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Messages - Eric Price M.D.

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night before - regular meal, not too heavy, carbs arent a bad idea - whole grain pasta a good one.  no alcohol, no coffee.  lots of fluids.
presurf (i surf at dawn) - clif bar, lots of water. no coffee
post surf - gatorade, tons of water. no coffee.  PBJ on whole grain or whole wheat and a banana on the way home.  then eggs or some protein at home plus more carbs.
rest of the day - tons of water throughout the day and lots of snacks between meals, like nuts, granola, yogurt, clif bar etc (ie no junk), and no coffee or alcohol.
reasoning - obviously hydration is super important pre and post. coffee and alcohol will dehydrate you and slow you down.
clif bar on the way to the water for carb energy that will last you a while.  the carbs in a clif bar will last longer than the simple carbs on a bagel.
way home replenish lost fluids (esp if in a wetsuit you will lose a lot more than you realize) and electrolytes. 
protein at home to keep you feeling full.  again, simple carbs like a bagel or white bread dont last long and you will feel hungry soon after eating them.
stay hydrated throughout the day to avoid that hangover feeling you can get if you don't.

Many of my patients ask this question.  A few red flags:
painful clicking in any joint
swelling in any joint
pain that wakes you up at night
neck/back pain with radiation +/- tingling down the arm/leg
locking of any joint
pain that isnt relieved by Motrin or any over the counter NSAID
pain that makes the joint or extremity feel weak
Its normal to be sore after and sometimes during a workout.  You should find exercises that dont cause the pain and workout around it (instead of thru it) except in the case of any of the above red flags.  For example, many of my patients, and surfer buddies, have shoulder bursitis so I tell them to avoid exercises like upright rows (seated rows are better), dips, and heavy lateral raises.   
Hope this helps.  Any specific body parts or symptoms, dont hesitate to ask. 

Thats a tricky one.  The main reason to get an ACL surgery is to restore knee stability.  If your knee feels stable then you dont need surgery.  The ACL is important in pivoting and twisting maneuvers, so if you try and pivot and your knee feels like it might "give out," then you need surgery.  If not you can do without it.  Only about 10% of my active patients are able to stay active without surgery.  The other prob is that without an ACL other structures (the menisci) can start to breakdown if the knee motion is off due to the torn ACL, possibly increasing your chances of getting arthritis down the line.  I keep my surfers out of the water for 4 months after surgery.  To learn more about ACL tears feel free to check out this link:
I hope this helps.

I have a few questions -
which part of the labrum is torn? is it a SLAP tear?
did you ever dislocate your shoulder?
have you had any physical therapy?
was your mri done with contrast (did they stick a needle in your shoulder and fill it up with fluid prior to the test)?
The labrum is the rim of tissue that surrounds the socket of the shoulder.  It is torn when the shoulder dislocates - that is called a bankart tear.  Surgery is often required in younger active people.   Another type of tear is called a SLAP tear, which usually needs to be fixed to surf without pain.  The surgery is done with a surgical camera called a scope.  Small incisions are used to get inside the shoulder and the labrum is sewn back to its proper location.  Several months of therapy are needed after surgery.  The goal is to get patients back to sports.  I have done many labrum repairs in surfers and they are able to get back in the water and surf without pain after the healing is done. 
for more info on shoulder labral tears see these two links:
also, feel free to send me a private message if you want to answer the above questions.  i'm happy to help you out.  one thing i would advise is to do it while you are still insured bc without insurance it is very expensive and even if the insurance runs out, you will have 90 days of free post-op coverage after the surgery (thats the way insurance works - the 3 months post op are free).  so dont hesistate to do it if you are thinking you will eventually get it done. 
Eric Price MD

gotham - sent you a PM w some questions about your hip.

most shoulder problems in surfers are bursitis, which is essentially tendonitis/inflammation of the rotator cuff, unless there is a specific traumatic event, in which case a tear could occur.  usually the cuff muscles and the muscles that surround the shoulder blade are underconditioned and they get inflammed from too much paddling.  also, poor form when paddling is a major cause of trouble.  your paddling stroke should begin to finish when your forearm is oriented 90 degrees to the surface of the water. Draw the forearm out of the water at that point by pulling your elbow straight up toward the waterís surface instead of continuing the circular paddling motion that would ultimately place your forearm next to your thigh and nearly parallel to the waterís surface. Sounds confusing, I know. But if you continue to paddle in a circular motion after the 90 degree point, you are placing a lot of strain on the small muscles of the rotator cuff and not generating much extra power in your stroke.          The bulk of the power in your stroke occurs in the beginning of the stroke, just as your hand enters the water and travels from the 0 to 90 degree position. Consider entering the water with your hand a little further to the side of your normal entry point instead of directly in front of your shoulder. When your hand strikes the water, pull your arm towards your midline instead of straight back, like a blend of the breast stroke and the forward crawl. This will involve more of your pectoralis and latissimus muscles when paddling and less of the rotator cuff. These muscles are significantly larger than the rotator cuff muscles, and can generate much more power than the rotator cuff.  Also, the smaller rotator cuff muscles will fatigue much faster than the larger pec and lat. To keep shoulders in shape during winter dry spells, I recommend the Vasa Trainer.
       A stable core is very important to transmit paddling power to your board. If your core is weak, then the energy will be wasted and dissipated elsewhere, forcing you to paddle harder and more frequently. Also, donít drag your feet in the water. As you get fatigued it is easy to get sloppy, and I see a lot of longboarders draping their legs over the sides of their boards creating excess drag. Ideally, on both a long and shortboard, your legs should be midline and taut to minimize drag.
Hope this helps.  the good news is that most of the time a little rest, motrin, and physical therapy will get you back in the water quickly. 

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