Joey Wahler (Host): This is Health Matters, Insights from WCH Medical Experts. Thanks for joining us. I'm Joey Wahler. Our guest, Mike Messaros. He's a Certified Licensed Athletic Trainer and Sports Medicine Supervisor at Wood County Hospital Rehabilitation Therapy. Mike, welcome.

Mike Messaros, MEd., ATC, LAT: Yes, thank you. Thanks for having me.

Host: Great to have you aboard. So first, what would you say from your experience these days are the most common athletic injuries you see in rehab and how should they typically be treated immediately after they occur?

Mike Messaros, MEd., ATC, LAT: Yeah, we see a lot of ankle injuries or ankle sprains specifically are the most common injury that we see. So we cover four high schools and then do rehab with the university, with Bowling Green State University. So athletic injuries have really dramatically increased due to the fact that kids are more prevalent to do sports and they do multi sports, so ankle injuries with running and jumping are a very, very common injury that we see.

More so ligaments. The ligament, it's like a rope that connects to the bone, so those sprain or slightly tear. And when we treat those it's real good to treat those right away with what we call R-I-C-E, which is Rest, Ice, Compression, and Elevation. We do that and we instruct them to do that like every hour, to try to apply ice 10 to 15 minutes on and then double the time off.

Get it elevated above the heart. And then we do a lot with compression, because if you can prevent swelling from occurring, it's a lot quicker for the athlete to return. When you deal with these joint injuries, especially ankles, and they swell a lot, the kids will lose the ability for the range of motion of working the ankle.

So if the ankle doesn't work properly, then they cannot run or jump. So we work really hard on trying to get swelling out of joints or prevent the swelling in the first place. So that's one of the more common injuries we see. We see a lot of knee injuries as well. Knee sprains. We see quite a few ACL tears are still very prevalent these days.

Those are a little bit more concerning that an athlete has much difficulty trying to participate in athletics if they have torn their ACL. So most of those are almost always surgical. And usually it's always a complete tear, rather than a partial tear.

We treat those the same at the start, but we kind of put those people in a different category because what we do nowadays is we try to do some early therapy, early working range of motion, getting the need to normalize before surgery.

So usually we spend anywhere two to four weeks before a surgical case on trying to normalize the knee because you have better outcomes.

Host: And so if it's not an injury that screams out injury like a tear that you just alluded to, any specific signs that an acute injury may require more than just at home care, something like imaging or advanced treatment?

Mike Messaros, MEd., ATC, LAT: Yes. That's a, that's a great question and that's something that we try to instruct especially the parents about like we have athletic trainers who are out at our high schools and see these kids immediately, you know and then the question comes up, should we go to the emergency room? Should we go to the family doctor? Should we get it x-rayed? Do we need to go to an orthopedist, you know, a more advanced bone doctor? So what we do with those things is kind of like putting a puzzle together. When we see these things acutely, we evaluate it. Some big areas to consider are visually we see if it swells. We will measure swelling from the good side to the bad side and see how much swelling there is, where they're point tender, where the ligaments are.

So like, I have an ankle here, so again a ligament connects bone to bone. The most common ankle sprain is when the ankle rolls in, it inverts or rolls under. And the ligaments run on the outside to the bones just like a clock. They run from here to here, back from here to here, and then up even here, up a little higher.

This is the one maybe you've heard about, they call the high ankle sprain. The high ankle sprain takes a little bit longer to heal just because it's connecting these two bones. So when we evaluate these, we see where they're point tender. And we also test the ligaments for stability. So we do some stress testing and kind of see how loose the ankle is.

 We ask the person if they hurt or felt anything. That's a very important thing. If they hurt or felt a pop, sometimes they'll tell you they even felt like a tear, when they rolled their ankle or inverted their ankle. So we put all these things together. We have some tests for the bones that we do to see if it's positive for a fracture.

But a lot of times the athlete will kind of dictate the situation. And what I mean by that is that. They can't walk on it. They can't put any weight on it. It hurts to bear weight. It feels unsteady or unstable. The ankle will discolor sometimes and turn black and blue and people don't understand how that happens.

It's like a bruise. You know, If I hit you in your arm, you get a bruise. But in the ankle, what happens is when one of these ligaments here pulls apart, stretches and tears to some degree, it bleeds. And then you'll see a discolored ankle. Sometimes it'll even go down to the foot and into the toes. Gravity will take it down.

So we look at all those things. We kind of put all those things together and then we kind of decide, you know, is this something that needs to be seen, needs to be x-rayed? And then we go from there. The one thing that has changed drastically through the years since my schooling, like 47 years ago, we used to take all these ankle injuries and we used to put them in boots, casts, put them on crutches.

We used to immobilize them. Through research, it has told us through the years that instead of immobilizing, we need to mobilize. And what that means is that we want to start early range of motion, so we don't take every ankle sprain anymore and put them on crutches, put them in a boot, put them in a cast.

We start early range of motion. We work that motion. We work so the muscles around the lower leg don't atrophy. And then research has told us that these people usually return quicker. So we can usually cut a couple weeks off the time. Now, granted, don't get me wrong, there's still places where we need to immobilize on significant second and third degree or multiligament ankle sprains.

We still put them, we don't use casts as much anymore sometimes, but we use cam walking boots anymore, and sometimes partial weight bearing. So there's still a place for immobilization in significant injuries, but most of the time, these ankle sprains are kind of of the first degree, we'll call it mild nature.

Host: And I love the show and tell, by the way, great job with that. So, what are the best strategies, would you say, that athletes, really of all levels, can adopt to prevent these common injuries, especially in the high impact sports, football, etc.?

Mike Messaros, MEd., ATC, LAT: Oh, sure. So, we have spent through the years more time on testing athletes and looking at them functionally. So, we still don't have a clear reason why, many hypotheses out there, for knee sprains, knee ACL tears, why people tear their ACLs? I mean, you look at the numbers in the NFL every year, and it's 30, 40 people, you know that tear their ACL.

It's still very common, even though we have all this modern medicine. We're better at picking these things up through the years with the advent of MRI technology and things, we don't have to just rely upon our stress testing or putting a needle in the knee anymore. We have better ways of picking them up.

So we do pick up more because of our techniques. But as far as prevention goes, we go out, and we go to our schools, and we offer this service for free. I'll take some of my staff, some of my physical therapists with me, and we have a whole list of things that we run kids through. We want to look at the way they land is very, very important. How they come down from jumping. That's of the most common mechanisms. How you tear your ACL is when you come down and land on a knee that's straight and you hyperextend the knee and snap it back or the knee bends to the inside. I just had a patient last night who I was working with, a younger high school girl and had her do just a squat in front of me and her knees buckle in they go into what we call valgus, which is going in inside.

And that then is a way that you can tear your ACL when you're coming down from landing. So we look at all these things anymore. We will score these kids. We will have them do some certain just simple activities, some step ups. We look at their mobility as far as their tightness. We see kids that are either too loose jointed and aren't strong enough.

So then we need to put them on a strengthening program. Or we see kids who are more, you wanna say tight, meaning like they have tight hamstrings and they need more flexibility work. So if you can get a kid, and I, really believe this, wholeheartedly that we want to see these kids early, like junior high, middle school age, because they develop bad habits.

And we want to correct those. So we see these kids, we evaluate them, and then we can give them a home program and exercises to do to strengthen or stretch certain structures.

Host: Couple other things. What role does an orthopedic specialist play in treating sports injuries and when should someone seek that kind of specialized care?

Mike Messaros, MEd., ATC, LAT: Sure. I work with a few of the local orthopedic doctors here, actually I meet with them a couple times a week and we go over not only just the general population that we have in the clinic, you know, the total knee patients, the shoulder, the rotator cuff tears, all of those people. Our doctors are really progressive in that they want to know how their patients are doing.

So, we go through those things. If we have any problems, then they're there to help us. So we work closely, especially in athletics, because we have orthopedists usually in a lot of the games, especially football, basketball, your higher risk sports. But there is real need for that because if you get an x-ray, let's say you have that ankle sprain and you go to the emergency room and you get the x-ray, okay.

And it's positive. Well, they're just going to immobilize you then, and then they're going to send you to the specialist, who would be the orthopedic specialist. Okay, so, same with the knees, you know, we don't send a lot of kids to the emergency room because we're outfitted in our athletic training rooms, you know, we have the crutches, we have the cam boots, we have the elastic wraps, the compression wraps to prevent swelling.

So unless a kid's in dire pain many times we can wait till the next morning. And then we have the ability to get them in with our orthopedist. So we kind of eliminate the middleman, you know, and go there. And then if something is needed, as far as like a surgery, then we set that up as well. But like I said, too, we do this pre rehab anymore on a lot of things because when a kid gets hurt or sprains a joint, a knee or an ankle, you know, it gets really, really big.

And it's really hard to visualize because a lot of these surgeries are done arthroscopically assisted. They do have to make an incision, but they start with a scope, make a diagnosis with the scope. And so it's hard to view through a scope when you have a big swollen bloody joint. We take time and get them normalized and normalize the joint the best we can.

And they have better outcomes. If you can get their motion better before surgery, they do a lot better. You get the muscles firing. You work on getting that so that there's no atrophy or wasting away of the muscle.

Host: And then finally, Mike, in summary here, since, as you've discussed, you and yours treat so many younger athletes; tell us a little bit about what I would imagine is the challenge of trying to get these guys and gals back out on the court, the field, whatever the case may be while at the same time I'm sure, particularly at that age, they just want to play right? So, how do you find that balance between treating and healing and yet dealing with the fact that at that age they feel like they're invincible oftentimes don't they?

Mike Messaros, MEd., ATC, LAT: Oh, sure. That is a great question and a good thing to really talk about because I see it here in the clinic, because I see some of the patients here and then when I go out to the schools as well. And it really, I think through the years, I really involve the parent or the guardian. And I involve the school and the coach, because kids just want to play, and you're right, they just want to play.

And especially, we have a couple patients right now who have what we call patellofemoral problems, that's another problem in the knee, you know, we talked about ACL, but it involves the kneecap here. Okay, the kneecap is a free floating bone and it lies within this tendon and every time these muscles up here of the quad, this would be the upper muscles of the quadriceps, every time these fire, this kneecap moves.

It's a free floating bone and it lies in this tendon and the tendon goes here. So if this thing is not tracking properly in its groove and moving, and it doesn't a lot of times, mostly because of two reasons. One, because some structures are tight, the hamstrings wrap around, pull the kneecap to the outside, or the medial side of the quad, the muscles are weak and allow the kneecap to get lazy and go over here when it should be here.

Causes all kind of inflammation and rubbing on the back of the kneecap, and even some people will sublux or dislocate that. So getting these people corrected without further injury, which is the athletic sport that they're doing, is tough because the kids just wanna play. When you tell a kid, no, we have to stretch and stretching these structures does not happen by doing one, two, three sessions. It's a long continual process, as is strengthening. You don't get strong overnight. So to safely let these kids play, sometimes we have to tell them we're going to take a couple months here and we have to stretch this. We have to strengthen that.

We have to get the parents on board to understand too, to give us backing and to make sure that the athlete is doing the home program. Because that's the big thing. If I see a kid for 45 to 60 minutes a couple times a week, what about the other 23 hours in the day? So it's what they do at home. And it's really their I use this, rehab is a sport.

I get t-shirts made up with this saying on it and I give it to the high school kids that's behind me. Because I strongly feel that it is a sport and you have to look at rehab as a sport. You might not be able to play basketball now because of this knee problem, but you go at your sport at full speed, that's what I want from rehab and that's what it takes to get back.

And if you don't give that kind of commitment and get these things straight, you're just going to be an athlete that gets washed out or is constantly hurt. So, getting the coach on board, making sure they're doing what they need to do at the school for their strengthening program, with the athletic trainer or the strength coach, and then at home with the parents.

So, I incorporate a lot of those people in the mix here and I really take time to explain to them what your problem is and how we need to fix it. But yeah, you might have to be out, and it's hard for kids to be out.

Host: Absolutely. Well, folks, we trust you're now more familiar with sports injury prevention and treatment for student athletes. I know I'm much more familiar with how the kneecap works, Mike, thanks to that great model. So we appreciate that as well. And remember, Mike says, rehab is a sport, right?

Mike Messaros, MEd., ATC, LAT: Yes, sir.

Host: And so Mike Messaros, valuable information indeed. Thanks so much again.

Mike Messaros, MEd., ATC, LAT: Thanks, Joey. Appreciate it.

Host: Absolutely. And for more detailed information and resources, we invite you to visit woodcountyhospital.org and search rehab services. If you found this podcast helpful, please do share it on your social media. And thanks again for being part of Health Matters, insights from WCH Medical Experts.

Stay tuned for more insights from Wood County Hospital experts. Remember, your health matters.