Deborah Howell (Host): Well, we love our sports in this country. Sometimes we love them so much we overdo it and then our body starts to rebel. Today we'll talk about the latest advancements in health care from cutting edge treatments for sports concussions to innovative techniques in musculoskeletal care with our guest, Dr. Joshua Snodgrass, Director of Sports Medicine at Memorial Care Sports Medicine Fellowship in Long Beach. Dr. Snodgrass will share his insights and expertise in optimizing health and performance for athletes and individuals alike. We're so glad you're here, Dr. Snodgrass. Welcome.

Joshua Snodgrass, MD: Thank you for having me.

Host: I'm hoping you can share the fascinating journey that led you both into primary care and sports medicine. And how do you see these intersecting in the lives of athletes or just anyone leading an active lifestyle?

Joshua Snodgrass, MD: You know, when I was growing up, my father was a firefighter for Riverside County and my mom was an oncology nurse at the hospital out in the Inland Empire. And, growing up, we were kind of part of like that last part of Gen X and we were, we were home by ourselves a lot of times. And, I grew up in the action sports industry where it was just one injury after another. If it wasn't me, it was one of my friends and I was the only one that had any kind of healthcare background. And it just kind of naturally progressed over the years to go more into a primary care so I have a broader spectrum of training. The sports side came because family medicine as a profession, they really like to focus on the community aspects of it.

And they look at kind of the buzzword that we hear a lot is underserved and chronic disease is a really difficult nut to crack, and it can kind of burn you out as a, as a physician sometimes, and transitioning that into the sports world, you still can work with an underserved population and do a lot of community outreach by supporting the local schools, but you get to work in a much kind of funner environment, I guess?

Host: Yeah, well, having fun on the job is, you know, there's a lot to that. Now, when it comes to treating athletes, what kinds of conditions do sports medicine primary care physicians typically encounter and how do these differ from traditional primary care cases?

Joshua Snodgrass, MD: Sure. The athletes, when I say athletes, like it can be your weekend warrior or it can be, you know, a Division I collegiate level or professional and above. Like, it really doesn't matter. It's just people are really good about finding new ways to hurt themselves, which is what I always call job security.

The primary care side, in a primary care setting, there's usually about estimate of 25 to 30 percent of your acute visits are because of a injury. And the primary care side is so governed by insurance regulations and protocols that it can sometimes drag the care out. Where, you know, if you are at home making the bed and you tweak something and pull your back and you know the, the primary care side is going to look at you, do their evaluation, but the insurance world is going to kind of slow you down and say, you know, you have to check these boxes.

You have to do your physical therapy. You have to get your x-ray. And it can take weeks to get back to feeling peak condition. On the sports side, we kind of measure things in weeks, but it's because your season or your championship is, you know, two weeks out and it's, it's, we take it a little bit further, and we go a little bit faster trying to get you the peak physical condition to meet whatever the patient's goal is, as opposed to checking boxes for an insurance company.

Host: Sure, I know if I were out of Pickleball for two weeks, I'd be very unhappy.

Joshua Snodgrass, MD: We see a fair amount of pickleball right now.

Host: I can imagine.

Joshua Snodgrass, MD: Seems to be the big thing.

Host: So with your experience in sports concussion evaluation and musculoskeletal injections, what are some key insights you've gained in these areas and what should patients be mindful of when it comes to their care?

Joshua Snodgrass, MD: So concussions are something that have been a hot topic in the media, and it's something that's been very close to me because a couple of years ago, my son, who was six at the time, he hit a tree while sledding and ended up having a skull fracture and a couple of brain bleeds. With my background in sports, you sometimes know too much, and it kind of scares you as a parent.

You know, I had the chance to sit down with a neurosurgeon during the course of his treatment. He came out fine, by the way, he's back to normal. But in the course of it, sitting there talking with the, one of the neurosurgeons at Memorial Care, we got on the topic of resiliency and we were looking at different treatments.

And it's kind of funny when you look at concussion research that's out there, there's a million different ways and a million different theories to make a diagnosis on a concussion or to evaluate a concussion. But there's almost nothing treatment wise, that's going to speed up the recovery of it. And all of the research is looking at like the resiliency of an individual.

And the resiliency is just, it's really difficult to define that. It's just some people are more resilient to certain things in life and others, they tend to get injured more. And there's not a lot in terms of like the treatment side of it, and we don't know nearly as much as we think we do about concussion, and, you know, watching my son's case all the way through, it makes me go back and wonder, you know, how much we don't know about the brain, and,

Host: Isn't the protocol always changing because you don't know so much about the brain?

Joshua Snodgrass, MD: Yeah, every year you know, we sit down at the colleges and we go through our protocols and we try to see like what's the best way to evaluate, how long do we need to hold someone out, when can we do a return to play protocol, and you know, there's a lot of overlap between what we do on sports and what happens in like the occupational world.

And basically what it comes down to is risk stratification, you know, how likely are you to hit your head again. And that kind of speeds up the protocol, depending on your symptoms, of course.

Host: it's really important, I would imagine, to balance the treatment of acute sports injuries with of course, the long term health and wellness of your patients. Can you share some unique approaches you take to striking this balance effectively?

Joshua Snodgrass, MD: With us on sports, it's really important to get to know the athlete and what their ultimate goal is. And we try to base treatment and timing for treatments around what they have planned or what championships or competitions are coming up. A lot of our younger patient gets a little bit more difficult because the parents are kind of determining like, you know, your work schedule.

I can't make this appointment or I can't make that. And, we have to come up with some pretty creative things. But a lot of it is just going back and forth with the patient to figure out what works for their schedule and what they're capable of doing. We lean a lot on chiropractors and physical therapists and, if they've got an athletic trainer, we try to stay in contact with them to see how they're doing.

But we can offset a lot of that by some of the diagnostic tools that we have. You know, one of the things that's big in sports medicine is using diagnostic ultrasound where, you know, we can kind of cut to the chase and see a lot of the soft tissue injuries in real time, which means we can do dynamic exams where, you know, before we had that modality, we were kind of limited to x-ray and MRI. We can kind of speed things up based on what we're seeing in real time.

Host: Excellent. I'm going to switch gears a little bit. We all, of course, want to perform at our best physically. What creative yet practical tips can you offer to prevent injury and optimize physical performance, whether we're athletes or just active individuals?

Joshua Snodgrass, MD: Oh, this is a big one. I think a lot of what helps you strike a work life balance, if you will, it starts early in life. One of the things I see with the younger athletes, again, it comes down to the parents, is early sports specialization can be detrimental to the mental resilience and mental health as we age.

If we put too much pressure on ourselves at an early age, we tend to be a little grumpier when we get older, then we, we take failure differently. And trying to balance your life with what you do versus that rest side of it can be huge. And it's, again, when you look at like the work comp industry, you have a tendency to see these overuse injuries.

And if you're an athlete, you know, no one's telling you that you have to do this other than your coach or yourself. But you can develop very similar injuries because of the frequency in which you do it. The American Academy of Pediatrics just published in January this year, 2024, a new position statement for the burnout and overuse and over-training syndrome.

And they're still showing that you have to focus on this balance. If you push too hard, you're gonna overdo it and you're gonna get injured.

Host: It's a hard thing to learn, but once you do, it's going to make a big, big difference in your sports career. Nutrition and hydration are also crucial in sports performance and injury prevention. Can you give us some insights on how these factors can impact our bodies, especially in the realm of sports medicine?

Joshua Snodgrass, MD: Sure and this ties in well with the you know, overuse and over training side as well. You know, if you're not getting proper nutrition, it makes sense. If you don't put the right gas in your car, it's not going to run that well, or at all. It's very much the same with food. When you start looking at different diets that people have, and we don't tell people that you have to have a certain diet.

 It's not really about what you eat, how you eat, or when you eat. It's more just about making sure you get proper nutrition. You know, I was having a conversation with a buddy of mine, and his wife is a vegan, which is a very difficult diet to have if you're a high level athlete, because, things like B12 and iron and calcium and vitamin D, like those typically will come from animal products.

 And if you're missing certain things in your diet because you have a vegan diet or a vegetarian diet or, you know, paleo diet, whatever diet that you choose for yourself, you have to make sure that you are supplementing those things. Otherwise, the body just doesn't have the building blocks and it doesn't have the fuel, which will ultimately slow you down, cause injury, and then delay that recovery process as well. So you've really got to pay attention to the nutrition.

Host: My dad was also a physician and he just said, eat a lot of variety, eat different things every single day.

Joshua Snodgrass, MD: That is, it's kind of funny, variety is kind of what they say, the spice of life, but it's all things in moderation. Like, don't be afraid to eat something, and don't eat the same thing every day. Just, even when you look at overuse injuries, if you do the same physical activity every day the same way, you're going to create an injury. So, spice things up.

Host: Exactly. So as someone passionate about discovering emerging technologies and treatments, can you highlight any recent advancements in sports medicine that have left a significant impact on patient care?

Joshua Snodgrass, MD: Yeah, having MSK ultrasound available has been huge. We started using that and implementing it on the sideline. When athletes are coming out, you know, a lot of times we can speed up the return to play process by just looking at some ligaments and tendons or muscles and making sure things aren't torn and they're just kind of bruised.

So, we can speed them up and get them out on the field faster. And then, one of the other things that I have a personal interest in is the hyperbarics world and using hyperbaric oxygen to kind of force feed nutrients to tissue.

You know, a lot of times getting oxygen in, that's kind of one of the building blocks that you have to have in order to create energy in the muscle and allow the body to heal. It's interesting to see how that's been advancing with the hyperbaric chambers that we have. And, you know, the wound care world's using that a lot more than we are in sports, but it's an emerging technology that I just like reading the literature on it.

Host: I see more and more of it in social posts, and people are raving. All right, as we all know, collaboration is key in healthcare. So how do you foster effective collaboration with other healthcare professionals and coaches and trainers to provide comprehensive care to your patients or athletes involved in extreme sports?

Joshua Snodgrass, MD: You know, communication is key in every facet of life, and it's really just about mutual respect. And it doesn't matter what someone does if you are working with them in any level of an organization. It's just treat them with respect and, you know, learn what their goal is and, learn what you can do to help them.

And when people figure out that you are there to really help them, it opens a lot of doors for you. And collaboration, I can't say enough of having a network that you can rely on when you don't know the answer to something and you can bounce ideas off each other in a very open and friendly environment is huge. And it's not about us, it's about the athlete.

Host: Right. Well, I tell you, as an athlete or semi athlete, semi professional, to have a team, it means everything because you know that every aspect of what you're going through, if it's an injury or a condition, that team is going to get you through every part of it.

Joshua Snodgrass, MD: Yeah, we have athletes, especially in our X Games side, we have athletes that are international and all over the world. It's one of like the downsides to my job is I'll get random phone calls at 3am on a Sunday because, you know, somebody was skateboarding at a competition in Rome. And we're trying to organize health care in an entirely different part of the world.

And, you know, we're talking to trainers and coaches and family members. And it's the fact that everyone knows that we have single goal. And it's like, how do we help this athlete? And let's, all come together and brainstorm and get it done.

Host: I love it. Sadly, we've come to the end of our time, but before we go, I'm hoping you could share at least one memorable success story or patient experience that illustrates the transformative power of sports medicine.

Joshua Snodgrass, MD: Yeah, there's actually a really fun story, and none of it's a HIPAA issue, he's given me permission to talk about it multiple times, and this is all public now. But there's a professional skateboarder, Jagger Eaton, he's ranked number one in the world right now. He had an injury going into the first ever Olympics that included skateboarding. We only had a few weeks get him ready to travel to Tokyo, and we sat down and went over options, and we were really nervous, because if anything went public at the time, he could have been dropped from the U.S. team, and he would have lost the chance of being, you know, one of the first U.S. athletes to compete at the Olympics in skateboarding. And, we started using ultrasound and, you know, a series of PRP injection, platelet rich plasma, which is a new modality. And kind of working with this therapist and working with his coach.

And we got him to a point where he was healthy enough and, you know, he traveled to Tokyo and ended up getting a bronze medal while skating with a pretty bad injury. And, you know, when he came back, he came over and, he invited me to go to his medal party, but unfortunately I was actually maybe two days post op because I had my ankle exploded.

Host: Oh, no.

Joshua Snodgrass, MD: So I, I couldn't go, I had just gotten out of surgery, so I couldn't make it to his medal party, but to see him go from, you know, what could have been a career ending injury to a full recovery, to winning a bronze medal, like now he's ranked number one in the world and I'm so fortunate to have been a part of it. And I just, there's no telling what he's going to do next. And I look forward to seeing how he performs. And it's great hearing his stories.

Host: That's very heartening. Job well done all around. Thank you so much for that, Dr. Snodgrass, and for being on the show today, we really do appreciate it.

Joshua Snodgrass, MD: Yeah, you're more than welcome. It was a pleasure.

Host: That's all for this time, and for more info, you can go to memorialcare.org/servicessportsmedicine, or call 562-933-0013 to make an appointment at Dr. Snodgrass's Long Beach, California office. To listen to a podcast of this show, please visit memorialcare.org. I'm Deborah Howell. Have yourself a great day.