room visits annually in the U.S. and more than half of the catastrophic injuries in female athletes. Cheerleading injuries are more likely to occur in practices and tend to involve the entire body — most commonly the ankle, wrist, shoulders, head, and neck.

In order to minimize the risk of catastrophic injury, restrictions have been placed on stunts. Mandates include limiting the height of human pyramid stunts, limiting the height in which a cheerleader may be thrown into the air for a basket toss, and a requirement for having a certain number of spotters on the ground during these acrobatics. Mats should be used during practice sessions and as much as possible during competitions. Stunts should not be attempted without proper training, and not until the cheerleader is confident and comfortable with performing the stunt.
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Concussions are another potential injury in cheerleading. A concussion is an injury to the brain resulting from an impact to the head. Concussions are a risk for any athlete, but are a particular concern for those participating in cheerleading due to the nature of the activity involving height, inversion, and rotation of the body as well as physical interaction and contact with other team members. Players and coaches need to be mindful of any symptoms that arise after a fall, including headache, dizziness, or nausea.

As with any activity in which their child participates, parents have a role to play in ensuring that their child is able to reap the benefits that come with the activity while being protected from unreasonable risk. If a parent has a concern about safety, they should bring it to the attention of the coach. If a satisfactory response is not received, they should contact the administration to make sure proper procedures are in place for safety.

Cheerleading has become a sport that places significant demands on the body and can result in severe injuries. Proper attention to safety and preparation can help minimize injury risk.

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New Tennessee Opioid Laws

Posted by on January 18, 2019

As of July 1, 2018, new laws went into effect in the state of Tennessee regarding the ways doctors are able to prescribe opioids to their patients. The changes were a direct result of a nationwide increase of deaths tied to opioid use, both prescription and illegal. According to the TN Together legislation, opioid related deaths in the US have quadrupled since 1999, and Tennessee remains in the top 15 of all states in drug overdose deaths.

There is no doubt those statistics are staggering, and it is not unreasonable at all to expect our elected officials to pass laws to save as many lives as possible. While it is too early to see a direct decrease in deaths related the new laws, the expectation is that more lives will be saved by reducing the amount of these prescriptions that are written.

There have been many questions surrounding these new laws and determining how patient care will be affected. We hope to provide some education and give patients a better understanding of what to expect for their course of treatment as a patient of Mid-Tennessee Bone and Joint.

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What is an opioid?
Opioids are a class of drugs that provide pain relief after a specific event. They are stronger than over the counter pain relievers. Common prescription names for opioids are Vicodin (hydrocodone), Ultram (tramadol), OxyContin or Percocet (oxycodone), Opana (oxymorphone), Kadian or Avinza (morphine), fentanyl and codeine. Heroin is another type of opioid that is not prescribed and is illegal.

When are opioids prescribed?
Opioids are prescribed to relieve moderate to severe pain after a surgery or serious illness. They are generally safe when used for a short time as prescribed, but misuse can be deadly. For most patients, three days or fewer will suffice, and only a small number of patients will require more than seven days’ worth.

What are the risks and side effects from opioid use?
While they’re beneficial for controlling severe pain, opioids can cause significant side effects when taken for prolonged periods. The most concerning has to do with risks of overdose and ensuring the prescription is taken in correct doses. Even when taken as directed, possible side effects include nausea, sleepiness, dizziness, and confusion. The risks for these side effects increase for patients who have existing mental health disorders, a history of drug abuse, or are 65 or older. It’s also incredibly important to avoid alcohol use while taking opioids. Mixing the two can depress the central nervous system, causing decreased breaths, unconsciousness, and death.

What does the new law say?
The law looks at the opioid crisis from three sides – prevention, treatment, and law enforcement. Doctors now have stricter guidelines on prescribing opioids and must routinely check the Controlled Substance Monitoring Database which tracks how often a patient has been prescribed an opioid.

Per the new law, opioid prescriptions are written for specific amounts based on need:
• Initial prescription, written with minimal restrictions – 3 days’ worth.
• Patients who underwent a minimally invasive procedure – 10 days’ worth.
• Patients who underwent an invasive procedure – 20 days’ worth.

Other requirements:
• For larger doses, prescriptions are only to be filled for half of the initial amount.
• Doctors must document specific need for increased supply.
• Patient must sign informed consent form agreeing that the physician outlined all of the risks and concerns in taking opioids.

These new requirements were written based on research into the reasons behind opioid abuse. For instance, a 10 day prescription of an opioid may only be filled five days’ worth at a time. The reason for this change goes back to studies that show most people who abuse opioids get the pills from someone else, whether from an active prescription or an old one where all of the pills were not taken. By dispensing only half of the pills at once, the aim is to reduce the amount of leftover medication. If the remaining five days’ worth is legitimately required, the patient just needs to return to the pharmacy for the rest.

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Are there exemptions?
There are very few situations in which larger or prolonged doses are allowed. If a patient is undergoing cancer treatment, is in hospice care, has been diagnosed with sickle cell disease, or for those patients who are at an in-patient facility such as a hospital, nursing home, or assisted care facility, then they are not part of the above restrictions. Additionally, patients who have experienced severe burns or major physical trauma and patients who are under the care of a healthcare professional for an opioid use disorder also qualify as an exemption to the new laws. As these exemptions are tied to very rare circumstances, we do not expect our patients will fall into a category in which an opioid prescription will be written.

How does MTBJ handle opioid prescriptions?
Typically, any opioid prescriptions will be reserved as an option for our patients who undergo surgery. Our physicians believe more education is vital when it comes to understanding the role opioids play in pain relief, and that better education about pain will help our community in the long run. Our goal is to manage our patients’ expectations about how much pain they should experience in the first few days after surgery and that it will get better.

As always, Mid-Tennessee Bone and Joint will continue to appropriately utilize a variety of therapies as we always have to address our patients’ pain. We pledge to diligently abide by these new federal opioid laws while continuing our great tradition of specialized, compassionate, and exceptional care.

Click here to read more articles from the Fall/Winter OrthoConnexion.

AC (Acromioclavicular) Joint Separation Injury

Posted by on January 15, 2019

Duke men’s basketball point guard, Tre Jones, suffered an AC Joint Separation this week and is reported to be out indefinitely. The injury happened due to a collision with an opposing player, with Jones bearing the brunt of the crash’s force to his right shoulder. It’s a painful injury that can be treated non-surgically or surgically, depending on the severity.


With this injury, the collarbone separates from the shoulder blade. It can range from a mild sprain to a complete ligament tear. To read more about this injury, visit OrthoInfo – Shoulder Separation as part of the American Academy of Orthopedic Surgeons.

For more information on the shoulder injuries we treat at Mid-Tennessee Bone and Joint, visit our shoulder page.

Christmas Door Decorating Contest!

Posted by on December 7, 2018

Our associates teamed up again this year to decorate doors around our clinic, and as you can tell from the photos below, we have some very creative people! We worked during lunch and after hours to create our masterpieces, and the results were well worth the extra time spent. Our first, second, and third place entries are below along with the rest of the doors. Let us know which one was your favorite!

1st place

2nd place

Tied for 3rd place

Tied for 3rd place

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MTBJ Donates to Harvest Share

Posted by on November 28, 2018

For the fourth year, Mid-Tennessee Bone and Joint associates have collected food donations to support Harvest Share Food Pantry here in Columbia. Over the span of four weeks, we collected more than 2,000 items that will go directly to this worthy organization.

The mission of Harvest Share is to provide food and comfort to those unable to help themselves. To date, Harvest Share has distributed thousands upon thousands of pounds of food to the starving men, women and children of Maury County. Their primary goal is to wipe out hunger in our community.

Just as our clinic has been blessed, we understand what a privilege it is to be able to bless others!




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Happy retirement, Elaine!

Posted by on November 10, 2018

We are celebrating the 43-year career and recent retirement of our colleague Elaine Alderson. Elaine was the first employee when Mid-Tennessee Bone and Joint opened its doors in January 1975.

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Known as “Mama Elaine” to our staff, she graduated from Santa Fe High School in 1967 as Valedictorian and began working as a legal secretary for then-Columbia law firm McFarland and Colley. She stayed home until her son started school and around that time is when Dr. Eslick Daniel was starting his new orthopedic practice in Columbia. She was hired by Dr. Daniel and stayed for over four decades. She retired as the office Business Manager, taking care of accounts payable and stepping in when needed to manage scheduling, employee payroll, and insurance.

Elaine has seen many physicians come through these doors, lived through several moves to different offices, and through it all stood strong as the familiar face everyone looked forward to seeing each morning.

Retirement party Elaine Kenneth

Elaine exemplifies honesty, trustworthiness, and a willingness to do whatever it takes to get the job done. We are sad to see her go, but we are forever grateful for her tenure here! Congratulations, Elaine!

Dr. Randy Davidson Elected President of Campbell Club

Posted by on October 26, 2018

Dr. Randy Davidson was introduced as the next president of the Campbell Club at mtbj_photos-071-davidson_web-cropthe Campbell Clinic triennial meeting on October 5th, 2018, in Memphis, Tenn. He will serve in this position from 2019-2021. The Campbell Club, the alumni association of Campbell Clinic, was founded in 1946 and includes graduates of the residency and fellowship programs, as well as associate members who serve on the staff of Campbell Clinic. There are more than 470 former residents and fellows involved in both academic and private practice all over the United States, Canada, South America, and Europe. Congratulations to Dr. Randy Davidson on this new position!


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Mako Surgical Device Assists Surgeons in Orthopedic Procedures

Posted by on August 1, 2018

Several months ago, Maury Regional Medical Center introduced their new Mako robotic surgical device to assist with a variety of surgical orthopedic procedures. Dr. Scott McCall and Dr. Cason Shirley are utilizing this machine to perform total knee replacements, partial knee replacements, and total hip replacements. This emergent technology is able to assist surgeons and ensure increased accuracy with the placement of surgical components. Maury Regional has been performing Mako surgeries since October of 2017. They estimate they have performed over 100 since then, and more are scheduled every day.

There are a variety of joint problems that can ultimately lead to surgery. A key reason is arthritis which can present with pain, stiffness and inflammation in the joints. For those over 60, osteoarthritis is typically the most common form. The progressive wear and tear on joints and cartilage leads to limited range of motion, significant pain deep within the joint, or occasionally the feeling of your bones catching or grating against each other. A knee or hip replacement typically relieves the pain and discomfort associated with this degenerative condition. Joint replacements can also be used to treat pain related to a previous trauma or injury to the joint.
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Often before proceeding with joint replacement there may be several weeks of physical therapy to determine if this may improve your joint pain and function. If given the opportunity to stretch, strengthen, and increase flexibility, pain may decrease and function may improve to the point where the patient may be able to delay surgery. Stronger muscles and improved flexibility can help stabilize the joint and reduce stress on an arthritic knee or hip. Other conservative treatment options include oral anti-inflammatory medicines or injections of cortisone or a lubricant type material into the knee.

For those patients who find themselves a candidate for a Mako joint replacement surgery, there may be some questions about how the surgery is performed and how it varies from a traditional surgery.

“With Mako, we can provide each patient with a personalized surgical experience based on their specific diagnosis and anatomy,” said Dr. Scott McCall. “Using a virtual 3D model, Mako allows surgeons to create each patient’s surgical plan pre-operatively before entering the operating room.”

One misconception is that the robot itself controls the incisions and that the doctor has very little input, which isn’t the case. “The procedure is not radically different than what we’ve done before,” Dr. Scott McCall said. “The surgeon is not sitting in a back room with joysticks doing surgery outside of the operating room. The robot sets the plan specific to the patient, and you can make small variations to maximize ligament replacement. The surgeon has control over the robot and the surgery at all times; however, the robot can make cuts a human cannot do.”

These patient-specific plans consider many factors, including gender, exact shape and measurements of the patient’s joint, and how the joint moves. These plans assist the surgeon in performing the surgery and ensure the most accurate delivery of the surgical design.
To prep for the surgery, the bone that will be fitted for the implant must first be sculpted, or resurfaced, to remove any diseased bone and cartilage. The new clean surface is then ready for the implant. Your doctor will discuss with you the different options of implants based on your lifestyle and individual needs.
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“During surgery, we can validate that plan and make any other necessary adjustments to tailor it precisely to what the patient needs,” said Dr. Cason Shirley. “It’s exciting to be able to offer this transformative technology across the joint replacement service line to perform total knee, total hip and partial knee replacements.”

It has also been shown that patients who undergo a Mako-assisted surgery may see benefits such as a smaller incision, less pain, and a faster recovery. Every patient responds differently to surgery and you may not experience all of these benefits. Rehabilitation after a Mako surgery is not any different from a traditional surgery, with approximately six to eight weeks of physical therapy required to strengthen the joint and regain motion.

“This is a multi-million dollar investment by Maury Regional Medical Center which allows us to offer cutting-edge technology to our patients and improve patient outcomes,” said McCall.


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Stress Fractures of the Foot and Ankle

Posted by on July 27, 2018

A stress fracture is a small crack in a bone, or severe bruising within a bone. Most stress fractures are caused by overuse and repetitive activity, and are common in runners and athletes who participate in running sports, such as soccer and basketball.

Stress fractures usually occur when people change their activities — such as by trying a new exercise, suddenly increasing the intensity of their workouts, or changing the workout surface (jogging on a treadmill vs. jogging outdoors). In addition, if osteoporosis or other disease has weakened the bones, just doing everyday activities may result in a stress fracture.
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The weight-bearing bones of the foot and lower leg are especially vulnerable to stress fractures because of the repetitive forces they must absorb during activities like walking, running, and jumping.

Refraining from high impact activities for an adequate period of time is key to recovering from a stress fracture in the foot or ankle. Returning to activity too quickly can not only delay the healing process but also increase the risk for a complete fracture. Should a complete fracture occur, it will take far longer to recover and return to activities.


Stress fractures occur most often in the second and third metatarsals in the foot, which are thinner (and often longer) than the adjacent first metatarsal. This is the area of greatest impact on your foot as you push off when you walk or run.

Stress fractures are also common in the calcaneus (heel); fibula (the outer bone of the lower leg and ankle); talus (a small bone in the ankle joint); and the navicular (a bone on the top of the midfoot).
Stress fracture

Many stress fractures are overuse injuries. They occur over time when repetitive forces result in microscopic damage to the bone. The repetitive force that causes a stress fracture is not great enough to cause an acute fracture — such as a broken ankle caused by a fall. Overuse stress fractures occur when an athletic movement is repeated so often, weight-bearing bones and supporting muscles do not have enough time to heal between exercise sessions.

Bone is in a constant state of turnover—a process called remodeling. New bone develops and replaces older bone. If an athlete’s activity is too great, the breakdown of older bone occurs rapidly — it outpaces the body’s ability to repair and replace it. As a result, the bone weakens and becomes vulnerable to stress fractures.


The most common cause of stress fractures is a sudden increase in physical activity. This increase can be in the frequency of activity—such as exercising more days per week. It can also be in the duration or intensity of activity—such as running longer distances.

Even for the non-athlete, a sudden increase in activity can cause a stress fracture. For example, if you walk infrequently on a day-to-day basis but end up walking excessively (or on uneven surfaces) while on a vacation, you might experience a stress fracture. A new style of shoes can lessen your foot’s ability to absorb repetitive forces and result in a stress fracture.

Bone Insufficiency
Conditions that decrease bone strength and density, such as osteoporosis, and certain long-term medications can make you more likely to experience a stress fracture-even when you are performing normal everyday activities. For example, stress fractures are more common in the winter months, when Vitamin D is lower in the body.

Studies show that female athletes are more prone to stress fractures than male athletes. This may be due, in part, to decreased bone density from a condition that doctors call the “female athlete triad.” When a girl or young woman goes to extremes in dieting or exercise, three interrelated illnesses may develop: eating disorders, menstrual dysfunction, and premature osteoporosis. As a female athlete’s bone mass decreases, her chances for getting a stress fracture increase.

Poor Conditioning
Doing too much too soon is a common cause of stress fracture. This is often the case with individuals who are just beginning an exercise program-but it occurs in experienced athletes, as well. For example, runners who train less over the winter months may be anxious to pick up right where they left off at the end of the previous season. Instead of starting off slowly, they resume running at their previous mileage. This situation in which athletes not only increase activity levels, but push through any discomfort and do not give their bodies the opportunity to recover, can lead to stress fractures.

Improper Technique
Anything that alters the mechanics of how your foot absorbs impact as it strikes the ground may increase your risk for a stress fracture. For example, if you have a blister, bunion, or tendonitis, it can affect how you put weight on your foot when you walk or run, and may require an area of bone to handle more weight and pressure than usual.

Change in Surface
A change in training or playing surface, such as a tennis player going from a grass court to a hard court, or a runner moving from a treadmill to an outdoor track, can increase the risk for stress fracture.

Improper Equipment
Wearing worn or flimsy shoes that have lost their shock-absorbing ability may contribute to stress fractures.


The most common symptom of a stress fracture in the foot or ankle is pain. The pain usually develops gradually and worsens during weight-bearing activity. Other symptoms may include:

• Pain that diminishes during rest
• Pain that occurs and intensifies during normal, daily activities
• Swelling on the top of the foot or on the outside of the ankle
• Tenderness to touch at the site of the fracture
• Possible bruising

First Aid

See your doctor as soon as possible if you think that you have a stress fracture in your foot or ankle. Ignoring the pain can have serious consequences. The bone may break completely.

Until your appointment with the doctor, follow the RICE protocol. RICE stands for rest, ice, compression, and elevation.

• Rest. Avoid activities that put weight on your foot. If you have to bear weight for any reason, make sure you are wearing a very supportive shoe. A thick-soled cork sandal is better than a thin slipper.
• Ice. Apply ice immediately after the injury to keep the swelling down. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on your skin.
• Compression. To prevent additional swelling, lightly wrap the area in a soft bandage.
• Elevation. As often as possible, rest with your foot raised up higher than your heart.
In addition, nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen or naproxen can help relieve pain and reduce swelling.

Physical Examination

Your doctor will discuss your medical history and general health. He or she will ask about your work, your activities, your diet, and what medications you are taking.It is important that your doctor is aware of your risk factors for stress fracture. If you have had a stress fracture before, your doctor may order a full medical work-up with laboratory tests to check for nutritional deficiencies such as low calcium or Vitamin D.

After discussing your symptoms and health history, your doctor will examine your foot and ankle. During the examination, he or she will look for areas of tenderness and apply gentle pressure directly to the injured bone. Often, the key to diagnosing a stress fracture is the patient’s report of pain in response to this pressure. Pain from a stress fracture is typically limited to the area directly over the injured bone and is not generalized over the whole foot. Your doctor may order imaging tests, such as x-ray or MRI, to help confirm the diagnosis.


The goal of treatment is to relieve pain and allow the fracture to heal so that you are able to return to your activities. Following your doctor’s treatment plan will help you return to activities faster and prevent further damage to the bone. Treatment will vary depending on the location of the stress fracture and its severity. The majority of stress fractures are treated nonsurgically.

Nonsurgical Treatment
In addition to the RICE protocol and anti-inflammatory medication, your doctor may recommend that you use crutches to keep weight off your foot until the pain subsides. Other recommendations for nonsurgical treatment may include:

• Modified activities. It typically takes from 6 to 8 weeks for a stress fracture to heal. During that time, switch to activities that place less stress on your foot and leg. Swimming and cycling are good alternative activities. However, you should not resume any type of physical activity that involves your injured foot or ankle-even if it is low impact-without your doctor’s recommendation.
• Protective footwear. To reduce stress on your foot and leg, your doctor may recommend wearing protective footwear. This may be a stiff-soled shoe, a wooden-soled sandal, or a removable short-leg fracture brace shoe.
• Casting. Stress fractures in the fifth metatarsal bone (on the outer side of the foot) or in the navicular or talus bones take longer to heal. Your doctor may apply a cast to your foot to keep your bones in a fixed position and to remove the stress on your involved leg.

Surgical Treatment
Some stress fractures require surgery to heal properly. In most cases, this involves supporting the bones by inserting a type of fastener. This is called internal fixation. Pins, screws, and/or plates are most often used to hold the small bones of the foot and ankle together during the healing process.


In most cases, it takes from 6 to 8 weeks for a stress fracture to heal. More serious stress fractures can take longer. Although it can be hard to be sidelined with an injury, returning to activity too soon can put you at risk for larger, harder-to-heal stress fractures and an even longer down time. Reinjury could lead to chronic problems and the stress fracture might never heal properly.

Once your pain has subsided, your doctor may confirm that the stress fracture has healed by taking x-rays. A computed tomography (CT) scan can also be useful in determining healing, especially in bones where the fracture line was initially hard to see.

Once the stress fracture has healed and you are pain free, your doctor will allow a gradual return to activity. During the early phase of rehabilitation, your doctor may recommend alternating days of activity with days of rest. This gives your bone the time to grow and withstand the new demands being placed upon it. As your fitness level improves, slowly increase the frequency, duration, and intensity of your exercise.


The following guidelines can help you prevent stress fractures in the future:

• Eat a healthy diet. A balanced diet rich in calcium and Vitamin D will help build bone strength.
• Use proper equipment. Old or worn running shoes may lose their ability to absorb shock and can lead to injury. In general, athletic shoes should have a softer insole, and a stiffer outer sole.
• Start new activity slowly. Gradually increase your time, speed, and distance. In most cases, a 10 percent increase per week is appropriate.
• Cross train. Vary your activities to help avoid overstressing one area of your body. For example, alternate a high-impact sport like running with lower-impact sports like swimming or cycling.
• Add strength training to your workout. One of the best ways to prevent early muscle fatigue and the loss of bone density that comes with aging is to incorporate strength training. Strength-training exercises use resistance methods like free weights, resistance bands, or your own body weight to build muscles and strength.
• Stop your activity if pain or swelling returns. Rest for a few days. If the pain continues, see your doctor.



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