Joey Wahler (Host): This is Health Matters, insights from WCH medical experts. Thanks so much for joining us. I am Joey Wahler. Our guest is Dr. Patrick Siparsky. He's an orthopedic sports medicine surgeon with Wood County Hospital. Hi there, Doctor. Welcome.

Patrick Siparsky, M.D.: Hi Joey. Thanks for the opportunity to be here.

Host: Great to have you aboard. Appreciate the time. So first, I guess some would presume that sports medicine is just for real athletes, but others can certainly benefit from seeing a specialist like you. Right?

Patrick Siparsky, M.D.: So actually sports medicine is just a broad term within orthopedics that mostly involves, knee and shoulder injuries, but it involves a whole spectrum of the whole body. It's coined sports medicine just based on a specific training for it. But other than that, it's actually people of all ages. It's males and females, it's everybody. It just any injury that we try to get people back to an active lifestyle.

Host: And so, that being said, obviously many of the injuries for those you treat have come about from things other than sports, right?

Patrick Siparsky, M.D.: Absolutely. So we see people with repetitive stress injuries all the time from work, sometimes traumatic injuries, people in all kinds of fields really. Even other doctors getting injured and people in an operating room all the way out to people working out on a job outside where they're doing heavy lifting or all kinds of things.

And the vast majority of patients in sports medicine are not actually getting injuries from athletics.

Host: Interesting. Gotcha. And so what are some of the more common injuries you're treating these days?

Patrick Siparsky, M.D.: So for me, the bulk of my work is within the knee and shoulder, and my specialty is mostly things that are done arthroscopically. So in the knee that can be, anything from an ACL tear to a meniscus injury or a cartilage injury. In the shoulder, it can be anything related to repetitive stress things like injuries to the biceps tendon or rotator cuff. Or it can be something that a person's had a traumatic injury and dislocated their shoulder and we need to take care of a dislocation. So it's a pretty wide variety of things that can take place in the soft tissues and cartilage and bone within the two joints.

Host: You mentioned rotator cuff, and here again, those that follow baseball know that that's a somewhat common injury, particularly for pitchers, but as you were touching on those that don't even play baseball or sports period, do suffer those as well. I guess oftentimes contractors, people that do physical work of some kind, right?

Patrick Siparsky, M.D.: Yep, absolutely. And you can have a 25-year-old professional baseball pitcher and a 60-year-old person who works on cars, and a 75-year-old person who loves to play tennis all present with the same rotator cuff tear. Obviously you have to treat everybody individually in terms of how you approach the treatment.

But certainly these are injuries that can occur to anybody of any age. They just happen to be more common people who are either very athletic and throwing overhead activities or in patients that are a little older or doing repetitive stress.

Host: Now you mentioned knee injuries and torn ACLs, and want to ask you a little bit about that, because you said that's a frequent one. So ACL injuries are often associated again with athletes, but who are some of the others at risk there that are hurting their knee in other ways?

Patrick Siparsky, M.D.: Absolutely. So ironically, people of ages all the way from young teens all the way up into their fifties and sixties tear their ACL. They often just occur through different mechanisms. I mean, you can get it as a teen or a young person playing sports just as easily as you can, as you get older from a car accident or from an awkward fall or other things.

And everybody's ACL tear is important and it just matters about how we go about treating it. Certainly the world of ACL reconstruction and ACL treatment has changed drastically over the last 20 to 30 years. We have all different mechanisms to fix these things, whether you're using your own tissue to fix it or using somebody else's.

We really do run the full spectrum. Very commonly we see people of all ages that have torn their ACL, but also have meniscus injuries or cartilage injuries. And those may be different in people of different ages and requires a little different algorithm for treatment. But in the end, we want everybody to have a stable knee.

Host: And so is there anyone in particular that's more at risk for a knee injury, like a torn ACL?

Patrick Siparsky, M.D.: Sure. So certain activities increase your risk. Okay. Certainly people who play sports with cutting and pivoting. So football, soccer, volleyball, anywhere where you've got cutting and pivoting training, really you have a higher risk. But certainly there is a higher risk in young females. I mean, we know that now pretty well.

There's a whole host of different reasons why that's become more of an issue, especially with the specialization of our sports where kids are playing soccer 300 days a year, or volleyball, or softball. And it's increased our risk of those injuries and created a whole nother level of ACL volume.

There are almost 300,000 ACL tears every year just in the United States alone. And so it is a very, very common injury.

Host: So you mentioned soccer, particularly among younger people, and I would imagine that youth soccer, you said it tends to happen these injuries, more to females than males. The cutting and pivoting, often the surface can contribute to it. Right? Playing on different surfaces at that age, and maybe not necessarily the greatest ones at times. Yes?

Patrick Siparsky, M.D.: Absolutely. So we certainly see a host of different injuries that come from both indoor and outdoor soccer based on whether you're playing on turf versus playing on grass. One of the big challenges now is that there's so much soccer going on that our fields are getting beat up pretty good.

And so a lot of times the conditions of the field, if you're the fourth game of the day and it's a little wet outside, you're going to see some injuries. But yeah, I mean the volume of ACL tears has almost gone up in a straight line when it comes to females based on the amount of activity, specialization in sports, especially related to soccer, volleyball, and softball.

Host: Gotcha. So what actually happens during an ACL repair? How is it done these days? What's the latest way of going about it?

Patrick Siparsky, M.D.: Yeah, so Joey, this is the neat part about my job, is that I get to see people of different ages and different activities, and I get to specialize the treatment. In the early times of ACL reconstruction, some 40, 50 years ago, we really only had one choice, which was to use the patient's own patellar tendon, which was very good. It was a really helpful way to do it, but it had its challenges that were associated with it for people after it was done.

And then came along additional treatments, including the use of one's hamstring tendons, and even cadaver tissue. But the most recent one to the party is the quadriceps tendon, which has become very popular in the last 10 to 15 years.

The reality is you really have to tailor your graft choice based on your patients. So you're going to think about it differently, even within the same sport. So does a quarterback need the same thing as a running back or a linebacker, or for that matter, does the goalie need the same as a forward in soccer?

The cool part now is that we really do get to specialize it. And sometimes even, you have kids coming from the same family who play different sports, who are getting a different graft. And so the neat thing is we really can specialize it to the person. I mean, if I had it, I'd be getting a different graft than my son or daughter, who are 15 and 14.

So it's just a different approach based on what you do and what your sport requires and what your plans are. If you're a wrestler, sometimes getting kneeling pain from a graft we take from the front of your knee; maybe that's not your best choice. If you're a jumping and landing athlete, maybe one graft works better than the other, but the real key now is we get to specialize it and individualize it to the patient.

And that doesn't matter even if you're in your forties when you tear it. And we have options when you're not 17 years old. And so that's been the biggest change in the world of ACL reconstruction in the last 20 years.

Host: So if you go for ACL repair, what is the process of the procedure?

Patrick Siparsky, M.D.: So the procedure itself, it has stages. So first, most of the time you come to see us before you've had additional imaging, so you've just got hurt yesterday playing sports. You come to see us, we'll typically order X-rays just to make sure there's been no fractures. And then we'll get an MRI, which will help us detail a lot more about the soft tissues, including the ACL and the meniscus and the cartilage.

And of course, in every knee we have to be very thorough because a lot of ACL tears come along with additional injuries. And we just need to be safe and make sure we're not missing anything. And then we have a really good conversation about what your goals are and about what the process is. We pick a particular type of graft for the ACL, what we're going to use to fix it, and then we go to surgery.

And then once we've completed surgery, the rehabilitation is dependent upon what exactly you had done. And the total recovery time is typically between nine and 12 months, but there is a whole host of different timeframes that depend upon what the patient's, requirements are, how much injury they've had and, and what they're going back to.

Host: And indeed I wanted to ask you about that because again, we make that sports comparison. We know that when athletes suffer a torn ACL, you typically hear, really always hear actually, done for the year, whatever that year or season consists of, but I would imagine for a non-athlete, a lot of it has to do with what they're going back to, as you said. Are you going back to scaling buildings or are you going back to sitting behind a desk, right?

Patrick Siparsky, M.D.: Absolutely. And I think the really important thing to understand is there's a difference between return to sport and return to your life, right? You're going to be going back to your life much, much sooner. Whether that's going back to work, going back to school, going back to practice for your sport, just not the actual competition of it.

That is not what takes the long period of time. The long period of time is really related to your ability to return to the highest level function that you need. So for example, if, like you mentioned, if you're somebody who's climbing ladders or working on a roof or, working under a car, we have to really work around the limitations, because we need to make sure you're safe to go back to those things. And we really have gained a tremendous amount of increased knowledge over the last 20 years as we collect more information about what makes people safe and less likely to re-injure. Years ago, we felt like if you had made it six months after that surgery and your knee was really stable, you were okay.

It turns out that there was a too high of a failure rate when we did that, and so we've really worked on trying to narrow that down and try to really optimize the rehabilitation, and we don't really just sit around waiting for that nine month mark to come about. We're working out the whole time, we're doing therapy. We're working to get you stronger and kind of building the rest of you back up to get you ready to go back. Not just focusing only on your knee.

Host: What's something more people from your experience should understand about orthopedic injuries or joint pain in general, especially as they age and stay active? For instance, I know personally, stretching becomes more important because flexibility becomes more of a focus as you start to get a little bit older.

And if you don't stretch, and most of us don't enjoy doing it, it's not the most glamorous thing, but it could lead to injuries, right?

Patrick Siparsky, M.D.: You're absolutely right, and I'm a big proponent of making sure that people actually try to address orthopedic related issues or musculoskeletal issues early, rather than waiting a long time to the point where we can't fix it without an operation. I mean, some of our greatest victories as surgeons are the patients we save from needing surgery and certainly as a shoulder surgeon and especially I see a lot of people that if we can address things early on and fix them without an operation, where people actually do great. And so, things like stretching, things like making sure you're being seen for things before they become so bad you can't function well.

That's the key and, we can get people into things like physical therapy or do injections that save people honestly, operations in the future if we can avoid it. And I, hundred percent agree, stretching is well worth the time that you put into it. It isn't glamorous, but it is something that can help a lot.

Host: Because a lot of times if you don't stretch enough or properly, you could get an injury in one part of the body because of tightness in a completely different part, right? Because everything's connecting. Sometimes we don't realize it until it's too late. Am I right?

Patrick Siparsky, M.D.: Absolutely. I mean I'll just give you an example. A lot of times people don't realize that when you get really bad, tight hamstrings, your next step is low back pain, and the last thing any of us want in our life to deal with is low back pain. It doesn't matter what you do for work, it doesn't matter what you do for sports.

Low back pain is always a pain, and you gotta work on trying to fix that before it becomes a problem. Otherwise you end up treating it for much longer.

Host: Absolutely. A few other things, doctor. And just switching gears here a little bit, you previously, of course, lived in northwest Ohio, recently returned. So I wonder what inspired you to come back and what's it feel like to care for a community that you've called home?

Patrick Siparsky, M.D.: My wife actually has a very close connection. She was born and raised in Toledo. Whole family lived in Toledo for the bulk of her life. We came here initially when I finished my fellowship training in sports medicine and shoulder surgery at Duke. We were here from 2013 to 2019 as I was one of the team physicians for University of Toledo and we had a wonderful time, and we really loved it. It was great having family close. Opportunity arose in Indiana and Indianapolis with IU Health and it was nice to see something different, but I think it's fair to say we always missed home and this is what we consider a home and I'm excited to be back.

A lot of friends and family and more importantly, just a wonderful community to be back with. And we missed it when we were gone and we're excited to be back. And, we really enjoyed our time here. It was a fantastic place to raise our family and, our kids are excited to be back and be in the area, but, I also have always really loved the community. I think that it's a great place to live in terms of being a doctor. We have a lot of people who really want to work and get back to their lives, and, just trying to take good care of people with really good personalized care was really, really well received here.

And, I think that's what's going to make it fun to be back again and, obviously being a little south of where I was before, get an access to a whole new community of people that I'm really excited to take care of and be a part of. And we're really looking forward to it. It's home for us,

Host: It sounds like it is indeed. And your passion certainly comes through Doctor, so I'm wondering such a big part of what you do is getting people back to what they do healthy. You have a story you can share? I would imagine you have many. What's one story that illustrates the way you're able to get people back to their previous lives, if you will?

Patrick Siparsky, M.D.: One that was fairly recent was I had a, a really wonderful patient. She was in her early forties, very, very active, was doing a Spartan race, actually. That's how active she is in her early forties, and came down awkwardly and sustained a very serious knee injury, tore her ACL, tore her meniscus, tore her, some of her collateral ligaments. And really it was a bad injury. She actually lived fairly far away but got to us and, needed a fairly acute level surgery and we had that surgery done and she worked incredibly hard to get back again, a person who really wanted to be active and, it was worth everything for her to get back to that because that's what makes her, her and did great.

 Sadly was back out there having fun again, injured her other knee. And so came back in, fixed the other knee, and now she's both knees fixed back out there having fun again, back working out all the time and, and really has had her ability to get her life restored to what she enjoys and getting her back to feeling like herself again.

And, the relationships that come along with this, you get invested in your patients. So when you see somebody come back after a year of working really hard on one knee and then sustain an injury to another side. It's so hard. You just feel for them and you want them to get back and you really want to dedicate to the same amount of work they're putting in that you gotta put in.

And, and watching people come back from these things is just incredibly rewarding for me. And I, really, I mean, it's what gets me up early every day, to want to see people get back. And it's not just about young athletes, it's about everybody. Because it doesn't matter whether you're 17 playing soccer or you're 41, going back to doing Spartan races; the idea that you can push through tremendous challenge and get back to the things you love is what made me pick this field.

And, they're complicated surgeries and complicated challenges, but they're really fun to watch people overcome.

Host: Well, certainly great to hear. Let me ask you one more before we let you go. In summary here, often, as you well know, there's a fine line, isn't there, between tolerating some pain and finally getting it addressed, right? And so sometimes people may be unsure as to what to do or when to do it. For someone dealing with ongoing pain that hasn't yet seen a specialist like yourself, what's your advice in taking that first step and really first determining whether they need to in the first place?

Patrick Siparsky, M.D.: That's a fantastic question. Because I think the old school mentality of no pain, no gain, might be a little outdated in our world because what that often leads to is you have a lot more pain. As we mentioned before, I think people should feel comfortable with their physicians.

And I think coming to someone early before you've had a more significant injury is actually super important. And as I mentioned earlier, some of the great victories in our world are what we don't operate on and we catch before it gets really bad. I, I like to think that, if people get more information early in an injury, let's say you're a runner and you realize my knee hurts for two days after I go on a 10 mile run, maybe we need to look at that before that becomes something that needs an operation.

Because a lot of what we do is actually not surgery related. And so, we are lucky here at Wood County because we have the massive physical therapy office with great physical therapists and a beautiful facility and a pool. And I mean, we have access to all these different treatments that it's oftentimes something we can fix long before it becomes a more serious injury.

And let's get you back out there having fun again instead of just being out there and being miserable.

Host: Sounds like a plan. Well, folks, we trust you are now more familiar with orthopedics and sports medicine. Dr. Patrick Siparsky, welcome back home if you will. Keep up all your great work and thanks so much again for the time. We appreciate it.

Patrick Siparsky, M.D.: I appreciate it. Thank you. Take care.

Host: Sure, and for more information or to make an appointment, please call 419-354-3072. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being a part of Health Matters, insights from WCH medical experts.