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Prakash Chandran (Host): More and more American adults are starting to exercise and play sports. While it’s only about 18% of us that are active on a given day, this means more of us will be needing care for sports-related injuries. Today we’ll be talking about sports medicine from an orthopedist point of view, and here with us to discuss is Dr. Ed Tingstad, an Orthopedic Surgeon at Pullman Regional Hospital. Dr. Tingstad, pleasure to have you. Now, most of us have heard the term sports medicine, but it’s a pretty broad field. Let’s start by having you explain what your focus is as a sports medicine doctor.

Dr. Ed Tingstad (Guest): Well, sports medicine, as you alluded to, it’s a lot of areas, but orthopedic sports medicine specialists help with muscle and joint injuries and the rehabilitation and treatment of all of those types of things from any kind of a muscle or a joint to getting somebody back from something such as an ankle sprain or a shoulder injury or a neck problem. From head to toe, we help people to play and be active from a muscle and joint perspective.

Prakash: And so what are some of the most common injuries that you see?

Dr. Tingstad: Sure. For example, this week I have seen probably three or four shoulder dislocations and multiple ankle sprains. We’ve seen torn rotator cuffs and ACL injuries. Knee, ankle, shoulder are probably the most common areas of injury. We see stress fractures in dancers’ feet, and I have a 5-year-old girl who has danced so much that she broke the bone of her foot in half and wonders why she can’t dance.

Prakash: Wow. You mentioned this dancing injury. I imagine that the injuries vary from sport to sport. Can you talk a little bit about that?

Dr. Tingstad: Sure. In the Fall season, football and soccer are most prominent activities for our kids, and so we see a lot of injuries related to those. Football causes a lot of shoulder injuries, and we see concussions. We see ankle sprains and lots of hand fractures. Yesterday, I saw three football players that broke the same metacarpal bone in their hand, and so those are things that — in the Fall seasons, it’s more of the outdoor sports including — and for volleyball, we see a lot of ankle sprains and knee injuries in volleyball players. And we get to see a wide range of things just because there’s such a variety of things that we see where we live. And then we see hunters who fall out of tree stands. I’m not sure that’s a sports medicine injury, but they think it is. And thankfully, they don’t fall too far most of the time.

Prakash: Right. So, I’ve actually read that the vast majority — like being 90% — of sports-related injuries do not require surgery for recovery, so would you say that’s true?

Dr. Tingstad: Oh, absolutely. Most sports medicine injuries do not require any surgery — probably even more than 90%. We tend to think of surgery as our last option, and finding ways to try to get people back from a range of things, whether that be helping them with therapy — we oftentimes take some of their blood, and we actually inject parts of their blood back into muscle injuries or sprain injuries, and that seems to help them heal more readily, but mostly people don’t require surgery for sports medicine injuries. A lot of times, it’s some reassurance, a little bit of protection, and then a rehab program that allows them to get back to a quick return. But yeah, most people don’t need surgery, thankfully.

Prakash: I actually want to stick on something you just mentioned. You said injecting blood back into the muscle where it’s injured? Can you talk a little more about that? How does that even work?

Dr. Tingstad: One, we’re still learning the exact details of how these things actually work, but over the last decade or so, we’ve increasingly learned that the person’s own blood and the parts of the blood — different components of it — some of the cells, and platelets, et cetera — are really good things to be able to place back into injured areas. For example, we have a young person who had an injury to their calf, and we were able to take some of their blood, spin down some of the components of it, get the growth factors concentrated in the blood, and then under ultrasound — with a needle under ultrasound — the ultrasound guides us, and we put their own blood products that are concentrated right back into that injury level area.

By putting them back into that injured area that can actually speed the healing process and actually help people have less pain. It’s kind of fun to watch and see because you see people get better quickly. It’s minimally invasive; it doesn’t hurt too much. Most people don’t like getting poked by a needle, but a lot of times that’s better than surgery. In some cases, it doubles the healing rate, meaning something that normally takes four weeks only takes two. That’s pretty exciting. Those Biologic solutions that are coming in our technology are really exciting right now. We feel it’s a fun time to be a sports medicine physician right now because there are so many new and good things coming.

Prakash: That sounds so fascinating, and it’s good to know that there are so many different types of recovery options that do not require surgery. Let’s talk about the types of injuries that do. Can you talk specifically about when a recovery option like the ones that you mentioned will not work and you do need surgery?

Dr. Tingstad: Sure. Probably two examples of that would be — I saw a young wrestler the other day whose shoulder keeps popping out of place. Repeated shoulder instability or popping out of place when it starts to happen routinely usually does not do well with continued non-surgical methods such as rehab, and bracing, et cetera. Shoulder instability is a very common one that we see in our active and contact sports, in particular hockey, football, soccer all seem to have a high incidence of shoulder instability. We see that being a common area that requires surgery.

The other really common one also is knee injuries that injure the anterior cruciate ligament. Anterior crucial ligament injuries, when they are torn — when the anterior crucial ligament, the central pivot ligament in the knee that helps us to have some stability — when that is torn completely, does not have the capacity to heal. One of the really exciting things right now in ACL or anterior cruciate ligament surgery is there are several new pilot studies going on by Dr. Martha Murray back in Boston and at the Cleveland Clinic, where you’re actually taking a collagen sponge and sticking it in the knee and sewing that in with some of their growth factors. That seems to help the ligament, for the first time, actually grow back and stick into the bone.

Those kind of things, ACLs that usually require a surgery and a big, invasive thing, are becoming less invasive, and new things like Dr. Murray’s work are really exciting because we can fix these increasingly with Biologic solutions, though they do require surgery. Probably shoulders and knee injuries like ACLs are the areas where we see people commonly needing surgery.

Prakash: And you alluded to this a little earlier in the interview, but you’re actually a physician for the Washington State University Cougars, and I was curious to what, specifically, your role is for the team and what are the types of injuries that you see the most?

Dr. Tingstad: Sure. I am the Orthopedic Head Team Physician for Washington State for the last 19 years. My privilege has been getting to help people get back to playing, and I manage those injuries from hand fractures, and shoulder dislocations, and ACL injuries, and ankle sprains, and muscle tears. When our quarterback gets a sore shoulder, it’s my job to see how we can safely get them back to play and help people get back on the field quickly and safely. It’s my job to decide when that’s the safest or not safest to do that and what are the ways that we can do that? We have a team of people that work — I do the musculoskeletal things — the fractures, and the dislocations, and the muscle injuries. We have other primary care sports medicine people who take care some of the concussions, and some of the abdominal issues, such as problems with eating and things like that.

My privilege is I get to help with getting the musculoskeletal — bones and joint injuries back. That’s been a fun thing for the last 19 years, and Washington State has a great tradition of having people who like to play and are almost a blue collar toughness, and sometimes we have to remind them they’re going to be 40 someday. Part of our role is to counsel them that sometimes playing is not the best right away. Sometimes I think that’s my bigger role than actually getting people back to play, just slowing them down a little bit.

Prakash: Yeah, that makes a lot of sense, trying to be preventative and smart about trying to let things heal naturally and being smart about when you get back on the field. It’s very clear that you have a lot of experience and you’ve served in a lot of different capacities, but for the people who are considering Pullman Regional Hospital’s Orthopedic Center of Excellence, can you talk specifically about the expertise that you bring?

Dr. Tingstad: Our team of people — thankfully, we have a group of people — I, and my partners have been fellowship trained, so we’ve done extra training in sports medicine beyond our orthopedic certification and training, meaning we did an extra year of training called a Fellowship in sports medicine. Our practice takes care of the sports injuries for both Washington State and the University of Idaho. We have a group of people who have been in the community for over 20 years. That’s been a really nice thing for us. We feel like we’ve been able to do this for a healthy length fo time. We have a group of four physicians who are sub-specialty trained, and that’s a good thing for our athletes, and I think necessary for today’s — you need people that have extra training that have done this for awhile, and that’s been something that we’ve been able to extend to the High Schools. And for the people that come to Pullman Regional Hospital, I think that is a nice thing to have people that have extended experience and are respected across the country.

Prakash: Well, this has been incredibly informative, Dr. Tingstad. We really appreciate you being with us here today, and hopefully this information has inspired a few people to get out there and be more active knowing you’ll take care of them if they get hurt. For more information on sports medicine and orthopedics, please visit the Orthopedic Center of Excellence at PullmanRegional.org. My guest today has been Dr. Ed Tingstad. I’m Prakash Chandran. Thank you so much for listening.