Maggie McKay (Host): With the warm summer weather and people's increased activity level, the risk of injuries increases as well. Most summertime injuries occur while playing sports. While sports are a great way for kids and adults to exercise and spend more time outdoors, this does make them more susceptible to injuries. Some of the most common summertime injuries are sprains and strains, fractures, broken bones, and dislocations. Let's find out more with Orthopedic Surgeon, Dr. Brad Raphael.

 Welcome to St. Joseph's Health MedCast. I'm your host, Maggie McKay. Thanks for being here, Dr. Raphael. So what kind of experience do you have working with athletes?

Bradley Raphael, MD: So hi Maggie. Thanks for having me. I've been very fortunate here since I've been working in Syracuse, New York in Central, New York. I Take care of a lot of local high schools as well as a couple of the major universities around here including Syracuse University's athletic department, as well as SUNY Oswego's athletic department. As I mentioned, a variety of high schools and some minor league and professional athletes that are based here in Central New York.

Host: So let's just start with what is a sprain and strain injury?

Bradley Raphael, MD: We kind of hear those terms interchangeably, but technically, sprain is usually an injury to a ligament, which is a soft tissue structure around one of the joints in your body versus a strain, where a sprain would be a ligament, a strain would be a muscle or a tendon that can get injured around your body as opposed to, you mentioned, fracture or, broken bones, which would be when the bone is involved.

Host: What are the most frequent types of sprains?

Bradley Raphael, MD: Oh, it depends on the season. So at this time of year with people playing outside, most of the injuries that we see are lower body injuries, whether it's an ankle sprain, sometimes sprains around the knee. Here in Central New York, the wintertime we see more ski injuries, more slip and falls on ice.

Whereas in the summertime, people who are outside, they're doing some hiking, running, playing field sports such as lacrosse, soccer, baseball, that's when you're going to see more of lower extremity injuries, the knee and ankle strains and sprains. Wintertime, not only do you see more of the winter type ski and falls and things like that involving the upper extremity, but you're also going to get more of the indoor such as basketball, which I guess you see all year round here in Central New York.

Host: And what's an overuse injury?

Bradley Raphael, MD: An overuse injury is very broad term discussing a, really a whole myriad of injuries. An overuse injury can be anything from a baseball pitcher, which we see that common in this time of year, spring and summer, where basically, I tell patients it's a supply and demand issue, where the blood supply, the nutrition supply to a joint, a muscle, a tendon, really does not meet the demand from playing baseball, whether it's an overuse meaning you've pitched too much, you've thrown too much, or it could be a volleyball or a basketball injury where you're jumping too much and you can get a lower extremity injury such as tendinitis around the knee or even a stress fracture.

Really an overuse is a general term for something that's not a necessarily an acute injury such as a fracture or a fall or a ruptured ligament but more of a chronic, really an overuse injury is the best way to describe it, meaning that you haven't given your body enough rest.

Host: Like runner's knee or shin splints, stuff like that.

Bradley Raphael, MD: Exactly. Shin splints, runner's knee, more of these chronic injuries as opposed to you're a runner who slips and falls and injures their knee, or a runner who slips off a sidewalk or in a pothole. That's more of an acute injury. I equate more of an overuse in your runner analogy to the shin splint or a runner who's running every day for three straight weeks and all of a sudden starts developing some pain in the front of the knee where they can't really pinpoint a specific injury or trauma. Or the baseball pitcher who is in Little League and is playing all season long through spring and they get to June, July and they never gave their self a break and now they've got either shoulder pain or elbow pain as opposed to the outfielder who's diving for a ball and dislocates their shoulder when they hit the ground, which is more of an acute injury.

Host: . Dr. Rapheal, when it comes to sports related injuries, what are they caused by most often?

Bradley Raphael, MD: There's really no real specific thing I can pinpoint. I would break it down into what we were just talking about. A lot of times it can be an overuse injury where you just haven't given the body enough rest in between activities versus a true traumatic event, whether it's not only a sporting event, but you see baseball players in the major league in the last couple years getting injured just celebrating after a World Series championship or a baseball classic championship.

So, you really have such a wide range of injuries and injury causes that to try to prevent everything would be a near impossible feat. so I always tell people just try to avoid anything that you can really prepare for, such as an overuse injury. Just be smart about what you're doing.

Don't put yourself in a situation where you've either not warmed up appropriately, you're not stretched appropriately, or these are all things that can contribute to these injuries. But a lot of times they're fluke injuries that they're really accidents and accidents do happen no matter how much preparation or prevention you can attempt to do.

Host: And I imagine during summer, dehydration is a big one. Keep drinking the water before you work out, right?

Bradley Raphael, MD: It is a huge thing because not only can dehydration cause headache and in severe cases, more metabolic issues like heat stroke and things like that. But, once you get tired, you get dehydrated, that's when you start to fatigue and your muscles start to wear out. And that's when you put more stress and strain on your joints.

And that's when you can have more severe injuries where you're too tired. Just like anything else, you get dehydrated, you get tired. And you really can't prepare yourself for that accident that happens and, you don't have that protection from a good, strong, core, whether it's your hips, your back, where when you get dehydrated, you just become more weak and that makes you more prone to musculoskeletal injuries in addition to the metabolic injuries that we talked about.

Host: I know you talked about some injuries are unavoidable, you know, you can't prevent them, but you did mention stretching, warming up, drinking water. In addition to those, are there some other ways that people can prevent summer sports injuries?

Bradley Raphael, MD: Well, that's the most important thing. I always tell patients, don't put yourself in a situation that common sense would tell you otherwise to get out of. So, don't just start running a marathon without stretching first. But, don't go play a baseball game, or a recreational softball game, or a family picnic three legged race without doing appropriate stretching, without maybe getting some activation in the muscles, whether it's some hamstring stretches, some back stretches. It's amazing how many people come and see me with a knee or an ankle or a shoulder injury that even before their injury, they say, you know what my ankle was bothering me or my shoulder was bothering me, but I just didn't think much of it.

Listen to your body. Don't put your body in a situation that you're going to regret. So, I always tell people, if you're having pain, maybe avoid stressing it with extra activity. Go see your physical therapist. Go see your primary care doctor. Go see your orthopedist. So that you can avoid what was a small injury that can turn into more of a complicated injury or a more severe injury.

Host: And don't overtrain or train improperly. My son always makes fun of me when I tell him like, the right shoes for the right sport. He thinks I'm crazy, but I have to say when I started playing pickleball, I wore my runners, and I was always tripping and not falling but off balance and then I got, what do they call them?

Court shoes because they're more for back and forth, or lateral rather than front and back, and I swear it made a huge difference. So how do you feel about the proper protective gear when it comes to sports and injuries?

Bradley Raphael, MD: I think you're 100 percent correct. I think that, it all starts from your bottom of your foot all the way up. In fact a lot of knee injuries we're seeing are a result of improper shoe wear, and basically, this age, not only in pickleball, but you see a lot of debate whether, in professional football, the field surface, whether it's grass versus turf, and it all depends on the quality of the turf and the quality of the grass, so you can't really make generalizations without having more research into it, but your shoe explanation is a great example of friction between your shoe and the surface. Whether it's a tennis court or a pickleball court or a grass or turf surface and you're playing football or a basketball surface where you're wearing basketball sneakers.

It's all about getting the right traction. And you don't want to have too much traction, which is the concern with turf, where your feet stop too quickly and there's too much friction between your shoe and the turf, which puts more stress through your knee and your hip, which could result into more knee or hip injuries.

Or in your case, a pickleball court, where it sounds like you are having not enough friction in your shoes, where you were maybe doing a little more slipping before you got the appropriate Tennis shoes or pickleball shoes where you have a little bit more friction, and now you can go side to side and you feel more supported, so you're not going to be unstable.

Additionally, you also want to have shoes that aren't too worn out, so replace your shoes very frequently. And also, you want to have good ankle support. So many times, I see young athletes come in in flip flops or Uggs or shoes without very good ankle support. And it's Crocs, exactly Crocs, where, all the kids love them and I'm not going to tell you not to wear them.

But I just need to reinforce that if you're wearing that all the time, that will put more stress on your ankle and your knee. And a lot of times just good shoe wear can help prevent some overuse knee injuries.

Host: And when should someone see a doctor for an injury? Like don't put it off, right?

Bradley Raphael, MD: Don't put it off. A lot of people, they don't want to see doctors for whatever reason. And quite honestly, as a doctor, I don't want to see a doctor, but when it starts to inhibit a couple of things, one is I tell people, if it wakes you up at night, you gotta go see a doctor.

The other thing is, once it starts preventing you from doing things that you either want to do or need to do, whether it's work or sport, you got to see a doctor. But, you're going to have bumps and bruises and you don't need, you don't want to, people don't have time to see their doctor for every bump and bruise.

But once it affects the way that you're walking, once it affects the way that you're able to work or do the things you want to do, that's when you want to go see your doctor. Because you're never going to be faulted for going to see a doctor. No doctor is ever going to say, well, you shouldn't have come in.

But, I can't tell you how many times today alone I said, well, why did you wait two, three years to come and see me? And then the injury can get worse.

Host: Well, in closing, is there anything else you'd like to share that we didn't cover?

Bradley Raphael, MD: Honestly, my biggest recommendation would be listen to your body and just be smart. My orthopedic golden rule is if it hurts, don't do it. Go see someone, don't just keep fighting through the pain. Make sure you really do get some good stretching and warming up, not just stretching, but really kind of activate the blood flow to the muscles, especially if you're doing an overhead athletic sport such as, baseball or football or lacrosse or, even some basketball activities. Just get a good warm up in before you start going to play. And I love pickleball. People love to complain about the pickleball injuries, but I think that the mental health benefit, and the cardiovascular benefit from pickleball and the socialization benefit is infinitely better and more important than any risk you have to getting injured. So go out there and play pickleball.

Host: Okay. Good to know. Well, thank you so much for sharing your expertise and giving us all this useful information, especially during summer when, like we said in the beginning, people are out more than usual, but it's also good to keep in mind all year round.

Bradley Raphael, MD: Well, I appreciate it. Thank you for having me on. I look forward to doing this in the future. And any questions, just holler.

Host: All right. Thank you so much. Again, that's Dr. Brad Raphael. Make sure to call your doctor if you're hurt yourself. And to find out more, you can also visit SOS Plus After Hours Care on Wide Waters Parkway in DeWitt. Open every day of the week. For more information, call 315-883-5652. That's 315-883-5652. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie McKay. Thanks for listening to St. Joseph's Health Medcast from St. Joseph's Health.