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Tuesday, September 28, 2021

Why I love Sports Medicine, and if you are injured, Why You Should Too?

The following is an excerpt from my book "Secrets to Keep Moving".


TEAM Approach Vital to Sports Medicine

What is Sports Medicine?

 

 

The sports medicine approach to injuries, athletic or not, can be very different from general podiatric or orthopedic approaches. Sports Medicine evolved from the professional and college teams needing to get their players safely, but as quickly as possible, back onto the playing fields. It evolved away from the surgical treatment of injuries as the mainstay of treatment. Was there another way to treat an injury, besides surgery, that led to the same results without the surgical scar and without the time off required for surgery? Was there another way to treat an injury without prolonged casting/immobilization of the body part? And in those early days of sports medicine (1960 and 70s), there were no removable boots available!!

 

The sports medicine approach is a paradigm switch from “Doctor please heal me!” to “What can I do to help myself get better?” The sports medicine approach is a switch from pills and shots and casts to ice, soaking, alternative exercise, home exercise programs, braces, etc. Sports medicine doctors will use surgery when needed, shots when needed, casts when needed, and medicine when needed. The doctor’s orientation to an injury is less doctor focused, and more physical therapy focused, and more patient involvement. Treating a patient with a sports medicine approach is truly an attitude difference. Hopefully, this book will infuse the reader with this attitude.

 

A sports medicine approach is in its purest sense a team approach---patient, therapist, doctor, other specialists (acupuncture, trainers, dietician, coaches, etc.) Everyone’s input is vital, looking at the same injury from different perspectives. The patient’s subjective view, experiencing the problem first-hand, is balanced by other sometimes more objective views. Having treated many athletes and non-athletes, I realize patients can be very objective about their injuries, or not at all. Most importantly, no one should advise anything that potentially harms the patient (patients have a way of doing that to themselves too much already).

 

From 1975 to 2000,  the sports medicine explosion happened. Prior to 1975, there were sporadic sports medicine centers across the country, now they dominate the healthcare world. Everyone wants to use the word sports medicine in their practices, but how do they practice sports medicine?

 

The consumer needs to find the sports medicine doctors and therapists in their areas by talking to fellow athletes, the running shoe shops, the cycling stores, the athletic clubs, and online services like Yelp.com. In podiatry you go to www.aapsm.org and go to their membership list. They need to shop around if their initial treatment plan is lacking in patient home programs, physical therapy programs, alternative exercise programs, and other signs that this doctor does not really practice sports medicine principles.

 

I personally do not think the doctor or therapist needs to play sports to be good at sports medicine, but it helps immensely. Does the doctor/therapist understand your need to get back to exercise quickly? A typical proactive program contains a minimum to 4 and sometimes 7-8 activities for the patient to do between office visits to get better. Some sports medicine physicians do leave this to the therapist, but I prefer some individualization from the doctor.

 

1. What stretching can be done?

2. What strengthening can be done?

3. How often do I ice the area, or should I soak it?

4. What does physical therapy have to offer?

5. Would alternative activities (for example, biking if it is an injured runner) help and what kinds?

6. Should I take medicine? And when?

7. Should I wear a brace, splint, or do some form of taping?

8. Should I change something about my shoe gear, equipment (for example, have my bike pedals adjusted), lacing, shoe inserts?

9. Should my training be different?

10. Will I need any tests, and how it that decided?

 

These are such basic questions that must be answered within the first 2 visits of a typical sports medicine practice. Since 99% of all sports medicine injuries are non-surgical, the sports medicine specialist, or his/her team, should be the expert in rehabilitation. It is so important for our bodies to get the best and safest treatments. We need these bodies to be fully functional for hopefully a long time.

Every health care profession has a sports medicine division. That can be a good place to look for a specialist in your area. For podiatry, the American Academy of Podiatric Sports Medicine (www.aapsm.org) is the appropriate starting place. But, I have found that no matter how you label yourself, the patient must evaluate whether or not you really have the sports medicine attitude.

Monday, September 27, 2021

Treatment for Acute Injuries: Remember P.R.I.C.E.

PRICE therapy

 

Here I will use an Ankle Sprain as an example of Acute Injury needing PRICE.

Following an Ankle Sprain, it is important to create a pain free environment. The keys components have been taught in High School and College Health Classes forever.

 

P----Protection

R----Rest

I-----Ice

C----Compression

E----Elevation

 

    Protection is always a start so that the injury does not re-occur in the days, weeks, and months following the acute episode. The rule of thumb is that the second sprain is always worse than the first. Braces, like those worn after an ankle sprain, are needed until the surrounding muscles get strong again. However, a type of shoe, an orthotic, a pad, some tape, a splint, can also be part of the protection to give crucial “protected weight bearing”. Here an orthotic to stabilize the arch is used to protect the injured posterior tibial tendon which supports the arch. With the orthotic device in place, the injured tendon does not have to work as hard and can mend faster.



Orthotic device used to center the heel in a pronated foot.

 

    Rest is a four lettered word to most athletes, but crucial in minimizing the re-aggravation of the ankle. Rest is created by whatever it takes to make the ankle pain free. This may be crutches, removable cast, ankle brace, limited activity, and/or completely getting off the foot involved. I tell the patients that we must use Activity Modification principles, but never use the R word!! The first 4 days after a sprain is the most crucial time to chill out. Yet, since no one can really be sure 100% of the time what is wrong, the first 2 to 3 weeks following a sprain should be relatively pain free.

 

    Ice for 96 hours following a sprain is crucial. Other Anti-Inflammatory Measures are also helpful. Yet, ice is used for months and months in a typical sprain, it is just knowing when to use it that is important. You use it constantly after activity, or for 4 straight days after any flare-up.

 

Compression is also crucial to move swelling out of the swollen area. The product seen below is of Tubigrip, but a common substitute is an Ace Wrap.



The secret to compression is to put more compression below and less compression above the ankle. This may require some tape of some type to hold on the wrap above the ankle. Make sure this tape is not wrapped all the way around and possibly cut off the circulation.

 

Elevation of the foot and ankle even 1 inch off the floor is very beneficial. As long as it is comfortable, and as long as there is swelling, try to elevate the foot and ankle as much as possible. Super Elevation once a day for 30 minutes is very important. Super Elevation is where you lie on the floor and elevate your foot on the wall or couch 3 feet above your heart. Combine this with compression and gentle non painful range of motion of the ankle and the swelling will improve  greatly.

The above is from my book "Secrets to Keep Moving". I hope you will read it to learn how I practice podiatry.

My wife, Patty, and I just got back from a great week in South Lake Tahoe. We had some excitement with an experience with a nearby bear. The sunset was glorious, but the orange/red glow is from the Wildfire nearby! Sad!




Saturday, September 11, 2021

Healing Plantar Fascial Tear Images: Dark, Intact, but Irregular

This is my grandson, and one of my best friends, Henry. Henry is shown here starting Kindergarten about 3 weeks ago. He says his favorite is "Math" because he loves looking for "Patterns". Just an Angel. 


Here is an MRI image for a plantar fascial tear healing well. The plantar fascia is this dense band of fibrous tissue that runs from the heel to the front of your foot. This image is at the 6 month point, therefore a second MRI. The fibrous bands look mainly dark, but very irregular, as this process of healing is a bit different from patient to patient. If you look first at the heel bone, and then 2 inches in front, you can see normal looking dense regular plantar fascia that we hope will happen over the next 6 months. 

Friday, September 10, 2021

Tip for Orthotic Devices in Side to Side Sports: Keep Them Low to the Ground


High level soccer player presented today for his orthotic devices solely for these cleats. The custom orthotic must be low to the ground, so when you flip this over, the heel does not have its typical post or lift. I always joke with the patient when they bring in such bright shoes, that they better be good to wear these!!

Here you can see after flipping over the orthotic device that there is no additional lift that could potentially lift them out of their shoes. This is ideal for any side to side cutting sports where the risk of ankle sprains is higher than running or walking. 



An even closer look at the orthotic bottom (plantar) area. The orthotic device really supports the foot well and distributes weight very evenly around the foot, so stress points are harder to develop which can lead to injury. 

Thursday, September 9, 2021

5th Metatarsal Fracture: 10 Weeks into the Healing Process




10 weeks ago this military vet rolled her ankle avoiding her dog and that abrupt twist fractured her 5th metatarsal base. She was 6 weeks in a removable boot with crutches when I saw her. To protect the bone, and allow her to get out of her boot and back to activity, I made a rush of some custom orthotic devices and taught her how to use KT tape to circumferentially wrap the area. She took 10 days to painlessly wean from the boot, and has been walking for 3 weeks in athletic shoes, tape, and orthotics. Since she walks without a limp, and is controlling her pain within the 0-2 pain level parameters, I started her on an every other day walk run program. She is to email me when she gets to level 5 and then level 10. If you are uncertain about this program, you can type it into the search bar. 
     She had no pain on examination today. I felt no need to xray since the fracture line never looks great on xray for the first 3-4 months. I find I can rehab the patient based on their symptoms. 

Wednesday, September 8, 2021

Foot Pain: Can I Off Weight? Great for the Bottom of the Foot Problems

Today I want to discuss a product I use daily, and many times each day. It is called "Adhesive Felt" with 1/8 inch the preferred thickness for the bottom of the foot. In the photo below, I am protecting a sore 2nd metatarsal with an off weighting horseshoe shaped pad. When the bottom of your foot hurts, consider this remedy. Rich 






https://www.amazon.com/Felt-Adhesive-Orthopedic-Aetna-Corporation/dp/B0053D30TC/ref=pd_sbs_2/137-5657958-3764962?pd_rd_w=NArKX&pf_rd_p=0f56f70f-21e6-4d11-bb4a-bcdb928a3c5a&pf_rd_r=6XJA9FEW5NJ0K863RMX1&pd_rd_r=707526a4-402c-4860-8d21-fd0d0634bb19&pd_rd_wg=XZAPp&pd_rd_i=B0053D30TC&psc=1

Tuesday, September 7, 2021

Ankle Sprain: How to Present the Injury to a Health Care Provider

I just got back from a 6 day trip to see my son and daughter in law and grandson William in San Diego. My wife and I had a marvelous time, but it is time to get to work tomorrow. Perhaps I care share one little photo of William for my readers. 

William is 6 months old and of course I am much older

     This post is about having an ankle sprain and trying to write down all the important things to tell the health care provider when you go in for the visit. However, it could apply to any injury, and it is both for the health provider and you. After the initial pain, and maybe you are still lying there on the ground, you have to start asking why? Why me? Why now? What lead up to this injury? The answers to these and other questions can help prevent other injuries in the future.

#1  What exactly happen? Fall down stairs, land on someone's foot, etc
#2  Has this happened before? Are you prone to sprain your ankles? 
#3  Did you feel that your ankle was weak before your sprain occurred?
#4  Were you doing too much prior to the injury?
#5  Do you have good stable shoes for your ankle?
#6  Do you wear ankle braces during the activity you sprained your ankle?
#7  In what direction did your ankle move during the sprain?
#8  In what direction did your body move during the sprain?
#9  Did the sprain cause you to fall?
#10 Was a pure accident like a slip on slippery surface?

I hope these questions will help you focus on the injury to get at the cause and mechanics of the injury. Rich 

Wednesday, September 1, 2021

Thickened Nails: Sometimes There Is One Growing Underneath!!

Hello, this is my last post for a few days as I visit my grandson William in San Diego. I will be back on Wednesday 9/8. At the end of the post, I will show you a picture of William, so very cute. 
     A patient on Monday presents with a thickened and possibly ingrown toenail. There was no pain, but it did not feel right at all. After doing both some electrical thinning of the nail, and then some manual debridement with clippers, this is what we ended up with. I surmise that this is the normal nail beginning to grow under. I will see her in 3 months and we will see how it grows back. 
     Okay, here is William. So sweet. Definitely like his mom and dad (my son).