Scott Webb (Host): My guest today is a sports medicine primary physician, and though she treats athletes who have suffered injuries, she also treats folks with chronic injuries and pain that aren't necessarily sports injuries. And I'm joined today by Dr. Erica Sadeghi. She specializes in sports medicine, and she's here today to tell us what she does and how she helps a multitude of patients. 

 This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. 

Host: Doctor, thanks so much for your time today. Welcome to the show.

Dr. Erika Sadeghi: Thank you for having me.

Host: It's a pleasure to have you here. We're going to talk about something that's near and dear to my heart, sports. I have a couple of kids, and both of them were athletes, and one of them is still in high school. And so, sports medicine is a big part of my life and obviously a big part of your life as well. So, let's talk about that today. What does the sports medicine provider do? How do you care for patients? And just to get rolling here, what types of ailments do you treat and see most often?

Dr. Erika Sadeghi: I'm so happy to hear that you also have a passion because this is really what gets me excited every day coming to work. You know, when I grew up, they said, "Find a job that you enjoy going to work every day." And here I am in sports medicine, and this is what I love doing. So, it doesn't feel like work most days.

Host: That's great. 

Dr. Erika Sadeghi: Yeah. So, I feel very lucky to be in this position to treat athletes. But I see athletes to non-athletes. So, there's certainly a spectrum there. You don't have to be an athlete to see a sports medicine physician or a specialist. A lot of injuries can come from sports. But also, you can develop a lot of chronic musculoskeletal pain from not sports. So, I see a very wide spectrum of ailments that come through the office. Essentially, it's really any non-surgical joint ache or pain that can be joint, or it can be a muscle tendon, a chronic tendon, or acute tendon issue. And it can be from the neck and below. So, I try to stay very general in that sense. 

My background: I'm a family medicine doctor that went on to complete a fellowship in sports medicine. For all intents and purposes in the office, I'm really a non-surgical orthopedic specialist. And so, I treat patients who may not need surgery- patients who do not qualify for surgery. And I also treat a lot of athletes also. So, the spectrum is very wide in terms of what a sports medicine doctor can treat, and there's a huge umbrella there.

Host: Yeah. It's a huge umbrella, for sure, and I'm sure you're seeing a lot of pickleball players now. I'm hearing about a lot of older folks playing pickleball and the dreaded pickleball injuries. But as you say, it's not just sports injuries. Sure, you are a sports medicine provider, but it's any type of injury that either doesn't qualify or doesn't need surgery from the neck down. So, it's good to set the stage here. And wondering for all of us, whether we've injured ourselves playing sports or not, when should we be thinking anyway about seeing someone like yourself?

Dr. Erika Sadeghi: Oftentimes, patients can land themselves in our office, either through an urgent care visit, so if they were injured in a sports game and they immediately, maybe on the weekend, saw an urgent care specialist and then referred to our office. Sometimes, they see their pediatrician, or family medicine doctor, or internal medicine doctor, and they then are referred to our office. But you know, oftentimes, we see patients who just pick up the phone and give our office a call, and that may be because they have a knee pain or a shoulder pain. 

And so, I actually encourage patients; certainly, you can start with your primary care doctor. And when the pain gets to be bad enough, you feel like it's starting to interfere with your everyday activity or inability to perform your adult daily activities, that's a really good time to come into our office and be evaluated because oftentimes, again, I'm seeing patients that are from pediatrics to geriatrics and those patients that are maybe older and living independently. If you're having a joint ache or pain that is somehow limiting you from staying or keeping that independence, it's really important that we address that so that we can maintain that independence. And for maybe an adolescent athlete, for example, if they have a joint ache or pain or an issue with their muscle tendon that's preventing them from playing a sport or happily participating in a sport, that's another reason to be evaluated.

Host: Yeah. As you say, there are these, of course, acute injuries, things that we just do to ourselves, whether that's falling off a ladder or a car accident or whatever it might be sports or otherwise, but then it really is those chronic things that just sort of wear on us and begin to limit us and, you know, affect our quality of life. So, you can see the value in seeing someone like yourself, whether we injured ourselves playing sports or not, or no matter how long we've had the injuries. Because a lot of us, doctor, I think we do just put it off because, you know, it seems like a lot of work, and we're maybe afraid you're going to recommend surgery, right? So, by the time you see folks, do you feel like they've been suffering for a while?

Dr. Erika Sadeghi: Yes, you nailed it. And that's exactly what happens: sometimes patients are afraid to come to the doctors because they're afraid of what we might tell them. And I've been in practice for a little over nine years, and I was trained in the sense that I really try to sit down and have a very good conversation with patients, and that's part of the field that I'm in sports medicine. A lot has to do with counseling and patient education. And so, it's not a scary place. I hope I can foster that in my appointment visits so that patients don't feel, you know, intimidated to come and seek care. Because when it starts to interfere with your daily function or things that you love doing, or just like you said, your quality of life, yes, absolutely, it's important to be evaluated because these are precious years. Every day, we wake up, and we're grateful for it. These are precious days that we have.

Host: I want to ask you what musculoskeletal medicine is. That's a big word, musculoskeletal. And how does it relate to sports medicine?

Dr. Erika Sadeghi: Musculoskeletal medicine is exactly what it says. And when we look at the body, we have bones, and we have joints, we have tendons that turn into muscle, which turn back to tendons, which attach to the joints that allow us to move and function. And we were designed so beautifully this way. Unfortunately, though, we were also designed to wear out and wear out those joints and wear out those tendons. It's something that I also treat. I treat the muscle. I treat the tendon. I treat the joint. I treat the bone. I also diagnose where the pain is coming from.

And what's really unique is a niche that has been developed in my area of expertise, which is sports medicine, which is ultrasonography. And so, this is not just the ultrasound that you imagine getting from your OB when, you know, you may be pregnant or experience that. This is a musculoskeletal ultrasound, so it's very specific to bone, joint, muscle, and tendon, and it helps me diagnose problems. And then, it also is a therapeutic ultrasound, so it helps guide injections, and it helps guide certain procedures, specialty procedures, that we do here in the office that are minimally invasive but that can treat pain and help patients recover. 

So, there are so many new advancements in our area of sports medicine, but the word musculoskeletal is really just getting down to the grittiness of it. That's the muscle-tendon complex that we're treating that attaches right to the joint.

Host: Yeah, definitely. So, let's talk about how orthopedics and outpatient rehab work together for the best patient care. 

Dr. Erika Sadeghi: Our system is set up so uniquely and strategically also so that the physicians can refer to the physical therapists who are highly trained in strength and conditioning and rehabilitation of whatever joint ache or problem we're dealing with whatever diagnosis it we're dealing with. And so, we set up this, really, triad within our system with our physical therapists so that you have a team, patients have a team behind them. I work very closely with the physical therapists. They help guide me, and I help guide them. Usually, the physician is the one making the diagnosis. Once we have the diagnosis, the physical therapist does all the hard work. Sending the patients through usually one to two times per week, depending on what the issue may be, for several weeks for a full course. Again, depending on the issue, they are sending their notes to me. I'm seeing their rehab. I'm seeing the day-to-day. And so I may check in with the patient periodically throughout the course of their injury. But really, the physical therapist is working with the patient on a more daily basis, more weekly basis. They're the ones that guide the patient back to health and develop a program for them that allows them to strengthen and condition that area of injury. And because we have this really close relationship with our physical therapist, we tend to see better results with our patients. 

Scott Webb: Yeah, definitely do. And it does definitely seem like a sort of multidisciplinary team. As you say, folks can see their primaries. But when they get to you, you work with PTs and maybe the other types of therapists, occupational and otherwise. So, it seems, as you say, a real team effort there. And maybe it depends on the type of injury. I'm sure it does, but maybe just go through some of the major non-operative care options available to folks. 

Dr. Erika Sadeghi: It also depends on what diagnosis, what joint, what tendon we're dealing with. And so, certainly, there are more common injuries that we see here in our orthopedic clinic than others: shoulders, knees, hips. And it depends on age category too. So, if we're talking about patients who are maybe 65 and above, 55 and above, and they're coming in with shoulder pain, and they have a diagnosis of shoulder arthritis, well, there's certain injections that we do, or cortisone injections into the shoulder, similar to the hip and the knee. Now, if somebody's coming in, and they are maybe younger, and they're playing pickleball like you referenced earlier, they may have developed, it’s called a tennis elbow, but now we should re-term it as a pickleball elbow.

Host: Yeah. we have tennis elbow, pickle elbow, and golf elbow. There are so many types of elbow, aren't there? 

Dr. Erika Sadeghi: Exactly! We have now developed platelet-rich plasma in our clinic, and we inject that platelet-rich plasma right back into the tendon, and it heals great. So, there are certainly different treatments out there. Another treatment that we've developed here at Elliot Orthopedics is something called Iovera. It helps with the postop recovery from total knee replacements. And so, this is where really the non-surgical aspect of my specialty plays a role, where we are freezing the nerves around the knee, essentially putting them to sleep for three months so that patients don't have knee pain from their knee arthritis. Oftentimes, we do this after they have a knee replacement, and they feel this incredible pain relief. So, for three months, they have this great rehab potential after their knee replacement. But those are some of the techniques. So, nerve ablation therapies that we can do with the ultrasound, we can do cryo-neurolysis with the ultrasound, which freezes the nerves. We can burn the nerves with the ultrasound, and we can inject joints, we can inject tendons, we can do platelet-rich plasma with the ultrasound. There are so many different techniques out there, and it's wonderful that we have this all at our fingertips here at Elliott Ortho.

Host: Yeah. It's so cool. Sometimes when I have these conversations, I think that, you know, it sounds like something like sci-fi, like Star Trek. You know, it's just like, "No, you can't do that." But it turns out you can, which is pretty amazing. It's been really interesting today. I just want to wrap up here. You know, you had sort of set the stage from the start that you're not an orthopedic surgeon, that you're a non-surgical doctor from the neck down. When do you decide, or when is it recommended then for folks to go for surgery after you've tried everything else, PT and platelet-rich plasma, and all your tools in your tool belt? Is that when it's time for surgery?

Dr. Erika Sadeghi: You know, that's a complicated question to answer, and I think that it's very dependent on what the diagnosis is. Oftentimes, surgery can be elective. And so, for example, if somebody has knee arthritis, and they have exhausted all of their care, there are, I don't know, many surgeons out there who are going to tell them you need surgery. Most of the time, patients have gotten to that point where they know when they're ready to cross that threshold and pull the trigger on an elective surgery such as a knee replacement. That's just one example. But most surgeries that I'm personally dealing with are more on an elective basis. There are certain surgeries, obviously, in orthopedics that are not elective. And those surgeries, you know, patients are not given that choice. But for the most part, once patients have exhausted all conservative care, I often have them consult with my surgical colleagues to see if there's more of a permanent solution that they can be offered.

Host: Well, it's been great to meet you today. Great to learn more. 

Dr. Erika Sadeghi: Likewise.

Host: Yeah, I see your title. I say, "Okay, well, sports medicine, so she just deals with sports injuries," but as we've established here today, it can be sports injuries, or it can just be injuries. It can just be these acute things that, as you said, our bodies begin to break down, they begin to wear out, and then maybe that's time to see you and work with your team there, possibly consult a surgeon. But no matter what the experience would be, it seems like patients are in good hands. So, thank you so much for your time today. You stay well.

Dr. Erika Sadeghi: Yeah. Thank you. You too. Have a wonderful day. 

Host: And for more information, go to elliotthospital.org/orthopaedics. If you enjoyed this podcast, please tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.