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Bill Klaproth (Host): If you play tennis or golf or softball or are active in any sports or weekend fun, you know injuries can and will happen. So it’s good to know Eisenhower Desert Orthopedic Center uses an orthopedic approach to sports medicine to care for all types of athletes. So let’s find out more with Dr. Matthew Diltz and Dr. Patrick St. Pierre. Both are board certified orthopedic surgeons with Eisenhower Health. Dr. Diltz and Dr. St Pierre, thank you so much for your time. Dr. Diltz, let’s start with you and let’s start with the basics. Many people hear the term sports medicine and may not really understand if it applies to them. They might think it’s only for serious athletes or people who are engaged in sports at level they think must be more serious than their own. But that’s not really the case, is it? Can you tell us who sports medicine specialists treat and when someone should come to see you?

Matthew Diltz, MD (Guest): The whole concept of sports medicine has really evolved. In the past, it was just something you did in your youth. We now realize how important it is for not only our physical wellbeing, but our mental wellbeing. So really, we encourage people to stay active. Not just weekend warriors anymore but stay active working out several times a week. So anything that’s a barrier to you staying active and working out, it’s sports medicine. We also throw in the term joint preservation. Really, we’re trying to preserve the original joints and make sure we can stay active. Some of the most active healthy people we see in their 70s are ones that are still working out four or five times a day. So sports medicine is anything that maintains your activity and keeps you focused.

Host: Right. So staying active. Very important. We learned a new term there, joint preservation. So Dr. St. Pierre, I understand you specialize in upper extremity conditions as a surgeon and do a lot of shoulder injuries. So I imagine you're seeing a lot of people who have concerns about their tennis game or golf swing. How does sports medicine help with shoulder or even elbow conditions?

Patrick St. Pierre, MD (Guest): That’s absolutely correct. So I often tell my patients that my job is to keep them on the tennis court and the golf course. Matt made some really good points. We’re trying to keep people active. Especially in our valley we have a lot of people in their 50s, 60s, and 70s and even later than that that are still being very active playing pick up ball and golf and tennis. Sports medicine not only treats just the injury, but we’re trying to prevent the injuries. So we’re talking a lot about warming up and how to strengthen your muscles and how you stay in conditions so you can prevent those injuries from occurring. Then, if they do occur, then we’ll treat them and get them back on the court.

Host: You’ve got a great job keeping people on the golf course and the tennis court. They must love you that you're able to do that for them. Dr. Diltz, you see a lot of hip and knee patients. What about people wanting to protect their knees from injury? So many people have meniscus tears and ACL injuries. What can people do to stay healthy and less prone to injury?

Dr. Diltz: Just staying healthy. Staying out there and being active. It’s counterintuitive, but the ones that we see with the injuries earlier are typically ones that decide they want to preserve the knee, so they become sedentary. Then they get up and they try to do something, even something minor, and they can end up with an injury. So it’s really important to stay active. When you start having knee swelling or injuries, it’s important to get them checked out because you don’t want them to progress to something that does require some type of surgical intervention. I would say the majority of the modalities that we use are non-surgical. We just want to catch things early.

Host: Dr. Diltz, let me stick with you for a minute. It sounds like what you're saying is stay active. It’s kind of a use it or lose it with your joints?

Dr. Diltz: 100%. Yeah. You need to stay active. Becoming sedentary is not the solution. So if there is something that’s bothering you and you're noticing that you're decreasing your activity level, get it checked out and we’ll see what we can do to keep you out there.

Host: So I think this next question is so true for many of us. Dr. St. Pierre, many of us make the mistake of getting back into a fitness routine with a little too much enthusiasm and hurt ourselves. Is there a point when we should bypass starting a CrossFit program because it might do more damage than good?

Dr. Pierre: Well, it’s not really a point of whether you should bypass it, but you need to approach it in a logical and predictable manner. So timing is really the issue. I mean we’re all very active when we’re in high school and college, and then we get busy into our lives and working and raising a family. So after 20/30 years we either retire or kids go off to college. So now you have more time. Then you realize that you're not in as good as shape as you should be, so people go back to doing it. But you can't go from where you were when you were 20 and then all of a sudden start there when you're 55. You have to slowly build yourself up.

The hard part about using a CrossFit or some of these boot camps is they’ll throw people in right away. After taking 25 years off or 30 years off, that’s when those injuries occur. So we would encourage people to take it in a graduated type of production. So they start with the walking, start with running, working out. Getting with a trainer or somebody, a fitness person, before you just jump into throwing kettle bells over your head.

Host: Right. It sounds like a slower start is the better approach. So Dr. Diltz, it might be surprising to some people, but stretching before exercise is no longer considered helpful for reducing injury. Do you think there’s value in stretching after exercise? Can it help reduce sore muscles or provide some other benefits?

Dr. Diltz: Yeah. Sometimes these articles and studies that we look at are really interesting in print. We want to over apply some of the information that we have. There have been studies that show that stretching before exercise doesn’t reduce the incidence of injury during exercise or sport, but it’s important to not throw out stretching all together. Stretching is extremely important. We see a lot of injuries in people that have tight muscles. A lot of times tight hamstrings can be associated with people having problems with their back. I think that exercise like yoga and Pilates are extremely important. So stretching before you go out there and play a soccer match might not decrease your injury on the soccer field, but that’s not to say that stretching’s not an important part of being healthy.

So I think that stretching before, after, during exercise. If you go watch tennis out here, the BNP, Pat St. Pierre’s been the medical director for years. Part of their routine before they go out there is they get warmed up. In the training room, they have trainers that are stretching them constantly. So stretching’s an important part of being fit. Right before exercise it might not decrease injury, but that’s not to say we shouldn’t stretch.

Host: Alright. Really good information. So stretching still has a role, especially in flexibility as you get older as well. So Dr. St. Pierre, can you explain the role of physical therapy for sports medicine patients?

Dr. Pierre: I'm going to hop onto the stretching issue because I think it’s very, very important. A lot of the studies show that static stretching and stretching out a muscle unit didn’t help performance because the muscle unit needs to be able to react. So now the emphasis is more on dynamic and really warming up the muscle and getting it to stretch dynamically. Not just to rush out and do two minutes of stretching you hamstrings then running right out. So, again, it’s a gradual process where you're starting to wake the muscle up and then you stretch it. You're doing dynamic stuff. That’s why yoga and Pilates is very important.

Then physical therapy can also work into that as well because we use physical therapists and home physical therapy to help out patients because ultimately the therapist is going to help a patient who maybe has hurt their shoulder or their knee, get them back up into condition. Then they're also going to talk about pre-conditioning exercises and things that we want to prevent injuries. So physical therapy is also very proactive. They’re going to help our sports medicine patients keep away from the injuries after they’ve recovered from whatever that is.

Host: Yeah. Really good information. So Dr. Diltz, I understand that you provide medical services for many of the high school athletic programs in your area. What are the common sports injuries that you see in high school athletes? Are there any preventative measures students should take to try to avoid injury?

Dr. Diltz: Yes. Eisenhower’s been great in giving back to the community. So they really sponsor the high schools and they make sure that there’s a doctor out there for all the football games so we can prevent concussions and really people going back to sport after they’ve had a concussion. Identify it and do the proactive measures afterwards to make sure the student athlete returns back to sport. They also help us organize all the preparticipation physicals in the area. That’s an important part of screening in seeing if we do have an injury to catch it and make sure that we do everything to protect it and make sure it doesn’t get worse. Some of the schools charge $20 or $30 a physical and we’ll do over 200 physicals. All that money goes back to the sports program at the school to really support it.

We see lots of injuries in the high school athletes. Being able to identify them early is great. Having trainers at the high schools is great. I see a lot of ACL injuries. It’s good to identify those early because it makes the knee unstable and that could lead to further injuries to the cartilage and meniscus. So I think that Eisenhower’s been great in supporting, identifying these injuries early and making sure they don’t progress.

Host: Well, I could see where identifying injuries early would certainly have a benefit. So Dr. St. Pierre, were going to move up a little bit in age into more of my age range. What is your advice to middle age golfers or tennis players who are injured during play? We always have this oh should I ice it? Should I heat it? Should I take ibuprofen, Advil, or naproxen, which is Aleve? At what point should someone see a doctor?

Dr. Pierre: I think that’s a very good question because it happens to all of us. There’s no one who gets to be 90 years old without having injuries somewhere along the way. The pneumonic RICE, which is rest, ice, compression, and elevation, is a good one. It’s still very valid today. So icing an acute injury is usually better because what heat does is heat brings increased blood flow. By doing the increased blood flow, you get more swelling. Often in acute injury that’s not a good thing. Now, heat can be very useful as someone’s recovering from an injury or if they’ve injured a muscle and you want to heat it and loosen it up. You want to increase compliant so you can stretch and get back to doing everything. So there’s a role for ice and heat in the treatment somewhere along the line.

Now, using ibuprofen or naproxen or even Tylenol is a good idea. So sometimes that will help with reducing the acute injury and the inflammation that’s around it. Usually people get better. Our bodies are really amazing. They heal all these different things. You don’t have to rush to the doctor 20 minutes after an injury occurs because most times you're going to get better. If it’s been a week or two and you're not getting any better, or if it’s more catastrophic—but we’re kind of talking about the run of the mill weekend sprains and strains—then you can give it some time. Rest your body. Allow it to heal, get some rest. Make sure you're eating well and there’s good nutrition then see how you do. If it doesn’t get any better, then you should probably come and see us.

Host: Alright, very good. Let’s turn to injuries that require surgery. Dr. Diltz, you do a lot of arthroscopic surgeries. Can you tell us what is arthroscopic surgery and how is it different than other orthopedic surgeries?

Dr. Diltz: Yeah. The arthroscope really has revolutionized the field of operative sports medicine. It’s essentially and underwater camera. So a lot of the injuries that we see involve the joint. So it allows us to put a small camera into the joint. It’s got a pump on it. So it pumps water into that joint and it opens up or distends the joint so we can move around and look and have good visualization of the injury without a big incision. Our visualization is much better than if we had a big open exposure. We now have cameras or arthroscopes that have 4K imaging. So it’s pretty amazing the detail you see.

You have to remember a lot of the ways we’re trying to identify the injury involves MRIs. That’s essentially a big magnet that pushes around water because there's a charge and you see water differentials. Looking at it with the camera really gives us an idea of the exact nature of the injury and gives us an opportunity to really treat it with small incisions, which leads to a much quicker a recovery.

Host: Yeah. That’s really good news. A lot of people benefit from that. So Dr. St. Pierre, I understand Eisenhower Desert Orthopedic Center has an interest in developing a biologics program. First off, can you tell us what that is? Then explain a little bit about what’s in the market and your group’s approach to responsibly exploring these options.

Dr. Pierre: Well, biologics in medicine is very controversial and new and exciting topic right now. It stems from trying to get cells that are going to help the healing process. So whether it’s platelets or it’s stem cells, there are different things that we can use to try to help the process of our body healing. Like I mentioned earlier, our bodies are amazing. They do heal. But if we can give it more of those fuel and the cells that are going to be able to heal a cartilage injury or arthritis or something like that, that sounds great. Who wouldn’t want to have an injection instead of having a surgery? So, unfortunately, there’s not a lot of studies that have been done. It is not approved by the FDA. There are people that are doing these injections and charging a lot of money and are not backing it up with science or being able to measure how well they work.

So what we’re trying to do at Desert Orthopedic Center is to develop a program where we’re going to offer it to patients who have the right type of disease that may benefit from it. So we’re not going to tell somebody with end stage arthritis in their knee that a shot’s going to help them because it’s not going to. We want to get the right patients, and then we’re gonna follow them. So we’re gonna have a program that’s going to be very detailed that will follow them for their radiographic improvement, their clinical scores, and whether they can get back to doing something so we can contribute to the advancement of this trough a real scientific way of looking at it.

Host: Yeah really interesting and a space we should all watch. Dr. Diltz and Dr. St. Pierre, thank you for your time. To learn more about sports medicine at Eisenhower Desert Orthopedic Center or to get connected to a provider, call 760-773-4545 or visit eisenhowerhealth.org/edoc. If you found this podcast helpful, please share it on your social channels. This is Living Well with Eisenhower Health. I'm Bill Klaproth. Thanks for listening.