Dr Patrick Vavken is a recognized expert in shoulder and elbow surgery and plays a key role in the success story of the ADUS Clinic in the Zurich Unterland region. As Head of Orthopedics and Traumatology, he is a key pillar of a team distinguished by its excellent medical services and patient-centered care. With extensive training and many years of experience in renowned medical institutions, Dr Vavken has built up a wealth of specialist knowledge that makes him an expert in his field.
His focus is particularly on the treatment of joint instability and hypermobility, cartilage damage, and joint-preserving procedures on the shoulder and elbow. Dr Vavken’s commitment to the advancement of shoulder and elbow surgery is also evident in his research work and his dedication to innovative therapeutic approaches. In doing so, he relies on both tried-and-tested procedures and the latest technologies to provide his patients with the best possible care.
As part of the medical team at the ADUS Clinic, it is particularly important to Dr Vavken that patients feel well looked after from the very beginning. Dr Vavken brings not only his expertise as a specialist in orthopedic surgery and traumatology, but also his particular interest in joint-preserving procedures, especially in children and adolescents. His work as a senior consultant at renowned medical institutions such as the University Hospital and University Children’s Hospital of Basel, as well as at Boston Children’s Hospital/Harvard Medical School, has established him as a highly respected specialist in his field.
At the ADUS Clinic, patients can be sure that they are being cared for by a first-class team of specialists who are passionate and dedicated to their health. With Dr Vavken at the helm, the clinic stands for outstanding medical care and an atmosphere in which patients can simply feel well looked after.
The editorial team at the Leading Medicine Guide had the opportunity to speak with Dr Vavken, focusing on measures that athletes, as well as the average active person, can take to maintain and improve shoulder function and general health.
The shoulder is an extremely versatile and important joint in the human body, particularly for athletes, whose performance depends significantly on the health and functionality of this joint. Various factors play a crucial role in achieving and maintaining optimal performance in sport. In addition to targeted training and exercises, aspects such as sleep, nutrition and protein intake are also of great importance.
Poor sleep quality can also lead to reduced recovery of the shoulder muscles, which in turn increases the risk of injury and can impair sporting performance.
There are several measures that can be taken to promote restful sleep and thus improve shoulder function, but also one’s overall quality of life. These include maintaining a regular bedtime and wake-up time, creating a quiet and dark sleeping environment, and avoiding stimulating activities before going to bed. “Sleep is actually the new obsession for young people! But exactly what sleep does is still not fully understood. We are gaining a better understanding of the effects of sleep, but we don’t quite get it yet. What is certain is that sleep patterns change over the course of a lifetime. Parents are familiar with the phenomenon of the fetal sleep rhythm, in which babies in the womb are awake for 3–4 hours, then take a half-hour nap, and are awake again for 3–4 hours – this rhythm of 4 to 0.5–1 hours is the typical fetal sleep rhythm, which is sufficient for the little ones. As an adult, you could probably manage that pattern for a while (I was trained to do so for a time in the military), but ultimately the need for sleep is greater. Sleep is important for physical recovery, but also for cognitive recovery. Sleep is also important for metabolism, insulin production, muscle building, heart health, etc. In a classic comparison regarding cognitive performance, a night without sleep is equivalent to having a blood alcohol level of 0.1 per mille. For this reason, pilots are not allowed to fly for too long and bus drivers are not allowed to drive for too long. In Formula 1, for example, it is sometimes contractually stipulated between the drivers and the teams how much sleep they must get before a race. “The average person needs eight hours’ sleep. However, studies have also shown that too much sleep is just as harmful as too little – eight hours is ideal,” explains Dr Vavken by way of introduction, before going on to mention important aspects of sleep hygiene and aids:
“You should avoid drinking coffee 3–4 hours before going to bed and get into the habit of a so-called ‘wind-down routine’, i.e. winding down and putting your body into sleep mode. You should sleep in a room designated for that purpose, i.e. where you don’t watch TV or do other things; you can also pay attention to the room temperature here. Those who have difficulty falling asleep can also help themselves by taking ashwagandha, which comes from Ayurvedic medicine and promotes relaxation. Taking melatonin can also help; this is normally produced in response to darkness and signals to the body that it is time to relax and sleep. You should not take conventional sleeping pills – these are, for example, sometimes reserved for people who are sleepwalkers.”
Ashwagandha, also known as Indian ginseng, is a perennial plant from the nightshade family, native to India, the Middle East and parts of Africa. It has been used for centuries in traditional Indian medicine. The plant’s roots and berries are valued for their medicinal properties and are said to offer a variety of health benefits, including stress relief, improved cognitive function, reduced inflammation and better sleep quality. Ashwagandha is available in various forms, including powder, capsules, extracts and tea. It is advisable to consult a doctor before taking it, particularly if you are taking other medication or have existing health conditions, to take potential interactions or side effects into account.
Stress management techniques such as relaxation exercises, meditation or breathing techniques can help reduce stress and promote restful sleep. Eating heavy meals shortly before bedtime should be avoided, as should excessive consumption of caffeine and alcohol. Regular physical activity as part of an exercise program can also improve sleep quality; however, intense workouts immediately before bedtime should be avoided, as this can in turn disrupt sleep. A comfortable sleeping environment with a suitable mattress and pillow can help improve sleep quality and allow the shoulder muscles to recover fully.
“A real sleep killer is the personal processing of everyday life, which for many people is associated with stress, and this is more pronounced in women. There is a specific technique that can be used here. Imagine placing the day’s stress and worries into a box before going to sleep and placing this box outside the door. If stress is carried into the night, for many people this manifests as teeth grinding or snoring, whereby a great deal of energy—which is actually needed for sleep—is lost and one cannot find peace. Yet rest is essential, including for the recovery of the muscles and the musculoskeletal system. Neuromuscular, or cognitive, recovery of the brain is also important. Because if the nerves aren’t functioning, then a muscle cannot function either, and even the strongest person cannot then perform at their best, thereby risking injury during sport or other activities. Restful sleep is also important for cardiovascular health and insulin resistance. If you gradually undermine this, you will also gradually put on weight, and your metabolism will be disrupted, which ultimately causes the joints to suffer as well,” explains Dr Vavken.
A healthy and balanced diet is particularly important for athletes, with protein intake playing a particularly important role.
Proteins are essential building blocks for the repair and development of muscle tissue, including the muscles that stabilize and move the shoulder. Adequate protein intake supports muscle recovery after intense training and helps improve shoulder function. “If I were to emphasise one thing to improve performance, it would be protein intake. Most people don’t get enough. For an average person who engages in normal sporting activities – for example, playing in a volleyball team or going to the gym three times a week – they need around 1.5–2 grams of protein per kilogram of body weight per day. So someone weighing 90 kilos needs around 135 grams of protein. That’s a lot. Even if you like meat, that would be the equivalent of two steaks you’d have to eat. Awareness of sustainability and animal welfare has grown – 500 grams of low-fat quark, for example, contains 50 grams of protein, so meat doesn’t always have to be your protein source. Hummus and lentils are also very high in protein, so there are vegetarian and vegan options available too. An additional benefit of protein is that it is very filling. Anyone who starts the day with a croissant – in other words, with carbohydrates – will be hungry again after three hours. Not enough insulin is produced, so you don’t feel full for very long. If you eat eggs, low-fat quark or yoghurt in the morning instead, you’ll feel full for much longer,” says Dr Vavken.
In addition to protein, other nutrients are also important. Antioxidants found in fresh fruit and vegetables help reduce inflammation and promote muscle recovery. Healthy fats found in nuts, seeds, avocados and oily fish support joint health and help reduce inflammation. A balanced diet rich in protein, fruit, vegetables and healthy fats can help improve athletic performance. By ensuring they follow a varied and nutrient-rich diet, athletes can promote the health of their shoulders and prevent injuries, which in turn supports their athletic performance.
Proper hydration plays a crucial role in supporting the joints, including the shoulder, and can help prevent injuries.
Water is an essential component of synovial fluid, which acts as a lubricant and shock absorber for the joints. Adequate fluid intake supports the production of synovial fluid and helps to keep the joints supple and well-lubricated. “Unfortunately, most people don’t drink enough water. However, you should also consider how much water you actually need. For example, if I eat a lot of protein – which is good – then I also need plenty of water, because protein draws water. You really should be drinking around 2–3 liters of water a day. Unfortunately, most people start the morning with a bad habit. You get up, having lost a lot of fluid and electrolytes through normal night-time sweating, and then you drink a coffee. The coffee stimulates the kidneys, and electrolytes are flushed out the next time you urinate. It is much better to start the morning by drinking a large glass of water with a small pinch of salt (as an electrolyte replacement) and wait an hour before having your first coffee. Biologically speaking, humans are saltwater organisms anyway, not freshwater ones. And in the 1980s, the theory emerged that low protein and low salt were good for you, a notion that stuck in people’s minds for a good 20 years but is now completely outdated. “Of course, you should keep an eye on your salt intake,” explains Prof. Dr Vavken, adding a comment on alcohol consumption:
“Alcohol consumption does not cause direct damage to the joints themselves, but it does cause indirect damage – because if you fall over while drunk, you can hurt yourself. Having a glass of wine now and then in the evening is fine, but anyone who drinks three glasses or more will sleep poorly and usually wake up with a slight hangover, dehydrated and not feeling refreshed. Then you look for sources of energy, perhaps drink another two coffees and eat a chocolate bar; all of this adds to the stress, and arguments with family or colleagues are inevitable. You simply have to be a bit careful here and make some changes, following the motto ‘Oh, I’ve gone astray now, I need to turn back’.
Adequate hydration also ensures that the ligaments, tendons and muscles that stabilize the shoulder are sufficiently supplied with fluid. Well-hydrated tissues are more resilient to stress and less prone to injury. Furthermore, adequate fluid intake promotes blood circulation, which improves the supply of nutrients to the joints and contributes to faster recovery after exercise. To provide optimal support for the joints, including the shoulder, and to prevent injuries, it is important to drink water regularly and to compensate for fluid loss during exercise by drinking extra fluids. Athletes should ensure they stay sufficiently hydrated before, during and after training, particularly during intense or prolonged activities and in hot environments. Individual hydration needs may vary depending on body size, metabolic rate, activity level and environmental conditions. It is advisable to use your own thirst as a guide and to drink small amounts of water regularly to ensure optimal hydration. A balanced diet including hydrating foods such as fruit and vegetables can also contribute to fluid intake and support overall hydration.
There is a wide range of exercises and training programs specifically designed to improve shoulder stability and mobility.
“Generally speaking, it can be said that from the age of 30, you lose 1% of muscle mass per year. If injuries or operations are added to the mix during this time, the loss is even greater. And this is where you need to take action. Physical activity is the ultimate longevity booster; it combats mental and physical decline and helps prevent dementia. Ideally, you should focus on the two major muscle groups: the thighs and buttocks, and the second-largest muscle group, the shoulder girdle. So if I can activate these two muscle groups, I’ve already achieved a great deal. And here are five simple exercises that anyone can do; it’s enough to repeat them for the required 15 minutes 3–4 times a week: Deadlift (a strength exercise where a barbell is lifted from the floor to hip height), squats, pull-ups, overhead press (pressing something heavy upwards) and push-ups. You can do these exercises anywhere. Studies have shown that the muscle’s response to growth is completely independent of age. So a 60-year-old can build muscle just as effectively as a 16-year-old. It’s just that people’s capacity for making excuses is quite high… And anyone with a mainly sedentary job should roll their shoulders every now and then, get up from time to time, and take the stairs instead of the lift,” Dr Vavken strongly recommends.
Certain dietary supplements and vitamins can help support the health and function of the shoulder joints and thus improve athletic performance.
Taking dietary supplements and vitamins alone is no guarantee of improved athletic performance. A balanced diet, regular exercise, adequate rest and targeted training remain the key elements. Before starting to take dietary supplements, it is certainly advisable to consult a doctor or nutritionist to ensure that they are suitable for your individual needs and state of health.
Everyone is probably familiar with the situation: you’re standing in front of the shelves in a health food shop or a pharmacy, for example, and see hundreds of different packs of vitamins and supplements, all heavily advertised. This is often when you start to feel overwhelmed. Dr Vavken can shed some light on this: “As mentioned, protein is intended to support the muscles and thus stabilize the joints; this can also be taken in capsule form. Creatine (approx. 1–3 grams per day) is also important for the muscles. Vitamins aren’t bad in principle – but your needs are usually met by a healthy diet. You can take vitamin D after a long, cold winter or if your job keeps you indoors and you don’t get enough sunlight. Turmeric (combined with black pepper) is highly recommended because it has the same anti-inflammatory effect as ibuprofen and also aids cognitive performance. Omega-3 is also beneficial. Vitamin B12 is important for vegans because of the essential amino acids, as mammals cannot produce these themselves.
Athletes can take preventive measures to avoid overuse injuries to the shoulder and ensure optimal performance in the long term.
A key component of these strategies is proper warm-up and stretching before training or competition to prepare the muscles, tendons and ligaments for the upcoming strain and to promote blood circulation. Through targeted strength training aimed at strengthening the shoulder muscles, athletes can improve the stability and support of the shoulder joint. Exercises such as shoulder presses, lateral and front raises, and back exercises are helpful in this regard. Furthermore, correct technique during sporting activities is crucial to avoiding overuse injuries. Athletes should ensure they maintain good posture and proper movement execution. A slow and gradual build-up of training, as well as sufficient rest periods between sessions, are important to allow the shoulder muscles to recover and repair. By varying training exercises and sports, one-sided strain can be reduced and the shoulder joints trained in a balanced way. Finally, avoiding overuse is another important aspect. Athletes should also take care not to put excessive strain on the shoulder, particularly during one-sided movements or repetitive gestures.
“The key is a balance between recovery and building muscle. And ultimately, it’s always about a healthy diet, sufficient sleep and hydration, as well as exercise. Ballet dancers and young female swimmers actually have it tough in the sporting world. The former can find it really difficult to build muscle and often suffer from overuse injuries, while the swimmers are put off by other sports because swimming already gives them broad shoulders. Nevertheless, it is always the four components – diet, sleep, hydration and exercise – that make the difference,” says Dr Vavken, and with this enduring appeal we conclude our conversation.
Thank you very much, Dr Vavken, for your insights into optimal performance!
