Joey Wahler (Host): It helps athletes stay healthy. So, we're discussing sports medicine. Our guest is Dr. Shaka Walker. He's an orthopedic surgeon with St. Clair Health. This is Curating Care, a podcast brought to you by St. Clair Health, health expert care from people who care. Thanks so much for joining us. I'm Joey Wahler. Hi there, doctor. Welcome.

Shaka M. Walker, MD: Thank you for having me, Joey.

Host: Great to have you aboard. We appreciate the time. First, what would you say first inspired you to pursue orthopedic surgery and sports medicine in the first place?

Shaka M. Walker, MD: So, I think like a lot of people was mentorship. I went to the Air Force Academy. I was a student athlete there playing soccer, and they had a program that allowed us to shadow orthopedic surgeons. So, I got a chance to work with some of the surgeons there, see what their daily life looked like. We interacted with them because, of course, if we got hurt, that's who we would go and see. And that is what attracted me to the profession initially. When I went to the academy, I wanted to be an astronaut, and that was kind of a long-term goal. That's one of the places you could go to either become a pilot or a physician or some other scientist that would put you on that pathway.

Host: Wow. So, you enjoyed hitting the books, yes?

Shaka M. Walker, MD: Yes, I did.

Host: Good for you. And so, between being a college soccer player and being one at Air Force, you're used to being around athletes that are always in great condition.

Shaka M. Walker, MD: Yes.

Host: It's so interesting that that was the seed that led you to this. So, what does it take to become a sports medicine orthopedic surgeon? What was your path?

Shaka M. Walker, MD: So, I think you have to love sports and athletics. I think you have to have a bit of a love affair with training and people meeting their goals. I think when you're younger, a lot of times, you view other people as your competition, the other team, the opponent. But in life, you find out that you are your own best competition. And so, you are inspired to get yourself better, which also helps you to work with other folks. For me, the path took me from the Air Force Academy to Georgetown University. The Air Force paid for me to go to school there. And then, I had another great mentor there who had been in the Air Force, who steered me towards the University of California, San Francisco, which is where I got my orthopedic training.

Host: And you mentioned mentors for young doctors or doctors-to-be that are in training, they can be very influential, can't they?

Shaka M. Walker, MD: Yes. I think that it is very difficult to know whether or not you're going to like this job unless you can talk to somebody who can personalize it for you and give you some idea of what life would be like in their sort of daily grind and practice. Can they have a family? What's life like outside of work? And then, what's the day like? So, you can see the balance of am I in the operating room mostly or in the office mostly? And then, what kinds of things do I see? And those mentors can also give you advice that's really useful when you go through the process of applying.

Host: Absolutely. And speaking of the office versus the OR, what would you say a typical day in your practice looks like, whether it be in clinic or in the operating room?

Shaka M. Walker, MD: So in clinic, it's typically 30 to 40 patients in a day, which may sound like a lot, but some of those visits are pretty quick. And then, I spend a lot of time listening. You know, I think if you're going to be a physician, you have to be a really excellent listener, and you have to be very observant. Letting people tell their story, letting them know how injury or pain is affecting their life, what their goals are and trying to come up with a plan, working with them to get them toward the success in that goal.

In the operating room, I'm typically there one and a half days per week, and it's a mixture of cases. So, you might have a shoulder arthroscopy case for rotator cuff. You might have a case for knee meniscus debridement or cartilage surgery. ACL is also pretty frequent. I also do knee replacements as well. And then, there's the basic call cases like hip fractures.

Host: So, that covers some of the more common procedures you perform in the OR. How about some of the more common sports-related injuries you deal with overall in athletes? Obviously, not everyone needs to be operated on, right?

Shaka M. Walker, MD: Yeah. So, the most common knee condition I would deal with would be something called patellofemoral pain. It's pain in the front of the knee. Typically, aggravated by squatting and kneeling and stairs, and that's something that almost everybody experiences typically because of weakness in the quadriceps, weakness in the hip stabilizers, and just too much load walking up or down stairs. Weight gain also plays a role. Meniscus tears are also very common. That typically presents as pain along the edge of the joint, either on the inside or outside, sometimes with locking or catching. And that can be traumatic or atraumatic in terms of the cause. Cartilage defects are also very common.

And then, a fair bit of my practice deals with people who have shoulder problems, typically shoulder instability or rotator cuff disease. And if you've ever had shoulder instability, it's typically you've either dislocated your shoulder or the shoulder has popped out and popped back in. We call that a subluxation. For rotator cuff disease, it's typically pain oftentimes at night if you sleep on the shoulder or lay on it. And then, pain with overhead movement. And that tends to be pretty debilitating.

Host: You mentioned quads. And whether it's quad injuries or hamstrings, oftentimes those things can lead to other issues if they're not properly addressed, right? Because even tight quads or hamstrings for people that don't stress enough, aren't very flexible to begin with, it's all connected, isn't it?

Shaka M. Walker, MD: It is. I think when you're young, everything kind of moves well. You're pretty flexible. You can run and jump and do things. Most people, their first foray into any significant muscular injury happens in their late teens or early twenties when they do something relatively explosive. But even slipping on ice, this is very common here in Pittsburgh, you can tear your quadriceps. I think that was the injury of last winter where we saw probably a dozen of those in about a month period of time. And it's just something simple. Someone goes out to shovel their driveway or walkway and they slip and there's a forceful contraction. The quadriceps that leads to that tendon tearing. And that typically will be treated with surgery. Patellar tendon injuries can occur as well. And then, we also see a lot of tendonitis, so inflammation of tendons, whether it's tennis elbow or golfer's elbow, patellar tendonitis and basketball and volleyball players, Achilles tendonitis and runners. So, that's sort of the gamut of things that we will see.

Host: What would you say your view is these days, Doc, on sport specialization versus multi-sport participation because you have kids that want to play the same sport year round. And then, in contrast, you have those that want to dabble in a little bit of everything, right?

Shaka M. Walker, MD: I think that the science, it supports the players or the young athletes playing a lot of different sports. The challenge is that we're professionalizing youth sports in a way where an 8-year-old feels like if they don't play basketball in basketball season, spring basketball, summer gym basketball, and fall basketball, that they're going to fall behind, that their place on the team won't be assured. And I think that coaches and leagues are partly to blame for this. Parents are also partly to blame for this. I have three kids, they all play soccer. Up until about the end of middle school, they also played softball, basketball, ran track, and they did other sports.

The advice I would give to kids and to parents is to say, if you have one sport that you think your kid's going to be great at or going to excel at, or that you enjoy, you let them play that sport and you can develop that. But at least, let them play at a recreational level the other sports. So, you don't have to be a travel or club athlete in all sports, but at least give yourself time to be a kid and play a sport where maybe the outcome doesn't matter. You're not a great basketball player, but you're just there, you're having fun. Because a lot of athletic fluency comes from engaging different body parts and learning different concepts.

Steve Kerr, famous basketball coach, who grew up playing soccer, his father was a diplomat actually. He said he notices a difference in the European players playing in the U.S. and the NBA versus the American players because they all grew up playing soccer. So, a different spatial awareness and sort of a different field management that you have to use and different ideas. And I think the same thing is true. You know, if you want to be a great soccer player, you should probably play basketball or another sport so that you learn how to move your body and how to think about management of space and time.

And then, truly, other thing is just these rec sports, because the pressure's not as high, the kids can just have fun. These days kids are on their phones or not out as much, just playing pickup basketball or touch football like we were when we were kids because we didn't have that, that distraction. But I think that that's a really important part of development of young athletes and just young people in general. And ideally, what you want is to not specialize too soon because what I tend to find happens is that certain sports, figure skating, gymnastics, just naturally, they start very early. But the burnout rates are really high. And that's what you see in kids who specialize very early, is they'll start playing at six and they're done at 12. And a lot of kids drop out of a sport and it's because the pressure becomes too high and because you've professionalized it to a certain extent, it becomes a job, it becomes a chore. And there aren't too many kids I know who want to do something if it doesn't feel like it's fun.

Host: It certainly makes sense to me. So in terms of strength and conditioning, Doctor, other than the obvious benefits, how important are they in injury prevention, especially for younger athletes?

Shaka M. Walker, MD: So extremely important. I think that if you are playing at a high level in any club sport, you should try to choose a club that has a focus, strength, and conditioning program as part of what they're teaching. And it doesn't mean that you're hitting the gym or lifting heavy weights, but it's being able to do exercises that you can control your own body weight, so things that work on function, things like squats and lunges, exercises to strengthen the core and the back, especially shoulder exercises. So, we're talking about things like pushups and pullups, but we're also talking about squats and box jumps.

And I think that the most important factor that I see in terms of injury for kids is if there's a strength and conditioning program, there's an emphasis on power generation. So, they can jump and they can run fast. They can accelerate like crazy. You also have to marry that up with the ability to absorb force and to slow down, how to land and not get hurt, how to change directions and not get hurt, how to slow down and not get hurt. Because when you talk about things like ACL tears, those are not injuries that happen when you go. Those are injuries that happen when you stop or you try to change directions. Typically, there's an issue with those muscles not firing the right sequence that leads to the knee being put in a position of risk. Clubs that teach these things will have fewer injuries, which means the athletes get more time to enjoy the sport and less time seeing people like me.

Host: Gotcha. So generally speaking, how do you usually go about determining whether an athlete needs surgery versus more conservative treatment? Where is that line usually?

Shaka M. Walker, MD: For most injuries, there's always a nonsurgical option, it's very rare that someone comes in and I say that you absolutely have to have surgery for this problem. But generally, what it is, is you're trying to get the joint mobilized, trying to get it strengthened. So, there's a lot of work and coordination with physical therapist. I have a lot of physical therapists who are on my contacts list and they will text and give me feedback about an athlete or somebody who's recovering from injury or we'll have a phone call just to see where we are. They'll give me ideas in terms of what type of rehab they think would work best. So, it really is a dialogue, but I start with non-surgical treatment for virtually all of my patients. And then, we kind of go up this escalatory ladder where if the non-surgical treatment isn't working And the imaging supports it, then we start talking about surgical options.

Host: You mentioned ACL tears recently. What does a successful recovery plan typically look like after a major surgery? Like, just to name one, ACL reconstruction or even rotator cuff repair to name another.

Shaka M. Walker, MD: What that looks like-- I'll take ACL for example. A year out from the injury, what I would like to see is an athlete who has equal strength in their quadriceps, good strength in their hip stabilizers, pain-free, able to go back to their sport. Now, that starts with day zero, the day before surgery, and then day one, the day of surgery where you're trying to reestablish motion, trying to work against muscle atrophy, and then gradually get them back to activity. But we're talking about a nine to 12-month process before you return to play. During that time, the graft that we put in, whether it's from a cadaver or from the patient, an autograft, that is being changed by their body to be more like a ligament. So, it takes time for that process of ligamentization to occur. MRI studies show that the ligament is still maturing up to two years from the time of surgery. And so, there's a lot of effort and work that has to be put in to do that. And again, it's a lot of time working on their own, a lot of time working with physical therapy, and frequent visits to come back to make sure we're meeting our mileposts.

Host: And you led me beautifully there into my next question, which is how do you and yours typically work with physical therapists to coordinate a return to activity?

Shaka M. Walker, MD: I would say that they are a vital part of the team. There isn't a surgery I can think of in orthopedics that will go well without physical therapy. And they can do the things oftentimes that we don't because they see the patient much more frequently. So if you had surgery, you might see me the day of surgery, a couple days after surgery or the day after surgery, typically; a couple weeks after to take stitches out if we need to. And then, maybe at six weeks after surgery. In that same six week span of time, you might see the therapist 12 times. So, they are very much attuned to even small areas where you look like you might be going off trajectory and are very good about contacting me or the other surgeons about getting you back into the office to see if there's an intervention that's needed.

Being an athlete, I always view this process as basically a team. And the patient's on the team, the doctor's on the team, nurses and anesthesia are on the team, physical therapy is definitely on the team. We're all working to make sure that the patient can meet their goals.

Host: A couple other things. January, as you know, is when many refocus on their health. Some begin training for the Pittsburgh marathon in May. So, what should runners keep in mind as they start their training this early in the year?

Shaka M. Walker, MD: There are a lot of available resources. If you're going to be a first-time marathon runner, there are lots of resources on the internet that can help give you a training plan. I think it works best if you're a first-time runner to be with a group, sometimes with like a charitable organization where you're raising money because then you get the benefit of people together, and it's a great communal activity.

In terms of the mileage ramp up, I recommend not more than 10% increase in mileage every two weeks. You don't need fancy shoes. You just need shoes that are comfortable and you should replace them roughly every 500 miles or if they start to show any sort of breakdown of like the seams or the sole. At around that 30 miles per week threshold, you have to be careful because that's where injuries creep in.

And then, the one other thing that most runners forget is you have to strength train when you're running. If you're not strength training in conjunction with running, you may end up injuring yourself. And then, the final thing I would say is if you get groin pain, see a doctor. Femoral neck stress fractures can occur and most people will attribute those to muscle pulls or muscle soreness. If you feel pain in your groin after running and if that pain persists with walking, get an x-ray, get an MRI just to make sure that you're not going down that path, because that's a disaster for a young person.

Host: Absolutely. And in summary here, Doc, if you could give just one piece of advice to the athletes joining us to prevent injury, what would it be?

Shaka M. Walker, MD: So for my younger athletes, I would say be a kid. This is supposed to be fun. Do things you enjoy doing. Don't feel pressured to win or lose or perform. Be a kid. And that will help you to stay focused on what you really should be doing.

Now, for the adults, I would say the same thing. Be a kid, learn how to play and enjoy yourself so that you can then go out and be active for many years. As you get older, you gotta take care of your body, which means sleep, nutrition, strength training. But for the younger athletes, it's the same message. If you don't sleep enough, you're going to get hurt. Poor nutrition is a cause of injury. And training has to be something that is just sort of your everyday life. And if you view it as fun, then it doesn't feel like a chore. If you enjoy running and you have to get up and run. You don't dread it, you enjoy it. Same thing with strength training, same thing with any sports you do. And I think that that's really the emphasis. And that's why I really enjoy sports medicine, because what we do is we help people get back to the lifestyle they want to have and have fun.

Host: And your passion definitely comes through, Doc. Folks, we trust you are now more familiar with sports medicine. Dr. Walker, keep up all your great work. You certainly know from what you speak, both as a physician and a former soccer player at Air Force who wanted to be an astronaut-- how interesting. By the way, do you ever still think about that when you watch the astronauts do their thing?

Shaka M. Walker, MD: I do, I do. Hopefully, someday they make space travel easy enough and safe enough that we can all do it.

Host: Okay. Maybe you can sometime during your lifetime, actually see the possibility of practicing sports medicine in space. Wouldn't that be something?

Shaka M. Walker, MD: That would be great.

Host: All right. Well, for more information or to schedule an appointment with Dr. Walker, please call 412-942-7262 or visit stclair.org. And thanks so much again for being part of Curating Care, a podcast brought to you by St. Clair, health expert care from people who care.