Exercise and Sports-Related Injuries:

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): And welcome to the show. I am Deborah Howell, and today we'll be talking about exercise and sports-related injuries and how to protect our joints from long-term damage. Our guest today is Dr. Trong B. Nguyen, orthopedic surgeon at the MemorialCare Joint Replacement Center at Orange Coast Medical Center. He's also a sports medicine surgeon. Welcome, Dr. Nguyen.

Trong Nguyen, MD: Thank you. Thanks for having me.

Deborah Howell (Host): So with millions of adults and children incorporating exercise and sports into their daily fitness regimens, injuries of course are sadly bound to occur. So do your joints actually benefit from daily exercise and athletic activity even though there's a potential for injury?

Trong Nguyen, MD: Well obviously there's a balance, but yes, sports and fitness is important in terms of our cardiovascular health, in terms of our muscle strength, conditioning. Also important for bone health, as patients and people who are stagnant or don't exercise develop a significant risk for osteoporosis. And so, it has an important effect on our whole body in terms of muscle strength and cardiovascular health and fitness. So, usually is recommended, but of course it always needs to be monitored depending on a patient's medical status.

Deborah Howell (Host): Sure. Use it or lose it. How do exercise and sports-related injuries often occur then?

Trong Nguyen, MD: Injuries related to exercise and sports are commonly categorized into two types of injuries. One is most commonly is an overuse or repetitive type of injury. And obviously the other one is a more of a traumatic type of injury. So overuse injuries can lead to tendinitis, stress fractures. Basically it's related to doing the same motion or same activities over and over and over again without resting or proper care. And then of course traumatic injuries can be related to falls, twist injuries, collisions, and those kind of injuries.

Deborah Howell (Host): We’ve all been there. So what are the most common athletic injuries you see with your patients, both kids and adults?

Trong Nguyen, MD: Most of the common injuries are related to sports occur obviously in the shoulder, elbow, depending on what kind of sports you play, knee, ankles. Depending on the sport, if for example you're a basketball player or soccer player, there's a lot of lower extremity injuries. Upper extremity injuries occur commonly in sports such as volleyball, baseball, that require a lot of shoulder, arm movements. So it really depends on what kind of sport you play.

Deborah Howell (Host): A lot of side movement and things like sports and, I mean like squash and tennis and things like that. So our kids tend to participate more in organized sports rather than general exercise. So what are some of the tips for parents to help prevent overuse or sports-related injuries with their children?

Trong Nguyen, MD: Yeah, that's becoming a rather significant issue in the last several years. Because youth sports has been such a big focus with parents. And you know, part of it is the culture that we live in where everybody has a strong competitive drive to be the best, which is a great thing. And so a lot of parents want to push their kids into playing lots of sports and different types of sports. And maybe even some of the parents are hopeful for college scholarships to help with tuition and pushing kids into sports for financial reasons. So whatever the reason is, there's always an issue of overuse and additional sports-related injuries. And so what I usually counsel parents on when patients have injuries related to overuse, I usually recommend that they give the kids breaks and take off-season time to let the body heal, let the body retrain, let the body take a break from the constant sports. Because year-round sports has definitely been shown to increase the risk for not only traumatic injuries but, you know, overuse injuries. And so I recommend that either kids take breaks or try different sports so that different muscles and different joints are being used. Cross-training among different sports can help prevent those type of injuries. And I usually counsel parents that even professional athletes take breaks. And so if professional athletes and adults take breaks, you know, during the off-season, why can't kids do it? And why are we forcing our kids to play 12 months a year and putting them at risk for injuries? And so, a lot of parents are pretty cognizant about that and have good common sense, so sometimes they need reminding, but it's important to keep that in mind.

Deborah Howell (Host): Just as an example, you know, instead of playing football year-round you'd maybe, I mean if a guy would be open to it, do Pilates or yoga or just something else.

Trong Nguyen, MD: Well yeah, absolutely. And a lot of professional athletes have turned to that because they understand that there's a lot of other training that's required to allow them to excel in the sport that they are in. Just playing the same sport over and over, you're going to, your body reaches a point, or your body part reaches a point where it may potentially fail or get injured. And so when you train and cross-train and do other activities, it actually enhances your athletic performance in the primary sport that you're looking at. So it's important to do that and important for athletes to understand that.

Deborah Howell (Host): Even rugby players sometimes use ballet as an example for something else to do and they're proud of it.

Trong Nguyen, MD: Absolutely, absolutely. Yeah, I think those are great adjuncts to athletic sports.

Deborah Howell (Host): Although every patient is different, doctor, what's a typical course of treatment when you see a patient with an athletic-related injury, and do you often prescribe physical therapy as a first line of treatment?

Trong Nguyen, MD: Yeah, again it depends on the type of injury. So for example, if it's a traumatic injury, then usually rest and ice and getting the swelling down is usually the first line of treatment. And then depending on the type of injury, whether it needs surgery or not, will determine whether someone needs physical therapy or not. For example, if it's a simple ankle sprain, then yes, physical therapy is often very important. However, if it's a, for example, a rotator cuff tear or an anterior cruciate ligament rupture, those typically will require surgery to fix the tear and fix the problem. So, and then usually physical therapy is part of the postoperative rehab. Overuse type injuries, yes, physical therapy is often the first line of treatment, along with rest, ice, and anti-inflammatories. But yeah, it depends on the type of injury.

Deborah Howell (Host): Now if a patient needs to have surgery, what can they expect, and is it a myth that surgery means they're done playing their sport for good?

Trong Nguyen, MD: Yeah, that is sort of a myth. Obviously it depends on the severity of the injury and what type of injury. So, but most sports injuries, I would say, if it requires surgery, then the majority of patients return to sports. Obviously it's not 100%, but if the majority of patients have successful outcomes, then they're able to participate at the level that they were before the injury. And so it has multi-factorial in terms of the prognosis of how people return to sports. And with good therapy, good rehab, and good outcomes, then there's a potential for return to sport without a problem.

Deborah Howell (Host): Gotcha. You have to do your PT though. Or it's not going to happen naturally.

Trong Nguyen, MD: That I recommend most the majority, pretty much all the time, with any kind of injury, for sure. Physical therapy, post-op rehab. And a lot of times I'll have patients do pre-operative rehab too, depending on the injury as well. And depending on what kind of surgery is needed. I'll have patients do pre-operative physical therapy and that way it primes the body part for the surgery and makes the postoperative recovery a lot easier, if it's possible.

Deborah Howell (Host): What are some of the symptoms and red flags to look out for with injuries that tell you it's time to see your physician?

Trong Nguyen, MD: Again, depending on the type of injury. So traumatic injuries: slip, fall, collisions, sprains where someone twists, or, you know, if there's obviously lots of pain, swelling, inability to stand or bear weight on your ankle or leg or foot. And then more kind of chronic injuries where people feel like they're not able to perform their normal activities or normal athletic moves that they typically do. Persistent pain, feelings of instability, or you know, sometimes people will describe for example their knee buckling or catching or feeling like something's locking up. And also pain and swelling. Obviously those are the main things to look out for.

Deborah Howell (Host): Okay. And finally, Doctor, many athletes and fitness fanatics of course often try to tough out an injury. So what could happen if an injury goes untreated for too long?

Trong Nguyen, MD: Yeah, that's usually not recommended. I mean there's certain things where, you know, like simple sprains where if it's not severe and it's a reoccurring injury then and they know what's going on, then playing through it is usually not recommended unless you know exactly what's going on with the injury. And so, if there's a significant injury to your knee or your ankle or your shoulder and you continue to play on it, there's potential for further damage. And so it's usually recommended that if there's, you know, significant pain or swelling and it's decreasing your athletic performance and preventing you from doing the things that you normally do, then it should often get looked at. Even if it's just to get a checkup and make sure there's nothing structurally wrong. Then, then it's good to get it checked out and at least you know and have a good diagnosis. But yeah, usually toughing...

Deborah Howell (Host): Catch it early, because there might be long-term effects.

Trong Nguyen, MD: Right, right. Usually toughing it out is not recommended. But I know a lot of athletes, you know, want to tough it out and you know, there's a balance obviously to that. Everything in kind of moderation is a good mantra.

Deborah Howell (Host): Yeah, and just be mindful that there could be long-term or permanent effects to consider.

Trong Nguyen, MD: Correct.

Deborah Howell (Host): Dr. Nguyen, thank you so much for taking the time to be on the show with us today. We learned so much from you.

Trong Nguyen, MD: No problem. Thank you very much for having me.

Deborah Howell (Host): For more info or to listen to a podcast of this show, please visit memorialcare.org/podcasts. That's memorialcare.org/podcasts. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.