Transcription:
Repetitive Stress Injuries in Athletes

Melanie Cole (Host):    Repeatedly performing the same athletic task, such as throwing a baseball, can lead to injuries. What steps can athletes take to reduce their risk for these repetitive stress injuries? My guest today is Dr. Stephen Brockmeier. He is a board-certified orthopedic surgeon who specializes in sports medicine and shoulder surgery at UVA. Welcome to the show, Dr. Brockmeier. So tell us a little about some of the more common stress injuries that you see.

Dr. Stephen BrockMeier (Guest):  Thanks, Melanie. Thanks for having me. So each sport kind of has its own subset of repetitive or we like to call overuse injuries. The ones that we see most commonly or certainly get the most attention are associated with the overhead athletes, as you mentioned in the introduction of this topic, something you hear very commonly associated with either baseball players or racket sport players like tennis, where you have some overuse injuries that are pretty common involving the elbow and the shoulder, and these are pretty common things that we see.

Melanie:  So in sports, in our little athletes, in our high school and collegiate athletes, and I'm sure in professional sports, Dr. Brockmeier, they have you know throwing limits. There are people that put it out there that, you know, can't have your little athlete out there for more than a few innings. So what are they doing to hopefully reduce this?

Dr. BrockMeier:  Yeah, so there is a lot of research going on in this area, specifically the baseball player population. And really what they are looking at is, is there a pitch count and is there a better pitch count given the age of the athlete? There is a subset of this that we see in youth athletes that really can be very problematic. And so you are either looking at pitch counts. I think one of the major mistakes that are made, especially with those of us who are parents with our children, is underestimating the rest that these children will need. So it's not only pitch counts in one given outing but it's also sometime for the arm to kind of rest and recover from a repetitive stress type sport. So oftentimes these kids will pitch and then they will go and play in the outfield or go play in a different position and there is really not a lot of down time to let the arm accommodate it. That's I think one of the common mistakes that we see.

Melanie:  With all sports and even with, you know, exercisers running and people that do certain exercises repetitively, these overuse injuries are becoming more and more common. Do you recommend cross training? What do you recommend as a way to sort of prevent some of these overuse injuries?

Dr. BrockMeier:  Yeah. I mean I think you mentioned one of the key areas of prevention is a good healthy conditioning. You know, I preach moderation to my patients. I think youth sports in particular have directed over to being kind of a specialist. So a kid is a baseball player or a soccer player or a basketball player. It used to be back when I was a child that, you know, the three-sport athletes were the true athletes. I think some of the better athletes you’ll see are the ones who really develop their athleticism through a lot of different sports. And so one of the traps obviously is doing the same sport repetitively. If that’s something that you are doing, I think it's really critical to train in different ways to improve on your endurance and your muscle memory and all those various things without doing the same exact thing over and over and over again.

Melanie:  What do you do if you do start to suffer an overuse injury or a repetitive stress injury? Do you like your patients to ice, elevate, rest, wrap? What is it you want people to do to give this some relief?

Dr. BrockMeier:  Yeah. I mean the good news is with a lot of these injuries, the majority of times, this is something that gets better without any type of intervention, And the key component almost always is going to be rest, meaning that the athlete needs to take a period of time, and normally it's not just a day or two, away from their sport to let their body try to recover. You know, the majority of these can get better if you just give your body a chance to help. So icing can be helpful; rest is critical. There are certain rehabilitation exercises that are specific to each type of injury that we will often institute. Things of that nature are the initial steps that we’ll take, and that normally gets this better in the majority of athletes.

Melanie:  And what about those people that are just your exercisers? I mean, they don't want to stop running, right, Dr. Brockmeier? They don't want to stop going to the gym doing the things that they are doing. How do you get those people to settle down a little bit, cross train, do some other things?

Dr. BrockMeier:  Yeah. I think to really answer that question, you may want to have a psychotherapist on the line here because this is really a way of life. I mean, you know, people don't generally get these types of injuries sitting on the couch. And so it's really hard for some of these people to take a break. So what I tend to try to do is I try to find a different area that they can maintain some of the stress relief and some of the other aspects of sports or of fitness that these people really use this for and focus them on that area while they are letting their body recover. So if it's a runner, for example, maybe they try swimming or other type of cross training type activities. You know if it’s a baseball player if it's somebody playing a specific sport, maybe you focus on some of the training aspects of things. And sometimes these people actually really get into the rehab portion of the treatment for these types of injuries. So you can kind of try and focus their energy and their attention and, you know, kind of their obsessions, so to speak, on rehabilitating from the injury. And they tend to be pretty dedicated to that.

Melanie:  Dr. Brockmeier, what we are seeing now something sort of new in the sports medicine field, and it's not even necessarily in sports medicine now, are occupational repetitive stress injuries, I mean everything from using a computer to texting, these things, these overuse injuries. Are you seeing that now?

Dr. BrockMeier:  Yeah, you do. You know, occupational injuries account for a good percentage of the patients that we see for a variety of things, both overuse injuries as well as structural things that may require surgery. This is something that can be particularly challenging because it's not like this is a hobby or kind of a recreational pursuit. This is how somebody makes their living so that's a real challenging thing because oftentimes it requires at least a period of time to allow the body to recover from whatever the treatment’s going to be and it can have major impact and ramification for this individual as far as how they make a living.

Melanie:  Are you looking at ergonomics? Are you helping them to decide different positional ways that maybe whatever it is they are doing can, you know, not cause some of these repetitive injuries that you might be seeing?

Dr. BrockMeier:  Yeah, certainly ergonomics from the standpoint of the elbow and wrist type of injuries that we see commonly, very important. Low back, you know, is something that obviously all of us will get from time to time. But the way that you lift for those that do labor is really critical. And then some of the stuff that I see in the shoulder or in the knee, a lot of these things are related to repetitive stress as well, so maybe limiting overhead positioning of the arm to kind of let the shoulder maybe not be quite as symptomatic or positional things with relation to the lower extremity. All of these things are really things that you have to consider to try to get these people healthy and pain-free and to be able to continue to do their job.

Melanie:  So really, you know, a burgeoning field and a burgeoning topic, this occupational frozen shoulder, from your desk, being at improper height and such, so what do you tell people when they've got this kind of situation? Do you ask them to assess their work situation and then go from there?

Dr. BrockMeier:  You know, it's funny; a lot of people have already done that. People are always looking for why “it shouldn't be that all of a sudden my shoulder starts hurting,” so what happened? And sometimes it is something related to either repetitive things that thy are doing at work that initially they don't seem to pick up on but then do, and other times they are just trying to find a reason. Some things we see will come on just with age-related changes or just with use over time. But these are questions that we'll often ask when we are first meeting a patient: How did this happen? What are some things that may be contributing? How can we address those things to try to minimize symptoms for you? So, yeah, all of these things are very critical.

Melanie:  In just the last few minutes, Dr. Brockmeier, if you would, give listeners your very best advice, and those that may be suffering from sports-related repetitive stress injuries, overuse injuries, and why they should come to UVA Orthopedics for their sports medicine care.

Dr. BrockMeier:  Sure. Well, I think what I would tell them is obviously this is something that is really common, so you are very much not alone. And a lot of times it can be managed very efficiently just by recognizing what the problem is and taking some simple steps to try to address it and correct it. The body can correct a lot of these problems if just given the opportunity to do so. Our group, we really have a multi specialty group. I have four partners who are board certified and some specialty trained orthopedic surgeons for those patients who do require more specialized care. But we have primary care sports medicine doctors, specialists in running athletes and other conditioning type sports, exercise physiologists, things of that nature, and all of us work together to treat kind of the entire spectrum essentially of bone and joint problems and try to get people to be active and to be healthy and fit and enjoy their lives and their jobs and their other pursuits.

Melanie:  Thank you so much for being with us. Absolutely great information. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That's uvahealth.com. This is Melanie Cole. Thanks so much for listening.