Scott Webb (Host): Pickleball is the fastest growing recreational sport in America, and as a result, folks are getting injured and going to see my guest today. I'm joined by Dr. Georges Haidamous. He's a double fellowship trained orthopedic surgeon, and he's here to tell us about the most common racket sports injuries he's treating, and how despite being a surgeon, surgery is often a last resort for many of his patients.

Welcome to BayCare HealthChat. I'm Scott Webb.

Doctor, it's so nice to have you here today. I was mentioning to you that I have a friend in her fifties who picked up pickleball, as many folks are doing. You just walk the aisles. I was walking the aisles at a store the other day, and I just couldn't believe how many pickleball rackets there are. So it's very popular, obviously, as are other racket sports. And you've got folks a little bit older in life, picking up something new and now they're injuring themselves, so it's a great time to have you on and just wondering, what are some of the common pickleball and other racket sport injuries that you're seeing?

Georges Haidamous, MD: Thank you, Scott. Yeah, I agree with what you said pickleball is the fastest growing sport in the US. So, that makes sense seeing all of these rackets on the shelves. And I actually was thinking the same thing yesterday. I saw the same thing. You know, with this type of sport, especially being on a shorter distance compared to tennis and other racket sports, we have these bursting movements, quick which makes it fun at the same time.

I'm sure you've played it before. I had the chance to play it. Because of this repetitive, quick action on the different joints of the body, we see that pickleball injuries can involve let's start from the top, the shoulders. We can get some rotator cuff injuries, which are the important muscles that kind of power the shoulder and allow it to move and be stable in a way. We can get elbow injuries and we commonly know the tennis elbow and maybe we can start calling it the pickleball elbow and this is an inflammation of the outer side of the elbow.

We can get a very common injury of the knee, which is an important ligament that stabilizes the knee called the ACL. Especially that this sports involves a lot of quick pivoting and shifting and twisting. This is a main mechanism of injury of this ligament, and we can see also meniscus tears. And people who haven't played a lot and practiced and get into the field or on the playground, and start playing intensively, we see like ankle sprains and Achilles tendon ruptures. And this is the tendon in the back, the big one that we feel in the back of the ankle. We see a lot of muscle sprains and people who have arthritis can get an exacerbation of their arthritis, which is the damage of the cartilage because of the impact between the two bones that are not really covered with good cartilage.

Host: Yeah. And is it just your sense that it's a combination of factors? It's the, maybe some of the age of the participants, lack of maybe staying active all the years and then just picking up something like pickleball? Are they not preparing for the sport? Are they not stretching? Those types of things. What's your sense of why you're seeing so many of these types of injuries?

Georges Haidamous, MD: Yes, definitely. That plays a very significant role. Being inactive or not prepared for this type of activity predisposes us to injuries. Plus, the fact that we go into this type of sport for fun, and we do not typically, know the mechanics of this sport and the combination of not being ready in terms of having good muscle quality and having maybe less than ideal mechanics to play this game put us at increased risk of having these injuries. So it's a combination, definitely.

Host: Yeah. As you say, folks just want to have fun. And in my experience, yeah, the court is small, but I found it to be much more intense and grueling than I expected it to be. Definitely exacerbated my arthritis. No question. I paid for it for days after playing a little pickleball. I guess I'm just wondering, how are you treating the injuries and do you treat them any differently based on the age of the patients?

Georges Haidamous, MD: Yes, that's correct. The age part, I just wanted to mention that the injuries that we see with older age can be different from younger players. And again, arthritis it makes sense to be found in older patients. We see ACL injuries interestingly in both very young and older patients.

Rotator cuff and impingement syndrome, we can see them in young and old patients. But the treatment, usually our focus, is really to optimize non-surgical treatment. We want to try and be as conservative as we can. And I would divide the treatment into two phases. The acute phase, which the goal from that is controlling pain and inflammation. So that's the short term. And in these cases we recommend usually rest, ice. I really like icing because it's a very natural way. It helps cool down the inflammation. Sometimes we do injections like cortisone. We have other types of injections, anti-inflammatory medications and bracing. So this is the acute phase that we need to control the pain and inflammation.

Sometimes we use like newer treatments which have natural growth factors. We use their own body like from the person's own tissues, blood. And these are called biologics. One of the most common ones is called the PRP and platelet rich plasma. And there are some indications that they can work on certain types of injuries, like a tennis elbow inflammation.

So that's the short term, but the long term, the goal from that is improving the conditioning and strengthening of the muscles to sustain this demand that we're putting on it and to have pain free sports activity. This is of course, strengthening the muscles, stretching and improving our mechanics.

But when this fails, which is in a few instances we can resort the surgery and we try to as much as we can do it in very specific conditions when we fail to treat the injury with conservative measures.

Host: Yeah. I was mentioning, that I have a friend in her fifties and she tore just about everything you can tear in your knee. And, maybe the approach with someone like her in her fifties, because she may return to pickleball at some point, but unlike maybe a younger athlete, a teenage athlete, who's trying to get back on the field or the court as quickly as possible.

Is your approach just a little bit different when you think about whether or not surgery, is something you really want to do?

Georges Haidamous, MD: Yes. as we talked before. Basically treatment decision we see it more commonly now being affected by the level of activity. So we see 50 year olds, 60 year olds, and even older who are very active. And sometimes if we have, for example, let's say an ACL in an older, but very active patient, we might be a little bit more aggressive in treating this.

Another example would be the shoulder rotator cuff tears. Because we think that some people who have high demand might benefit from having a good stable joint, we might really be more aggressive, I would say, in treating these. Depending on the case, of course.

Host: Yeah, I see what you mean, case by case, and of course, just how active the patient is and wants to be, how long they're willing to deal with recovery and recuperation and all that. Yeah, so let's just finish up here and just talk about, you know, how can we prevent these injuries?

We touched on it a little bit, maybe stretching a little bit more, maybe knowing your own limitations, that kind of thing, maybe taking a couple of Tylenol before you play, but in general, how can we prevent these injuries?

Georges Haidamous, MD: Yes, so I would say the first thing would start by making sure your health can support this type of activity. And this is, I would say, for someone who has medical problems, like heart problems, lung problems, different things that can put them at risk from a health standpoint when they go into the field and play and that would put a lot of stress on their heart. Getting a clearance, especially in these players or patients would be ideal from their primary care doctor, that you're good. You can play at a certain intensity, just for safety reasons. The second thing, and the very important thing is warmup, which can include and definitely a very important role for stretching and strengthening. And this is not just done at the warmup, but even before that getting prepared.

But we see that having certain exercises that involve stretching and strengthening can really decrease the chances of getting injuries in different joints. And the principle behind that, we see it in baseball players or throwers where there's a principle called the kinetic chain or the concept called the kinetic chain.

So even though the ball is coming out from the hand, but the whole chain starts from the foot. So when the foot is planted, goes up through the knees, hips, core, and then to the shoulder, and then to the hand. So any weakness in this chain can predispose us to injury in the involved joint. So like the shoulder or the elbow in a thrower.

So we need this chain to be good, strong, and we can do that by maintaining good strength, working on the core muscles, which connect the upper and lower body. Working on the quads and hamstrings, and of course, our rotator cuff, our back muscles are very important. Good exercises we can think of are rowing exercises for the back, squeezing shoulder blades together, anything like that.

And usually avoiding overhead activity for the shoulders is good. The other thing is the intensity of playing. So if we're new to the game, it's important to start slow and then build up so that we get the chance to improve our muscles and the game more. And hydration, diet is very important, appropriate shoe wear and being active all year around is helpful to the muscles and the body.

Host: Yeah. All those things, of course. And, I always just try to remind myself, just what are my limitations, right? And what are my goals, right? If I'm just out here to have fun, then maybe I don't have to play with such intensity that I actually could injure myself because that sort of takes away the fun and it puts you on the shelf for maybe months or a year or something like that. So, great advice from an expert today. Thank you so much. I appreciate it.

Georges Haidamous, MD: Thank you so much for your time.

Host: And for more information, go to BayCare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.