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Scott Webb: Doctor, it's great to have you back on the podcast. Last time we talked about the rotator cuff and how it gets injured and how you help folks. And today we're gonna talk, you know, the common, the greatest hits, if you will, the common injuries, strains, sprains, fractures, all that good stuff. Just before we get rolling here, I wanna have you tell listeners about your specialties, your background.

I know you have a sort of family history in medicine, you know, how did you get where you are today being a sports medicine specialist?

Dr. Thomas Schmittdiel: Thank you so much for having me. I am a, primary care sports medicine physician. So what that means is I have a background and I did my residency training in a family medicine, so a little bit of a generalist, primary care physician. And then I was lucky enough to have an additional year of focused muscle skeletal and ultrasound training, with a sports medicine fellowship.

So I do not do surgery, but my goal is to treat and help people with non-operative, muscle skeletal needs. And so we're talking right up my bread and butter with our strain sprains and, basic fractures.

Scott Webb: Yeah, like I said, sort of the greatest hits. So I want to have you just kind of talk a little bit more about them. You know, the most common things that you see how folks end up there in the office, and maybe the differences, like what's the difference between a strain and a strain and a fracture and so forth.

Dr. Thomas Schmittdiel: I'm happy to talk about all that. I will say from a medical perspective, most doctors when they talk to each other aren't gonna refer to injuries as sprains and strains and things like that. We try to grade the injuries a little more scientifically, but I think for everybody who's out in the real world and dealing with these issues, the way I remember it is, I think of a sprain as when you hurt a ligament.

A strain is when you injure a muscle, and then a fracture is when you break a bone. And for those who don't know, we try to differentiate different parts of the body and how things are connected. And so ligaments connect bones to bones in our major support and structural part of your skeleton. A tendon connects a muscle to a bone, and that's the main point to where your muscles are able to move your skeleton and you can move around, do the things you wanna do.

And then the bones themselves are basically your scaffolding or your structure. So that's how I think most people should at least understand SPR strains and fractures.

Scott Webb: Yeah, that's a perfect way to break it down. And I'm sure just, you know, being a person who's lived over 50 years and played sports and my kids played sports, and it's just so easy to do these things, right? Like, I mean, I've stepped outta the shower and I think I gave myself plantar fasciitis, you know? Uh.

So these things, strange sprains fractures. Maybe just give us a sense, the people that you're seeing in the office, whether it's young athletes or older adults playing pickleball. Like how are they getting there? What are we doing to ourselves?

Dr. Thomas Schmittdiel: People are living life. It's pretty hard to go through, life without having any type of injury. The, most common things I see are the two kind of categories I classify them in my head is, did this just happen like within the last few days? We call that an acute injury, and those are usually from traumas, falls, twist, or. And then the other category is what I consider chronic injuries, which are basically overuse. Some of the tissues have deteriorated and that just comes with, , living a full, there's nothing much we can do.

Scott Webb: Right. Yeah, it does seem like strains, sprains, fractures. You know, we, I said that we talked about rotator cuff, and you know, that could be more of a chronic thing for some folks. It just keeps getting worse over time. But a lot of these things do seem sort of more acute, whether it's athletes or not.

You said you don't do surgery, you're not a surgeon, so let's talk to non-surgical ways that you can treat these, you know, ultra common injuries and maybe what we can do at home to help ourselves.

Dr. Thomas Schmittdiel: Absolutely. The one I always like to start with, 'cause I think it helps people conceptualize, sprains is the ankle sprain I grew up playing basketball and volleyball. I have sprained both my ankles. I cannot tell you how many times.

Scott Webb: Just lost track, right?

Dr. Thomas Schmittdiel: Yep. It's, it's just the name of the game. But when it comes to ankle sprains, basically what happens is, is a person will typically misstep mis jump, and their foot will either come under or roll out.

And when that happens, all the force of the body is pushed through the ankle. And the ankle is basically connected through all these ligaments. And if you put a lot of force through the ligament, it's gonna stretch longer than it should. And if it stretches too long, it's gonna end up partially tearing.

And then unfortunately, there are the very severe cases where you have a, what we call a complete tear. , most people tend to invert their ankle, which means their foot comes under 'em, and then they will sprain the outside ligaments or what we call the lateral ligaments. And fun fact, for everybody listening, the most common place people do sprain their ankle is over their anterior tail of fibular ligament.

So next time you're at a cocktail party, you can always throw out the atfl.

Scott Webb: Yep.

Dr. Thomas Schmittdiel: but um, those are the most common ways people will sprain their ankle.

Scott Webb: Yeah. And then how about, you know, in terms of helping folks like the non-surgical things you can do, like my daughter as a basketball player, as you said you were. So she sprained her ankle again, more times than I can count. And, , in high school season she's able to see the trainer and get it taped and just.

Play through it. Right. In a a u season, she just basically has to put her brace on and hope for the best. So How are you helping folks in these nonsurgical type , situations and anything we can do at home to help ourselves?

Dr. Thomas Schmittdiel: there are a lot of things we can do to help ourselves at home. The most common question I feel like I get, especially doing a lot of sideline coverage for some of the local high schools and working some, amateur events as a visiting physician. , people when they roll and they sprain their ankle, their question always is, oh, do I need to leave and go get an x-ray? And the big thing I always try to tell people are, , the doctors use actually a very specific set of criteria. We call it the Ottawa rules. I'm not gonna bore you with all the details of what they are, but basically, if you are not able to put weight on your ankle or through your foot and you can't walk on it, that's basically a great sign to go to the ER to get checked out.

Scott Webb: Okay.

Dr. Thomas Schmittdiel: There are some more kind of details that if you wanna go to medical school, I'm happy to talk to you about, but if you're having difficulty putting weight through it, and then especially if you give yourself a few hours of rest, and you're still not able to put their weight, it's probably a good idea to go get checked out at your care year.

Scott Webb: Yeah, and right as you say, you know, if you use that sort of test, if you will. It could be a strain, it could be a sprain, it could be a fracture. But the bottom line is if you can't put weight on it, if you can't walk on it, something is wrong. Go to where the doctors are and the x-rays are and that type of thing.

Right.

Dr. Thomas Schmittdiel: Exactly, and you know, I, I know the wait times can be annoying, but I come from the thought process of I'd much rather know early, because the earlier we know, the better we can treat you.

Scott Webb: Right. So let's talk about, recovery times. Once folks have come in there and they've met with you and you have a plan, whether it's physical therapy or otherwise, how long generally is the recovery time for some of these things?

Dr. Thomas Schmittdiel: I always try to tell patients that, you know, if they have a really bad sprain, it sometimes is even better just to have a clean break because sprains can be really frustrating and they can take a longer amount of time to heal than some bones. So full recovery from a moderate ankle sprain can take up to 12 weeks.

But it's actually been pretty interesting how, as we learn more and more about how people are healing, our thought process on how we treat ankle sprains is actually evolving. So the old adage is stay off it, keep it, you know, iced up and, not move it for a few weeks, let it heal.

But more and more data, more and more studies are coming out just showing that we actually wanna get people moving and rotating that ankle in different ranges of motion, because the more we move that ankle, the less stiff they're gonna feel and it actually promotes healing.

Scott Webb: Hm.

Dr. Thomas Schmittdiel: So usually I always tell people within the first two or three days of a sprain, I do wanna do the classic rest.

Ice, elevate, compression, all that good stuff. And then once, you come and see us, if you're able to walk, usually we'll give you a pretty good ankle brace. My recommendation is I always like what I call the double ankle braces, where you have a lace up component and a strap component, just because I feel like they give people a little more.

Stability than just your typical lace up brace or your typical air cast, which is a hard plastic case. Most urgent cares will give out. And then after you're able to walk on it a little bit, we really try to get, all of our athletes and all of our patients doing some range of motion exercises just because it helps blood flow and it helps people recover quicker.

Scott Webb: You know, as we get close to finishing up here, doctor, I wanted to ask you, is there anything that you recommend? Like should we be bracing ourselves even though we don't have a sprained ankle? Will that help us to avoid sprains? That kind of thing.

Dr. Thomas Schmittdiel: There's not a lot of great data saying, you know, wear a brace on every body part, 'cause that's gonna completely prevent injury. You know, if you have a history of injury, like you've had ankle sprains in the past, I think wearing a brace for protection is a great thing. I. Um, the new thing that I'm really trying to promote with all of my athletes and, you know, patients in general after they injure something, I really want them to get into doing some physical therapy and rehab exercises because the stronger we get all the muscles around it, the more stable that joint's gonna be.

And especially when it comes to ankle sprains, because we have a lot of small nerves that tell your brain where your foot is in space. And what I mean by that is you wanna know where you're stepping without actually having to stare at your foot the whole time. And so, um, the more, uh, range of motion, the more strengthening you do, it helps that, uh, brain foot connection.

It helps heal those nerves and it hopefully will help you from misstepping or reinjuring yourself in the future. So to me, doing good strengthening and good, what we call proprioceptive training after you injure something is really, really important.

Scott Webb: Yeah. That's great. It's been great having you on both times. Rotator cuff before today. We're talking strains, sprains, fractures. I'm sure we'll speak again in the future. And as you say, uh, being. Uh, you know, having played basketball and watching my daughter, and, you know, the last thing a basketball player wants to do is have to look down at their feet and wonder, wonder where their feet are, wonder where their feet are gonna land.

Like, that's just not conducive to, uh, high level or even, you know, rec league basketball. So appreciate your time, your expertise. Thanks so much.

Dr. Thomas Schmittdiel: My pleasure. Happy to be back and.