Dime Q&A: Expert Surgeon Talks Nutrition And Staying Injury-Free

As an athlete, there was nothing more interesting to me growing up than sports nutrition, weight training and staying healthy.

So with everything Dirk is battling through right now, here’s a chat I had with Dr. Bal Raj, a leading Orthopedic Fitness Surgeon and expert. Based in Beverly Hills, Calif., Dr. Raj is a Double (American & Canadian) Board Certified Orthopedic Surgeon specializing in sports & fitness procedures. He has worked with both athletes, Hollywood execs and A-Listers, and was named one of the “Top Orthopedic Surgeons in Los Angeles and a Leading Physician of the World” by the International Association of Orthopedic Surgeons. He’s been featured on MSNBC, CNN, E! “The Doctors,” Newsweek and is a regular columnist for WebMD.

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Dime: What exactly do you mean when you say you promote a long-term healthy lifestyle? Is it different for professional athletes and regular people?
DBR: Promoting a long-term healthy lifestyle in general is for everyone, athletes and regular people because we are all prone to injuries. As we get older, the wear and tear on our joints and hormonal changes take effect. So the best thing we can do is be cognizant of that and be preventative. For example, as we get older from 20 to 40, what happens is our natural level of testosterone, our natural level of the growth hormone, it cuts down to half. Our joints are more susceptible to injury because of wear and tear especially our knees, hips and our back, so any increased weight will accelerate that. I think when people are in their 20s or at a younger age, we have all of these great hormones going through our body and our muscles are young and youthful. Literally when we have a pizza, it vaporizes. I think it’s very important to realize that in order to keep yourself healthy, you have to number one, focus on diet and concentrate on your diet and exercise. What you eat is what you are. If you are filth five times a day, that (shows up) five years down the road, especially with a lack of hormonal support or a lack of extreme super hormones that they have in their early 20s or teens will be manifested. Exercise is as important too. Regular exercise on a daily basis will stimulate your hormones and will increase your growth hormones levels, your natural growth hormone and natural testosterone levels. It will also increase levels of hormones in your brain that will allow you to not be anxious and not be depressed. So all of these factors combine, especially as we get older and especially for that athlete who challenges their body to the 10th degree, and will reduce the risk of injury significantly.

Dime: You mentioned nutrition. Could you give some keys for nutrition to a young athlete or teenager that wants to learn how to eat properly?
DBR: It’s something that we don’t think about…Nutrition is something that, I think everyone should be on a diet that is not no carbs but low carbs. Low carbs and good protein. First of all, at least 35 percent of your food should be eaten at breakfast. If you eat a good breakfast, it sets you up for the day. It will increase your metabolism. It will give you protein storage. Number one, it will give you energy. Number two, eating frequently, not big meals but smaller meals throughout the day that are protein-based will give you slow-carbs. And slow-carbs are usually fruits.

So watch what you eat. Fruits are great, a great source of fiber, great for your head, great for your brain, great for repairing muscle. As long as you don’t starve yourself and have five or six meals a day and then stop at around seven o’clock, allowing yourself four hours to digest before you sleep, it maintains your metabolic rate at a high level throughout the day and also you’ll be feeding your muscles throughout the day. Your muscles need protein.

Dime: There’s some concern nowadays with younger kids playing a sport all year long. How do you feel about that?
DBR: Playing a sport all year long and being a hard athlete myself, what limited me was injuries because I never took care of myself in the proper way that I’m preaching people now. Playing sports all year long, you just have to be preventative. I think if someone wants to play sports and they’re enthusiastic and they have the want and the desire the do so, they just have to recognize that before they go and start using their muscles extensively, they need to have a lot more protein to stay in-shape beforehand and afterwards for recovery, number one. They have to be cognizant of stretching. One of the biggest problems we have nowadays is a lot of people won’t stretch and if they won’t stretch, your muscles…the fascia gets tight. For example, if your hip flexors are tight what happens is you start loading on your back a lot more. Then, you are prone to back injury. A good trainer would be acknowledging that this child because he’s taller or this child because he has no glute is more prone to back injuries, so therefore we need to make sure his hip flexors are stretched out. It’s very important, being preventative is very important. I don’t advocate taking people away from a sport.

Dime: You just mentioned recognizing where an athlete may be weak. Is that something where you can look at someone and tell where he or she might have problems in the future?
DBR: 100 percent. You can look at someone’s body mythology, watch how they walk and you can realize “You’re going to have a problem with this joint. You’re going to have a problem with that joint.” A prime example: someone who has no glutes and is tall and has long legs and who’s in a sport where they are bent over or spinning all day, they are going to have tight flexors so they’re going to be more prone to back problems. If you see someone with longer arms in a sport that involves weights in some ways, they may be more prone to shoulder issues. A lot of it is looking at a person and looking at the mythology of that person’s body, people with longer necks are more prone to neck issues. In looking at the sports they’re participating in and evaluating them and making sure they are environmentally protected as possible. For example, when I see someone who has a longer neck, I think the biggest thing for them is strengthening their trapezius to try to protect the neck. We can look at any athlete and realize what they’re going to be prone to.

Dime: What about weight or muscle gains? Do those affect the body or cause injuries at all?
DBR: Here’s the deal with weight. Our knees, hips and back are all weight-bearing joints. For example, for every extra pound you put on weight-wise, you put four extra reactive pounds on your knee joints. So at the point where you are starting to get overweight and get older, you have to be more cognizant that this knee may not tolerate an extra ten pounds and recognizing that if I’m 220 pounds versus 230 pounds, with this 230 pounds I can’t jump as high or I’m having too much pain in my knee and maybe I should bring myself back to 220 pounds. 10 pounds is an extra 40 pounds of extra force on your knee. Maybe your cartilage is already worn out to a certain degree and that’s the critical point where you start having pain. Number two, muscle is good for you. If you have muscle, you can protect joints. Strong quads and hamstrings around your knee, especially with basketball players, will protect and stabilize the joint and will unload forces on a joint. I think you have to look at each person separately and see where they’re at. In general, too much weight for any good athlete – basketball or football player – is not going to be beneficial in the long term.

Dime: Do you think injuries have changed since you first started? People seem to be more knowledgeable now but is that a double-edged sword sometimes as people can try to treat themselves?
DBR: That’s the biggest problem people have. Things have changed so much now. The general person is recognizing injuries that didn’t exist 20-25 years ago because our general knowledge wasn’t there. For example, everyone understands the concepts of core. Now, people are isolating their core saying, “I have an oblique injury.” An oblique injury happens in basketball a lot because of frequent twisting. People are a lot more knowledgeable and now people are going to the Internet and trying to treat themselves. A lot of times, people will tend to make mistakes, won’t rest their injury enough or go into denial about taking care of it and I think that’s the worst thing you can do, especially professional athletes. They really need to rely on not just their doctors but also their trainers as well because we’re trained to recognize exactly the severity of an injury and what we need to do quickly to get them better because that’s what it’s all about. The longer they play around with it and try to treat it themselves, the worse it gets.

Dime: So do you talk about this stuff a lot with the pros that you deal with?
DBR: Yeah. All the time. I have people who need have played around so much or they’ve tried to treat themselves so much that it’s gone on long enough and by the time they get to me, it’s “I need to get better next week.” (laughs) I look at them and say “You’re not gonna get better next week. It’s impossible.” Now, we have to establish the diagnosis which for myself with the tools I have is obvious. We establish the diagnosis and implement treatment with compliance. But by that time, you have someone where you have to train their mindset to slow down. They’ve already set themselves back by weeks by not seeing me, by ignoring me and treating it yourself.

Dime: With technology that you have, how does that affect players as far as what they can play through and what they can’t play through?
DBR: It helps them actually. Once I isolate an injury, instead of calling something a knee sprain like I did years ago, you can actually isolate and recognize this muscle is what’s going on or it’s this part of the knee joint that’s involved and then it allows us to treat aggressively. It allows the player so they don’t spend months and months with a trainer or someone who is just going through the same routine and they aren’t getting better because the issue isn’t isolated or treated adequately. It allows me to be a lot more aggressive. If there’s an issue or a knee injury in a certain area, well my goal is number one to unload the joint in that area so I unload the joint by strengthening the muscles around that area and number two, correct it. How can I correct it? Well, there’s injections stemming from Hyaluronic acid injections to cartilage injections to stem cell injections to surgery so we have a lot more tools that we can address issues with.

Dime: With basketball players, what are the most common injuries?
DBR: Basketball is simple. The most common injuries are knee and ankle injuries and it’s from impact and torso injuries. Ligament tears in ankle and ankle sprains, meniscal tears in the knee, jumper’s knee which is patellar tendonitis, ACL tears, generally you won’t see a lot of upper body injuries as much. Once in a while you will see shoulder injuries, but they are infrequent. Basketball is a weight-bearing sport and a jumping sport. It’s usually knees, ankles and low back.

What do you think is the most important aspect of staying healthy?

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