Intro: It's your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospiltal. Here's Melanie Cole.

Melanie Cole, MS (Host): Henry Mayo Physical Therapy's comprehensive sports injury program helps athletes of all ages recover, rebuild, and return to play safely. From personalized treatment plans to cutting edge rehab techniques at the Performance Institute, we are here to show you how Henry Mayo is setting standard for sports injury recovery in Santa Clarita. Whether you're an athlete, a parent, a coach, or simply interested in injury prevention, this episode is packed with insights you won't want to miss. We are going inside Henry Mayo Newhall Physical Therapy Program.

Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital, and we're going inside Henry Mayo Physical Therapy Sports injury Program with my guest Chris Morales. He's a physical therapist at Henry Mayo Physical Therapy working out of the Performance Institute located in the Valencia Outpatient clinic.

Chris, welcome. Thank you so much for being with us today. So when we think of sports injuries, what are some of the most common that you see at Henry Mayo Physical Therapy, and how do you typically approach the beginning when you come across an injured athlete or a weekend warrior or anybody, really? Tell us a little bit about the program itself and what you see most often.

Chris Morales: Yeah. Thanks again for having me, and thank you for that introduction, Melanie. To answer the first part of your question, the most common injury I probably see are ankle sprains, just due to the nature of ankle sprains being very prevalent and mostly all our athletes in the Santa Clarita Valley. With that, the injuries that I see also that are pretty common are going to be things like low back pain since that's another one that's also pretty prevalent in terms of the percentage that I see in my caseload. Third to that would probably be knee pain. Not any specific diagnosis of knee pain, just kind of knee pain in general, so like your runner's knee. So, those would probably be the top three that I see most commonly here.

In terms of the start of that process and what it looks like, to start with the ankle sprains, you want to definitely do a thorough assessment and diagnosis to rule in or rule out any other competing diagnosis that the athlete might be dealing with. They could have potential for a stress fracture and potential for other red flag signs that they might need further imaging or followup for. So, we want to make sure that their care here is within my oversight. So, that's something that we look into.

And then, through the assessment, we could also figure out a game plan for them, depending on their impairments, whether it be strength, if they're lacking any range of motion or mobility in their ankle or foot. And we also want to view the whole body as a whole as well, not just being too keyed into that body part, because we do have the rest of the body involved, especially as an athlete. We want to make sure that they're ready to return to sport appropriately. And then, same thing that goes for back pain and knee pain during a thorough assessment to kind of rule and rule things out, and then really hit on those key areas that they might be having deficits in so we could help them return to play quicker.

Melanie Cole, MS: We're going to talk about return to play in just a little bit. But Chris, how is rehabbing the process different for athletes versus the general population? When you're working with people, what's the difference with what you see?

Chris Morales: Yeah, very good question. I think the biggest key difference is that since our athletes are typically trying to return to a sport, there's a little bit more of a higher demand in terms of what their body output needs to be in terms of their strength, their mobility. They probably require more than your typical everyday weekend warrior, just because athletes are demanded a lot from their sports. We want to make sure that they're not just physically ready, but they're conditioned in terms of their aerobic health as well. So, I think that's a key difference there, is just the demands and needs for their sport kind of require them to make sure that they have this higher level of activity and return to play based on their impairment impairments that we see here in the clinic.

Melanie Cole, MS: When we think of injuries, naturally, you and I being health professionals in this field, we would rather not see people. And injury prevention is such a big deal right now and really always has been. But as we think of injury prevention, Chris, and we know that our athletes like to really work on their one sport.

I have a son who's a gymnast, and I know how hard it was to get them to do other things. Speak a little bit about injury prevention, and when you're working with these athletes, getting them to understand that cross training so they're not being so sport-specific, so they're not getting these chronic overuse because there's our acute injuries that happen, like you said, strains and sprains and twisting ankles. But then, there's the chronic things that come with too many throwing arm injuries or overuse injuries. Speak about injury prevention for us and why that's so important and what that even really means.

Chris Morales: Yeah. I think a lot of the current research is showing that specializing in a sport early for a lot of our youth athletes is a big detriment to them, just as the reasons you stated due to those overuse injuries and them not training their bodies in different ways. So, I'm a big advocate for our athletes to try different sports as they're growing up and as they're training so that they're hitting different stimulus in their joints, working on different muscle groups, and then just enhancing their overall skillset.

One sport might demand more than another versus in terms of the type of movements that they're doing, the type of plyometrics. So, each movement in sport is going to be different. So, I think when athletes kind of have of more of a foundation and of a base to go off of when they are having that diverse group of sports, that allows them to enhance their physical performance and also can help prevent them from future injuries, because they are participating in moving their bodies in different ways that kind of makes their body more robust and resilient. So, I think definitely allowing athletes to try different sports early on rather than specializing them right away, which we do see a lot of parents do for their kids. And a lot of it's just because they're not aware of that. So, I think that's a big part of injury reduction.

In terms of that, I think also the biggest things to harp on with injury preventions are going to be the main staples, which is sleep, recovery and nutrition. As much as there is some type of component with strength training and physical therapy that could help play a part in that, I think the big three are always going to be your recovery, how well you're sleeping, your nutrition. Making sure that you have enough energy to fuel for your sports and practices. And then, lastly, just like the overall recovery that you're doing. So, making sure that you're giving enough time for your body to rest before you go back to practice, or giving yourself some time off before you are ready to return after recovering from an injury, things like that.

Melanie Cole, MS: Those are great points, and really great advice. And now, let's touch on that return to play because we both know that athletes don't always want to sit it out, whether it was concussion or some sort of knee injury. And we know our girls and ACL and things, in soccer, we know they want to get back out there, they want to get back out on the field or the pitcher, whatever it is.

So when we think of return to play, and you play a big part in this, Chris, I think that coaches have to have that cleared from their athletic trainers, their physical therapists, the professionals like you. So, what goes in to return to play? And when you're working with these athletes, how are you convincing them, "Hey, man, you got to wait a little bit longer because you're just going to re-injure that"?

Chris Morales: Yeah, no, excellent question. I think the biggest thing that comes to mind for me is communication at all levels between not just the player, but between the coach, between everyone else involved in the athlete's plan of care. So whether that be the physical therapist, the athletic trainer, even the personal trainers there too, as long as everyone's in good communication of what the athlete is currently dealing with, the timeframe of how long they expect for them to recover.

And then, in terms of return to play criteria, I think it's important for establishing certain guidelines, say, for that concussion example that an athlete sustains, we want to make sure that they're cleared in passing their concussion test so that we feel comfortable for them returning to sport. Because yeah, if they do return too early, they do face that risk of re-injury and we want to prevent that as much as we can.

And yeah, I think a big aspect of it too is it's really hard for athletes to take complete rest or be away from their sport, because that's their whole identity, that's what it's tied to, is being an active participant in what they love to do. And it's hard to tell someone that you can't do that for a while. But I think the biggest thing with physical therapy or rehab is to let the athletes know that there are some things that they can do in their time. We might just have to restrict them from maybe certain contact or maybe certain drills in the practice or maybe shorten the duration. So, I think we still try to find ways for the athlete to be engaged in participating in the sport. We just have to give them restrictions and then we communicate with the athlete too. I think that's the utmost important, is making sure that the athlete understands the rehab process, the timeframe, how long they expect for it to take, what they could do about it, and then how we could help facilitate them getting back to their sport.

But I think that's definitely a very important conversation for us to have with the athlete because, at the end of the day, it's their ultimate decision if they want to return. Say, like, it's the championship game. I think a good example that comes to mind is recently during the NBA finals, Tyrese Haliburton had a calf strain, and a lot of people would advise you from playing in the game so immediately after having a calf strain, because you are at increased risk of rupturing your Achilles. Let alone and behold, he went and played the game and he did rupture his Achilles, unfortunately. But it's a championship game. Sometimes that's the risk that you kind of have to take if you want to win something big like that. So, there's different cases, scenarios, so that you definitely have to weigh the risk to the reward ratio for all these type of things. So, it's all context-dependent.

Melanie Cole, MS: Yeah, that's true. And while we think of physical therapy, athletic training, and athletes, another part of your job is the general population. And earlier I asked you about the difference between rehab and physical therapy, and let's think of our middle age and older population, the injuries that you see and not even necessarily injuries, but the back issues are so, so prevalent. The golfer's shoulder and elbow, the things that you see in the older population. I mean, backs obviously, but knees and hips. And you're rehabbing new hips and you're rehabbing new knees. Tell us a little bit about your program, Chris, and how you're working with this population that are coming and going from your clinic, because they've got so many different things. I mean, it's a big part of the field.

Chris Morales: Yeah. I see all my older adults as athletes still. Because at the end of the day, they do have some type of activity they want to get back to, whether it be like pickle ball or even just playing with their grandkids and stuff like that. So, I always try to tie their function to something that they want to get back and love doing, because that's what's going to motivate them to participate in exercise, participate in their rehab.

A lot of those older patients that I do see, I feel like have been told all the things they can't do. So, I really try to focus on the things they can do and build off of that, so that they feel more functional throughout their everyday life. We do know that fall risk is a big indicator for, increased risk of death for our older adults. So, we want to make sure that they're decreasing their fall risk and that's going to be through strength training, through physical therapy, through being able for them to engage in physical activity more so that they could prevent those risk and underlying conditions that they face. Because as we do get older, it is harder for us to participate and live in active lifestyle. So, we want to do the best that we can to make sure that they stay active and are engaging in all those activities.

Melanie Cole, MS: That's true and functional training is just really so important for quality of life for that population. Now, as we get ready to wrap up, I'd love for you, Chris, to tell us about your team at Henry Mayo Physical Therapy and any memorable success stories or patient transformations that you've seen. Give us kind of a real look inside what you do and tell us about your team as well.

Chris Morales: Yeah, our team here at Henry Mayo is very great. As you already know, I run the Sports Performance Institute. So, I am primarily working with more of our athletes and our active adults. But all our therapists here at Henry Mayo Valencia Outpatient Clinic and the Golden Valley one are great. We have therapists that specialize in anything from neuro to a hand and lymph. We also have occupational therapists here that also work with extremities and specialize with the hand. So, we are your one-stop shop for like any type of service that you may come across.

So, our team here is great. You'll be welcomed. From the front desk team to our aides, everyone just has that helping hands approach to make sure that we're making sure our patients feel that they are being heard and that they're getting their needs met to reach their goals. So, that's our team here. What was the second part to your question? Sorry, I forgot.

Melanie Cole, MS: No, that's okay. Any memorable stories?

Chris Morales: Yeah, I think honestly all my patients always could be pretty memorable. It's always very rewarding for me in my profession to see someone get back to what they love doing or whether they're returning to their sport, returning back to their job or just, like I said, improving their quality of life.

But I think one story that resonates with me would probably be working with an older individual who came to me with pretty chronic low back pain, been kind of on and off, has kind of gone the whole running around from seeing anybody from like chiros to pain specialists and just couldn't get anything going for him. So, he was under my care and a lot of it was just kind of educating him on and how his back is strong and still resilient. There's still things that he is able to do. And like I said, just focusing on those things and then we're able to build it up from there. He started loving exercise, was always ready to get to work. And those type of patients I always love working with because just the effects that you see in their life and how long lasting it is makes you really appreciative of what I do and the service that I provide.

Melanie Cole, MS: It's very rewarding. And I'm sure your patients really, really appreciate you working with them. And thank you again for joining us and telling us about Henry Mayo Physical Therapy. And you can always visit our website at henrymayo.com/physicaltherapy for more information and to get connected with one of our providers.

That wraps up this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thank you so much for joining us today.