Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Safe Workouts for Expecting Mothers
Join us as we chat with Dr. Caitlin Lewis, a sports medicine physician at Cleveland Clinic, who is expecting her first child and is eager to share her expertise on exercising during pregnancy. We'll uncover how staying active can not only prepare you for labor and delivery but also significantly lower the risks of gestational diabetes, hypertension and preeclampsia. Plus, listen for when it's safe to start exercising after delivery and what exercises can have the most impact.
Tune in for this episode that promises to empower you with knowledge and practical strategies for a healthier, stronger you during and after pregnancy.
To make an appointment with Dr. Caitlin Lewis, please call the Cleveland Clinic Sports Medicine Department at 216-343-4675.
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the executive producer of Speaking of Women's Health, and I am back in the Sunflower House for another edition. For another edition, and joining us on this Sunflower podcast is Dr Caitlin Lewis.
Speaker 1:Dr Lewis is a staff physician in the Cleveland Clinic Center for Sports Medicine and she's a hometown girl.
Speaker 1:She grew up in Kent, ohio, and she completed her undergraduate studies at St Louis University. She returned to Ohio for medical school at the University of Toledo, family Medicine Residency at Riverside Methodist Hospital in Columbus and then she came to the Cleveland Clinic to complete a sports medicine fellowship at the Cleveland Clinic and she now serves as the primary care team physician for the Cleveland Charge basketball team and Dr Caitlin Lewis. She's board certified in family medicine and she has a certificate of added qualification in sports medicine, and Dr Lewis enjoys working with athletes and active people of all ages in injury treatment as well as injury prevention, and her specialty interests include non-operative management of orthopedic conditions, acute and chronic sports injuries, tendon and ligament conditions and management of medical problems in sports. Welcome, dr Lewis. We're so excited to finally have you as a guest on the Speaking of Women's Health podcast to talk about a very important topic exercise and pregnancy and I heard from a little birdie that you're expecting your first baby around Thanksgiving.
Speaker 2:I am. I am Thank you for having me. Yes, I'm expecting our first baby right before Thanksgiving, so this is a topic near and dear to my heart, both personally and professionally.
Speaker 1:Yes, yes, and I bet you're at that stage where you're feeling your own baby. Get plenty of exercise at your expense.
Speaker 2:That is correct, especially at night, it seems.
Speaker 1:Well, for our listeners who are listening on either our YouTube channel Speaking of Women's Health or our Rumble, which is also Speaking of Women's Health, you can see how fabulous and glowing Dr Lewis looks. So tell us, dr Lewis, what are some of the benefits of exercising during pregnancy?
Speaker 2:So there are lots of benefits to exercise during pregnancy and luckily we are living in a time now where exercise is much more encouraged than it used to be previously during pregnancy. So one of the main things that I want to bring up is really increasing your fitness while you're pregnant, or maintaining your fitness is partly preparing you for labor and delivery. You know, one of my colleagues compared labor and delivery to an endurance sport, and part of your exercise goal is for preparation for labor and delivery. You wouldn't run a marathon without adequate training, and so part of your goal while pregnant is to train for really carrying a baby and delivering a baby into the world.
Speaker 1:So tell me more about these benefits of exercising doctor.
Speaker 2:So, in addition to benefit for labor and delivery, there is benefits as far as decreased risk of gestational diabetes, gestational hypertension, preeclampsia, able to help maintain healthy weight gain and not excessive weight gain with pregnancy, actually increased incidence of vaginal delivery. So then lowers the risk of a cesarean section delivery or vacuum-assisted delivery, lower risk of varicose veins, which some of us are concerned about. But also helpful with improving sleep, improving mental health, which is a common use of exercise, as well as even helping with back pain. So there's lots of benefits to regular exercise during pregnancy.
Speaker 1:Those were such excellent points. Those were such excellent points and we have had a podcast on labor and preeclampsia and risk factors that can portend to other diseases in adulthood that start in pregnancy.
Speaker 2:So reducing all those during pregnancy and beyond is just so important. But there's always the flip side of the coin. So tell us what some of the risks of exercising during pregnancy are. So the risks of exercise during pregnancy are pretty relative. You know there are some contraindications to exercise or medical conditions where you shouldn't exercise, and we can talk about those a little bit later. But really exercise that should be avoided are more the risks of exercise. So again, kind of relative.
Speaker 2:So high contact sports like soccer and ice hockey and basketball or boxing are things to avoid. And then things where you might fall so when you're pregnant you don't want to fall. So things like gymnastics and horseback riding, road cycling so cycling on the road where you might get hit, exercise where you might get extremely hot, like hot yoga, where your core temperature might elevate, or things that may increase risk of complications with your pregnancy. Also, scuba diving is one that I thought of is one that definitely probably shouldn't participate in your pregnancy. Also, scuba diving is one that I thought of as one that you know definitely probably shouldn't participate in in your pregnancy but when you're pregnant, um, but really other than those risk types of activities, there's really very little demonstration of risk to the fetus or the mother during pregnancy.
Speaker 1:And I think that's so important to sleep better, have better mental health uh, health towards the end of pregnancy. There can be so much physical discomfort. That and also reducing back pain. We have some great information on our speakingofwomenshealthcom website on treating back pain in pregnancy with acupuncture. So tell us what some of the best exercises that one could do during pregnancy, or even tell us what you're doing.
Speaker 2:So an important balance between cardiovascular exercise and strength training are really the best exercises during pregnancy. So if you're already doing something that you enjoy, you can continue doing that type of exercise, things that are, I'm going to say, safe, but safe for pregnant exercise, for cardiovascular things like walking, jogging if you're already jogging, cycling is okay, swimming are great ways to increase your cardiovascular fitness. And then general strength training. So you have to think about, you know, strengthening your lower body and your upper body, even for postpartum. So if you're carrying a baby or, you know, going up and down a lot of stairs, those are good things that you need to train for. So general strength training, including weight training, is important. So personally, I'm walking on the treadmill and doing some on the Peloton bike, um, and then free weights in my basement. So I'm lucky to have a reasonably stock gym in my basement. So doing, you know, some strength training, um, about three days a week. In the cardiovascular training, two to three days a week.
Speaker 1:So does that have to be modified at all if someone's expecting twins or triplets or like later in pregnancy with just some of the ligament and tendon, sometimes instability and balance issues?
Speaker 2:Yeah. So one of the relative contraindications to exercise would be a multiple pregnancy or twins or triplets with complications. But a healthy woman having a healthy pregnancy otherwise is okay to participate in lower impact exercise like walking. Riding a bike may be difficult just because of space with a growing belly. Swimming, though, is also a great exercise that actually helps take weight off of your body and off of your joints, so being in the water is actually a really good exercise. Then later in your pregnancy, same sort of thing, you know. So modifying it's something that I talk about with my patients all the time is as your body changes you will also have to change your exercise, and so working on tailoring back the intensity, sometimes the frequency and duration as well, but the general cardiovascular and strength training can continue, just has to be a little bit different.
Speaker 1:And tell us about Kegel exercises during pregnancy. So many women postpartum have mild to moderate degrees of pelvic prolapse or stress, urinary incontinence, leaking when they cough or sneeze that they never did before. So when should a woman start Kegels and how often should she do that?
Speaker 2:So Kegel exercises are just pelvic floor training in general really can and should begin even preconception. So working on those things as a female, as you are in reproductive age, is a great time to start. But if you have not started yet, you are not too late. Anytime during pregnancy you can start, and if you miss that, also during pregnancy, as soon as it kind of comes to light. Exercises for your pelvic floor are going to help with. All the things you mentioned Can be performed daily and really I recommend meeting with a pelvic floor therapist if you're having issues either knowing if you're engaging your pelvic floor, knowing if you're doing Kegels correctly. They're highly trained in teaching as well as monitoring how you're using your pelvic floor and helping develop those skills, whether it's pre, during or post-pregnancy.
Speaker 1:Now, one of our earlier podcasts was on urinary incontinence, which is such a common problem in women, and certainly having pregnancy delivery, just age gravity, having a vagina which is essentially a hole in your pelvic floor, leads to some problems with bladder support. So I would strongly recommend all females to know how to do Kegels, and I found in my practice when I do pelvic exams, at least 10% of women don't even know how to contract the muscles, and those women do need to see a female physical therapist. So tell us about, maybe, what an ideal exercise regimen might look like for just the average pregnant woman. And is that different for a woman who's expecting her first baby versus what if she's got several young children that she's also chasing after?
Speaker 2:So I think there's two parts to that question, right? So the ideal exercise program and then talking about the barriers to a good exercise program as well. So ideally, the recommendations from the ACOG are the same as an adult. So, as I said when we first started, things have changed over the years and now the American Congress of Obstetrics and Gynecologists recommend 150 minutes of moderate intensity exercise per week. Generally people divide that into 30 minute sessions five days a week, but some people will lump it more.
Speaker 2:I usually recommend at least spreading it over five days a week. Um, but some people will lump it more. I usually recommend at least spreading it over three days a week, so you're not doing too much all at once, especially later in your pregnancy. Um, even breaking it into 10 minutes of walking is fine. 10 minutes a couple of times a day is a good suggestion. Daily activity is really what's encouraged, Um, and I usually recommend at least two days of strength training per week or resistance training.
Speaker 2:And so if you're new to exercise, that's not a contraindication to exercise.
Speaker 2:You absolutely can and start during pregnancy.
Speaker 2:You might start with those five to 10 minute increments of just walking, you know, either on a treadmill or around your neighborhood on a flat surface is generally what I would recommend early, not a bunch of hills.
Speaker 2:And then, really talking about the barriers, you brought up a good comment that people are busy and if you have multiple children or even just a busy schedule, there's a lot of barriers to exercise. And so that's where I would recommend breaking up into smaller segments and you don't have to be perfect, and I would also strongly suggest not comparing yourself to someone on the internet or someone else. You know that is pregnant. You know everyone's going to be different, so whatever you can get in is going to be good. The other piece I'll add is the fatigue is real first trimester and now, as I'm entering into third'll add is the fatigue is real first trimester and now, as I'm entering into third, it is the fatigue is real. So finding small times when you can exercise actually is shown to increase your energy. So those are good reasons to try and break down some of those barriers.
Speaker 1:So you have been listening to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the executive producer of the nonprofit Speaking of Women's Health, and we are speaking with sports medicine expert and soon-to-be mom, dr Caitlin Lewis, and we're talking all about exercise, barriers to exercise, types of exercise, contraindications, potentially and how many women are able to continue to do the same exercise regimen that they did prior to pregnancy, assuming that it's not like scuba diving or high intensity physical contact that could obviously hurt the abdomen or the baby.
Speaker 2:I would say how many people I'd say as many women as interested, truly and I would encourage women to try and continue what they had been doing, at least in the beginning, in the first trimester. If you are a runner, you know you can still run. You may need to slow down, you may need to change your terrain or your surface or even your shoes, but you can continue doing that. And I know some CrossFit athletes that have continued to do CrossFit type exercises but modify. So maybe you're not jumping as much, maybe you aren't lifting as much, but still some of those movements are going to be functional strength training movements. So even there are even some people that do participate in some of those maybe riskier sports that are at the professional level. That can continue for a little while. We just passed an Olympic year and there are several reports of pregnant participants in the Olympics, which is really, really cool.
Speaker 1:Yeah, that's very exciting. So I would imagine women that are very elite obviously come in with a better fitness level and want to probably continue and have that competitive spirit. But at some point I would think everyone has to have some modifications. I just know with all of my pregnancies it was very unsettling, especially in the third trimester when I could feel all the ligaments loosen and shift to get ready for the baby to deliver. That I would just feel my whole entire pelvis like shift in rock and I wonder how much of that has to do with women having a higher rate of joint replacements and does some of that altered physiology wear and tear on their cartilage in their hips or knees? I know some of it's the angle. I just wondered if you had any thoughts about that.
Speaker 2:No, quite possibly I do get patients even, you know, in their 40s or 50s that may be past childbearing age, but I wouldn't say the typical age for a joint replacement that do have joint problems earlier. That could absolutely be related. Oftentimes they'll hearken back to a time when they were pregnant and say oh, you know, my, my second boy was living in my right hip and now my right hip hurts. 15 years later has been hurting, or things like that. I don't know if we have any evidence for that, but I think it's a very good observation.
Speaker 1:Well, I think it also goes to you want to have a good pelvic floor for bladder function and also for just maintaining your whole pelvic structure and your hip movements and good nutrition. I did an earlier podcast on joint supplements, joint pain and joint replacements and came across those stats in women and I saw that there were many women who had had hip replacements who later went on and had a successful pregnancy and delivery. So certainly sometimes young people have various conditions that cause them to need a new, a new joint, and certainly those folks may need some modifications and exercise. So what are some of the signs that a woman should know that it's time to either stop exercising or take a break?
Speaker 2:So the common ones vaginal bleeding so obviously anytime there's vaginal bleeding during pregnancy we get concerned, and that can occur during exercise or too intensive exercise. Abdominal pain there's a difference between feeling your abdominal muscles engage in true pain and so during exercise we want you to engage your core, even when you're pregnant. But pain is not normal. Along with that contractions. So painful contractions as you get later in pregnancy may have Brex and Hicks contractions and sometimes that is due to too intensive exercise. But regular painful contractions are definitely something that are a warning sign that you need to back off. Obviously, any fluid leakage is something that should not be taken lightly. If it's due to exercise headaches, dizziness, chest pain any of those symptoms that would make you stop exercise normally are definitely reasons you would stop. Muscle weakness and balance, I would also say, is one. So if you're starting to feel off balance because of center of gravity, shifts or weaknesses are unsteady on your feet, increasing your fall, risk reasons to back off what you're doing. Maybe consider chair exercise in that instance, still doing some things modified.
Speaker 1:And I know there's just so much on the internet like YouTube videos or exercise or examples to like see chair yoga and those kinds of things. Are there any kind of resources that are not very expensive that you might be able to direct, you know, women to who maybe aren't elite athletes and they're not in a regular exercise mode, but maybe they're preparing for a pregnancy or just found out that they're pregnant and they really do want to be strong? You know, like our motto is be strong, be healthy and be in charge. So you've got to really work on fitness as part of that, yeah.
Speaker 2:There are some good. You know I don't have any specific examples other than one, but some good um online resources, even through social media. There can be good posts um through from, uh, physical therapists or public floor therapists. Oftentimes I have good exercise regimens. I will say again, I'm not not a paid person, but Peloton does have some really good prenatal strength training and yoga and meditation and all sorts of resources too. Personally, that's what I'm using. That are the prenatal based classes. So if you're already on the Peloton platform, it's a good resource to tap into. But there are plenty of other free resources via YouTube, social media that are good as well.
Speaker 1:That's interesting. You know, a while back, when you know Peloton became such a rage, I was like taking a look at that, especially during the pandemic when my exercise facility was closed down, and I just didn't like the and I love to bike, I, I, I bike a lot stationary, you know, at the gym, but also on my own bike, and I really just didn't like the Peloton seats. Do you have to get a modified seat when you're pregnant Cause, you know, obviously your whole pelvis is changing and widening?
Speaker 2:special seats you can swap out. I have been able to maintain our current seat, but I have adjusted my height and they do make ones you can swap out too, so some people may benefit from a wider seat or a more cushioned seat than the one that's provided.
Speaker 1:Yeah, I probably. I think my own regular bike has extra cushion, so maybe I should have started with that to start, with extra cushion. Maybe I should have started with that to start with. So let's move into some of the post-pregnancy stuff because you know, after you have a baby, your rib cage is wider, you have weight to lose, you might have leaking breast. I mean you've got a new human being to take care of. There's just so many changes and can be kind of overwhelming. I mean, my shoe size got a half a size larger. I mean there are some physical structural changes and so a lot of women, whether they're an elite athlete or not, really want to get their body back in shape. So how soon can a woman begin exercising and what exercises are safe?
Speaker 2:That is a loaded question, dr Thacker. That's a hot topic for sure. So my personal take on this is there are things you can do before you are quote unquote cleared by your obstetrician, and things that you can resume afterwards. Things you can do beforehand, really immediately after delivery, is working on some of that core control that hopefully you're doing during pregnancy. So working on diaphragmatic breathing, working on activating your core muscles, which is very gentle and just doing some activating things, and also walking.
Speaker 2:Walking meaning immediately postpartum. You can walk five minutes or 10 minutes, just get your legs out from underneath you. We all know there's fluid shifts after you deliver and people get swollen and uncomfortable. One of the ways that can help that is just doing some gentle movement so you're not going to have time or energy to go on a 30 minute walk, but you might be able to do five minutes and that's okay as long as you're comfortable doing that. So everyone's individual.
Speaker 2:Once you pass that six-week mark, that's when oftentimes an obstetrician will clear you which we don't really like that word in sports medicine either, but clear you to resume exercise. And what that really means, when it boils down to, is you can start to progress into exercise. You're going to be very deconditioned, you are going to be weak. You are going to be very deconditioned, you are going to be weak, you are going to not have much strength or energy and so you can start progressing back, similar to what I said earlier that labor and delivery is an endurance sport and that you need to be prepared for that.
Speaker 2:We also would not let an athlete with a musculoskeletal injury go back to sport immediately after they have their injury or their surgery. They're going to go through a progression, a return to sport, progression, and really that's what postpartum women should also do. Your body has changed. You're not the same. You can't jump right back in where you were before. That's also a good time to work with a pelvic floor therapist on core strengthening work on that pelvic floor therapist on core strengthening work on that pelvic floor activation and core work, which goes a long way also. Oftentimes people have hip pain also. Rectus diastasis is a common complaint after and so working on all of those things with your pelvic floor, that's a great time to start just making sure that you are comfortable and have a good plan.
Speaker 1:So for our listeners a diastasis recti is the two rectus abdominal muscles can split because obviously you know everything has expanded and then sometimes there's some trouble coming together and it's just not a nice, flat, strong abdomen. Do you recommend like modified sit-ups to help like pull those muscles together and strengthen and tighten the abdominal muscles?
Speaker 2:Yeah, so sit-ups are actually one I would steer clear of. If you have erectus stasis, at least in the short term. There's a term that people refer to as coning, where you're basically your intra-abdominal muscles will look like they're peeking through that separation and you'll get a little bulge in the middle. That's a sign that we don't want to increase that intra-abdominal pressure in that way. So sit-ups often cause that. But there are things, many other exercises that engage the core and allow those muscles to really wake up and work together and close that, close that diastasis as time goes on. Part of it is time, there's no magic, there's nothing and part of it is absolutely time. But working on general fitness and re-engaging your core has been shown to help resolve that separation.
Speaker 1:And also core exercises certainly help the back and low back pain is a problem of all ages and we had a very popular podcast on back pain and sciatica and so really protecting your core muscles really helps protect your spine. And, of course, I would think, nutrition We've had so many podcasts on nutrition, that getting healthy protein to help your body repair, because it's just been such a catabolic state and the whole labor, delivery, the postpartum phase, takes a lot of energy and a lot of repair and then so do all the demands with breastfeeding. One thing that I suffered with postpartum and it's interesting because I'm in the field of menopause, so I see postmenopausal women who've lost their estrogen and I'll have orthopedic surgeons actually send me women with tendonitis that they can see inflammation of the tendons post-menopausally and they refer them to me to give them estrogen and then their tendons get better. And so when I was postpartum which if you're breastfeeding you still have a pretty low estrogen state, you know you have high state. Then deliver the baby and it's low I had terrible decorvanes tenosynovitis and it was horrible.
Speaker 1:I mean it was very hard to even pick up my baby. I had terrible D corvain's tenosynovitis and it was horrible. I mean it was very hard to even pick up my baby. I had my hands in splints and my physician colleagues were like joking oh, is that gonorrhea D, corvain's tenosynovitis? Oh no, it's postpartum. So I would think that maybe the lack of estrogen in some women not all women are predisposed to having tendon problems with low estrogen, but some women are. So I wonder, um, are there things that you have to wait to do so that you're not overly stressing out your tendons and ligaments? Everyone's different.
Speaker 2:So that's a, that's a classic. We call it mommy thumb is day for veins is the name of that one, and so everyone sort of responds differently. And so that's one of the things of progressing gradually back into your exercise. We know that tendons in the sports medicine world don't like abrupt changes, and so if you're already in a compromised state you can say, with low estrogen, a big jump in your activity, your tendons are not going to respond well to that. And that's one of the things I think we see with day core veins, with the risks is you go from maybe not lifting a ton and then you have a drop in your estrogen, you're lifting your baby all the time, and so it's that that movement.
Speaker 2:Same can go with Achilles tendon. We see it a lot in knees and with patellar tendonitis and also hips, with gluteal tendonitis also, where those muscles and tendons are just not ready to take a huge change in their demand, and so it's sometimes hard to avoid, especially with, say, like mommy's thumb. But that is some reason to gradually progress back into exercise, allow your joints to sort of, you know, stiffen up a little bit, which is helpful. After things relax, they kind of get a little bit more stiff, which then means a little more control, and then those tendons don't have to work as hard. So gradual return to exercise is helpful for that.
Speaker 1:And is there any nutritional supplements that you might recommend? You know certain types of protein Like sometimes I'll tell women, whey protein if they tend to have more tendinitis or just high quality foods.
Speaker 2:In general it's high quality foods. You know there's only two supplements that I will regularly recommend for patients. One is glucosamine chondroitin for joints that is proven to be helpful with cartilage health. Then also turmeric supplements that is, of a high quality turmeric and enough of a supplement has been shown to help with inflammation as well. Obviously, if breastfeeding, to make sure those are safe for breastfeeding and not contraindicated. But those are two supplements and then really just a good, high quality diet. Really maintaining your calories is always important, whether you are breastfeeding or not. Dropping your calories too quickly or not is not going to be helpful for you.
Speaker 1:No. Now tell us maybe some tips of what women could do to prevent injuries while exercising. Obviously, women are more predisposed to ACL injuries. Is that right? Imbalance in the quad and hamstring muscles? Yep, yeah, absolutely. And why is that that there is that imbalance more in women than in females than in males?
Speaker 2:We don't entirely know. We think it's related to pelvic structure, likely as well as, like you said, an overbalance, overpower of the quad under activation of the hamstring and likely under activation of glutes also, and then there's likely some pathophysiology to that also that leads to increased risk of ACL tears. There's actually a growing body of literature talking about where you are in your menstrual cycle and increased ACL risk also, so I think there's a lot of investigation and interest in that. I don't think we know entirely why.
Speaker 1:Do you think that there's any benefit to maybe seeing a physical therapist or a trainer to just kind of be evaluated to see if you have any muscle imbalance, like you said, maybe under activation of the glutes, or because when I've had different things and different reasons to go see a physical therapist and they've done some simple testing, like and I thought I know my body pretty well and I stretch and exercise regularly and obviously I went to medical school and then I'm shocked when there's like this imbalance that they so easily show and I'm thinking maybe I should have gone in preventatively as opposed to wait till I had a problem to then go fix it.
Speaker 2:Yeah, that is a huge interest of mine is really injury prevention. I don't think we do enough of that and I think in youth sports and recreational sports we all focus on the actual exercise and not as much on the injury prevention, which injury prevention oftentimes comes down to functional movements and kind of the small movements and training, not the big sport related or exercise related movement. And so one of the best ways to do that is by seeing a physical therapist. You know, I would love to say that in the office the sports medicine physician could do a great evaluation, but we are a little bit pressed for time in the office, where a physical therapist oftentimes has 45 minutes to an hour to do a really good evaluation. I personally like to see patients and then refer them on, also because there's different things we can pick up as well, but absolutely that's a great way to get a good. Biomechanical screening is what I call it looking at all the different mechanics and strengths that you don't know, that you're missing.
Speaker 1:I think the first time I ever saw a physical therapist as a patient was postpartum, you know, neck and shoulder problems because of the whole nursing and just the different body positions, and it really makes such a big, big difference, although I imagine probably if you don't have a problem or a complaint, most likely insurance probably wouldn't cover for you to go for just like a preventive musculoskeletal evaluation yeah, for just like a preventive musculoskeletal evaluation, yeah.
Speaker 2:So what are some of the more common exercise or sports injuries that you see in women In women in general, I tend to see a lot of hip complaints is a common reason. Patients will come in both in the joint which is actually in the front of your hip or your groin, and also on the side, where some people will call it their hip joint, but it's actually outside of their hip joint where your gluteal muscle tendons attach out on that outside prominence of your hip. The other biggest complaint I see in females is knee pain. So pain in the front of your knee more commonly, where we call it the patellofemoral joint or underneath your kneecap, is a spot in the knee where it tends to get a little bit more force in females than in males. Complaining of pain with things like squatting, lunging up and down stairs is a common complaint. Those things actually tend to do really well with physical therapy, so it's another plug for PT, but those are common complaints that I see definitely more in females than males.
Speaker 1:Interesting and do you see different injuries? I would imagine in midlife women as opposed to younger women.
Speaker 2:Yes and no, it tends to be a different type of presentation. So in younger women we tend to see more acute onset of these problems and they're usually from an overuse standpoint or a misuse, so really not controlling their joints. In older midlife women tend to see more degenerative type changes, but oftentimes the same complaints and they may say oh, I had that pain when I was in my teens or my twenties, but it went away and then came back and it's usually a different type of pathology or problem, but really end up seeing a lot of the same types of pain just in a different way.
Speaker 1:I know with this recent rage of pickleball you see it like everywhere a lot of injuries, yeah, and and and a lot of midlife. Women haven't even thought about or been screened for osteoporosis and we have several podcasts on osteoporosis. We've won some awards actually for our speaking women's health podcast on osteoporosis. So I mean I like to just make the plug that if you're not really doing exercise and then you're starting something new, you've got to think do you have underlying cardiovascular disease? Is there any impairment in your balance or strength, as well as if there's any potential for falling or trauma, which just walking down the street is always a possibility that you should really know what your risk for osteoporosis is.
Speaker 2:Yes.
Speaker 1:I would agree.
Speaker 1:And I know that in my field, in menopause, there's so much online, there's all these influencers and social media and Instagram where a lot of the influencers are selling things and they're not necessarily in that midlife woman's best interest, I would just assume. I mean, I'm not an elite professional athlete, although I have to confess, when I would play tennis with my young son I used to say, yes, I did play at Wimbledon. And he was so little, he was like only three. He looked up at me because he could see how I played tennis. No, you didn't, I couldn't even pull it off.
Speaker 2:You couldn't even fool him.
Speaker 1:I couldn't even fool him. I was like not that good, but I would imagine it's the same thing. Are there people selling things? I mean, do women who don't live and breathe elite athleticism every day? Do they need to kind of be aware in the pregnancy exercise realm, or just in general?
Speaker 2:I would say absolutely need to be aware of some of the things that influencers may be taught in or selling. Lots of different supplements that are not proven to be beneficial and cost a lot of money. Lots of products things like recovery products or performance type products that are not proven to be helpful, um that I would recommend. Speaking to a sports medicine physician about Um, I get many questions on different, even injectable type um treatments that you can buy online. It's crazy the things you can buy online these days, um and I always welcome the questions because if there's no good evidence behind it, it's really hard to recommend. If there's no known risk, sometimes it's okay to try, but if there is known risks or suspected risks on something, I would not trust what an influencer says that does not have a medical background.
Speaker 1:Yeah, I think that is such sage advice and any other last parting help or tips that you can give our listeners, or how people can either follow you on social media or contact you or see you as a sports medicine physician.
Speaker 2:So I work mainly out of the Sports Health Center at Cleveland Clinic and so I'm open to see any pregnant female, any active female, anyone that wants to be more active. So you can call our office at the Cleveland Clinic Center for Sports Medicine and they can get you set up. And really my closing comments are really whether you're pregnant or not, always I encourage regular physical activity. There's no bad time to start and there's really no downsides. But having some guidance to get started is always helpful and we're all here for you.
Speaker 1:Well, thank you, dr Lewis, for joining us in the Sunflower House and the Speaking of Women's Health podcast, and you certainly live our motto and practice our motto to be strong, be healthy and be in charge, and I'd like to thank our listeners for tuning in. We're so grateful for your support and we hope that you'll consider supporting the podcast, share it with others, leave a five-star rating for us and, to catch all the latest from Speaking Women's Health, be sure to follow or subscribe wherever you listen to podcasts Apple Podcasts, spotify tune in. It's completely free to subscribe and then you won't miss any future podcasts. So thanks again for joining us.
