Joey Wahler (Host): They affect more than just older people. So we're discussing knee injuries in younger patients. Our guest is Dr. Marc Haro. He's an Orthopedic Surgery and Sports Medicine doctor with Novant Health. This is Meaningful Medicine, a Novant Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Thanks so much for joining us. I'm Joey Wahler. Hi, Dr. Haro. Welcome.

Dr. Marc Haro: Alright, thanks for having me.

Host: Great to have you aboard. So first you work with several local schools as a team doctor. You help train young athletes to prevent injuries. So we often think of knee injuries affecting older patients as we touched on a moment ago. But why might a teenager or a younger adult come to you with knee problems at a younger age?

Dr. Marc Haro: Yeah, there's pretty much two main categories why younger patients come and see us. It's either an injury like I broke something, or I did something or more of a chronic or overuse type of injury that has been bugging them for a while, but finally getting to the point where it's either a nuisance or keeping them from doing the things that they enjoy.

Host: Gotcha. So generally speaking, how easy or hard as it were, is it to injure a knee? And what kind of mechanical movements are most risky there?

Dr. Marc Haro: Yeah, I mean, there's different types of injuries. Again, the knee is pretty resilient. But there are definitely certain types of injuries that we see commonly, especially in young active people. We tend to see ligament injuries, like anterior cruciate ligament injuries, or ACL tears pretty commonly in the young active populations such as the high school football player or soccer player, or even the weekend warrior.

The rest of the injuries that are more overuse type injuries, again, typically build up over time. So the knee really is pretty resilient.

Host: So that being said, what are some of the activities and sports that are hardest on the knees?

Dr. Marc Haro: Yeah, I mean, I think the things that we see probably the most injuries from are probably some of those higher level activities such as soccer, some competitive soccer, football, basketball; any of those sports that require higher levels of cutting, jumping, landing type activities.

Host: How often would you say that outside factors play a role here in knee injuries? Like you mentioned soccer, cutting, some of the sports that involve that, but how about the surface that some of those athletes are playing on? Maybe it's an artificial surface that's not in the best condition. How big a contributing factor can that be?

Dr. Marc Haro: Yeah, it's a little bit controversial. I mean, there's some data that may support that there are some role in some of the knee ligament injuries that we see with artificial turf or different types of turf, but I don't think we have great data to confirm one way or the other. I think a lot of it just happens to do with either the activities they're doing and the actual, like how conditioned and trained the athlete is, seems to be a much more important factor.

Host: Gotcha. Now, you mentioned weekend warriors, Doc. How often can a knee injury occur from overdoing things? Maybe you've been inactive for a while and now you're pushing yourself too much when you return, or maybe you're just pushing yourself too much, period. Right?

Dr. Marc Haro: Some of it depends on the age group, but especially as we kind of get into our twenties and thirties and older, we start to see maybe a little bit higher rates of overuse injuries or even injuries that you wouldn't think would be traumatic now causing pain or injuries such as meniscus tears that may have occurred from going back to the gym and doing deep squatting and, maybe they had a little bit of issues previously.

It just, it wasn't bothersome or, they hadn't been running and decided to take up running, and now we're starting to get some knee tendonitis, or even occasionally we'll see stress fractures.

Host: Well, you mentioned squats. I'm going to ask you about weightlifting more in just a moment, but first, in terms of running, what can younger people do to help prevent knee injuries there?

Dr. Marc Haro: Yeah, I mean, I think the biggest thing is just make sure you're warming up appropriately. Staying flexible and strong and easing your way into activities. I always love it when I hear a young athlete that hasn't done anything all summer, jump right back into fall cross country, and they go from sitting on the couch playing video games or talking to their friends, to all of a sudden running 15 miles a week. And then all of a sudden we get a, a hoard of young athletes coming in for stress injuries around the knee, whether it's a stress fracture or whether it's tendonitis. So definitely staying in shape and conditioning well during the off season or in the lead up to this is probably the best way to prevent some of these injuries from occurring.

Host: And in a situation like that, you mentioned cross country, getting off to too fast of a start, no pun intended, after laying off for a while. What can be done to avoid that type of thing with scholastic aged athletes? Obviously it's up to coaches in large part to make sure they're monitoring the situation, right?

Dr. Marc Haro: Yeah, I think the biggest thing is not pushing through pain. That's one thing that you know, sometimes it gets driven in, is the no pain, no gain type of mentality, which isn't always a good idea. We definitely see young athletes who start to run in the fall and start to get some pain around the knee or in the shin area.

And, you they want to keep pushing and they keep running through the pain, and then eventually they end up with a stress reaction or a stress fracture, and we have to shut them down for weeks or months at that point. So it's better to be smart and if you're having some discomfort backing down a little bit, making sure that you're gradually increasing your activity level before you know it gets to be the point where you have to shut down for weeks or months.

Host: Because part of the problem here I would imagine, Doctor, is the fact that when you're younger and less experienced in whatever activity you're up to, you don't quote unquote know your body as well as someone older and more experienced. And hence, you might not know where that fine line is quite as well, right?

Dr. Marc Haro: Potentially. We do see some adults and young adults that don't exactly, maybe know their limits as well either. But yeah, I mean, a lot of kids have never been hurt before and they don't really know what to expect. And, they're starting in competitive sports and they're young and they're used to bouncing back and not having any injuries.

And before they know it, they, what they were able to push through before, what their friends were able to push through, now is causing them problems. So I think it's definitely important to educate and make sure that kids understand that sometimes pain like this is not something that's easily just ignored.

Host: Absolutely. I mentioned I wanted to get back to weightlifting. What can be done when lifting to help keep knees injury free? Especially if you're doing something like squats or dead lifts or other exercises with heavier weight, that can put a lot of stress on those knees if you're not doing them right. Yes?

Dr. Marc Haro: I mean, I think those are all actually healthy activities and I actually encourage it quite a bit to do strength training. I think it's great, but if you're already having some preexisting knee pain, I think that's one time to maybe worry about deep squatting or if you're having issues with your meniscus or some swelling; just to be very cautious about that. Because that can definitely and potentially exacerbate the problem. But what we do find is people who stay stronger tend to have less problems in their knees. So I think proper technique and same with running is gradually working your way up is probably the best bet to keep yourself out of trouble.

Host: How about the early warning signs of a possible knee injury that parents and coaches should never ignore? How do you know there might be a problem beyond just some aches and pains?

Dr. Marc Haro: When I see young patients and talking to parents I usually like to break things down into are these dangerous versus not dangerous type of things. Is this something we need to be worried about? And some of the things that we tend to worry about is when there's swelling within the knee.

That's never really normal in a young person. If you're starting to see swelling or the knee is puffy, that should be a little bit of a red flag that something's not quite right. The other things would be not willing to put weight on the leg or not able to fully straighten the leg out or bend the leg with normal motion.

Some of those things are not common in young people unless there's been an injury and typically an injury inside the knee joint, which there's structural changes that are preventing that motion. So those are some of the things that I really look for when I'm first seeing a person with a knee injury.

Host: Couple of other things for you. First, I'll ask you about surgery in just a moment, but what non-surgical options do you talk through or even try with younger patients? We hear so much about knee surgery, but short of that, when and what can be done in certain situations?

Dr. Marc Haro: I would say the majority of the patients I see, I try to treat non-operatively or non-surgically if at all possible. Definitely starting on anti-inflammatories and icing and rest even can be a very important thing. I think physical therapy is very valuable in these situations as well as making sure that you're having proper coaching and training can work on technique and potentially eliminate or minimize the risk of some of these injuries.

Host: And so having said that, at what point then could surgery or even knee replacement be the best option, even for a younger patient?

Dr. Marc Haro: Yeah, I mean, I think it goes back down to my dangerous versus not dangerous analogy. When there's something structurally broken, sometimes we worry that we need to do something with this. Now, that's not always the case. Patients are a little bit too eager that they, if something's broken they need it fixed.

But, you know, when there's a knee ligament injury where the individual potentially have further instability or further issues down the road, meniscus tears that are torn and caught within the knee; those are times we typically think of surgery. So broken bones, torn tendons, cartilage issues that the knee is locked or not having the appropriate range of motion. Those are typically the things that lead to surgery.

Host: And in summary here, what message do you want young athletes, those joining us perhaps, to take away about knee health and playing their respective sport or activity smartly?

Dr. Marc Haro: Yeah. And I think the biggest thing is again just to make sure that you're training appropriately. And even in the off season, if you're playing sports year round, make sure you're staying strong and active. So when you go back into sports, you're properly conditioned to minimize the potential risks of injuries let's say.

Each fall we see a, like I said, a flurry of young people coming in with knee injuries who haven't done much over the summer. And, most of those could have been avoided with proper conditioning, stretching, staying active at least to some degree over the summer.

Host: So perhaps most important here, be smart and cautious out of the starting gate, both literally and figuratively. Right?

Dr. Marc Haro: Yeah, that's correct.

Host: Alright. Well folks, we trust you're now more familiar with knee injuries in younger people. Dr. Haro, valuable information indeed. Thanks so much again.

Dr. Marc Haro: Alright, thanks for having me.

Host: Absolutely. And to find a physician, please visit novanthealth.org. For more health and wellness information from our experts, please visit healthyheadlines.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks again for being part of Meaningful Medicine, a Novant Health Podcast.