Transcription:
Prevention and Treatment of Common Sports Injuries

Melanie Cole (Host): Exercising is good for you but sometimes you can injure yourself when you play sports or you exercise. Accidents, poor training practices, and improper gear can cause many different kinds of injuries. My guest today is Dr. Evan Argintar. He's an orthopedic surgeon with MedStar Orthopedic Institute at MedStar Washington Hospital Center. Welcome to the show, Dr. Argintar. What are some of the most common sports injuries that you see?

Dr. Evan Argintar (Guest): Thanks for having me. There are so many different sports injuries and so sometimes it's perhaps easier to frame it by the region of the body. In terms of shoulders, it's very common to get inflammation of the rotator cuff, rotator cuff tendonitis. For the hip, often athletes will get hip trochanteric bursitis. In the knee, patients get a constellation of symptoms that will lead to patellofemoral syndrome or anterior knee pain. For the ankle, often patients will sprain their ankles or injure the lateral ligament of their ankles.

Melanie: When we're talking about injuries, there are two types: acute and chronic. Explain the difference please.

Dr. Argintar: Well, the chronic injury is the one that is been bothering the athletes for weeks to months, even years. Sometimes there are injuries that are clinically silent so patients may have a chronic injury that doesn't really bother them. They make acutely injure it which means they get acute symptoms, after a throw, after a slide, after a push during the sport, or even something professionally. So, from the perspective of an orthopedic surgeon, it is purely did you have symptoms before that accident or did you not? However, sometimes they can be blurred.

Melanie: Let's talk about knee injuries for a minute. You mentioned patellofemoral syndrome. What is that and how is the knee easily getting common sports injuries?

Dr. Argintar: Patellofemoral syndrome is, by far, the most common clinical problem that I see with athletes and even non-athletic people--even couch potatoes, a lot of people have this problem. It is really a constellation of a whole group of different diagnoses often lumped together appropriately. Some people will call this jumpers knee, patellar tendon, tendonitis anterior knee pain syndrome, but what it all comes down to is pain on the front of the knee. When I try to identify the cause of this commonly occurring issue, again, it all comes down to the flexibility or lack thereof as well as specific weaknesses. A very common collection of symptoms are tight IT band; tight hamstring, which is the muscle behind your leg; and then, people tend to have weak medial quadriceps and weak hip abductors. The hip abductors are really tiny but critically important muscles on the side of the hip. It helps pelvic control but also plays a role in the natural tracking of the kneecap.

Melanie: Are there any ways to keep your knees healthy?

Dr. Argintar: Well, absolutely. First of all, weight bearing is good for all joints as well as the knee. But then, there are people that struggle with these inflexibility weaknesses. I often see people with knee pain. I'm very able to predictably get them better. The bigger challenge is in maintaining that clinical improvement and I do that with the creation of a home exercise program that is instilled in a patient by frequently going to a physical therapist that works on creating a program that focuses on the flexibility of these two really large muscles that can get very stiff. It also works on core strengthening, pelvic girdle strengthening, medial quad strengthening. The patients with pain are able to get better and then they're able to maintain that improvement as they play sports or do whatever else they wanted to do.

Melanie: Some injuries we're seeing a lot of lately are ACL injuries and especially to soccer playing girls. What do you tell parents and the athletes themselves if they feel like they've gotten an injury? What do you tell them to do right after the fact?

Dr. Argintar: Well, the first thing is, it can be dangerous sometimes to give advice to people over the phone or over e-mail. So, the first thing I tell them is that if they have any real concern, there's only so much any doctor can do by just hearing about the problem. The clinical exam is just as important. So, any parent with a child or any athlete who has a problem or a concern, I would say, “Get evaluated.” That being said, the first question I ask them is, especially in respect to the knee, and even more focused with the soccer players, was it a non-contact injury? Oftentimes that smells of an ACL injury. I ask them did their knees swell up. There are a lots of problems that don't create the effusion or the knee swelling in the joint, and so as I'm trying to stratified different diagnoses based on how the parents, or even the athletes, describe their symptoms. Those are two of the things that I try to tease out early.

Melanie: Are you still using or advising RICE for people to do if they just get a short term injury?

Dr. Argintar: The answer is yes. RICE is still a good thing. Five years of orthopedic residency and RICE is the number one thing that works for all injuries. RICE is resting, icing, compression and elevation. All that does is it decreases inflammation. Remember inflammation is a good thing. It brings blood to a site of injury and blood has growth factors and healing factors that help stimulate healing. The problem is that with bleeding, you get swelling and swelling causes stiffness, so it's always a bit of a balancing act. You want to optimize the good stuff coming with the blood and minimizing the bad side effects of that. So, all of the compression, icing and elevation minimizes the consequences of swelling ideally.

Melanie: Dr. Argintar, is there ever a time that heat comes into play?

Dr. Argintar: Yes, heat is good. People often ask me, “Should I ice it? Should I heat it? What should I do?” The reality is that both, in general, are safe, and I tell patients to kind of play around with both and see if and when either gives more of benefit. In general, though, after an acute injury, you twist your knee and it's swollen, so icing tends to be better because it decreases the swelling. Then, for more chronic issues, heat tends to be better because that brings the blood flow, bring some of the healing agents. Both are safe although I will caution the patient icing to make sure to give yourself a break every once in a while. Patients can actually give themselves frostbite from too much ice.

Melanie: Speak about some available treatment options for the longer term if somebody does injure their rotator cuff or their ACL, or they get patellofemoral syndrome. What do you tell them about some treatment options that might be available?

Dr. Argintar: Well, the first thing is you have got to shut it down. Pain is your body's mechanism of telling you that something is not going right and so you have to listen to that. People will get into problems when they try to ignore the knee pain and run, or ignore the shoulder pain and pitch, and then you start creating a more complicated knot that takes a lot longer time to unravel. After you let things calm down, often with the help of the therapist or an orthopedic surgeon, you have to figure out what the cause of that problem is. Sometimes accidents happen and your body can heal them. Oftentimes, though, there is a bad plumbing issue whether that be inflexibility, or a weakness, or a combination thereof. Usually, if you don't identify and actually treat that issue then you're prone to that same injury again. Most athletes and most patients prefer to have an event that they don't repeat.

Melanie: What do you use as a first line of defense? Do you tell people to use NSAIDS or go to physical therapy? Kind of just walk us through a treatment line until you would possibly discuss surgical intervention?

Dr. Argintar: Sure. As an orthopedic surgeon my favorite thing to do is operate. However, fortunately, I operate on a very small minority of my patients and always surgery is the last option. And, so, in general, some of the things that I recommend for a lot of the overuse injuries or traumatic injuries like in shoulders, elbows, hips, knees and ankles, would be some combination of activity modification, a strong anti-inflammatory, often physical therapy and, in some cases, a steroid injection.

Melanie: So, that's a good point. Speak about a steroid injection. If somebody gets one in their shoulder or their elbow, how often can they get those?

Dr. Argintar: That is a great question. There is a big stigma attached to the word “steroid”, and that is appropriately existing from the anabolic steroids that got appropriate negative press with professional athletes. This is not that. A steroids injection or a cortisone injection is a direct injection of a medicine that decreases inflammation. It does it in a different way than the typical NSAID, which is the non-steroidal anti-inflammatory. A Steroid is, of course, a steroidal anti-inflammatory. In terms of frequency, some people are worried by the way it side effects, like weight gain, which does not happen with the injection because it doesn't go into your mouth and go around your body through absorption, through your stomach. It depends on the problem. Everything in moderation is okay, and it depends on the age. So, if you have an arthritic knee, I have patients coming in every two or three months sometimes for an injection. That's how they get by and avoid surgery. For a younger person, I would give them one injection with the goal of never giving it to them again.

Melanie: Then, wrap it up for us with your best advice about possibly preventing some of these common sports injuries--what you really tell patients every single day.

Dr. Argintar: The best way to prevent injury is to have a strong defense and there are specific muscle groups in the hips, in the shoulders, in the knees, and ankles. It is very easy to neglect them and often the neglect leads to a bad plumbing issue which is clinically silent until you injure yourself. So, my advice for the shoulder would be, for the shoulder, periscapular strengthening, rotator cuff strengthening. For the hip, hip abductor strengthening, core strengthening. For the knee, hamstring IT band flexibility, medial quad strengthening. For the ankle, calf flexibility. These are the things that an average person could potentially Google and just learn how to do some simple stretching and strengthening exercises that could either both defend from injury or make an injury less bad and more easily recoverable.

Melanie: Thank you so much for being with us today, Dr. Argintar. That's great information. You're listening to Medical Intel with MedStar Washington Hospital Center, and for more information you can go to www.medstarwashington.org. That's www.medstarwashington.org. This is Melanie Cole. Thanks so much for listening.