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Michael Carrese (Host): Given the popularity of professional sports in America, there's increased awareness of the efforts that athletes put forth to maintain maximal performance and reduce the impact of sports injuries. As a result, we often hear the term sports medicine as an overarching term. Well, we're going to get into some specifics about what that means today with the help of orthopedic surgeon, Dr. Shivajee Nallamothu, who's a specialist in joint replacement and sports medicine. This is McLaren's in Good Health. I'm Michael Carrese, and Dr. Nallamothu, can you start by defining sports medicine for our listeners?

Dr. Shivajee Nallamothu (Guest): Sure. Sports medicine involves any injuries that we take care of, which include any types of falls twisting injuries. And so a lot of it has to do with knee injuries, shoulder injuries, elbow foot and ankle anything that you could hurt while you're playing sports. Basically it's that easy.

Host: So you've been doing this for a long time. Sports medicine. In your experience, what type of patients do you typically treat? Are we talking about mostly student athletes, college athletes? We're talking adults? What's the range like?

Dr. Nallamothu: Oh, children these days, start sports very early, even four year old starts playing hockey, basketball, even football. They're doing flag football now. Yeah, you've probably seen that in the local high schools. And because of these early ages, we've take care of kids from four year olds and older patients that again, at 60 years old, now with pickleball, they're still saying in sports at extended period of time. So now I'm starting to see four year olds all the way up to even 65, 70 year olds that are playing pickleball at their local racket clubs.

Host: Well, it's good everybody's being active, I guess, right?

Dr. Nallamothu: Oh yes. It's actually excellent there. They're very happy. They're active, they maintain their balance and health. So this is all excellent.

Host: And what do you see for the most part, if you can characterize, you know, the most common conditions that you are treating in your office?

Dr. Nallamothu: A lot of it is ankle injuries from side to side movements. But it's also a, the racket sports will cause shoulder injuries. Especially with twisting and running and impact types of sports. You can get meniscal tears, ACL tears, anterior cruciate ligament is a ligament that stabilizes the knee. So it, depending on what kind of activity you're doing, you can get an ACL tear. Also rotator cuff injuries, that's the muscles that lift your arms up. And with twisting like racket sports, you can injure that. You can also get dislocations in sports where you're falling with an outstretched arm. And so there are all kinds of injuries that you can get, but most of them are these types of ligament problems. And then when we're taking care of 60 to 70 olds, now we're seeing arthritis in the joints. And so we have to maintain the range of motion and strength with arthritis while they're trying to maintain their activity levels. So it's kind of really disappointing to them when they have to decrease their activity.

Host: What do you do about arthritis?

Dr. Nallamothu: Well, we could do a lot of conservative treatments. This includes injections, bracing, physical therapy. Cause sometimes the muscles start weakening a little bit and then the joints take more of the force and the rotation. And so then it starts hurting more. So as they start hurting more, we can treat them with these conservative treatments without having to do any surgeries. We start with that first.

Host: Well, and that applies across the board too. You're an orthopedic surgeon, but you do an awful lot of stuff leading up to the point where surgery is the only option. Right?

Dr. Nallamothu: Right. I tell people sometimes it's harder to take care patients without surgery because, you know, there's a lot of maintenance that the patient has to do a lot of work that they have to do to maintain their activity level. And so I tell them, you know, most of the work is from them when it's a nonsurgical treatment, and because they're so knowledgeable about their injuries and their sports, they're really good about being compliant and doing the things that we ask, to see if they can get better. And they're very motivated people too.

Host: So of course the goal for athletes is to avoid injuries. So they don't need to come see great doctors like you. What advice do you have generally for athletes and parents of athletes to minimize the risk of injury?

Dr. Nallamothu: So a lot of kids do play sports through the whole year. And that's one thing that, you know, we try to kind of advise them to play other sports cause it works on the other parts of their bodies. So they get stronger. The balance, the hand eye coordination, all that improves with these other sports. But to avoid injury, we try to get them to do preseason preparation, including like stretching programs, which actually should be year round, and then training for that sport, more specific training. So they don't land wrong when they land from jumping, they twist the right way. Even with golf, if you don't have the right mechanics, you can cause problems. And again we encourage multiple sports. And you'd be surprised how many people that are middle aged and older play multiple sports a lot more than some of the kids nowadays.

Host: Well, I wanted to ask you about that because this has been a trend over the last couple of decades. I'd say, where kids start to specialize in a sport pretty early and get into travel programs and really intense focus on a particular sport. And what I'm hearing you say is that's really not such a great idea,

Dr. Nallamothu: Right. If you talk to a lot of college coaches, they'll actually say that they like the players that play multiple sports because it not only encourages the player to develop in a more, you know, a complete manner. They develop their shoulders in certain sports, their hips in certain sports, their ankles in certain sports. So if they played different sports, they actually developed their whole body and they can actually tell in college, you know, the college recruiters, they can see what athlete is really athletic and what athlete concentrates on just one sport. And they appreciate that cause it's a full body development and especially at a younger age, the more sports they play, first of all you figure out which one they actually like, and then they want to entertain that sport and spend more time doing it. And I see a lot of kids that play one sport for four or five years and all of a sudden I see them jumping into a different sport cause they like it better and they actually develop a lot better that way.

Host: Have you seen a trend or are you worried at all about kids starting too young with intense sports activity?

Dr. Nallamothu: Well that's one of the things that the NFL started putting out is the younger kids playing flag football instead of contact football. So they're still young kids playing contact football. But they're starting to figure it out that it's better to develop their skills than it is to try to get them into a sport where they might get injured. And especially with football and you know, skill sports like basketball, soccer, golf, you can't just start that when you're in high school. So you do have to start earlier. But you've got to really maintain their health if they get injured, you know, that's another reason for the kid to stop playing a sport. So if you watch really carefully and make sure that they're developing the right way, they get the right Coaches. That's important too. So they're not being pushed too hard. Then they develop carefully, and if they're disciplined in their rehab programs, even if they get injuries, they can come back pretty quick. Let me see. I see a lot of kids, they heal up pretty fast. And most of the time we have to just get out of the way and let them heal before we get them back into sports too early. You get them in too soon, parents get worried, the kid kind of doesn't want to play anymore if they keep getting hurt.

Host: Well, right. So you do all the things we were mentioning before, all the advice you give about stretching and preseason off season training, all those smart things to avoid injuries, and all the treatment that you can do before surgery. But sometimes surgery is necessary. Can you just talk for a minute or so about that process of getting ready for surgery and what people can expect from that process?

Dr. Nallamothu: Sure. If a person has an injury that actually needs surgery, we do the initial studies, you know, MRIs or cat scans, x-rays. If they do need to have surgery, then we go over the whole process with them. We prepare them beforehand, let them know what the risks and the complications are so that they have the right expectations to recover. Also, if they're going back to a certain sport, we got to make sure that they wait the right amount of time. Like for an ACL reconstruction, anterior cruciate ligament reconstruction, it's a year before they get into sports sometimes, get back into their favorite sport. If it's a meniscal tear or it could be a shorter period of time. So we have to actually manage their expectations. If they expect to go back too soon, they'll want to go back too soon and the parents feel pressured and they want to let them get back into their fun activities and then all of a sudden they hurt themselves again. So the easy part is the surgery. The hard part is the recovery process. I tell that to patients all the time. I have the easy job.

The hard job is for the parents and the family, and the coaches, to be on the same page. So it makes sure that we write down with them exactly what's expected at what time of recovery, whether it's a few days from now versus what we expect three months from now. And then when is the goal to get back into sports? Frequently I'll give them goals by month period. This is what we need to see in three months. We need to see this. And then we talk carefully about when they can go back. And then sometimes we'll let them test it in physical therapy. The therapists that we have, they're excellent and they really test the patient before they get them back into sports. And they'll communicate with me and let me know if they think they're ready and then sometimes we do that at the physical therapy facilities. I'll test them out in that specific sport and see if they think they're ready to at least try to get back into practicing. I tell parents if they keep hurting themselves, that's the first reason they want to stop and they'll find something else to do.

Host: Well, speaking of stopping, we're going to have to leave it there, but I want to thank orthopedic surgeon, Dr. Shivajee Nallamothu for being with us today. He's a specialist in joint replacement and sports medicine. And to learn more about Dr. Nallamothu or submit a question, you can visit McLaren.org/nallamothu, that's spelled N A L L A M O T H U, McLaren.org/nallamothu. Doctor, thanks very much for being with us.

Dr. Nallamothu: Thank you, sir.

Host: If you found this podcast helpful, please share it on your social channels or check out the full podcast library for additional topics that may interest you. This is McLaren's in Good Health. Thanks for listening.