(pleasant music) - [Narrator] The region's premier medical information program, (soft electronic music) "Call the Doctor."

- Anytime somebody's playing a sport or even exercising, injury is a risk.

(soft electronic music) Some sports injuries can be treated with various types of therapies, medications, or even surgery.

Other injuries can be severe enough to leave lasting consequences.

We wanted to dig into types of sports injuries to find out how we can better protect ourselves and our kids, and what help is out there when sports injuries do occur.

Sports injuries on this episode of "Call The Doctor."

Hello and welcome, we are so glad you're with us for this season, and this episode of "Call the Doctor," we're gonna get right to tonight's panelists, and I'd love for you to just introduce yourselves, and let people know who you are, and where they can find you, doctor?

- Good evening.

My name is William Charlton, I'm a board certified orthopedic surgeon with subspecialty in sports medicine.

And I'm an orthopedic surgeon employed by Commonwealth Health.

- All tight, welcome.

Good to have you back.

(William's voice drowns) - Hello, I'm Janet Coleman, I'm a certified McKenzie physical therapist.

I am the clinical manager for PRO Rehab in Moosic and in Pittston.

- All right, welcome, it's good to have you here.

- And I'm a Dr. Paul Horchos, I'm a rehabilitation specialist.

I work with Northeast Rehab Associates in Scranton.

And I specialize in brain injuries.

- All right, good to have you back as well.

So, we are talking today, I say this every single time, but it's a very large topic, I know, concussions and sports injuries.

This is a topic that came from a lot of you.

We heard a lot of questions about this.

When I'm out and about in the community, I get questions about this topic.

This is why we're taking it to you.

So, we'll start with, I suppose what is probably, correct me if I'm wrong, the most severe of sports injuries, or at least one that could have some lasting, what's the word I'm looking for here?

Issues, concussions.

And I know there's a lot of talk about concussions right now with CTE, and what they're finding in football players.

But I'm interested from your perspective, what you are seeing, and we'll start with you, Dr. Charlton 'cause I know you have kind of a bird's eye view of at least football.

- Yes.

I mean, as a sports medicine physician, we are frequently the first provider to care for the athlete.

And recently, it's been, there was over 2 million sports-related concussions per year.

And the numbers estimated approximately 20% of the athletes don't report it.

So, it's way underreported.

So, there's a real concern.

It's being recognized to a greater degree.

And it's life threatening.

So, yeah.

- Is it the more, I have heard that the more concussions you have, they sort of build up a little bit.

Can you talk about multiple concussions, and what a risk that might be?

- Just from the data, I mean, there are higher risks in certain subgroups, and clearly, under 18 is a higher risk.

Female athletes, considering same sport participation, females have a higher risk of concussions.

And a history of prior concussion does increase the risk of severity or long-term effect.

- What do people come to you for if there has been a concussion?

What are some of the things that you can help them do?

- Sure.

Well, I see patients coming in who have been struggling from the concussion, it's not getting better.

Their concerns, they're experiencing fogginess, they're experiencing nausea, dizziness, headaches, lack of sleep, not being able to complete their daily functions.

And what happens is, it's really, it's multi-dimensional how therapy has to help that.

we have to look at their VOMS, or their Vestibular Ocular Motor Screening Sections, where we look at how their eye movements are occurring, is that causing those symptoms, and how we can improve those areas.

We look at their balance as well.

Many patients are losing balance.

They're saying, "I'm falling over, I'm hitting into walls, I don't know what is happening."

So, that's another piece to it.

Neck pain draws into it.

Muscle spasms, basically like a whiplash injury, if they hit into another person, that they're experiencing those symptoms as well.

So, it's really complex.

It's multi-dimensional as to how therapy can help in all those areas.

I know football is particularly vilified, but it seems as though you can get a concussion doing a lot of things.

- [Dr. Janet] Sure!

What are some of the other activities that you might throw out the red flag, and say this is a risk too?

- Sure, I mean, even cheerleading, we've had cheerleaders who have had been on the bottom, and had another girl fall on top of them.

That can happen, basketball, there's injuries from that, soccer, actually for female, soccer at times is the highest reported injury for concussion for girls, for females, football for boys.

So, it could be anything, biking, if you're bicycling, and you fall off your bike, and you hit your head, it doesn't have to necessarily be just those football type of injuries.

- Do you know right away when you have concussion, Dr. Horchos, is it obvious?

- Well, I mean, one of the things that I wanted to say about what Dr. Charlton had said, is that 90% of concussions don't involve a loss of consciousness.

That's very important.

Okay, so only 10% of concussions are actually having a period where a person is unconscious.

And that's the typical thing we think of when a person has a concussion.

But any kind of alteration in their mentation or their ability to think, or feelings of dizziness, or any kind of spaciness, even if it's just brief, can be representative of a concussion.

- Is there a certain amount of time that you might need, if you're playing a sport, you're exercising, you think you may have had a hard hit, or something to that effect?

Is there amount of time that you might need to figure out exactly whether you were just knocked pretty hard, or that is something to worry about?

- Well, that's how sideline assessments can be very helpful.

And having an athletic trainer or a doctor, or the physical therapist at the game can be very helpful to determine that.

But really, it's important that the players that are involved in the sport realize that if there's any question in their mind, sit out for a play.

They can always go back in.

But being able to be safe in that regards is the best way to go.

So, it's better to be safe than sorry.

- When you were saying that people would come to you, and they might have a couple of those symptoms, or from an injury, how long do people wait?

Is that something that's kind of, and I realize this is anecdotal and very general, but are you seeing people right after the fact, or are people living with this for a couple of weeks before they're calling for help?

- Yeah, there's definitely several weeks before they come for help.

Most concussions will resolve within a few days to a few weeks.

It's usually the patients who are still suffering with symptoms, maybe six weeks later or eight weeks later, that we're starting to see them looking for help, because it's not going away.

They're starting to realize that it's affecting their daily life activities, their daily functions.

And that's starting to scare them a little more 'cause it's not getting better.

- [Dr. Horchos] Their grades.

- Yeah, their grades.

- So, they'll start, you'll have students that'll be A students, and they may still be A students, but instead of spending an hour doing their homework, they may now be spending three hours doing their homework.

So, it's not just important to watch their grades, it's also to watch how much effort they're putting into keeping their grades up.

- What are some of the things you do on the sideline to determine that, how serious of an issue you have on your hands?

- Well, I mean I think it starts with, and sort of, they alluded to this, is education.

So, we have to all be aware, parents, coaches, and certainly players of what a concussion is, the long-term potential effects.

So, any hard hit, really, maybe that player should be taken off, or at least assessed.

When a concussion is established, or let's say when there is an injury, the on field approach is gonna be ABCs.

First, we assess the airway, the breathing and the cardiac.

You wanna make sure, you don't know, it may, the velocity of the hit.

There could be significant, life-threatening injuries.

Rare but possible.

So, ABCs is the first assessment.

You wanna protect their cervical spine in case there was a cervical spine injury.

You wanna do a very brief neurological exam on the field, and once we know there's no significant neurological deficit, then we can take that patient or athlete off and assess them further with some handy tools that have been developed in terms of assessing severity, and return to play guidelines.

But really, the first, the critical few minutes are sometimes important to recognize.

And everyone's gotta be aware, and therefore, other players and coachings have to know the importance of assessing it, and bringing that player off.

Guidelines now in every state, certainly support, if there is a diagnosis of a concussion, that player is not returning to play that day.

That is clear and consistent.

And we need to have those consistencies.

- I've had several players who have actually been told to get off of the field by another player.

They say to them, the quarterback will say, "What quarter are we in?"

Or something, some question that they should obviously know the answer to.

And so, the other player will say, "You're not right.

Go over to the sidelines."

So, it really does take a village to kind of manage these patients, and at least to identify them initially.

- Do you feel as though education about concussions is better than it used to be?

Are more coaches willing to play ball?

No pun intended, are more athletes willing to come out now?

- I think that's absolutely true.

And the associated issues with that are that people also see professional athletes recovering from cerebral concussions quickly.

And they assume that they should be recovering quickly too.

So, the awareness of concussions has become better.

But we also have to realize that professional athletes have professional people who are working with them to get them better.

- Right, it's also their job to be.

- Exactly.

- Is physically.

- There was also a scientific study that demonstrated education by the parent's side, actually had better outcomes within three months than families and patients who are not educated on in terms of concussion management, symptom management.

So, education is critical for diagnosis and management.

- And I would bet as health professionals, you really do rely on the people who are around that, whoever athlete student immediately because they're the ones who are going to to know.

They're the ones who will have to make the diagnosis.

- Correct.

- What about helmets?

You brought up helmets a little bit earlier.

- Well, I mean, everybody thinks that helmets are the magical thing that's gonna protect them from concussions.

And they're not, but they can be helpful, and having proper fit on helmets is extremely important.

And now, there's new helmet technology called MIPS, M-I-P-S, which helps to reduce some of the rotatory forces that occur in a hit.

So, those helmets can be helpful.

I recommend that a lot of students would check the Virginia Tech helmet ratings website.

That's a really good resource for seeing whether the helmet you're interested in buying is a good helmet.

They have a star rating system.

It's very, basically, every sport that uses helmets is represented in that website.

- Hmm.

Well, we've spent some time on concussions, we can certainly go back to them, but obviously sports injuries, there's a whole lot more to talk about other than that.

What are some common injuries?

We'll start with you here, what do you see?

- Yeah, we see a lot of ankle sprains, we see knee injuries, we see a lot of running injuries.

Shin splints can occur a lot in our athletic population.

And a lotta overuse injuries where we have, kids now playing sports year round, they're not stretching properly, they're not giving their bodies a break.

So, they're seeing more muscular and soft tissue sprains and strains.

At times, we'll see shoulder injuries from young baseball players who may be weak throughout their lats and their core.

And what happens is, then they compensate, and they're using, relying way too much on the shoulder musculature that's not strong enough to help support them.

- And what about you?

What are some of the injuries you see?

- Well, I see a lot of young ladies who have back injuries, and so whether it be gymnastics or cheerleading, and they fall.

And one of the things that we're always concerned about is whether or not they could have an occult fracture in their lumbar spine.

That's very important.

So if they have persistent pain into their lower back, young ladies have a propensity to have a small crack in one of the bones in their back.

And it's very important that it be identified quickly, so it could be treated properly and heal.

- What would happen, perhaps if there is one, and it's not found right away, or it doesn't heal properly?

- Then, it could become a lifelong issue where they could have back pain for the rest of their life.

- [Julie] Wow.

- That is absolutely true.

I in my practice have diagnosed many, well, over the years, so the most common cause of back pain in adolescence is what Dr. Horchos is talking about.

It's called spondylolysis.

A big term for basically a hairline crack in the lower back.

The most common cause of back pain, which is crazy.

So, be aware of your children and your younger athletes 'cause if they have pain in the back, it's not, certainly, if it goes away, maybe it's a strained sprain.

But some pain that lasts weeks in the low back is a concern, and I've diagnosed multiple times, there's some very unique tests, basic tests can be negative.

So, you order a special test, and every one that I have been suspicious for has been positive.

And so, short term, we can heal this with appropriate treatment like bracing.

And it takes us a few months.

So, we have to talk to the patient and the family about shutting things down for a while.

But if it is missed, it can certainly lead to long-term problems.

So, that really hits home because I've personally diagnosed many patients over the years with that.

It's more common than you think.

- Well, you're a surgeon, I know, so it's possible that by the time you see the cases, they might be a little more severe, but can you give an example of something that could have been fixed pretty quickly, or a little more easily that turned into a bigger issue?

- Well, I mean that's a classic example of low back pain and adolescence.

So, bracing can treat it, but generally, I think listen to your body, listen to your young athlete, and if things continue for weeks, and sports is not, maybe they not necessarily want to play, but it's not fun anymore, or they have pain outside off of the court or the field, with activities of daily living, then be concerned, and talk to them.

- Still such things as growing pains?

You hear that a lot, I've heard that a lot now.

That's growing pains, that's growing, is that an old wives' tale?

Is there really something else going on there?

- Well- - I mean, yeah.

- What I see sometimes that can happen is, is if there's a large growth spurt that happens at one time, especially in the knees, you can see that happen, where some will get a bump on their knee, and it's Osgood-Schlatter is what it's called.

And that's just really basically that muscle tendon pulling on the bone tissue, and making that feel painful.

And a lot of times, you'll see, teenagers that are complaining after those growth spurts.

And I think that that's where you see people saying that.

The other thing also to mention is posture.

As doctor was talkin' about the backs, are teenagers, when you think about it, they're sitting all day at school.

What is their posture like in those seats?

Not typically very good.

- And they're on the phones.

(voices drowning) And they're doing this thing- - They're on the cell phone, their neck- - This thing.

- They're looking down, yes.

So, posture is huge as well for all students, as well as athletes.

- I've heard you all mention at different points, females, or women, or let's talk about that a little bit.

Are there different risk factors for females or women, young women than there are men, and why is it different?

I'll go with you.

- Yeah, I mean, it's so important to be able to identify what the risk factors are for young ladies because it's great to get them involved in sports, and they love it, and they can gain so much for being involved in sports.

So, that's I think a really important feature.

But young ladies and women are different from men, and their spinal architecture, their architecture, their pelvis changes the way that their knees work.

And so, you have to try to strengthen those knees in a different kind of way.

With regards to cerebral concussions, one of the thoughts with women is that everybody's head weighs about 12 pounds, but women have a significantly smaller neck than men.

So, their neck musculature just isn't as strong.

And I think that's one of the reasons why in female soccer, when they head the ball, they have a tendency to get more concussions because their neck is just not bulky, and so if you tell a young lady, "Oh, I want you to make your neck stronger," they suddenly think that they're gonna be like Dwayne the Rock Johnson.

(participants chuckling) You know what I mean?

But there's lots of ways that you can make them stronger and still keep them svelte.

So, that's I think one of the most important things you need to tell young ladies, is that if you exercise and you get stronger, you're not going to get bulky, you're just gonna get stronger.

- Stronger.

What do you see when it comes to, and I know you have two daughters of your own who play, so do you advise them differently than you would advise young men?

- I do as far as from a strengthening component of what muscles to strengthen.

I do worry at times about ACLs.

Because again, we wanna make sure that that does not happen.

So, you wanna make sure their legs stay strong, that their hips are strong.

One thing that we find a lot, and we do test for this at our facility, we have an athletic republic training facility that's attached to my rehab center.

We're able to put athletes on a leg press that is actually hooked up to a digital computer, and that will tell us their power and their strength from the right side compared to the left.

They should be within 10 to 15% for the balance between both sides.

And what we find is that when that percentage gets high, when that percentage gets way over that into that 40% range, that then someone could get injured, especially females, a lot earlier, they could have more knee injuries.

So, we try to balance that as much as we can.

Could there be a situation where they don't even know they're unbalanced?

Definitely, yes.

That's not always obvious- - Most do not until they get tested.

And once they get tested and we take them through the whole process, then they find, and they say, "You know what, yeah, I realize that."

So again, you're only as strong as your weakest link, right?

So, you really have to make sure that both sides are as strong as, or both sides are equal or as close to equal as possible.

Yeah.

- Do you see some injuries, Dr. Charlton, that more females come in versus males?

- Yeah, I mean, I think the big concern for females is, as they get older, their bone density can be affected.

And they have something unique, menstruation.

So, menstrual periods can affect calcium stores, and can lead to osteopenia or a weakened bone.

And they may be at higher risk for, in certain situations, stress fractures.

That would be a big concern for female athletes more than males.

Males are at risk as well.

But a little bit higher in females in combined with the problem with menstrual cycles, and add in maybe a needing disorder that everyone is at risk for.

And you can have problems with calcium, metabolism, and stress fractures.

- So, maybe I'd look at this all wrong when we started the very beginning, saying athletes, or even if you're exercising, 'cause it sounds like these are issues that affect anybody at any point, really.

I mean, possibly, if you're involved in a sport, you're at a higher risk, but you probably also see just as many people who injure themselves walking, going up a step- - Sure.

We like to call them the mature athletes.

- Right.

(chuckling) - Okay, right?

I mean the whole idea here is that we're trying to get people to do sports throughout their entire lifetime.

And so, whether you're young or old, you have the propensity to be injured, and so, there's always something that we can do to try to help you.

Whether it be something to help change your technique, or to prevent you from getting injured, or something to do that you can recover from.

- I think that's another theme I'm hearing too, is that you have a high risk of getting injured if you are perhaps not strong in a certain area, what would you like to see happen?

Either in people in general or athletes?

What's the message you'd like to get out there?

- I mean, in my clinic when I see a large amount of joint pain and tendonitis, and tendon tears, I just stress the importance of, that there is, generally with weight, I call it the trifecta.

There may be thinning cartilage, although mild, there's clearly muscle atrophy once you hit 35.

So if you don't work out, you generally lose muscle mass every year when you start turning 35.

Your calcium stores max out at 25.

But certainly, the muscle is as big at 35, we usually gain a little weight, maybe we're less active, and we have some early degeneration in our joints.

So, that trifecta causes that middle-aged syndrome, where you think twice about getting up from the floor.

Maybe some back pain steps in.

So, the critical thing that I stress is stretching and strengthening.

And spinal alignment.

And I say that every time, like seems every day.

So, keeping your spine straight, opening up the nerves, the shoulders, the low back, and improving flexibility and strength.

And that will keep you going harder, longer in life.

That's my opinion, yes.

- Even if you are not an athlete, you're just going to be better off for it.

- Absolutely, you're taking the trash out every day, you're lifting heavy things, you're cleaning, vacuuming.

That's a significant stress on shoulders.

So, everyone needs to do it to minimize injuries.

- I'll ask you the same because I think this is kind of, again, a theme I've been hearing tonight.

- Yeah, I really think, like doctor said, you have to keep everything strong and flexible.

I also think a lot comes back to the core.

We talk a lot about the core stability, but the stronger your abdominals are, your back, the stronger your back extensors are, the stronger your hips are.

That helps everything else around it.

So when those are weak, then we start to put added stressors in our extremities, added stressors to the knees, into the shoulders and the arms.

So, we have to try to keep our core strong.

And again, that goes on through all of life.

I mean, I see patients that are in their sixties and seventies that are trying to strengthen their core.

And it's all in different ways, but we find ways to get that done through certain exercises at those ages.

- Mmm.

Different exercises you would offer to young people versus the mature athletes, as you like to put them?

- Well, I mean maybe so, but they're all deserving of this kind of intervention.

Right?

And that's I think, the most important thing.

Just 'cause you're a 60-year-old who goes for a five mile bicycle ride, doesn't mean that you're any less valuable, right, than a young basketball player on a high school basketball team.

It's still, it's actually keeping that older person probably healthy by being active, and trying to do those things.

So, you really want to try to encourage it, and you want to ask the patients, "what is it that you wanna be able to do?

What is it, what sport, what activity are you interested in doing?

What are you having difficulty doing?"

So, you really want to let them know that it's okay to talk about that.

- That leads me right into the last thing we can talk about here in these few minutes, which is something that you all enthusiastically said a bit earlier, which was, yes, an ACL tear, a concussion, yes.

These are emergency situations in some cases.

But what about just your normal, I twisted that ankle, I twisted this.

How much do we just kind of put up with and hope goes away?

When would you like to see people come to you for help?

- I mean generally, we all have injuries, and aches and pains.

I mean, see how it affects your activities of daily living.

And certainly, give it a few days if you can move, I would say, but have a low threshold to contact your doctor.

Generally.

- Just always let a professional take a look and see?

- Yeah, I mean, it depends on the problem or the complaint, but generally, you want to be fit, know your body.

So that's, how do you know your body?

Spend time with it.

Two to three days a week.

Either in the gym, Pilates, yoga, I mean, there's huge benefits.

But I think the better you know your body, then you become more aware of what doesn't feel right, - [Julie] Something's wrong.

- And yeah.

So, that would be my message.

- I think that also, it's easy to get strong anti-inflammatory medications these days.

So sometimes, if you have a patient who's utilizing these medications, to be able to do what they want to be able to do.

Whether they be anti-inflammatory creams or anti-inflammatory pills, if they're taking too many of those, then that has to be a warning sign that like, we gotta look at it and see what else we can do to fix it.

- So if that's something you're relying on, your over-the-counter pain medications.

- Exactly, and I mean, and it doesn't have to always be surgery either.

Therapy can be helpful, different types of medications, and there are now different types of injections that include PRP injections, which are a type of blood injections that you can do on a patient that can really help joint recovery.

So, there's a lot of different things that can be done to fix these things.

- And don't sit around in pain.

(chuckling) - Right.

- Right, well thank you to all of you.

I realize that we could go on all night long on the various sports injury, and we probably just only scratched the surface, but I at least hope we've helped with some bit of information that you were looking for, that's gonna do it for this episode of "Call the Doctor."

We are very glad you've joined us.

If you've missed something, you wanna listen to this again, you can find the entire show at our website, wvia.org, (soft electronic music) as well as episodes from the past to check out.

And you can also find us, of course, on the WVIA mobile app.

I'm Julie Sidoni, thanks again for watching, and for all of us here at WVIA, we'll see you next time.

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