Roque "Rocky" Rodriguez-Urena served as a medic at Balad Air Base, about 40 miles north of Baghdad in one of the most hostile regions of Iraq in 2004 and 2005.

Because of regular rocket and mortar attacks, some soldiers and airmen took to calling the base "Mortaritaville."

"It was just nasty," says Urena, describing the horrific injuries he and colleagues saw while working in the busy, top level trauma center at the base in the Sunni Triangle.

The experiences left him, like so many veterans who have served in Iraq and Afghanistan, with post-traumatic syndrome disorder, or PTSD. Urena retired from the Air Force in 2008 after 25 years of service.

After retirement, he and his wife, Marlene, looked for a place to live that was "not too far and not too close to New York City," where he grew up and his extended family lives. The Dominican Republic native says his wife fell in love with Charleston and they and their daughter, Alyssa, moved to Summerville.

Still dealing with PTSD, Urena decided not to look for work for a while and instead volunteered for an array of jobs, including working at the emergency room at Trident. In Sept. 2009, he started working for pay as a medical technician on a "per diem" basis, two or three days a week.

Over the years, he has found counseling to be "too painful emotionally" and "mentally exhausting" because he had to relive the experiences. Instead, he turned to another form of self-therapy that is simple, relatively inexpensive and often not talked about: physical exercise.

Go Rocky, go

Urena, who enjoyed mountain biking but admits to previously "hating running," decided to train for the Air Force Marathon in 2007 and found it, and being active in general, to be an ideal way to cope with his memories of war. He has since finished a total of 10 marathons, 11 half marathons and recent Cooper River Bridge Runs.

He also diversified his fitness routine with tennis and indoor volleyball in a co-ed church league. The 56-year-old, by the way, is 5'9 and super lean 137 pounds and easily looks a decade or more younger. Urena jokes, "I tell people I'm 37."

But despite all the activities he's embraced, mountain biking remains his passion. Weekly, he heads off to trails at Wannamaker County Park or Marrington Plantation where he finds a special kind of peace. "When I'm on the trails, it's just me and that bike. Everything else goes away," says Urena.

His love of mountain biking led a friend to suggest that he apply to participate in President Bush's W100, a three-day, combined 100K (62 miles) bike ride in Crawford, Texas, on Memorial Day weekend. He did but didn't expect to be chosen to be among 20 wounded veterans for the ride in 2013.

"When I got the call from President Bush's office, I thought it was a prank," recalls Urena.

But it wasn't. And the experience wasn't the last time he heard from Bush.

In February, The George W. Bush Presidential Center invited Urena to a summit, "Empowering Our Nation's Warriors," with major political and business leaders. In May, he returned to the W100.

When Bush saw him, Urena recalled him saying, " 'Hey, Rocky, you're looking great!' That felt really, really good. I knew when he said it, he meant it."

The attention from Bush aside, Urena says exercise, particularly the release of endorphins, and opportunities to participate in Wounded Warrior events are key in his continued healing process.

Exercise Rx

Dr. Yevgeniy Gelfand, a psychiatrist at Trident, knows Urena from working with him in the ER and says a growing body of evidence is showing that exercise can be a valuable tool in battling PTSD, which he describes as "complex disorder" that researchers are still learning about.

Gelfand says drugs often have been the first and foremost treatment for it and have generally proven not to work too well.

"In the West, everyone wants a pill. That's how we're conditioned," says Gelfand. "I think exercise is often overlooked (as a therapy)."

Besides endorphins, Gelfand says exercise provides a "sense of well-being" through improved sleep, providing a sense of control, and giving people goals and a sense of accomplishment.

One of the issues with PTSD, Gelfand says, is "hyper-arousal" or "hyper-awareness" because the sufferer feels that danger is omnipresent.

"When you do strenuous exercise, it puts that sense on the back burner and makes you live more in the present moment," says Gelfand.

He adds that martial arts have an extra benefit for channeling a veteran's "warrior spirit," which they often find hard to turn off when returning to civilian life.

Gelfand says many veterans resent "having drugs thrown at them" as a solution for their PTSD and that leaves many wondering why they put their lives on the line in the first place.

"Exercise should be one of the first things we tell sufferers of PTSD to do," says Gelfand. "After all, we are human. We were supposed to be active and outside. That's not the way it is now. ... Going back to those roots helps us revitalize ourselves."

Reach David Quick at 937-5516.