Transcription:
Sports Medicine During COVID-19

Melanie Cole (Host):  Welcome to Better Edge, a Northwestern Medicine Podcast for Physicians. I'm Melanie Cole. And today we're discussing sports medicine in the COVID-19 era. Joining me is Dr. Lucas Buchler. He's an Assistant Professor of Orthopedic Surgery at Northwestern Medicine. Dr. Buchler, it's a pleasure to have you join us again today. Welcome back. So update us. How has the pandemic changed your approach to the management of sports related injuries? How's it going for you?

Lucas Buchler, MD (Guest): Well, certainly. And thank you for having me back. It's wonderful to be back joining you all here and I think for us, the pandemic has changed about everything about the way we practice in some capacities, some more than others. Our management of sports-related injuries specifically, the biggest change I would say is that we're seeing fewer of them. So, folks are not participating in group sports, group fitness. Most folks are doing some sort of individual activity or even limiting their activity quite a bit. So, we certainly have not seen the normal injuries we would expect to see over the course of the summer.

Host: That's a really an interesting turn for this. Is it going to make it so that you see new patients with injuries due to unconditioned musculature, as we do start to jump back into this?

Dr. Buchler: I think a lot of us are worried about that. And we've seen a little bit of that already. So, a lot of folks have whether they're trying new activities, retrying old activities, almost everybody's fitness and athletic pursuits have changed. We've seen a lot more chronic complaints, from folks who say, used to run 10 or 15 years ago, had been going to the gym, their gym closed, or their rec league sports shut down. And they said, you know what, I'm going to take running back up and then they'll come see us with knee pain or hip pain or a variety of other complaints. It really is from a, I don't want to take away from the folks' efforts, but it's a lack of conditioning. It's an activity that they haven't been used to doing and their musculature and their joints are not as prepared for it as they once were. And so we've seen a lot of complaints related to changes in activities and new activities that folks are doing. Just trying to find a way to stay active through all of this when they don't have access to their usual, their gym, their group fitness classes, their recreational sport leagues, things like that.

Host: Well as an exercise physiologist, I'm seeing the same. So, what measures are you advising your patients or even for other providers to tell their patients so that they can prevent the injuries possibly? If they are more unconditioned, what are you telling people to do?

Dr. Buchler: I think the biggest thing is simple instructions, is gradual engagement with new activities. We tell folks if you used to be a marathoner, but you haven't really run much in the last four or five years, we don't want you trying to go out and run eight or 10 miles in your first few weeks. We want you to start very gradually.

And the analogy I always use for folks in the office is, you have to crawl before you walk and walk before you jog and jog before you run. And, I think most folks understand that intuitively, but sometimes a reminder that going into things a little more gradually and a little less aggressive can help keep some of these things at bay by allowing their body some time to condition, to recover a bit and to ramp up to the level of activity that they hope to be at.

Host: How have you evolved your practice? Are you using Telemedicine, Dr. Buchler for any of these sports medicine injuries? How's that working out for you?

Dr. Buchler: Quite a bit, I think a couple of major changes for our practice or at least for me on an individual level is I'm doing much more Telehealth than I ever have. So, early in our pandemic shutdown around March and April, our office was completely closed. We were only doing Telehealth. Now we're back to seeing patients in the office, but we have tried to limit unnecessary visits to the office. So, for folks, we feel that a re-examination may not provide value, we have transitioned them over to Telehealth follow-ups. We do a lot of our imaging follow-ups, for example, we'll send someone to get an MRI. We'll do a review with them through Telehealth. And really for me, I find that maybe works even better because I can share my screen.

I can show the patient the study. I can use my pointer to identify exactly what I'm talking about and take them through the study and show them, not just tell them what the injury is, but really show them the pictures. And I think that we've found that there's a lot of value in that for us and for the patients. And that's been a big change. And then I think many of us have been in a routine habit of for me, at least, I was in a routine habit of most patients follow up with us every six to eight weeks. And I've tried to be more thoughtful about that. If a patient has a condition that's likely to take longer than that to resolve, or if their symptoms are improving, I tell folks you don't have to come back into the office. So, we really only want folks coming into the office who needed to be there, who need to be reexamined, or if there's some conversation that needs to be had that we feel is better in person. So, we have transitioned to doing a lot more Telehealth.

And I think that's a change that will persist even once we have a vaccine and our numbers calm down and we start getting back to normal, I think we'll keep the Telehealth up because it seems that our patients like it.

Host: I agree. I think that this is going to be sort of an evolution and maybe one positive thing that has come out of this pandemic is the switch over to Telehealth, which has helped so many people. Now I have to ask you about this, Dr. Buchler, tell us more about your role with, was it with the Blackhawks that you were working with the team at the Bubble in Edmonton for the year's playoff series? Tell us more about that experience. What was it like?

Dr. Buchler: It was a great experience. It was very unique. So, I did, I traveled with the Blackhawks to Edmonton. We left the last week of July and were there for through most of August. I was grateful for the opportunity. It's obviously a long time away from home and the practice and family. But my wife and kids were very patient and tolerant with that. And from a practice standpoint, we have a really great team who kept things rolling. But for me on an individual level, it was a really unique experience. Hopefully, we'll never see something like it again. And so, it was really neat to be a part of that. So, we traveled up the last week of July.

I think the most unique part of it was the what the NHL called at least was establishing the bubble. So, for the two weeks leading up to our trip, we were basically self-quarantining at home, seeing only family, we were being tested daily or every other day, throughout the variety of that period. And then once we had confirmed that everybody who would be with the traveling party had tested negative, I think four or five times straight before the trip, we were then allowed to join the travel party. We traveled into Edmonton. And then basically the first week we were quarantined with the team.

So, we were supposed to have limited or minimal interaction with anybody outside of our individual team traveling party. And I think that it was, I had it a lot of briefing leading up to that trip. And so, I knew what the structure was going to be, but I'll be honest. I was very impressed with how well the teams did and how well the league did with keeping things organized. In the bubble and Edmonton, every person's access was tiered. So, there was levels one through five. The team and all team-related personnel, which included most of our travel party was level one. And then, league personnel who needed to have direct involvement with the players were level two, all the way back down to folks who were supposed to have minimal crossover or minimal involvement with the players at a level five.

And that was more, security staff, maintenance staff, folks who needed to be in the bubble, but the hope was not to have any direct personal interaction with the team or the team staff and at least as far as I'm aware of, and we didn't have a single positive on any of the teams throughout that bubble experience. So, very well-organized and I think very well done.

Host: How cool is that? So, what do we know Dr. Buchler about the virus and athletes on their overall performance, health? Do we know any long-term complications, long-haulers as it were? And if so, how are you preparing to treat patients who might be experiencing these long-term effects?

Dr. Buchler: So, that's a great question. The short answer, and this is what I shared with a lot of the players and team members when we were in Edmonton is, there's a lot we're concerned about. And there's a lot, we don't know. I think there's a few primary concerns that we had with our professional athletes when it came to COVID. One was that it seemed not just in hockey players, but in all levels or all types of high-level athletes that not everyone who had clinical recovery from the sickness from COVID felt back to normal right away. For some, it took a few months, they felt a little bit of fatigue, they felt tired. They didn't quite feel that they had the jump that they used to.

And for some of the athletes that took a month or two or three even to resolve. And so, that was certainly one concern was even once someone had been cleared of all of the traditional COVID symptoms and it was no longer testing positive or where there was no longer concern for active diseases, how do we re-engage them with their fitness and conditioning and getting them back to competition ready?

And then the other big concern is any sort of long-term cardiac or pulmonary complications. We know that COVID obviously has a significant pulmonary effect on the lungs, but it seems to also have some changes we've seen athletes, and other patients with EKG changes. And so, there is some concerns about cardiac manifestations of the disease. At least I can speak from our team's standpoint, we took a very conservative approach, all the players, that there was any concern for at least that I'm aware of in the NHL, not in the bubble, but leading up to that, they've all had extensive fitness testing, physical examination, and cardiac and pulmonary evaluation to ensure that there wasn't any worrisome changes. But I think those are the things we worry about is that yes, we know that the disease in most young, healthy folks tends to be self-limited, should typically resolve in one to two weeks.

But what we don't know is, what we won't find out for years until we can really study this well, is if there's any sort of long-term limitations or impacts from a cardiac or pulmonary standpoint. I don't think anything clearly defined as far as we're aware right now, but I think all of us have the same concerns that you do is that we just don't know.

Host: True. True. And it certainly is a mystery now, but we're finding out more all the time, Dr. Buchler. And so, it's really so interesting and I hope you'll come on and update us as you learn more. But as we wrap up, what else would you like other providers to know about sports medicine in these unprecedented COVID times?

Dr. Buchler: Well I think that, we just need to continue to educate folks and try to share the best information that we have and the frustrating part is that's so limited right now that we just don't know a ton. But we try to share that with folks. A lot of our patients, I'm an orthopedic surgeon, I'm certainly not an expert when it comes to viral disease, but a lot of our patients have a lot of questions because, they don't have access to a lot of clear information and sometimes it's just reassuring for them to hear even from us that, yeah, I don't know all the answers either. But we've encouraged folks when it comes to sports to try to be smart, to try to limit their person to person interaction as much as possible. As frustrating, and even sometimes boring as it is; individual sports may be better than team sports right now, if it can all be avoided from a fitness and entertainment standpoint. But I think the biggest thing is to pay attention, to be diligent and cognizant of the symptoms and to be aware and to try to limit unnecessary interactions. I think we've had some very exciting updates over the last week or two with the vaccine being rolled out.

And I think we're all hoping that we're going to be seeing light at the end of the tunnel here very soon. But until that time, I think we all need to do our part to try to limit the spread as much as possible. Despite the fact that most folks who are young and healthy and participating in these things would likely be okay, the reality is that's not everybody and we all need to do our part to try to limit the spread of the disease.

Host: I agree, 100%. And what an informative episode, Dr. Buchler, it's a pleasure as always. Thank you for joining us. To refer your patient, please visit our website at nm.org/ortho to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for Physicians. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine Podcasts. I'm Melanie Cole.