Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And joining me today to address and talk about treating various fitness and sports-related injuries is Dr. Mariam Ashraf. She's an Assistant Attending anesthesiologist at New York-Presbyterian Hospital Weill Cornell Medical Center, and an Assistant Professor of Clinical Anesthesiology at Weill Cornell Medical College - Cornell University.

Dr. Ashraf, it's a pleasure to have you join us today. I'd like you to start because, you know, this is marathon season, kids are starting sports in school, there's a whole lot of sports injuries. And then, there's the people like me that just like to walk and run and do things. So, I'd like you to tell us the most common injuries that you see. Tell us a little bit about the prevalence of these kinds of fitness and sports injuries.

Dr. Mariam Ashraf: Absolutely. Thank you so much for having me. I'm really happy that I get to kind of chat about this, because it's a question I get asked so much by friends, families, patients. And I think over the past 10 years, there's been increasing awareness about the overall benefits of fitness and exercise. More and more people are joining gyms and increasing their activity across the all age levels. I mean, even this past weekend, I met a 92-year-old at my gym. Now, with people posting on YouTube, Instagram, TikTok, there are workout routines that are so easily accessible. And then, with that, there's an increased risk of injury with a lot of uncontrolled movements, poor equipment, and overtraining.

And then, on the flip side, like you were saying, there's another category of people who are regular athletes or professionals who develop overuse injuries and contact injuries from group sports. So, I will say the most common injuries I see are muscle strains and joint-related injuries, and they're usually involving the shoulders and knees.

Melanie Cole, MS: Wow. Okay. So, the shoulders. We talked about chronic overuse a little bit. So, people like to stick to one sport, and I know even with certain sports, there's throwing limits in baseball, you know. But golf is a big one and we're mentioning shoulders here. So, golf is a big one. Tennis is another big one where people, that's all they do. And tell us a little bit about that chronic overuse, how that happens because when they're not mixing it up with weight training or swimming or walking or doing something else. Then, they just get that one repetitive movement.

Dr. Mariam Ashraf: I agree. And some people find an activity or sport that they really, really enjoy. The problem with doing one sport or activity over and over again is that you're repeating the same movement patterns, and that can place a lot of stress on the same muscles, the same joints and tendons without adequate recovery time.

So for example, if someone's training for a marathon, they'll prep by running frequently to increase their endurance. But if they don't take adequate rest or do a different type of activity, I'll often see them come in with shin splints or stress fractures. So, cross training helps spread the love, so to speak. It ensures a more well-rounded approach by activating different muscles. And by varying your routine and engaging in different activities, you allow your body to rest certain muscles while working out others.

Melanie Cole, MS: Yeah, that's so important that we do that. So, another sport we're seeing a lot lately is pickleball. What injuries is that one really coming up with?

Dr. Mariam Ashraf: I think pickleball gained a lot of popularity as being an approachable activity for people of all fitness levels and ages. And it has a social component to it as well. That being said, with pickleball, it's a low-impact sport, but it's not zero impact. So most often, I'll see injuries involving the shoulder, like rotator cuff injuries, bicep or elbow tendonitis, and that usually comes from swinging the racket. And I'll also see injuries involving the knee from chasing the ball or running and turning around too quickly, which can cause a lot of stretching and damage to your knee. And a lot of these injuries can be avoided with just adequate stretching prior to exercise. And if that's the one advice I can give today, is just make sure you stretch because you need to loosen up those muscles, you need to loosen up those tendons so that when you are doing activity, they're ready for any impact that you're doing with that activity.

Melanie Cole, MS: Dr. Ashraf, I'm an exercise physiologist, and I know everything that you're saying is so true and stretching is important, plus warming up, walking around the block a few times, warming up to get the blood pumping is also so important to help reduce some of these injuries.

Now, you're a pain management specialist. Tell us how someone in your field supports people with these fitness and sports injuries, because you are just in a burgeoning field right now.

Dr. Mariam Ashraf: Absolutely. I think there's never a wrong reason to reach out to a pain physician, whether it's for dedicated therapy or even just for reassurance. I will say most often our patients come to us when they're experiencing pain, it's interfering with their daily life, and it's not responding to typical over-the-counter medications. And I think patients who are referred to us for fitness or sport-related injuries need guidance to create a therapeutic plan to return to their pre-injury level of function. So, that involves diagnosing the problem, treating the pain with anti-inflammatory medications, and physical therapy. If that doesn't work, we often use interventional procedures. So for example, if someone comes to us with a rotator cuff injury, we can do a nerve block or a shoulder injection so that we can actually help reduce their pain and that they can better engage with physical therapy.

Melanie Cole, MS: Wow. So many new ways that we're looking at this now. So, tell us as people are injuring themselves and people don't even know when they have, sometimes you hear it, you hear that pop everyone talks about, but some injuries come on a little more gradually. Some are not as apparent or more subtle. What does swelling in a joint mean? How do we know if we have a true injury, Dr. Ashraf?

Dr. Mariam Ashraf: Swelling in a joint typically indicates that there's some type of injury, inflammation, or underlying medical condition that's contributing to an accumulation of fluid in the joint space. Swelling can result from sprains, strains, fractures, meniscus or cartilage damage, tendonitis. But then on the flip side, it can also be a consequence of chronic medical conditions like arthritis or gout. So, signs that you have a true injury and should seek medical attention include acute onset pain, pain that you have all of a sudden, increased tenderness at the joint, decreased range of motion, any bruising or discoloration of the joint, or an inability to bear weight.

Melanie Cole, MS: Okay. So, that gives us a good starting place. Now, those first line treatments, when we see that swelling, when we see those things, we don't always rush off to a physician. Sometimes we try and, you know, do some things by ourself, and we've heard RICE for a long time. And now, even RICEM, adding a little movement there. Tell us about ice versus heat. You're a pain specialist. Which one's better?

Dr. Mariam Ashraf: And just to make sure everyone knows RICE, RICE stands for Rest, Ice, Compression, and Elevation, and that's kind of the tried and true method of things we recommend people do on their own while they're recovering from an acute injury. In terms of heat versus cold, some people are like, "Oh my gosh, I cannot stand to have an ice pack on my leg. I don't want this." But I would say I prefer cold when you want to reduce inflammation, you want to reduce pain, and you want to reduce swelling. On the flip side with heat, I recommend that for muscle spasm, when you feel like you have like a lot of tightness or stiffness around a joint. Because what heat does is it allows for vasodilation, so you're opening up those blood vessels, you're increasing blood flow, and you're allowing more circulation to an area of stiffness to help reduce that stiffness and calm that down a little bit. And then, like what you're saying, Melanie, I think the important things is we don't want to immobilize the joint for extended periods of time, because that just worsens the stiffness, it weakens the area of injury. So, I usually recommend engaging in gentle movement, some physical therapy to promote healing without risking further injury.

Melanie Cole, MS: Okay, that's great advice. We can all use that advice right now. Now, when do we see you? When do we go see a doctor about the pain, about the injury itself? What should prompt that?

Dr. Mariam Ashraf: Whenever I see patients, I ask them, just to see what brought them to me. And most of them will say, "I've had pain for more than two to four weeks," the pain is affecting their day to day life, like they're unable to do their routines, can't go grocery shopping, they can't go to work. And they're taking over-the-counter anti-inflammatory medications, and those aren't helping enough with the pain to allow them to return to their baseline level of function. And like I said, I think it's important to have another opinion. There's never a wrong reason to see a doctor. So if it's something you're worried about, I think just get it checked out, just to make sure.

Melanie Cole, MS: I think that's so smart. And I neglected to ask you about pain medication. Because you mentioned injections and things like that, but if we're taking our own, do you like Tylenol, Motrin, Naproxen, Aleve? There's so many things, and people get very confused.

Dr. Mariam Ashraf: Absolutely. Walking around in a pharmacy is really overwhelming. There's so many types. So, Tylenol and then NSAIDs is what we call the class of anti-inflammatory medications that include ibuprofen, Aleve, naproxen. So, there are two separate categories. Tylenol is relatively low risk. I recommend that patients who are having any type of acute pain or injury, they can take up to 3000 milligrams per day. So, that equates to if you have a Tylenol Extra Strength, you can take two tablets about every eight hours with very, very low risk. The only thing I caution patients who are taking Tylenol is that if you have a history of liver injury, you should consult with the physician, and then try to avoid drinking any alcohol when you're taking Tylenol because it can cause liver injury.

With NSAIDs like ibuprofen, Aleve, and naproxen, they're anti-inflammatory. They really help reduce pain and swelling. However, they do come with the risk of causing some upset stomach. So, it can cause worsening heartburn. It can cause ulcers. At the worst state, it can also even cause bleeding. So, I think if people are taking more than five to seven days of ibuprofen, Aleve, naproxen in a row, that's when I would talk to a doctor just to make sure that you're doing it under the supervision of a doctor and there's no additional side effects that you're experiencing from it.

Melanie Cole, MS: Great advice. Now, what about complementary injury and pain therapies? Chiropractic, acupuncture, massage. I mean, in my mind, Dr. Ashraf, back in the day when I was in school, everything was separate. Chiropractors were over here. Physical therapists were over here. Now, everybody's kind of coming together, and really cemented by you pain specialists, really bringing everybody together to help with what we're seeing going on with so many people being involved in fitness and sports. What about some of these complimentary things? Do you like them?

Dr. Mariam Ashraf: I completely agree, Melanie. I think the whole approach to medicine, not even just within pain management, but in every field, we're realizing that multidisciplinary therapy is the most important thing for patients. One medication doesn't solve everyone's problem, and it's nice to have complementary techniques to help reduce pain and improve function for acute injuries.

A lot of these therapies, they don't address or fix the organic cause of the injury, but they will help reduce symptoms as your body tries to heal. The only thing I would caution is any, like, excessive manipulation. So, for example, if you have a neck injury, you're not sure what's going on, I would avoid doing those like really excessive rotations and manipulations that sometimes you'll see on YouTube or TikTok where you go to a chiropractor, and they completely twist your neck and you hear a very refreshing crack. Those are things that we don't think are good for you, especially if you don't know what's going on in your spine, it can be kind of risky. But other things like acupuncture, massage, all of those things I think are really helpful, and they help patients feel better and do more. And the more you can do in terms of your physical fitness, the more likely you are to recover from an injury.

Melanie Cole, MS: That's so true. And those things scare me. Wow. It is definitely a loud sound now. I'd like you to summarize for us and wrap this up with your best advice for staying active in the game and for prevention of these fitness-related sports injuries. But while you're telling us this, Dr. Ashraf, please reinforce what a pain management specialist, an anesthesiologist really can do to help the community stay more active and keep these injuries at bay.

Dr. Mariam Ashraf: I think fitness and exercise is so key to health and longevity, and good techniques can allow you to stay in the game for a long time. I recommend patients warm up with stretching exercises that prepare your muscles and joints for more intense activity. Cool down properly with movements that help with flexibility and muscle recovery.

But the overall goal is that you're building a strong foundation with strength training, endurance training, and muscle balance. And we want to enhance your body mechanics for proper form to prevent that injury. So, I think, listen to your body. Overtraining can lead to fatigue, can lead to injury. So, I recommend mixing up your workouts, taking rest days. And then, if an injury does happen, don't hesitate to reach out to a pain physician. Reach out to your primary care provider just so that we know what's happening. The last thing we want is that we have someone who's been suffering pain for months and months when we could have acted earlier. So whether that's through recommending physical therapy techniques for complementary therapies, medication management, or interventional procedures, which is really honestly my bread and butter, is helping patients who need us to control their pain so that they can return to doing the physical fitness that they were doing before.

Melanie Cole, MS: Well, I would love to do another podcast with you on those interventional procedures. I'm sure listeners have so many questions. So, make sure that you come back on with us, and we can discuss what those are, because this is kind of a mystery, but a very exciting time in your field. Thank you so much for joining us today today, Dr. Ashraf.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify, iHeart, and Pandora.

For more health tips, you can go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids HealthCast. I'm Melanie Cole. Thanks so much for joining us today.

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