Justin M. Givens, M.D., orthopedic surgeon with Norton Orthopedic Institute, is among the first five surgeons in the country — and the first in Kentucky — to perform a new groundbreaking, robotic-arm assisted reverse shoulder replacement surgery with Mako SmartRobotics. This procedure hopes to offer a higher degree of precision and accuracy compared with traditional methods.

“It’s an honor to be among the first to use this technology,” Dr. Givens said. “This new procedure allows me to give my patients a level of accuracy unlike any other. It’s a more personalized approach to each patient’s needs, which can lead to improved results and faster recovery times.”

The technology is designed to elevate the surgeon’s control and confidence by providing the surgeon with a 3D image of the patient’s unique shoulder anatomy. Dr. Givens can then study the 3D simulations before surgery and view them on a screen during the procedure. The robotic arm assists him in shaving down the patient’s glenoid (shoulder socket), creating the new surface and inserting the implant.

“I still do the approach, meaning I make the incision and move the soft tissue, nerves and veins out of the way,” Dr. Givens said. “But now, the technology helps me to know the movements I’m making are exactly the ones I want to make. This gives us precision to ensure every cut and movement is exactly what the individual patient needs.”

The robotic arm’s capabilities help provide enhanced feedback to ensure the implant is positioned within the preplanned boundaries, while aiming for improved accuracy. The goal is to allow for a more natural range of motion and better long-term outcomes for patients.

“We’ve never had this level of accuracy before in this field,” Dr. Givens said. “Now, the procedures we’ve theorized can be put into practice, and that’s why it’s so exciting to be at the forefront of innovation.”

Reverse shoulder replacement is ideal for patients with severe arthritis, rotator cuff tears or other degenerative shoulder conditions that do not respond to conservative treatments. Furthermore, shoulder arthroplasty (reconstruction or replacement) is the fastest-growing joint arthroplasty in the U.S. According to Dr. Givens, more than 90% of patients are satisfied with their replacements, but doctors are consistently striving for more accuracy and reproducibility to improve that number and help patients achieve a higher level of satisfaction in a shorter amount of time.

Dr. Givens’ orthopedic surgery practice is focused on shoulder and elbow care, including arthroscopy, fracture repair, and joint replacement and revision. In 2024, he performed more than 150 shoulder arthroplasties and anticipates performing more than 200 in 2025.

“My goal is to restore the shoulder to where it’s supposed to be and allow my patients to get back to their normal activities,” Dr. Givens said. “I want my patients to go back to living their normal lives as soon as possible, and this new technology is another tool that will allow them to do so.”

The post Norton Orthopedic Institute surgeon performs new robotic-assisted shoulder replacement appeared first on Norton Healthcare.

A wake-up call before the sunrise, followed by a 4 a.m. drive to the backside of Churchill Downs. Cloaked in darkness, he makes his way to Barn 38 — the one belonging to his father, Steve. He changes clothes, learns his schedule and mounts his first horse. By 5:15 a.m., he’s underneath the bright, fluorescent lights of the 1-mile dirt, oval racetrack.

It’s time for morning exercise rides — a chance for Keith and Steve to prepare their thoroughbreds to race. Early-morning practice, if you will: Keith on horseback, Steve waiting at the rail with a stopwatch.

At 9:30 a.m., Keith dismounts and changes again. This time, it’s out of his riding clothes and into a pair of exercise shorts. He gets back in the car and makes his way to KORT Physical Therapy on Westport Road, across town. Two hours there, rebuilding the strength in his legs, hips and core.

For the past three months, this has been Keith’s routine.

“This whole recovery’s been incredibly smooth,” Keith said. “I’ve been more than well taken care of. It’s just an invigorating feeling to be backed by so many professionals.”

Keith’s preparation and work ethic have been paramount as he prepares to ride in his first race in more than 90 days, returning from the scariest moment of his young career.

‘I was conscious the entire time’

June 1, 2024, was supposed to be a big race day for Keith. He was set to ride in five of Churchill Downs’ 11 races.

But his day would come to an early, abrupt end.

In Race 1, Keith’s filly — Singsational — was bottlenecked after the start and clipped heels with another horse. She fell, tumbling to the dirt, but walked off uninjured.

Keith was not as lucky.

In the spill, he fractured his left femur and three ribs and experienced a right hemopneumothorax, a pressure-causing condition in which blood and air enter the cavity between the lungs and underneath the chest wall.

He would require surgery and a weeklong hospital stay.

“I was conscious the entire time,” Keith said. “I had recognized what happened and was fully aware of the circumstances. I don’t think I was ever overly scared and was attended to immediately by the ambulance. Yes it hurts, but I think the thing that hurts the most about getting hurt as a race rider is just the loss of momentum of success. I don’t think any rider is afraid of getting hurt or anything. It’s more just the fear of being away from the sport and the time it takes to get back.”

At that point, the 26-year-old jockey wasn’t sure what his future would hold, or when he’d be able to ride again.

‘I’ve just been so fulfilled by this position’

Horse racing is, quite literally, in Keith’s blood.

His grandfather was a jockey. His father is a Hall of Fame trainer. His brother, Erik, is also a jockey. Despite that pedigree, Keith’s journey into the saddle was unlike most in the business.

He was in college at the University of Texas at Austin, in the process of earning his master’s degree in professional accounting. But like millions of people, 2020 turned his career and life around. During the COVID-19 pandemic, his classes went remote. Keith came home and spent more time around the track.

He was bitten by the bug.

“I don’t want to call it a pipe dream, because it was very real situation to me, but I’d always thought of being a race rider, and I was always incredibly infatuated with the profession,” Keith said.

He started riding in June 2020 at Lone Star Park, just west of Dallas. He got his first win nearly a month later, one of his six that season. When the summer ended, he promised his parents he would go back and get his degree.

“As soon as I got that diploma, I sprinted right back to the race track,” Keith said.

He couldn’t stay away.

Keith started riding full time in 2022. Ever since, his career has taken off. He’s tallied more than 130 wins in that time, culminating in his victory in the Steel Valley Sprint in November 2023. Keith’s success earned him his first Kentucky Oaks and Kentucky Derby mounts in 2024, riding both races for Hall of Fame trainer D. Wayne Lukas.

“There’s no feeling like being on a thoroughbred race horse in full flight,” Keith said. “It’s such a profound feeling. It’s impossible to describe, and I’ve been so helplessly addicted to it. I’ve just been so fulfilled by this profession.”

‘We want to make a positive impact on their lives’

In the world of professional sports, injury management has risen to the forefront of the conversation.

In the NFL, the culture surrounding concussions has changed drastically, as independent neurologists now roam the sidelines, scanning the field for players who may have experienced a head injury during play. In the NBA, “load management” has become a topic of conversation, as teams become more careful with their star players and what injuries they attempt to play through. In MLB, arm care has become a priority, as more pitchers experience shoulder and elbow injuries than ever before.

But thoroughbred horse racing is different.

Unlike other professional athletes, whose health care is provided by their teams, jockeys are responsible for coordinating and overseeing their own medical care. Furthermore, if they’re unavailable to race, they aren’t compensated, meaning a debilitating injury is more than a physical obstacle. It’s also a lost paycheck. That’s why for decades, many jockeys chose not to seek care.

“[It’s] changing and not changing at the same time,” Keith said. “It’s a very fragile profession. It’s kind of a meritocracy, like, ‘What did you do for me yesterday?’ And so there is that fear of getting hurt and losing that momentum, and that’s why the population rushes back [from] injury, or has a propensity to. I feel like the population of jockeys today is way more receptive to receiving medical care and mental wellness care [than in years past]. And I think that’s kind of the general direction we’re headed.”

It’s a trend Norton Sports Health and Churchill Downs recognized and are collaborating to change.

In April 2022, Norton Sports Health became the official medical provider of Churchill Downs, as the racetrack was looking for a partner to help elevate jockey safety and welfare. This partnership coincided with new regulations from the Horseracing Integrity and Safety Authority (HISA), which went into effect July 1, 2022, with the goal of making the industry safer as a whole. Those changes included mandatory baseline concussion and physical exams for jockeys. They also required a physician be present at all live race days.

“It’s crucial that we provide the care these athletes need,” said Tiff L. Haub, M.S., ATC, director of Norton Sports Health. “Anytime you have a horse going 40 miles per hour on a track with someone on top, you know it can be dangerous. And we know concussions can have long-lasting effects. So, giving the jockeys that peace of mind prerace, letting them know they’re physically and mentally fit to race, is critical to their success and safety.”

Norton Sports Health has taken those mandates a step further, providing comprehensive care for the jockeys, coordinating and scheduling primary care and specialty visits, based on the athletes’ needs. Norton Sports Health physicians, nurses and certified athletic trainers are stationed at Churchill Downs for all 75 live race days each year. In addition, Norton Sports Health has supplied a performance dietitian and mental health professionals to provide care for the whole person. In spring 2023, Norton Sports Health began hosting jockey educational seminars, providing the riders with in-depth information on a variety of topics, including mental performance, nutrition and weight management.

“We want to make a positive impact on their lives, in any way we can,” Tiff said. “We always educate and emphasize to the jockeys, owners and trainers that the goal is for the jockey to ride, but only if they’re safe to do so. We want to support them being their best selves, so they can have their best ride.”

Furthermore, Norton Sports Health has initiated communication and training with other health care providers across the country, in an attempt to elevate care and safety at every American Thoroughbred racetrack. Finally, before each season, Norton Sports Health collaborates with Churchill Downs and Alpha Event Medicine to discuss and revisit the track’s emergency action plan, in the event of a trackside emergency.

“Since we’re the ones overseeing care at a racetrack as prestigious as Churchill Downs, we feel like it’s our duty to collaborate and elevate care across the country, to improve the health and safety of all jockeys, no matter where they’re riding.”

The overall goal is to bring horse racing in line with America’s other major sports.

‘We were working together’

After a week in the hospital following his on-track spill, Keith was discharged.

He connected with Tiff, who introduced him to Tyler Curry, P.T., DPT, OCS, physical therapist with KORT Physical Therapy. Together, the three created Keith’s physical therapy (PT) program. He started PT two weeks after discharge, beginning with light balance exercises, range-of-motion exercises and strength training. Eventually, he folded in cardiovascular exercises — jogging, swimming and biking.

“Around the month-and-a-half or two-month mark, we realized he was progressing enough in his goals and that he was driven and motivated enough that we could discuss a return-to-ride protocol and how we were going to attack that goal,” Tiff said.

Getting back on the track for the fall meet

“Keith’s been one of the most motivated athletes I’ve worked with,” Tyler said. “It was a learning experience for all three of us, in terms of trying to determine what Keith needed and understanding how to work him through a major injury. But he stayed focused on his end goal, and that made everything easy for us to work backward and put together a plan for each step in his recovery.”

When the calendar turned to August, Keith graduated to sport-specific exercises, with the goal of getting back on a horse. He started with basic galloping and exercise riding. The work was minimal and supervised. He would self-report his progress to Tiff and Tyler, and worked with them to create goals for his next ride.

“It was very uplifting,” Keith said. “I’ve worked with such a professional staff at Norton Sports Health and KORT — people who were well-versed in the sport — that I was able to give feedback and they were malleable enough to alter our progress. If that meant I needed more balance here, and a little less muscle mass there, they were always receptive to my feedback. It made me feel like we were working together.”

Two weeks later, Keith was cleared for a faster pace and for short-race simulations. The return to real racing was getting close.

Then on Sept. 12, a little more than 90 days after his spill, Keith was medically cleared to race again. He took his first mount Sept. 21, on a horse appropriately named Payne.

He finished fifth, but more importantly, came away from the race in good health.

“You heal as most appropriately and just find the optimal way back to the sport,” Keith said. “You get paid for what you do, but you pay for what you do. There are consequences to rushing back [from] injuries. And there’s a very strong propensity to do that. I feel like I’ve been attended to with extreme professionalism, and I feel like I’ve taken this injury incredibly seriously and focused on how to optimally return so that I’m 100% when I get back.”

‘Physically and mentally 100%’

“We were just as motivated to have Keith return to ride as he was,” Tiff said. “We wanted to make sure he didn’t ever have to feel like he was on his own. We wanted him to feel like we were on his team, guiding him through every step of the process. That way he could truly be physically and mentally 100% before he returned to race.”

Now with a few races under his belt, Keith can reset his sights on his goals, both short and long term. And while he tries to stay in the moment, it’s hard not to allow his mind to wander, about what a victory might look like on the first Saturday in May, riding one of his dad’s horses across the finish line.

But until he gets to next spring, he takes comfort in knowing he’s where he needs to be, surrounded by those who want to see him succeed.

“It’s impossible not to be that sentimental,” Keith said. “But right now, I’m trying to stay in the present. [We’ve made] very targeted progress. I don’t feel like we were ever guessing. We’ve constantly addressed what needs to be improved and what’s doing well and just refocusing, refocusing, refocusing to where it’s all progress. And I don’t feel like I ever plateaued. Even if it was one more rep, one more step each day, if it was a step in the right direction, it was something to be excited about.”

The post Norton Sports Health helps Churchill Downs jockey complete monthslong return to ride appeared first on Norton Healthcare.

Victor J. Kremser, M.D., will return to Hardin County as a nonsurgical orthopedic physician to serve Elizabethtown and the surrounding communities. In addition to his medical practice, Dr. Kremser also will serve as medical co-director of Churchill Downs racetrack, beginning during the 2024 Fall Meet.

“It’s an honor to return to Hardin County,” Dr. Kremser said. “This community has been like my home since I was a teenager. It’s where I met my wife and began studying medicine. Now, I join a talented staff at Norton Orthopedic Institute, with the goal of giving back to the people who’ve made a deep impact in my life and career.”

Dr. Kremser comes to Norton Healthcare after completing a fellowship at Andrews Sports Medicine & Orthopaedic Center, a world-renowned orthopedic clinic in Birmingham, Alabama. During his fellowship, he served as a team physician for Troy University in Troy, Alabama, helping the football team to a Sun Belt Conference championship. Additionally, he provided medical coverage for the Birmingham Barons, Birmingham Squadron, Samford University men’s and women’s basketball, Birmingham-Southern College men’s and women’s basketball, and the Alabama Ballet.

“In addition to being a great physician, Dr. Kremser brings a unique perspective to Elizabethtown because of his personal connection to the community,” said Sam Zuege, system vice president, orthopedic services, Norton Healthcare. “I can’t think of a better person to expand our care in the Hardin County community.”

Born in Cologne, Germany, Dr. Kremser’s Kentucky journey began in 2009, when he participated in a student exchange program in Bardstown, Kentucky. While there, he met his wife, whose parents are from Hardin County. He returned to Germany to finish high school, but came back to Kentucky in 2012 to pursue a bachelor’s degree in biomedical science from Morehead State University. He then attended medical school at the University of Kentucky in Lexington.

“The United States is home to the greatest sports culture and greatest athletes in the world,” Dr. Kremser said. “So it only made sense for me to pack my bags and chase my dream to become a sports medicine physician in America.”

The post Norton Orthopedic Institute welcomes new doctor to Elizabethtown appeared first on Norton Healthcare.

 1.      Pre-workout nutrition

Proper nutrition before a workout is necessary to give you the strength, energy and endurance you need to power through physical activity. Consuming the right kinds of foods before exercising can improve your blood sugar levels, focus and endurance.

It is important to have a well-balanced diet with foods to help fuel your workout. Marisa suggests the following guidelines:

Three hours before a workout, consume foods that are high in carbohydrates (including simple carbs 30 minutes before a workout), moderate in protein and low in fat.

We will dive more into each of these nutrients and their impacts below:

Carbohydrates for energy

Carbohydrates, or carbs, are your body’s main source of energy. Complex carbohydrates provide a steady release of energy and help optimize your body’s blood sugar levels. Complex carbs include whole grains, fruits, and vegetables. Just before a workout, you should consume simple sugars, which include fruit, fruit juice, fruit snacks, granola bars and sports drinks.

Protein for muscle support

Protein enhances exercise performance and provides your muscles with the necessary amino acids for muscle growth and repair. Lean-protein foods include chicken, turkey, fish, tofu and Greek yogurt.

Healthy fats for sustained energy

Healthy fats can enhance endurance and nutrient absorption, plus encourage the production of hormones that aid in muscle repair and recovery. Foods with healthy fats include avocados, nuts, seeds and olive oil.

When it comes to what to eat before a workout, fueling your body with the proper combination of high-carbohydrate, moderate-protein, low-fat foods three hours before exercise, combined with simple carbohydrates 30 minutes before a workout for quick energy, can enhance your energy levels, muscle function and overall performance. 

2.      Timing of meals

What you eat before a workout, as well as the timing of your meals, can make a significant difference in your performance. In this section we will discuss the ideal timing for pre-workout meals, strategies to avoid digestive discomfort and the importance of post-workout nutrition to enhance your recovery.

Ideal timing for pre-workout meals

Timing your meals properly can help optimize your energy levels without feeling too full or sluggish during your workout. You should eat a balanced meal high in carbs, moderate in protein and low in fat around three hours before working out. This can allow for enough time for adequate digestion and provide a steady release of energy without feeling overly full. If you don’t have that much time, opting for a smaller snack rich in carbs and protein at least 30 to 60 minutes before physical activity can help improve your energy levels for your workout. Right before working out, simple carbs and simple sugars can help “top off the tank” for quick energy.

Balancing meals to avoid digestive discomfort

Eating a large meal right before a workout can cause digestive discomfort during exercise, including bloating, cramps, nausea and sluggishness. Avoid consuming big or heavy meals soon before physical activity, and opt for lighter, easily digestible foods instead. Experiment with different meal timings and types of meals to figure out what works best for your own body and workout routine.

Post-workout nutrition and recovery

What you eat after a workout is also important as it supports muscle recovery and can replenish your electrolyte levels and glycogen stores. It is ideal to eat a combination of simple carbs and protein after working out. Marisa suggests a 3-to-1 ratio of simple carbs to protein during this time.

“After that quick snack post-workout, then we can incorporate a meal with complex carbs, fats and proteins,” she said.

Simple post-workout food combinations may include a protein shake with fruit, Greek yogurt with fruit and granola, a turkey sandwich, and rice bowls or pasta with protein to encourage muscle recovery.

3.      Protein intake

Protein is crucial when it comes to muscle growth, muscle repair and overall exercise performance. When you work out, and especially during resistance training, very tiny tears occur in muscle fibers. Protein provides the necessary amino acids to repair these microscopic tears, which can lead to muscle strength and growth over time. Without enough protein, your muscles can struggle to recover effectively, which could slow down the recovery process. Protein-rich foods should be incorporated into your regular diet and eaten throughout the day to support your physical health and overall wellness and to reduce the risk of sports injury.

Sources of high-quality protein

High-quality, lean-protein options are rich in amino acids and lower in saturated fat and cholesterol. Options to support muscle repair and growth: chicken breast, fish, turkey breast, cottage cheese, beans, legumes and eggs.

Timing of protein consumption

While it is important to eat protein throughout the day, timing your protein consumption for workouts can enhance support for your muscles, particularly after exercising. You should aim to consume a meal or snack rich in protein within 30 to 60 minutes after you finish your workout. This timing can help jump-start the muscle repair and recovery process, setting you up for improved future workouts.

4.      Carbohydrates for energy

Carbohydrates are one of the most important elements of what to eat before a workout. They are considered your body’s primary source of fuel, making them a major part of your pre-workout nutrition routine. Carbs can help you exercise at higher intensities for longer durations. Not eating enough carbs can cause you to feel fatigued.

Simple carbs vs. complex carbs

There is a time and place for both simple carbs and complex carbs, according to Marisa. Simply put, simple carbs can be consumed around exercise, while complex carbs should be consumed throughout the day.

Complex carbs include fruits, vegetables, whole grains and legumes. They contain fiber and other nutrients that can provide longer-lasting, consistent fuel for your muscles and avoid a “crash” of energy.

5.      Nutrient-rich snacking

Nutrient-dense snacks can provide your body with the essential nutrients and energy it needs for optimal workout performance. Three hours before a workout, a turkey and cheese sandwich with a banana and low-fat chocolate milk can be a great small meal to help fuel a workout. A pre-workout snack can be two applesauce cups.

Throughout the day, healthy snacks such as Greek yogurt with fruit, a handful of nuts, a banana with peanut butter, or green smoothie with leafy greens and protein powder can help provide sustained energy outside of the three-hour window before working out.

Snack ideas for varying workout intensities

With a little bit of planning, you can help prevent fatigue by tailoring your snack choices to match the intensity and duration of your workouts. For shorter, less-intense workouts, opt for lighter snacks, such as a piece of fruit or serving of trail mix. For longer, higher-intensity workouts, opt for snacks such as avocado toast, cottage cheese with fruit, or a turkey and cheese sandwich.

6.      Hydration

Even though hydration doesn’t involve eating, it still plays a crucial role in optimizing your workout performance and overall health. Proper hydration helps your body function better, whether you are exercising or not, but it is especially important for physical fitness — when you are working hard and sweating — to help reduce the risk of dehydration.

It’s important to stay hydrated before, during and after your workouts.

“You should drink half your body weight in fluid ounces on rest days, and for every hour of exercise, increase fluid intake by 16 to 24 ounces per hour,” Marisa said.

Restoring electrolytes is another important aspect of hydration. Electrolytes are minerals such as sodium, potassium and chloride, which are lost when sweating during exercise. Sports drinks can reduce dehydration-related complications such as muscle cramps and fatigue.

Find the best fuel for your workouts

You can maximize your workout results through proper nutrition, along with making strategic choices that reflect your individual needs and preferences. Everyone is unique in their physical fitness levels and food preferences, but consistency is key when it comes to a successful nutrition plan that supports your fitness goals and overall wellness.

Prioritizing healthy, balanced and nutrient-dense foods when you consider what to eat before a workout can optimize your physical performance, encourage muscle recovery and improve overall energy levels. You should experiment with different strategies and listen to your body to find what works best for you.

The post What to eat before a workout appeared first on Norton Healthcare.

That’s where the Norton Sports Health team comes in.

On Wednesday, May 15, Norton Sports Health staff members delivered 100-gallon cold tubs to 20 high schools across Louisville and Southern Indiana. The tubs are meant as a preventive measure to keep student-athletes safer from the risks of summer heat.

“I think it’s awesome,” said Aaron Mangum, MAT, ATC, CSCS, sports medicine coordinator, Norton Sports Health. “Our partnership with our schools — both private and public — is of utmost importance. These students are our future. They are the next generation of moms, dads and athletes. And we want to be able to provide them with the highest level of care available. And these cold tubs can save a life.”

The tubs were provided through a grant from the Max Gilpin Beat the Heat Fund through the Norton Children’s Hospital Foundation. The fund is named for and honors Max, a high school athlete who died afrer experiencing heatstroke at a football practice in 2008.

According to the National Athletic Trainers Association, immediate immersion in cold water is a recommended treatment for someone experiencing heat illness from exertion.

The tubs delivered by Norton Sports Health are large enough to submerge two average-sized people, and can be used both for when heatstroke is imminent and for year-round injury recovery.

To treat heat illness, the tub is filled with water and ice and cooled to a temperature of roughly 50 degrees Fahrenheit. An athlete experiencing a heat illness can be immersed in the tub up to the neck, with towels placed over the head and neck.

The goal is to decrease the athlete’s body temperature rapidly, bringing it back to normal levels.

Delivery of the potentially lifesaving tubs builds on the commitment Norton Sports Health and KORT physical therapy have made to area schools. Since 2009, the partnership has provided on-site athletic trainers for more than two dozen high schools across Louisville and Southern Indiana. Over the past three years, that commitment has expanded to include area middle schools.

“It’s important for Norton Sports Health, and for Norton Healthcare as a whole, to make sure our community has what it needs,” said Stephanie Fish, program manager, Norton Sports Health. “During the long summer days, it can be dangerous to be outside. So for us to acquire these tubs, and put them to good use, is exact what we’re supposed to be doing — making our community a safer place.”

The Louisville schools that received tubs were Assumption High School, Butler High School, Central High School, Christian Academy of Louisville, Eastern High School, Grace James Academy of Excellence, Iroquois High School, Kentucky Country Day School, Male High School, Pleasure Ridge Park High School, Presentation Academy, Shawnee High School, Valley High School, Western High School, Waggener High School, Sacred Heart Academy and W.E.B. DuBois Academy. The Southern Indiana schools were Floyd Central High School, Christian Academy of Indiana and New Albany High School.

“I think as an athletic trainer, the biggest thing we can provide is prevention,” Aaron said. “And not just injury prevention, but illness prevention. Heatstroke is an illness, and a lot of our partner schools are not close to a trauma hospital. They’re not close to a place where [the athlete] can receive immediate care. And so, we’re trying to bring in resources to support emergency care, so they can be treated properly and timely.”

The post Norton Sports Health delivers cold tubs to area high schools in daylong dash appeared first on Norton Healthcare.

The glitz, glamour and tradition of the day will culminate in one two-minute race, as the 20 best 3-year-old thoroughbreds will enter the starting gate and run 1¼ miles, while millions from around the world watch with excitement.

Many are watching the race itself, anticipating a photo finish. Some are locked on a specific horse, cheering for a wager to cash. Still others are taking in the scenery, some of the most beautiful in all of horse racing.

While that happens, new sets of eyes will be taking in history as well, focused on the health of jockeys and spectators.

For the first time, Norton Healthcare’s certified athletic trainers will be stationed at the Norton Sports Health Jockey Care Clinic at Churchill Downs, working alongside sports medicine physicians to support jockey health and patron care. The goal is a successful Derby Week with the safety of everyone in mind.

“It’s just electric,” said Tiff L. Haub, M.S., ATC, director of Norton Sports Health. “The feeling and the adrenaline that lead up to Derby Day are incomparable. We know our providers will be relied upon to help keep the jockeys in the best shape possible, and we’re ready to be there for them when they need us.”

The addition of certified athletic trainers builds on a partnership that established Norton Sports Health as the official medical provider of Churchill Downs in April 2022. Since then, Norton Sports Health physicians have been stationed at the track for all 75 race days each year.

The addition of the certified athletic trainers elevates the partnership and promotes safety.

“We know it takes a team,” said Dominic Morales, MAL, LAT, ATC, CES, sports health coordinator, Norton Sports Health. “And our sports medicine physicians are huge advocates for our athletic trainers.”

The seamless collaboration between the trackside physicians and athletic trainers allows the team to evaluate jockeys for a variety of injuries while also performing mandated sports physical exams and concussion evaluations.

“It’s crucial that we provide the care these athletes need,” Dominic said. “Anytime you have a horse going 40 miles per hour on a track with someone on top, you know it can be dangerous. And we know concussions can have long-lasting effects. So, giving the jockeys that peace of mind prerace, letting them know they’re physically and mentally fit to race, is critical to their success.”

Jockey health care has become a priority in recent years.

Institutions like the Horseracing Integrity and Safety Authority (HISA) have helped implement several health and safety mandates, including mandatory concussion testing. The goal is to bring horse racing in line with America’s other major sports.

By providing sports medicine physicians and certified athletic trainers who are skilled at treating athletic injuries, Norton Sports Health is boosting the medical care available for jockey athletes who have to push themselves to the limits, both physically and mentally.

In addition, Norton Sports Health has supplied performance dieticians and mental health professionals to provide care for the whole person.

“We really want to make a positive impact on their lives, in any way we can,” Tiff said. “We always educate and emphasize to the jockeys, owners and trainers that the goal is for the jockey to ride, but only if they’re safe to do so. We want to support them being their best selves, so they can have their best ride.”

Ready for anything

Despite its name, the clinic’s care doesn’t stop with jockeys.

The Norton Sports Health team also provides care for racetrack patrons, a massive undertaking during Kentucky Derby Week, when upward of 450,000 people may walk through the gates of Churchill Downs.

“We start planning a year in advance for Derby Week specifically,” Tiff said. “But January is when everything really ramps up. We talk about our needs and how we’re going to coordinate, while we also debrief about things we did last year that we may want to change or improve on. For other sports, like the NFL, they start with preseason games and build their way to their biggest games. But we have to be ready on day one.”

“With that amount of people, everything is elevated,” Dominic said. “The stakes are elevated. Injuries are often elevated. Everything is under the microscope. So we really have to be ready to go that whole week. By Derby Day, it should be a well-oiled machine. Our job is to be so well prepared ahead of time that come the big days … we’re ready to go.”

So as the horses break from the gate and turn for home, attracting the attention of millions, the jockeys can ride assured, knowing some of the people watching are ready to provide the best care possible.

The post Norton Healthcare athletic trainers working hands-on at Kentucky Derby for first time appeared first on Norton Healthcare.

In this article, we will explore the importance of building muscle tone among older adults, address common concerns and share practical tips and exercise ideas, specifically targeted to older adults, to help guide you along your fitness journey.

Understanding muscle tone

Muscle tone is the amount of tension muscles can hold, which helps us perform controlled movements and keeps our bodies sitting and standing upright. It is directly tied with the amount of movement someone is capable of performing, including mobility, stability and balance. For older adults, improved muscle tone can lead to improved posture, joint health and a reduced risk of falling. As we age, our bodies naturally experience a gradual decline in muscle mass. Therefore, it is important for older adults to perform activities that can preserve, enhance and even build muscle tone.

Practical strength exercises for older adults

Strength training isn’t just about lifting weights; it can include activities like using your own body weight, resistance bands and chairs. You don’t need a gym membership to start. Many of these exercises can be completed at home and built into your daily routine.

Building muscle after age 60 involves incorporating safe strength exercises that target different muscle groups, with modifications to accommodate various skill levels and physical abilities. Practical ideas for strength training exercises include:

1) Chair squats: Begin by sitting in a chair and standing up while extending your arms forward. You can use the chair for support and adjust the depth of your squat based on your personal comfort and ability.

2) Resistance band pulls: Put a resistance band around a fixed point, such as around your foot or in each hand, and pull the band to engage your arm and back muscles. Adjust the resistance by choosing bands with a tension that works well for you.

3) Leg raises: While seated or lying down, lift one leg at a time to engage your leg and core muscles. Seated leg raises provide more stability.

4) Wall push-ups: Place your hands on the wall, standing an arm’s length away, and perform push-ups against the wall. Adjust your distance from the wall to change control or intensity.

5) Seated dumbbell workout: With a straight back, sit down while holding a dumbbell or resistance band. Pull the dumbbell toward your chest or push above your head (depending on the exercise you choose). Select weights light enough that you can perform the exercise with controlled movements.

6) Toe taps: While seated, alternate tapping your toes on the ground. Engage your leg muscles and increase the pace for more intensity.

7) Balancing exercises: Stand on one leg or perform heel-to-toe walking to improve your balance and core strength. Use a chair, counter or wall for support if needed.

Lifestyle tips for maintaining muscle tone

Building muscle after age 60 is about more than exercise. It’s a series of lifestyle habits that promote muscle health, including proper nutrition, hydration and adequate rest.

Nutrition: Be sure your diet includes plenty of protein, which promotes muscle growth and repair after workouts. Lean protein sources include poultry, fish, beans and nuts. A balanced, nutrient-dense diet that includes protein, healthy carbs, vegetables and fruit is necessary. Vitamin deficiencies can impact muscle function. Talk to your provider about your nutrition habits for additional guidance.

Hydration: Drinking water can reduce muscle cramps and is important for overall health. You should aim for at least six to eight glasses of water per day. Be sure to hydrate before, during and after your workouts.

Rest: Aim for seven to nine hours of sleep per night to support your overall health and muscle growth and recovery. Muscles need time to recover and grow, so while it’s good to challenge yourself, don’t overdo it.

Daily walks: Walking is a low-impact exercise that is easily accessible. Walk around your neighborhood, in a local park or on a treadmill indoors. You can do it as a solo activity, include a friend for social connection or join a walking group.

Regular physical activity lays the foundation for building muscle tone after age 60. Incorporating these changes can lead to a healthier, more vibrant lifestyle as you age.

Addressing concerns: Muscle tone and aging bodies

There are several common misconceptions about older adults’ ability to build muscle after age 60.

Common concerns include:

1) Fear of pain or injury. Some people worry that they are too old to participate in strength training, and that they are guaranteed to injure themselves, especially if they have not been active for some time. While it is good to be mindful of possible injuries and one’s own abilities, there are many safe activities that align with a person’s health conditions and skill levels. Low-impact exercises, when under proper guidance and done with gradual progression, significantly can reduce the risk for injuries.

2) Too late to start. Many older adults believe that they’ve “missed the boat” when it comes to building muscle after age 60. However, you still can build muscle through resistance training, no matter your age, skill or activity level. Research demonstrates that older adults can improve muscle tone, strength and function regardless of when they start. Strength exercises can improve bone density, balance, metabolism and more.

Motivation and accountability

For older adults, building muscle after age 60 requires dedication and motivation. Strength exercises require consistency, repetition and effort over a period of time to see results. It’s important to explore strategies for remaining motivated, including setting realistic goals and seeking social support.

1) Set realistic goals. Starting a strength exercise routine shouldn’t involve a drastic overhaul of your current life. Start small and make regular promises to show up for yourself consistently. Setting realistic goals, such as completing a strength workout twice per week, can make it easier to track and celebrate your progress.

2) Understand your “why.” Tap into your internal motivation by reflecting on your reasons for wanting to build muscle. Is it to avoid falling? Retain your independence? Regularly remind yourself why you are doing these workouts and the positive impact it can have on your life.

3) Get social support. Surround yourself with positive people who will cheer on your progress. Maybe you have a workout partner or walking buddy. Perhaps you would enjoy the accountability and community that comes with group activities, such as walking clubs and workout classes.

4) Seek professional guidance. Consider seeking support from health care providers and fitness professionals who specialize in fitness for older adults, such as the team at Norton Sports Health, who can tailor workouts to your individual needs, preferences and current health conditions. This also can help with guidance on proper form, which can reduce the risk of injury.

When it comes to building muscle after age 60, older adults need to remember to be consistent. Schedule regular workouts at similar times every week. Mix up your routine to avoid getting bored or burned out. Start low and go slow; start with low impact exercises and low weights and progress gradually to build strength and avoid injury. Use technology, such as fitness apps or watches, to track and celebrate your progress.

Building a stronger future

Remember, it’s never too late to prioritize your physical health, and the journey to improved muscle tone while aging can be an empowering one! Strength training plays a key part in healthy aging, and for older adults, building muscle after age 60 can be an attainable and rewarding experience. However, it is necessary to consult with health care providers before beginning any new exercise routine. The team at Norton Sports Health is ready with its expertise to support older adults — of any age or skill level — with personalized fitness routines and guidance tailored to your unique needs.

The post Older adults’ guide to improving muscle tone and building muscle after age 60 appeared first on Norton Healthcare.

• At least 150 minutes per week of moderate-intensity exercise, such as brisk walking for 30 minutes per day, five days per week
• At least two days per week of muscle-strengthening activities
• Regular balance exercises

“The idea is to make movement a regular part of your lifestyle, so some physical activity is better than no physical activity at all,” said Joshua K. Wu, D.O., nonsurgical orthopedic sports medicine physician with Norton Orthopedic Institute and Norton Sports Health. “Keep your health conditions and abilities in mind while being as physically active as your situation allows.”

READ MORE: Exercises for joint pain

This article will explore five types of exercises for older adults that can be incorporated into daily routines, helping to forge a path to a healthier and more active lifestyle.

Walking: A foundation for daily activity

Benefits of walking

Walking is a simple activity that can be performed daily and is beneficial for both physical health and mental wellness. Walking is a low-impact exercise for older adults that can improve cardiovascular health, joint flexibility and muscle strength. A daily walk also can help maintain mobility, which can encourage overall independence in performing daily activities. Walking can promote mental wellness as well by increasing blood flow and the natural release of endorphins in the body. This can help improve mood and encourage mindfulness. Studies have shown that even 10 minutes of brisk walking is enough to help improve mood.

Incorporating walking into a daily routine
Making walking a regular part of your day is not only a reachable goal, it also can be enjoyable. Simple strategies may include taking a short walk after eating a meal, visiting a local park or participating in “social” walks with friends, neighbors or walking groups.

Safety tips for older adults
Walking can be an accessible and safe activity when you follow proper form and precautions to maximize benefits and prevent injuries. Keep proper posture and pace in mind when walking, which involves an upright posture, relaxed shoulders and chin parallel to the ground. A brisk pace is encouraged to increase heart rate, but the walks should not cause undue strain or discomfort. Take breaks as needed. Also, invest in comfortable and supportive footwear, such as sneakers with enough traction on the soles. 

Strength training: Maintaining muscle health

Meet the recommendations
The CDC recommends at least two days per week of strength training activities, but this doesn’t mean you have to go lift heavy weights at the gym. There are many ways to incorporate strength exercises for older adults, whether it involves weights (including light dumbbells), resistance bands or simply relying on body weight.

Find what works best for you
These exercises can be tailored to your strength level. Simple introductory routines include bicep curls with dumbbells (or even soup cans!). Leg raises and squats can be done through using your own body weight. Gradual progression is important, and you should focus on working different muscle groups to ensure a well-rounded exercise routine. If you are seeking additional direction, visual demonstrations of simple body weight exercises can be found on YouTube.

Don’t overdo it
Older adults should listen to their bodies when doing strength exercises. Start with light weights and move up. Increase resistance or intensity as you become more comfortable with your routine. It should be somewhat challenging, but not painful. If an exercise hurts, stop right away and find a modification or alternative exercise that works better for you.

Balance exercises: Enhancing stability

Reduce fall risks

Balance exercises can promote stability and reduce the risk of falls among older adults. These exercises also can improve confidence and bodily control and coordination, which are helpful in preventing the potential injuries commonly associated with falls. This can help you maintain your overall independence.

Balance exercise ideas
Examples of simple balance exercises include standing on one foot. Use the wall or another surface to steady you, if needed. Heel-to-toe walking, leg raises and toe taps are also effective balance exercises that can be done at home. Tai chi, which resembles moving meditation, is a series of slow movements and poses that promote balance through shifting weight during flowing movements.

Flexibility exercises: Promoting joint health

Benefits of stretching

Flexibility improves the range of motion around the joints, helping older adults move with more ease and comfort in their daily lives. Incorporating flexibility exercises with stretching can reduce pain and stiffness, enhance your mobility and range of motion, and supplement an active lifestyle by reducing injuries such as joint strains and sprains.

Simple stretching ideas

Daily stretches can be simple and target major muscle groups. For upper body, arm circles, gentle neck tilts and shoulder stretches can alleviate muscle tension and improve mobility. Lower body stretches include seated leg stretches, reaching toward your toes, calf stretches by pressing your foot against the wall, and gentle hip rotations. Gentle spinal twists and side bends can support your core strength and spinal mobility.

Cycling or swimming: Low-impact exercise options

Low-impact but highly effective
Low-impact exercise options are gentle yet effective cardiovascular workouts that are easier on the joints. Swimming and cycling are two popular low-impact exercises that reduce the impact on aging joints via smoother, gentler movements — while still providing a cardiovascular workout that encourages overall health.

Low-impact workout ideas
In addition to cycling and swimming, other popular low-impact exercises include an elliptical machine, water aerobics, yoga, and chair or ball exercises. Choose the exercises that align with your interests or feel motivating, fun and joyful based on your personal preferences and current physical condition.

It’s not ‘too late’ to be active!

Physical activity is key to enhancing physical strength, resilience and energy when aging. It’s not “too late” to reap the benefits of regular movement.

Incorporating daily exercises tailored to the needs of older adults — such as walking, strength training, balance exercises, flexibility routines and low-impact activities — can improve your physical and mental well-being into your golden years.

It is important to take your current health condition and abilities into consideration. Therefore, be sure to consult with your health care providers before starting any new exercise routine. A primary care provider, orthopedic specialist, physical therapist and personal trainer can provide you with guidance that meets your needs.

You don’t have to approach a healthier, more active lifestyle alone. Personalized guidance and programs are available through Norton Sports Health, where our specialists are trained to meet the unique needs of older adults at any age and skill level.

The post 5 types of exercises older adults can do every day appeared first on Norton Healthcare.

Strength and resistance training can play an important role in healthy aging. The aging process is often associated with a decline in muscle mass, strength and physical stamina. However, incorporating simple strength and resistance training exercises can help older adults maintain muscle mass, improve mobility and reduce certain health risks commonly associated with aging. Even if you didn’t lift weights in your younger years, it’s never too late to realize the benefits of a starting a healthy routine.

In this article, we will discuss the impact of aging on muscle mass, the benefits of building muscle as we age and the importance of incorporating strength and resistance training into our regular physical activity routines.

Strength training can help you age better

Aging is a natural process that impacts our overall bodies, including the muscles. As we age, there is an inevitable decline in muscle mass. In some individuals, this can lead to a syndrome known as sarcopenia, in which the loss of muscle leads to a reduction in strength and function. However, numerous studies have shown that strength and resistance training can help your body combat the physical effects of aging by preserving existing muscle mass and stimulating the growth of new muscle tissue, even beyond age 70. Improved strength, balance and overall physical function can lead to a more active and independent lifestyle.

Other health benefits of strength and resistance training among older adults include:

1) Improved metabolism: Strength training can help you burn more calories by increasing your metabolism. The body’s metabolism typically slows down after age 60, but regular strength exercises can help with weight management and obesity. It also improves insulin sensitivity, which can help treat and prevent Type 2 diabetes.

2) Increased bone and joint health: Resistance training can improve bone health while strengthening muscles. Bone density naturally decreases with age, but strength training exercises can stimulate bone tissue and help prevent osteoporosis. Stronger muscles also can support the joints and reduce injury risks. In patients with osteoarthritis, resistance training has been shown to improve strength and functional ability and to reduce pain, even in patients with advanced disease. Resistance training is also safe and may be beneficial in patients after a joint replacement surgery, such as the knee or hip.

3) Better balance and stability: The risk of injuries from falls can increase as we age, but stronger muscles can lead to improved balance and coordination.

4) Higher energy levels: Regular strength and resistance training can improve energy levels and stimulate endorphins, leading to increased mood and more energy to complete tasks and enjoy life. Resistance training also has shown beneficial effects in the treatment of both depression and anxiety.

5) Muscle strength and growth: Strength exercises can combat the physical effects of sarcopenia as one ages, leading to a stronger and healthier body in the older years.

6) Improved cardiovascular health: Strength and resistance exercises have been associated with improvements in overall heart health, including reduced blood pressure and cholesterol levels.

“Strength training can enhance our quality of life as we age,” said Luke A. Beggs, M.D., Ph.D., sports medicine specialist with Norton Orthopedic Institute. “Additionally, strength and resistance exercises can be adapted to all fitness levels, making workouts accessible to people of many different ages and abilities. There is a strong correlation between physical strength and reduction in all-cause mortality across the life span. In short, resistance training is one of the few interventions shown to lead to a longer, healthier life.”

Overcoming common misconceptions

Staying active and maintaining strength play an important role for older adults. Several misconceptions exist, however, that can deter people from starting a strength and resistance training routine. Let’s dispel some common rumors surrounding strength training while aging.

Myth: It’s too late to begin a strength training routine

False. It’s never too late to begin a fitness routine, regardless of your age. Older adults can experience significant benefits related to overall health, including muscle strength and bone density. Strength training exercises can be tailored to your age, abilities and current health status. You can use light weights or even ditch the weights altogether; body weight exercises also have been proven to help.

Myth: Cardio is more important for older adults
Cardio training is definitely important, but it’s not the only element for older adults’ overall health and wellness. Resistance training supports cardiovascular, bone and muscle health in different ways.

Myth: I don’t want big muscles at my age
Strength and resistance training among older adults focuses more on functional strength and muscle tone compared with extreme muscle mass gain. Building large, bulky muscles is not the goal and likely is not safe for many older adults’ abilities in the first place. You are more likely to use lighter weights or bands, or rely on body weight exercises.

Myth: I will definitely hurt myself if I try
This does not have to be true. Many older adults are understandably concerned with injury risks and age-related limitations related to strength training. However, approaching a new fitness routine under the guidance of a health professional can help ensure it is both a safe and effective practice for you. Consult with a health professional at Norton Sports Health to tailor a program that accommodates older adults’ individual needs and limitations.

Tips for starting strength training as you age

The American College of Sports Medicine recommends that a strength training program should be performed a minimum of two nonconsecutive days each week.  However, starting a strength training routine doesn’t require a complete overhaul of your current lifestyle. You can go to a gym for dedicated training time or incorporate elements of resistance training into your daily routine. For example, simple body weight activities like squats can be integrated into your daily life by taking small breaks throughout the day.

Be sure to consult with a health care professional before starting a new exercise routine. They can offer guidance for exercises that align with your current health status and abilities. Start slow, and be sure to have guidance on proper form and technique to prevent injuries.

1. Focus on gradual progression: Start with lighter weights and fewer repetitions until your body gets used to new types of movement.
2. Include resistance bands: A resistance band is a gentle way to add resistance to your exercises, helping to build strength without putting too much strain on the joints. 
3. Focus on functional movements: Strength training can mimic your everyday movements. Activities like squats, lunges, carries and overhead presses can enhance both strength and flexibility.
4. Incorporate balance training: Balance exercises can improve strength and stability. Standing on one leg or using a stability ball can improve balance.
5. Use proper form and technique: Learning and following correct form can reduce the risk of injuries and enhance your strength and resistance workouts. Consider working with a certified trainer or health care professional.
6. Stay consistent: Consistency is key, as they say. Make a regular schedule and stick to it. The Centers for Disease Control and Prevention recommends strength training exercises for older adults at least twice per week.
7. Listen to your body: Some movements may not be compatible with your current health status or abilities. Exercise should feel challenging to a certain degree, but if any movement hurts, stop immediately.
8. Have fun! Focus on exercises that you find enjoyable. You are more likely to continue with a routine when you experience a sense of fun or fulfillment.

Remember, it’s never too late to start a strength and resistance training routine. Always prioritize your health and safety and be sure your exercises align with your individual needs and current health status.

Feeling strong and empowered with age

Incorporating strength and resistance training exercises can help you live a healthier life while aging. The natural decline of muscle mass among older adults can impact a person’s overall health and well-being, but regular exercises can improve older adults’ strength, balance and muscle function. The health benefits of resistance training are wide-reaching: improved bone density, joint health, metabolism, cognitive function, and emotional/mental health. Regular physical health routines, such as strength and resistance training, can encourage more active and independent lifestyles into the golden years.

The specialists at Norton Sports Health provide medical care and performance training for people at any age or skill level, including older adults. Norton Sports Health also offers programs tailored to older adults, such as Senior LIFEready group fitness classes focusing on improving range of motion, strength training and flexibility for people ages 65 and older.

The post Why strength and resistance training can help you as you age appeared first on Norton Healthcare.

Golfer’s elbow is a soft-tissue overuse injury at the point where your forearm muscle tendons attach to the bone on the inside of your elbow. When the injury is on the outside of the elbow, the condition is commonly called tennis elbow or lateral epicondylitis.

The repetitive motion of swinging a golf club can put strain on a tendon, causing inner elbow pain.

“There are a lot of gripping mechanics that have to happen to be able to get a golf club through the ball and hit a ball consistently well, which can cause an elbow injury,” said Jeffrey S. Stephenson, M.D., sports medicine physician with Norton Orthopedic Institute.

Golfer’s elbow pain starts on the inner side of the elbow and can radiate down the inside of your forearm. Your elbow probably will be stiff, and clenching your fist can be painful. Sometimes there will be weakness in your hands and wrists and tingling or numbness on your ring and little finger.

Rest, ice and over-the-counter pain relievers typically will take care of the symptoms. If your pain is persistent or severe, contact your primary care provider about whether you need the expertise of a sports medicine specialist.

Ways to help prevent golfer’s elbow and inner elbow pain

To protect against injury, stretch the affected tendons through simple wrist-stretching exercises, and make sure you are swinging properly.

“If you are concerned that you are having consistent pain with your swing, it may be worthwhile to have your swing checked out by a golf professional,” Dr. Stephenson said. “If there are certain mechanical issues with your swing, it makes you more susceptible to injury.”

The wrong clubs also can affect your mechanics and put strain on your elbow. Get advice on the correct length and weight for your body and your swing.

If you are a golfer, don’t push yourself. Play shorter rounds and play less frequently to allow your muscles and tendons to get back in shape. Take regular breaks whether on the course or the range and avoid sudden bursts of activity, which can increase the risk of injury.

Stretching and strength exercises

Exercise to stretch the wrist flexor muscles in the forearm can improve your range of movement. Try this stretch twice a day:

• With your palm facing up, lift your arm in front parallel to the ground
• Allow your hand to fall downward by relaxing your wrist.
• With your other hand, grasp your fingers and pull the relaxed hand back toward your body.
• Hold for a slow count of 30 to 45 and rest for 30 seconds.
• Repeat three times.

Exercises can strengthen forearm and wrist muscles, helping build strength and endurance to support your elbow.

Try this exercise to target the forearm and wrist:

• Sit in a sturdy chair.
• With your forearm resting on your thigh and your palm facing upwards, hold a modest weight — no more than 2 pounds — in your hand
• Gradually lower the weight, relaxing at the wrist, and move the weight back to its original position. You can use your free hand to help.
• Repeat about 10 to 15 times and take a short break.
• Repeat twice.

The post How to prevent golfer’s elbow appeared first on Norton Healthcare.