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Interviewer: Experiencing pain or swelling on the outside of your knee might not be a problem with the knee itself, but rather the IT band. And to better help us understand more about this tendon, how it can be injured, and how to ultimately treat it, we're joined by sports medicine specialist, Dr. Chris Gee.

Let's start with the basics. What is the IT band?

Dr. Gee: Yeah. So the iliotibial band is basically a big thick band of tissue that . . . Well, I shouldn't say thick. It's a wide band. It attaches on your ileum, which is your pelvis, so kind of the side of the upper part of your hip, goes down across the bony hip bone on the side, and travels all the way down and attaches on the side of your leg or your tibia. And it's got a little bit of muscle called the tensor fasciae latae that sits within it, and it basically kind of holds things into the side of your leg, is what it does.

Interviewer: And what causes IT band syndrome? When somebody says, "Oh, I've got IT band problems," what were they likely doing that led to that?

Dr. Gee: So IT band syndrome is generally an overuse kind of problem. What it does is, since it is over the side of the hip and over the side of the knee and it's kind of holding things in, every time you bend the knee or bend the hip, it has a potential to kind of catch on some bony prominences that are there.

So it's most common in the knee, and what'll happen is every time you flex your knee, the IT band kind of swings back and snaps over the side of the femur.

Now, you can imagine if you are running or doing some other activity that there's a lot of kind of knee bending over and over and over, that's going to start to potentially get that area inflamed and it'll cause some pain in that area.

There can be a little bursa that sits underneath it. The bursa is a little sack that has very little fluid in it, and it's there to decrease friction, but that'll sometimes get inflamed and it makes it painful to run and walk, and it starts to get very tight feeling on the side of the knee or the hip.

Interviewer: So it would be similar to if you had something rubbing on your skin constantly over and over and over again. Eventually, that would start to irritate your skin. Is that kind of what's going on, except for it's on the inside?

Dr. Gee: Exactly. It's kind of like if you're wearing a backpack and that backpack has a strap that's rubbing on your shoulder. And over time, you're going to try to adjust that backpack. But with the IT band, you can't. It's still there and every time you're moving, it just keeps on snapping and catching and causing that pain.

Interviewer: That sounds like a design flaw that it would rub like that when you're doing something like running or moving.

Dr. Gee: Yeah, it's sort of a structural stabilizer and we need it, obviously, to kind of maintain things. But, well, it can be very painful at times and be quite limiting, particularly to runners or people that are in running sports like soccer.

Interviewer: So is there a reason why some people might have IT band syndrome? Two people doing the exact same thing and some people might experience IT band syndrome and some people don't?

Dr. Gee: A lot of it depends on kind of structural differences. Some people tend to be a lot tighter in their joints and they'll have tighter muscles in general. And that little tensor fasciae latae that sits within that can be a little tighter in some people, and so it'll pull on that a little bit more and it'll cause it to potentially snap in that area.

So that's number one, is that you're just sort of set up for it by your musculature and your tension. But number two, sometimes the way people run or their activity, if they're maybe rotating their leg in a certain way and just causing that to be a little more tight. So if their leg almost bows out a little bit, it will kind of put more tension onto that IT band, and just cause it to kind of catch and snap a little bit.

Interviewer: So if somebody's experiencing knee pain and it's caused by the IT band issue, it sounds like perhaps some of the treatments might include some exercises to strengthen the glutes and other muscles or some . . . I don't even know. What would you call that, where you're teaching your body how to fire muscles in a different way? What's that called?

Dr. Gee: Yeah, we mostly just say strength or dynamic control, is kind of what the term I'll use with people. It's not about just firing that muscle. It's more about getting it to fire with others in concert so that as you're moving that joint, they're all firing together and supporting that joint a little better.

Interviewer: And there are exercises that can help teach the body that?

Dr. Gee: Yeah. So a lot of times we'll work on something called clamshells, if you've heard of that. Those can be really helpful. They basically strengthen the lateral glutes and hips.

Interviewer: What about stretches? Actually, before I say stretches, I want to talk about foam rolling.

Dr. Gee: Yes.

Interviewer: Because I've heard people that have IT band syndrome, they swear by foam rolling. Is that helpful or is that not helpful?

Dr. Gee: So I find it very helpful, both personally and with patients. So you want to try to stretch this area out. Like we talked about, the IT band is a little tight and it's snapping over the side of the knee on the hip and it's going to cause pain, but it's actually a very difficult thing to stretch.

Even if you look up different kinds of stretches and do them, it's hard to really get a good stretch in that area. It's not like when you stretch out your quad muscle, you do the little hurdle or stretch or whatever, and you can really feel it pull that muscle. Sometimes it's harder to feel much of a pull on the side of that IT band.

And so what foam rolling does is you basically use the weight of your body against a roll and you're kind of rolling it back and forth and it's helping to loosen that tissue and to break up some of the tension that's in the muscle there and allows that to calm down. And that can be significantly helpful for people.

Interviewer: So the band itself is stretching when you foam roll, and then you're also stretching that attachment muscle that you mentioned earlier. What was that called? The . . .

Dr. Gee: The TFL.

Interviewer: The TFL, yeah.

Dr. Gee: Tensor fasciae latae. Yeah.

Interviewer: Yeah. And you're kind of stretching that as well. Is that what that foam rolling is doing?

Dr. Gee: Yeah, you're kind of putting some tension on it so that it releases and relaxes. Foam rolling can be a little painful for sure as you start off doing it. And depending on how painful it is, you may have to adjust how much weight you're actually putting on it.

I see high-level athletes that put their whole body on it and they're putting a lot of force in it, and sometimes you have to adjust and, "Okay, I can't quite put all of my force onto the side of my leg because it's so painful." But as you build that up, it feels better and you're able to work through more and more of the foam rolling.

Interviewer: What about percussive therapy, like Theraguns or something like that? Is that a good thing to use on your IT band?

Dr. Gee: Those can be helpful as well. What you're basically trying to do is just to get the muscle, the tensor fasciae latae in there, to release a little bit. If it has too much tension, it's going to pull too hard on that tissue and make it tight. And so, effectively, you're trying to hit that or cause it to break so that the tension in that releases a little bit. That can be helpful in that area.

As you get further down towards sometimes where the IT band attaches on the knee or the side of the leg, there's not as much tissue there, and so those Theraguns are going to cause more pain in that area. So you probably can't use them that well there. But up higher on the side of the hip, you can definitely do it and that can be helpful there.

Interviewer: And then knee braces, are those something that you find success with as well?

Dr. Gee: For IT band, not quite as much. Sometimes if they're having more anterior knee pain, so the kneecap tracking is an issue, you can put a brace on. It almost looks like one of those that has a hole in the front, like a neoprene sleeve with a hole in the front. Those basically are designed to kind of hold the kneecap in place so that it doesn't slide around and cause pain. The IT band doesn't quite have a good brace for it.

But most of the time what I will tell people is working on those muscles, like we talked about, and sometimes even doing something like a running gait analysis can be helpful. What that is, is you basically put a patient on a treadmill and then you film them and then you slow down the video and you kind of watch, as they're running, what they're doing.

So I tell people nobody teaches us how to run, we just start doing it, and sometimes we do things that aren't really helpful for our bodies. It can cause some pain. So sometimes speeding up the way we run, meaning we take shorter steps, so we're taking fewer steps, can help. Sometimes the way our foot hits the ground is a problem, and so adjusting maybe the type of shoe you wear or the way you bring your foot down can help.

And so there are a lot of different things that we can find on that that sometimes we can help patients to work through. They're a runner or running sport and they're having a lot of IT band issues, we can kind of work through some therapy, work through a running gait analysis, and get them back to their activity, where they want to be.

Interviewer: And then are kind of the treatments that you would use for IT band therapy very similar to what somebody might want to do to prevent it from happening in the first place or to keep it from coming back?

Dr. Gee: Yeah. This can be very much a chronic issue, and so patients that have this, I kind of tell them, "Hey, this is something you're going to have to be really good about, even after you get it feeling better, maintaining that length on there. And so working on stretching, working on doing some IT band things."

And this was something I had mentioned before. I've personally struggled with this. I have to foam roll after I run. It's just to make it so that it doesn't hurt the next day and things like that. And when you do that, you can maintain that really well.

And so I tell people, "Yeah, having some good stretches that you do when you run can be helpful to prevent this from becoming a problem or help maintain it once you've kind of got it under control."

Interviewer: And I know when somebody comes in, everybody is different and everybody has a different level of injury. Generally, though, when somebody starts doing some stretches, some exercises, what kind of recovery time are you looking at where the pain starts to go away?

Dr. Gee: It's probably going to take a few weeks for a muscle injury to recover. If it's a bad muscle injury, it can be up to six weeks or so. And so I advise people when they come in and they have sort of a lower grade muscle injury, maybe they've kind of strained a muscle, I tell them, "Give it a couple of weeks of avoiding that activity."

So maybe if running was your thing, you're trying to avoid lower extremity stuff. Maybe you're getting in a pool or swimming or something like that so that you're not impacting that for a couple of weeks. Allowing that to calm down and then gradually working your way back into your activity is probably the best way to prevent that from lagging on and to allow it to recover.

Interviewer: And do you recommend any sort of ibuprofen or anything like that for the inflammation?

Dr. Gee: One thing I should probably point out, and maybe I should have pointed this out before, but whenever we are exercising, what effectively we're doing is we're putting a strain on the muscle or the tendon. And to clarify, the tendon is a piece of tissue that attaches the muscle to the bone. So it's kind of like a rope holding the muscle to the bone.

But we're stretching those tissues to the point that if you could see it, you're going to see these tiny little tears in the muscle or the tendon. And the point is that when you tear it like that, your body goes back and strengthens it, makes it stronger.

But if you're doing that repeatedly, sometimes that will cause it to . . . you'll get too many tears, too many of those little tiny tears in there, and that's where pain comes in.

And so, at that point, decreasing some of the inflammation with ibuprofen, with ice, some rest, just to allow the muscle to kind of calm down and let your body's healing processes catch up, will allow you to then feel better.

Now, when it's healed, generally it's stronger. And so now you're going to be able to go out and lift more, you're going to be able to work more, you're going to be able to do more, than you were before, and that's the point of getting stronger with exercise.

Interviewer: And when is it time to see a sports medicine doc or a physical therapist if you're experiencing knee pain that you suspect might be IT band?

Dr. Gee: First of all, if you ever get an effusion in your knee, meaning the knee is really swollen, that's usually a concern that something more is going on.

The other thing is if you have tried some of the things I've talked about, so you looked up some stretches, you did some icing and anti-inflammatory and it's still really bothering you, then definitely getting in and seeing us could be helpful.

Sometimes we have to try some different studies and other imaging, X-rays, or things like that to see if something else is going on, or even other treatments like injections sometimes to kind of calm down the inflammation because ice and anti-inflammatories just haven't been enough to get on top of it.

So IT band is something that can definitely affect a lot of different kinds of athletes, and it can be very limiting to the point that you can't run and you can't be active in the way you want to be.

But the good news about it is that it's something that can be treated with good stretching, anti-inflammatories, icing, and even sometimes some physical therapy to get on top of it.

Ideally, we want you to be able to work through it and we want you to be able to stay active. And so if you're having issues managing it, definitely getting in and seeing a provider and getting on top of this is the way to go. And we can get you to a point that you can work through this and enjoy your sport or your activity without pain.

Interviewer: As technology and practices have improved, more people than ever are receiving joint implants. In fact, "The Journal of Rheumatology" projects as many as 600,000 joint replacements in the U.S. by the year 2030.

With more folks receiving an implant, how do you take care of it and ensure that it lasts as long as possible? To answer those questions, today, we are joined by Dr. Mike Archibeck. He is an associate professor with the Division of Adult Reconstruction at University of Utah Health.

Now, Dr. Archibeck, for someone who has just barely received a replacement joint, whether it be a knee or a hip or something like that, what do they need to know about taking care of it for, say, the first year after surgery?

Dr. Archibeck: Yeah. So I think I'm primarily going to talk about total knees and total hip replacements. That's kind of the purview of the Adult Reconstruction Division in the Department of Orthopedics. So we do total knees and total hips as well as revision total knees and total hips.

And so there are a few things that are generic in regards to how to maximize your recovery early after surgery. Most would consider the first year as kind of the recovery period. It's been shown that both hips and knees generally do improve over that year, even though the vast majority of the improvement is in the first few months.

And during that first year, there are a few things you can do to kind of maximize the outcome and protect it from the dangers. Early after surgery, one of the most common complications is a blood clot in the leg or something that we call a deep venous thrombosis. So, usually, patients are prescribed some form of blood thinner. It could be aspirin. It could be something stronger. So being sure to do bed exercise during the day, get up about every hour or so, and go for a short walk.

You also want to be sure that the wound heals. So one of the concerns early after surgery is infection. Try not to overdo it such that the knee or hip area becomes too swollen, that can slow or compromise wound healing, and being sure to avoid any other types of infections that you might get early after surgery, like a urinary tract infection or a skin infection.

So if any of those things develop, or dental issues, you want to touch base with your surgeon and be sure those are treated so they don't potentially get into the bloodstream and make it to the hip or knee replacement.

And then recovery-wise, some patients participate in formal physical therapy. And more commonly now, more and more patients are doing kind of directed physical therapy, but working on whatever the tasks might be that the therapists direct you to do.

So with a knee, early after surgery, one of the high priorities is working on range of motion. A hip, less of a concern range of motion, but with both, starting to work on gait training initially with a walker, and then subsequently, weaning to a cane, and gradually off. Usually, that process is coached by the therapist or the surgeon and his team.

And trying to avoid overdoing it. Like I mentioned, you can really set yourself back if you do too much too soon. You can get swollen, wound healing can be slower, and it can just be more painful and kind of slow the recovery process.

So, again, the main things to be careful about are watch for the signs of blood clot, which would be significant swelling in that leg that does not respond to elevation, protecting the wound from infection, and just being an active participant in your recovery and physical therapy.

Interviewer: For someone who has received a joint replacement or is about to have joint replacement surgery, the recovery takes anywhere from 10 months to a year. So when will they see the most improvement? I mean, when will they start walking again?

Dr. Archibeck: Yeah. So, with both, you'll really be walking the day of surgery, obviously to a limited degree, and you'll be using a walker typically. But with both, you're generally able to place as much weight on that implant or that extremity as you want.

But like you mentioned, the first few months, the improvement is very rapid. So week to week, you see a significant improvement.

The improvement after those first few months is a little more subtle. So you may not notice dramatic changes like you do early after surgery, but it will continue to improve, and you gain more confidence in it, and you think about it less as time goes by.

But most people kind of describe the first six weeks as the majority of the recovery, so that's really the time frame when the focus is on avoidance of complications. So blood clot, infection, things like that.

Interviewer: Wow. So after the first year, the body is healed up, we've made sure that the wounds are not getting infected, we're not getting clots, etc., but now we have a piece of hardware in our body. What do we have to do to make sure that we're taking care of the implant and make sure that we get as long of a use out of that implant as possible?

Dr. Archibeck: There are several things that are important to know. So one is how do these things fail? And there's a little bit of a difference with knee replacement and hip replacement, but in general, they can still fail by infection. So, obviously, that's a life-altering event if it occurs.

And generally, it's felt that that is caused by a remote infection that then enters the bloodstream and finds its way to the joint replacement. So, unfortunately, a chunk of metal like a hip and knee replacement is always more susceptible to infection than a native healthy joint.

So you just want to take generally good care of yourself. Keep your dental work up to date. That can be a potential source of infection.

Interviewer: Really? Dental work?

Dr. Archibeck: Yeah. In the past, they used to recommend antibiotics prior to any dental work, and that still is a bit of a controversial topic, but that's not felt to be absolutely necessary unless you're high risk or have multiple joint replacements. But again, that's a topic you'll get different opinions about.

Any other bacterial infections, so common ones would include urinary tract infection, skin infections on that leg or other areas, obviously sinusitis, pneumonia. As you typically would if those things develop, you just want to be diligent about getting them looked at and treated, and more so if you have prosthetic joints.

I mean, obviously, we're talking about hip and knee, but there are elbow replacements, ankle replacements, and others. So any bacterial infection can potentially go to those areas. So just kind of taking good care of yourself like you generally would.

Implants can wear out. So, luckily, hip and knee replacements, the materials that we use have significantly improved over time over the last couple of decades. And so, even at 20 years, most are still functioning well, but they do wear and tear.

So a few things you can do in that regard. It's generally recommended that you avoid repetitive, high-impact activities, such as running, for exercise or aggressive cutting and pivoting sports. Things like walking, hiking, biking, swimming, golfing, dancing, most people feel like skiing is fine, are all activities that are absolutely fine to do and don't need to be limited at all. You can do as much as you want.

Then there are those in-betweeners, like tennis, pickleball, skiing, where some of those the risk is more the risk of a fall. But generally speaking, those activities are felt to be okay too, just avoiding the really high-intensity cutting and pivoting type things.

The other thing that can help add to the longevity of an implant is maintaining a good body weight. So it's been shown that the risk of wear and tear . . . and by that, I mean the plastic can wear or parts can loosen. The risk of those issues arising increase a bit as your BMI, or body mass index, increases. So trying to maintain a good body weight is helpful. Avoiding high-impact activities.

And then another rare cause of failure would be an injury of some type. So the implants themselves are very durable. But obviously, the bone adjacent to the implant can be susceptible to fracture or injury.

Especially as you get into your advanced years, being careful to avoid situations that might put you at risk for a fall or an injury, making sure your home is safe in regards to no obstacles on the floor or edges of rugs, and just kind of doing your best to minimize the risk of a fall. A fracture around an implant obviously is considered a failure and typically requires surgery to correct.

With that being said, though, like I mentioned, when patients ask, "How long do these things last?" we give a relatively simple answer, like, "Hopefully 15 to 20 years." But to be honest, even at those intervals of time, the vast majority are still functioning well. Yeah, they're pretty durable implants.

Interviewer: What I'm hearing is after you get your joint replacement, if you take care of your body, your health, your weight, and so on, that your implant can last as long as 15 to 20 years?

Dr. Archibeck: Yeah, I think that's fair to say. The other thing that I should mention is that even if a joint replacement is functioning well, it's wise to see your physician. And recommendations vary, but I would say probably about every five years.

So the first year, there's a regimen of post-op visits. Usually two weeks, six weeks, maybe three months, a year. After that, though, we usually let patients go for a while. And it's wise, though, to return and get an X-ray and be evaluated, I would say, anywhere from every five to ten years.

The reason being is that there are things that can occur with the hip replacement or knee replacement that aren't always painful. So if you get a little bit of plastic wear, that might be something that we would be able to see on X-ray, but may not be a painful problem.

And sometimes, if caught early enough, the solution to that issue is relatively simple. If caught late, when it's maybe resulted in loosening of an implant, it can be a much more problematic issue to correct.

So routine follow-up, even after that first year, is wise. Especially as you get to the 15- to 20-year interval of time since surgery, then it becomes even more important because that's about when our concern kind of increases a little bit in regards to the risk of some of these wear-and-tear type mechanisms of failure.

The other thing that's worth mentioning is beyond just having it last a long time, obviously all patients want it to be as comfortable and functional as possible. And it's true that a hip replacement and a knee replacement probably will never feel like a totally normal joint, but the closer we can get it to that, the better.

And typically, hip replacements, for whatever reason, seem to approximate a normal hip more closely than a knee replacement. In other words, it's much more common to have some residual symptoms with a knee replacement.

But the most common reasons we see patients back who maybe had a knee replacement or a hip replacement five years ago, 10 years ago, and just somehow, again, feel concerned that it's not as comfortable as possible, or as they were hoping it would be, include weakness.

So that early post-op time frame, like we mentioned, it's important to work on strengthening. Maintaining that strength is equally as important to allow that hip or knee to function as good as it possibly can.

Again, maintaining a good body weight. It's been shown that if your BMI kind of creeps up a little bit, sometimes the patient's satisfaction level with their replacement decreases. So even though it's not intuitive that that would be the case, maintain a good body weight, maintain good strength.

And obviously, if it really seems like something is wrong, if it's painful and it seems to be not resolving or worsening, then you definitely want to see your physician to kind of rule out any concerning findings.

But again, continuing with those strengthening exercises, maintaining a good body weight, those things can help the joint replacement function most effectively for a long period of time.

Interviewer: Now, going back to that idea of satisfaction, if a patient gets a replacement and is able to take care of it for those 15, 20, or more years, what kind of improvements in quality of life can they expect after receiving a joint replacement?

Dr. Archibeck: That's a good question. The good news is that the vast majority of patients, even though they may have some residual symptoms, feel as though they're dramatically improved when compared to their status preoperatively.

So like I mentioned, it's often the younger patients that maybe notice the limitations or the shortcomings of joint replacement because of maybe their demands of it or their expectations of it.

Because they're just by nature more active, they may notice those limitations a little more than a very elderly patient that maybe isn't as active. Those patients often feel like, "Hey, this does feel pretty normal to me," whereas, maybe the younger, more active patient feels that they're still a little limited by it.

But like I mentioned, most patients, younger or older, generally feel significantly improved after surgery.

And as I mentioned earlier, they should expect to be able to participate in those activities that I mentioned without significant pain: walking, hiking, biking, swimming, things like that. The more demanding activity is, so things like stairs, squatting, walking up or downhill, long hikes, it's not uncommon to still maybe develop a little fatigue or a little ache in the joint. And those things, unfortunately, may persist.

So, with knee replacement, it's been estimated that about 15% to 20% of patients continue to have some degree of what they describe as pain, even though most patients are still very satisfied. Hip replacements, it's a little less. So maybe 5% to 10% of patients still have occasional pain. So, yeah, unfortunately, not a totally normal joint, but definitely typically a significant improvement.

Although the things that I mentioned, like infection or injury, are extremely scary and worrisome, they are very, very rare. And most people do very well after hip or knee replacement in regards to a significant improvement in their quality of life, both in regards to the level of pain that they have as well as their level of function and the activities that they're able to participate in.

Interviewer: Now, if your child is complaining of leg pains, could it be growing pains, or is it something more serious?

Dr. Julia Rawlings is a nonoperative sports medicine physician here at University of Utah Health. And let's start with the type of leg pain I think just about every kid, at some point, experiences. One point or another, it seems pretty benign. What exactly is growing pain? What are growing pains, I guess?

Dr. Rawlings: Yeah. So growing pains, the name came kind of early in the 1930s and 1940s when people thought that growth was related to these pains that children get, usually later in the afternoon, evening, or maybe even wakes them up at night. But we know now that it's not related to growth, but it's more likely just related to children being very active during the day. So it's just these pains that come on later in the day or at night, mostly from kind of overuse of muscles.

Interviewer: But it's not like the bones are stretching or anything like that. It's just . . .

Dr. Rawlings: No, it doesn't have anything to do with growing. It does happen in children, but it doesn't affect their growth. It's not directly related to growing.

Interviewer: My understanding is it's pretty normal for kids to be having this and just as part of, like, I guess being active and running around.

Dr. Rawlings: It's very common. And the places where it's most common, usually it happens in the calf, the thigh, or the back of the knee. So those are some of the spots that we look at.

Interviewer: Okay. And it's like an aching or just like . . . I guess, how do we know that it's like that kind of pain?

Dr. Rawlings: Yeah, it's like an aching or a throbbing pain. Sometimes children will grab the back of their legs or grab their thighs or just be more cranky. It's usually at the end of the day. It can wake them up at night though.

Interviewer: And so your child's complaining of pain. I guess, as a parent, if you're worried, you know, what should you be on the lookout for to find out if it's something more than just typical growing pains?

Dr. Rawlings: Yeah. So growing pains usually happen intermittently. So it can happen every night, but that's a little less common. So growing pains typically are intermittent. They're usually in both legs, not necessarily at the same time. And the child usually wakes up in the morning completely fine and running around like there's nothing wrong. Those are all very typical for growing pains.

Interviewer: So say a kid is, you know, maybe continually complaining about leg pain or maybe they're getting it through the day. As a parent, what are some of the signs and symptoms that you should be on the lookout for to kind of let you know this isn't growing pains, it's something more serious?

Dr. Rawlings: Yeah, great question. So if your child is complaining of pain, particularly during the day, if they are complaining of pain in the same leg, if the pain stops them from participating in sports activities or from running with their friends, if they are limping with the pain during the day, or if you see anything else that seems abnormal, so swelling of the leg, redness of the leg, if they're getting fevers with it, all of that is something besides growing pains, and you should be seen for that.

Interviewer: And not to, say, worry parents, you know, prematurely, but what could be going on with their child?

Dr. Rawlings: So it could be something as simple as an overuse injury. Lots of times, in children that play sports, we see overuse injury at the growth plates actually. That's probably one of the more common things. If they're very active, say a teenager running, they could get a stress injury. They could just have tight muscles, and stretching could be helpful. All the way up to the more serious things that are very rare and uncommon, like childhood arthritis or bone cancer.

Interviewer: If your child is, say, showing some of these symptoms, what kind of doctor should you be going to, to, you know, treat the leg? Is it a primary care pediatrician? Is it a sports medicine specialist?

Dr. Rawlings: I think, initially, if your pain is kind of vague and you're not sure what's going on, starting with the pediatrician is a great place. If it's something more serious, like they're not limping, they can't get into the pediatrician, it is reasonable to go to an urgent care or the emergency department, particularly if they won't walk at all. We need to see what's happening. There are . . . sometimes toddlers will have a small fall and twist their leg, and they won't walk, and they'll have a little fracture that you won't even pick up on. And so that's one of the more common reasons we'll see toddlers stop walking, and that's something that can be taken care of either by a pediatrician, a nonoperative sports medicine provider, or in an urgent care emergency medicine setting.

Interviewer: And is there anything, maybe a home remedy, something they could try at home before they, say, take them into a doctor to maybe alleviate any of the pain that they're experiencing?

Dr. Rawlings: Yeah. So if they're experiencing more of these growing pains, kind of intermittent pains in the evening or at night, you can do things like massage the legs, massage the muscles. Warm packs, heating pads are helpful. If it's severe, you can try some acetaminophen, Tylenol, or ibuprofen. And sometimes if it's pretty frequent, you can have them do some stretching during the day and see if that helps as well.

Interviewer: Are you working out from home with exercise bands? Well, you might want to watch out for this injury.

Dr. Troy Madsen is an Emergency Room physician at University of Utah Health. And a lot of us are trying to get in some exercise at home, and we might reach for those exercise bands. But, Dr. Madsen, I understand that there could be some risk working out with those exercise bands. Tell me more about that.

Dr. Madsen: You know, Scot, I have used exercise bands, and this is a risk I've never really considered, but apparently there is an increase in risk and injury to the eye that has been something that's been noted since the pandemic started. So what we're seeing, I think, more and more people are not going to the gym, they're working out from home, and a great tool is a resistance band. If you've ever used this, it's like a giant elastic band. You know, these things are huge. You put it around your foot, and then maybe you're leaning back or doing something with your leg, all kinds of different things, stretching, strengthening.

Well, at the University of Miami, they actually published their experience with seeing multiple patients come to the Emergency Department with injuries to their eyes from these resistance bands. So the title of this article is "Ocular Trauma Secondary to Exercise Resistance Bands During the COVID-19 Pandemic," published in the "American Journal of Emergency Medicine."

And you can imagine how this can happen. I don't know if this has ever happened to you, but let's say you wrap it around your foot, and you're stretching your leg out, and that thing is really tight. And then, maybe you've got socks on or something, and it slips off your foot and flips back and hits you in the eye.

Interviewer: Oh. Ow. Oh.

Dr. Madsen: Yeah, sounds miserable. Sounds absolutely miserable.

So they reported their experience in the "American Journal of Emergency Medicine," and they talked about 11 patients they had seen, and these were not minor injuries to the eye. So they said 11 patients, 14 eyes, so that means several of these patients had both eyes injured. Eighty-two percent of these patients had a hyphema.

So a hyphema is a pretty big deal. That's where you get blood behind the cornea. And, you know, if you ever look in the mirror, you see the cornea, you see your iris, the colored part of your eye. The cornea is the clear part over the top of that. And if you ever see blood there, it just looks like just this red line that's filling up behind there, that's a pretty big deal. That's a serious injury.

And then, vitreous hemorrhage in 36% of these patients. That's blood back behind the iris, back in kind of the main part of the eye. That can really affect your vision. Potentially, if it causes enough damage, potentially have long-term effects. Same thing with a hyphema if it's not treated.

So these are not minor injuries, but they saw a number of these, and just given the number they've seen, they reported on it in the "American Journal of Emergency Medicine" to make people aware that things are happening with resistance bands.

Interviewer: All right. So not happening to, necessarily, a large number of people that we know of, but is in the realm of possibility of happening apparently.

Dr. Madsen: Exactly. And I think the reason they published this and their conclusion was, if you're using a resistance band, wear glasses or consider wearing goggles. I mean, it may seem like overkill. It is something that emergency departments are seeing. This is one emergency department's experience. I'm sure it's happening elsewhere. I have to be honest. I have not seen this in the ER yet, but if we talk to some of our ophthalmologists, my guess is that they probably have. So it's out there, it's happening. You know, takeaway, be aware of it and consider wearing some glasses or goggles if you're using a resistance band.

Interviewer: Yeah, or consider just making sure that you're looking at how you're using it, and "If it was to slip right now, would it slip back and snap me in the eye?" And is there an adjustment you can do in your form that would, you know, prevent that from happening?

Dr. Madsen: Yeah, exactly.

Interviewer: Travis Nolan is an athletic trainer that works for the University of Utah Health Orthopedic Center and also works with high school athletes here in the valley. And the question today is if an athlete gets a fracture, should you always go get that x-rayed? Now, I threw on a trick word there, Travis. I said "always," right?

Travis: Yes, yeah, yeah.

Interviewer: So maybe not always. But first of all, you were saying that you've got stories of people who got a fracture, didn't get it x-rayed, didn't get it taken care of, and then it really impacted them later in their life. Give me an example of how that might happen.

Travis: I ended up coming in over this summer just to do some check-up on the school I work at and things like that, and this athlete pops in my room. And he wasn't really thinking about it much. He was doing some lifting and just experiencing some slight pain in his wrist. And he's like, "Hey, man. Is this normal? I took a little follow-on a couple of weeks ago." He actually did ended up going to see somebody. He was instructed to come back in if it wasn't getting better, and the athlete didn't do that. And so after evaluating it, I was pretty concerned for a fracture still present in his wrist.

And so we sent him back in. And I guess, long story short, since that second referral, getting him back into a doctor again, he has actually had four different surgeries on his wrist trying to restore normal function and trying to properly heal the bone that broke. And so he ended up breaking his scaphoid bone. And for those that have broken it or know about that bone, I'm sure they know the complications that can come from breaking that bone, and then it not healing properly because that bone can lose blood supply. And when that happens, it's called necrosis. And so part of that bone can sort of die off. He, to this day, still has trouble playing athletics. It has affected him in class, in school, writing, typing, so many aspects of his life, carrying things, lifting a backpack. And so he is definitely one of my big advocates when I have to tell other athletes to go get an x-ray, and he'll back me on that a lot of the time, so yeah.

Interviewer: So, for young high school athletes, are there some fractures that tend to occur more often that if it does occur, that is definitely a reason you want to go see somebody, ask for an x-ray? What are those kind of common fractures that could really give you problems down the road if you don't take care of them almost immediately?

Travis: Yeah, the ankle. So whether or not it's from twisting your ankle, getting it caught up in a pile, or if you're a basketball athlete, very common to come down on top of somebody's foot after you jump up into the air, and then any kind of fracture around the ankle bone. So whether it's a small chip off your tibia or fibula, those are sort of common when it comes to spraining your ankle. And most of the time, why doctors recommend x-rays for ankle sprain is because you can get . . . whether it's a small piece of your ligament sort of pulls off a little piece of bone, that's a common area to fracture as well.

The other area of the body that is another big one to go get checked out is called the base of your fifth metatarsal. So that's on the outside of your foot there. And that's a special bone because it's sort of just like the one on our wrist where if we don't catch it in time, it can also go through that sort of necrosis. And it's called a dancer's fracture, actually, because it happens in dance quite frequently. And so that's one of those areas where if you do have pain on the outside of your foot sort of near the . . . we call it the base of our fifth metatarsal. If you have pain in that location, that's a very important one to go get evaluated and x-rayed because it can go through that necrosis process.

And then also, they actually are seen quite often in the military. They're called marcher's fracture. So it's at second or third metatarsal in your foot, and that's the same thing. It's going to be those repetitive stress motions. So whether it's marching, running, jumping, that's another very common area in athletics or the sports world to see a fracture in.

Interviewer: So I noticed that these common fractures in athletics that you believe should be x-rayed seem to be around the wrists, ankles, and the feet, the smaller bone.

Travis: Yeah.

Interviewer: Yeah. So those are the ones that if you don't get them looked at, x-rayed, follow your doctor's instructions can really kind of mess things up in the future for you not only in athletics, but in regular life as well. And I'd imagine a lot of those you don't even know that there's a fracture. You probably . . . just pain. You thought maybe just strained something or sprained something. Is that accurate?

Travis: When athletes have a bigger emotional response, it's pretty easy to convince someone, like, "Hey, we should go get an x-ray on this," like, "You're in a lot of pain right now." It's more time those athletes that they're able to tolerate it. They're sort of pushing through it, they're playing with it still, or they come in and they're, like, "Dude, this is something I can deal with." And you have to have that conversation and you have to educate them on, "Hey, look. It's not about you missing a couple of games." This is about your long-term health, especially for those important areas, whether it's the scaphoid, the base of the fifth. There are some areas in your body where if you don't get them checked out and treated properly, they will cause long-term complications. You will have to get multiple surgeries on them in order to try restore normal function in your body.

Interviewer: And if the athlete is experiencing that, how much time do they have to go get the x-ray? Now, I know at University of Utah Health, we have a walk-in orthopedic center, which is great because you could just walk in, tell somebody what's going on, and they could do an x-ray right there. If they need to have a couple of days in order to arrange that, did you have a couple of days to do that or you really want to get it checked sooner than later?

Travis: Yeah. So can you wait overnight? Sure. Should you wait the entire weekend and then maybe go get it checked out on Monday? Those are some things that I probably wouldn't recommend unless you've been advised and it's already been evaluated by somebody, but make sure you're getting evaluated by a professional that can give you recommendations on, "Hey, this is one of those high-risk areas and this is why I would go get an x-ray tonight instead of waiting over the weekend."

updated: December 8, 2022
originally published: March 3, 2021

Interviewer: If shin splints have been bothering you for more than a few weeks, it could be more than shin splints. Athletic trainer Travis Nolan, why do you recommend a professional evaluation of chronic shin splints by a physical therapist or an athletic trainer if it's been something that's been going on for more than a few days?

Travis: You can very easily mix up shin splints with a stress fracture. They give very identical signs and symptoms. They cause the same sort of dysfunction. It's something that, most of the time, athletes can easily push through it and they can sort of tolerate and deal with the pain and it doesn't necessarily take them out of practice. But eventually, when it does take them out of practice, that's when you see them in a clinic. And then at that point, it's like, "Oh, man, you have a full-blown stress fracture. This has progressed, and now we need to hold you out for . . ." whatever it may be, four to six weeks, ". . . in order to let that stress fracture heal up."

So sometimes those situations can be avoided. They can be caught early, implemented restorally, and then you're not missing as much time from athletics if you get those stress fractures checked out sooner rather than later.

Interviewer: And what exactly is a stress fracture and how is that happening? What's going on there?

Travis: So a stress fracture is more so like a stress response from the bones. So it does go through certain stages. That stress response is also almost exactly what shin splints are. It's sort of a stress response in your shin. It's an inflammation and irritation of the periosteum or the covering around your shin bone, your long bone right there in your shin.

And so, basically, it progresses from that sort of first stage of just inflammation, it's bugging you, you only sort of notice it during that practice, and then it can progress to you start noticing it after practice. It doesn't just go away right away after practice like it usually did. And you've noticed it for a good amount of time after practice.

And then it's going to progress to now you're noticing it multiple times throughout the day. It's not just during athletics. It is before, it's during, and it's after. So it never really goes away.

And then it's going to slowly progress even further to that constant pain, sharpshooting almost, along the bone. And that's when you get closer to that stress fracture.

That beginning area is going to be sort of shin splints. So making sure you're treating your shin splints appropriately and doing the right thing so they don't progress and get worse.

Interviewer: So is a stress fracture basically the bone developing cracks in it because of repeated force?

Travis: Yes, exactly. Anything where you're just constantly sort of . . . it's those impact forces on the ground. Also, you have to look at your frequency, intensity, and duration of athletics. And especially pre-season, that's when we're in that sort of stress fracture area and the concern for it. It's more in the pre-season time because that's when your body is getting back used to sort of those impact activities and different things like that. So not just chalking it up to, "Ah, it's not much."

And going to get those things evaluated, making sure they aren't those stress fractures or fractures. Because that's when you're going to miss longer time from athletics. Going and getting an evaluation and sitting out for a week to let your body heal up, get rid of that inflammation process, and then you're back into athletics, instead of letting it get to a full-blown stress fracture where you are eventually missing four to six weeks.

Interviewer: You pulled your hamstring. You might have been playing a competitive sport, you might have been just playing something with your friends, you might have been running around with your dog, and you feel a pain in the back of your leg. It's possibly a pulled hamstring. Is that something you can handle on your own, or is it something that you really should seek help for? We're going to find out the details on how to heal a pulled hamstring today.

Travis Nolan is an athletic trainer at University of Utah Health. Travis, how does somebody know if they pulled their hamstring? What are the symptoms? Where would you feel the pain and that sort of thing?

Travis: Usually, the signs and symptoms are going to be sudden onset of pain in the posterior thigh or sort of in that back thigh musculature just below your buttocks. And so you're going to have a sudden onset of pain, most of the time sharp, very pinpoint, and local, so you can pretty much point to one spot in that area. It's not going to be your entire muscle belly. And also decrease of motion, decrease in strength in that muscle belly.

Those are some of your immediate signs and symptoms that you're definitely going to notice right away.

Interviewer: And if somebody does pull their hamstring, is that something that they can then take care of on their own, or should you really see somebody?

Travis: Most of the time, when you do have a strain or a pull, you can actually take care of that on your own. You can take care of that at home, as long as you know what you're doing and know your exercises.

And really, the biggest guiding principle through rehab with a strained or a pulled hamstring, it's going to be listen to your body. Listen to those pain levels and don't push through any kind of pain, because that is essentially your body trying to tell you, "Hey, we're trying to heal this area, and you are making it worse for us." And so you're just going to prolong your recovery and prolong your rehabilitation process by pushing through pain.

Interviewer: So if somebody has already pulled or strained a hamstring, and they've seen a professional, and they have some stretches or some exercises, and this feels much like the last time, then they could just get those exercises and stretches and proceed as normal.

If it's a first-time situation, would you really recommend going to see a physical therapist or an athletic trainer to get those exercises and stretches?

Travis: I would recommend for the first-time patients to go and get those exercises and stretches, a little bit of guidance, because sometimes those exercises, to a person, might seem a little tricky. They might seem complicated. And when patients run into that, even unknowingly, they can sort of get this noncompliance with their rehab program. It can be frustrating when you don't know exactly what you're doing.

And so when you're doing things appropriately and correctly, it's going to feel a lot better, and you're going to feel like you're actually making progress with this, and then you're not just going to maybe quit, because it's like, "Oh, man, it's not getting better. The pain is continuing."

So, yes, I would definitely recommend for those first-time people that maybe don't even know if it is a hamstring strain and maybe they're struggling trying to determine if that is what's going on, definitely go get it checked out by the right professional.

Interviewer: And those exercises and stretches, does that actually speed up the healing time?

Travis: Yes. By actually completing rehabilitation, so exercise, stretches, and using some modalities and these things you can find at home, such as ice, heat, different things like that, it is going to accelerate your healing process.

And most importantly, if you are an athlete or maybe just a recreational athlete, you will need to complete some exercises in order to build strength back in your hamstring, get the same length back in your hamstring that you had previously. Because there will be scar tissue formation from the injury, and that scar tissue formation is not only going to affect our range of motion, it's also going to affect the muscle strength and the sort of force production that our muscle is able to generate. And so, by doing rehab and exercises, you are going to return back to the level that you were previously before your injury.

Interviewer: So doing nothing, just resting, not necessarily the best idea.

Travis: No, not necessarily the best idea. Will it get better? Yes, it totally will. Will it return to the same level of function prior to your injury? Most likely not if you're just hanging out and sort of resting, and that's all you do in order to heal it.

Interviewer: And then if somebody has already been in and they pulled or strained it, and they have implemented the exercises and the stretches, how long does it generally take if you're being good about that and icing and heat to recover?

Travis: So the recovery process for a strained/pulled hamstring is quite varying, honestly. And that is probably one of the most debated things in research when it comes to pulled hamstrings and things like that. Specifically, when we're looking at athletes, there's the return-to-play timeline. It can range, honestly. And research has shown it can range from 7 to 50-plus days.

And so it really depends on the progress of the individual person. Everyone heals differently. As well as sort of the initial injury. Was it a Grade 1 hamstring strain? Was it a Grade 2 hamstring strain? And then it also all depends on sort of the level of athletics or the level of sort of recreational stuff that you're trying to get back to. That can sort of determine your return-to-play timeline, if you will.

Interviewer: And if somebody wants to have their hamstring pull looked at, the walk-in clinic at University of Utah Health would be a great option. If that's not an option, just any physical therapist or athletic trainer, would they be able to help with a hamstring pull like this?

Travis: Yes, definitely. And I know there are a lot of physical therapists that you can schedule appointments with, go see, get this checked out. And so, yes, this is definitely something that getting in to somebody, in my opinion, especially for the general population, it's only going to accelerate your healing process and your recovery time and getting back into those activities that you actually love doing.

Interviewer: Three common injuries that young athletes might get and what to do about them. Dr. Julia Rawlings practices primary care sports medicine and pediatric emergency medicine at University of Utah Health. Wanted to talk about three injuries that a young athlete might get and what to do about those. And the three injuries we're going to cover are shoulder, ankle, and hand. So Dr. Rawlings, shoulder injuries, what type of athlete normally gets those?

Dr. Rawlings: Yeah. So we see acute shoulder injuries, again, meaning from a trauma or something that's happened that day, typically from contact sports. So football rugby, soccer, skiing, those are all pretty common sports where you can see shoulder injuries.

Interviewer: All right. And when should a shoulder injury be something that would concern somebody enough that they might want to see a doctor such as yourself?

Dr. Rawlings: So definitely if you dislocate your shoulder, which hopefully the person would be pretty quick at getting help for that. But if the shoulder is popped out of place, we definitely want that to be seen as quickly as possible. If there's any problem with actually moving the arm using the shoulder, then that should be seen. Especially in a younger person, then we would want to get an X-ray. A younger person is more likely to break a bone than to tear a tendon like the rotator cuff, and so we would want to see those people sooner rather than later.

Interviewer: Number two, the ankle. What types of athletes suffer ankle injuries?

Dr. Rawlings: So anybody that's running on an uneven surface. So if you've got grass, turf, you're trail running, or if you're playing basketball and you could step on somebody else's shoes, you have the high possibility of rolling your ankle and getting an ankle injury. So I would say the most common thing we see is you get an ankle sprain from rolling your ankle inward, or sometimes, especially in younger patients, we'll actually see broken ankles instead of an ankle sprain.

Interviewer: And as far as ankles are concerned, is it pretty obvious if I'm going to have to go see a doctor as opposed to if it's something that I think is going to just get better on its own in a couple of days?

Dr. Rawlings: You know, I don't think it's always that obvious actually.

Interviewer: Okay.

Dr. Rawlings: I have definitely seen people come in that they've just kind of been hobbling around for a week and they end up having a broken bone. So I think sometimes people just assume it's a bad sprain. So I would say, again, if you're having a hard time putting weight through the leg and you can't walk, that's a good time to be evaluated. If you twisted it, it gets swollen but you can walk around on it, it's unlikely to be a broken bone, more likely to be a sprain. Although some people, especially kids, are pretty tough and they'll walk around on broken bones. So the smaller bone in the ankle, they'll walk around with a broken bone. So yeah, if you can't put weight through it, you should come in. If it gets really big and swollen, you should come in. And in general, if you're pretty active, even if you have a bad sprain, we like to see those just because they do really well with physical therapy, and you're at risk for re-spraining your ankle if you don't get the appropriate motion, strength, and balance back in your ankle.

Interviewer: You had mentioned with the shoulder that younger athletes are more likely to break a bone than tear a muscle. Is there a younger athlete consideration to ankle injuries as well?

Dr. Rawlings: Yes. So especially really young kids that have growth plates that are open still, they're more likely to break a bone just because the bone is weaker than the ligaments. Once you kind of get to the early teen years, you're more likely to sprain an ankle probably until you get to be older, where you get some osteoporosis and stuff, but generally those are traumas from just ground level falls and things like that in the older population.

Interviewer: All right. Three common injuries that young athletes might face and what to do about them. What about the hand? What kind of athlete is facing hand issues?

Dr. Rawlings: Yeah. So again, I typically see these in people that are doing contact. So I'm thinking specifically of football, they have a lot of contact with their hands. I've seen a fair amount of injuries in the walk-in injury clinic from rock climbing, people that will kind of have a sudden pop in their finger. And again, I guess one thing that's important to mention is that just because we're sports medicine physicians, we're actually musculoskeletal medicine physicians, so we see a lot of patients in the injury clinic that were not playing sports. People that were, you know, hammered their thumb . . .

Interviewer: Done it.

Dr. Rawlings: . . . or, you know, were doing housework or just walking. This is not a sports clinic, this is a musculoskeletal injury clinic, so there's all types of ways that we see people injuring their hands and are not necessarily related to sports.

Interviewer: So on a hand injury, is that something that you probably would want to have seen sooner than later? I'd imagine, especially since there's a lot of joints there, it would be.

Dr. Rawlings: Yeah, that's something that's pretty easy for us in general to get an idea of what's going on in the injury clinic. We can make sure you don't have a broken bone. A lot of the fractures we can actually reduce, meaning make them straighter, in the injury clinic and then get you set up with the appropriate follow-up, either with the non-operative sports medicine provider or with our hand specialist.

Interviewer: All right. Perfect. Thank you very much for giving us an insight on some injuries that young athletes might face and also reminding us that what you do there goes beyond athletes. It could go to somebody who fell off a ladder, for example, and hurt their shoulder, might want to come in as long as, of course, you know, they didn't hit their head and get a concussion or something like that.

Dr. Rawlings: Correct.

Interviewer: Right? Yeah.

Dr. Rawlings: If have bones, muscles, and ligaments and they're injured, we're happy to see you.

Interviewer: So your index finger is swollen. It's not a bee bite. It's not an insect bite. It's not anything that you're injured, and you're not really sure what it is. Is it normal?

We're in the studio with Dr. Kirtly Parker Jones, the expert in all things normal. That's how I always introduce her.

Dr. Jones: You usually introduce me as all things woman.

Interviewer: Oh, that's right.

Dr. Jones: But this is a good topic to think about.

Interviewer: Okay. Yes. So, Dr. Jones, my mother, because I think our audience by now thinks I'm just not normal, but my mother has this problem that's been recurring for over a month now that I don't think it's normal, but you be the judge on that and you help me decide. So her index finger . . .

Dr. Jones: Just on one hand?

Interviewer: One finger of one hand is swollen. And she thought it was maybe just an insect bite. She didn't injure it, but it's swollen. It's sometimes painful. Not all the time. It just varies. And we don't know what it is.

Dr. Jones: This is a great question because it's a paradigm for how we begin to think about a problem. This is not a girl's problem first of all. At least I don't think it is. It may be a problem that's more common in women, but this is not a girl's problem. So it's not my area of expertise. But what I am, having been trained as a physician, is an expert in thinking about how to solve problems. So, first, tell me more. It's been a month?

Interviewer: It's been about a month.

Dr. Jones: It's sometimes painful, but not all the time?

Interviewer: Yes. And so about a week ago . . .

Dr. Jones: Yeah.

Interviewer: . . . I asked her, I'm like, "Is it getting better? Have you tried icing it?" And she goes, "No." And so she ices it, and she noticed it just got so much worse . . .

Dr. Jones: Okay.

Interviewer: . . . to the point where she couldn't even bend it.

Dr. Jones: Right. So that's part of the questions. What makes it better and what makes it worse? So what makes this worse is icing it or making it cold. Does it have a color? Is it pale or is it red or is it the same color as the rest of her finger?

Interviewer: You know what, from how I can see, it looks normal. It just looks like, you know, when your skin is too stretched out because it's been swollen so it looks, I guess, shiny, right?

Dr. Jones: Okay. And the pain, is it sharp? Is it tingly? Is it achy? What is the kind of pain?

Interviewer: As she describes it to me, it's kind of tingly and it aches.

Dr. Jones: Aches, okay. So are you normal? And the answer is no. That normal is defined as something that happens to 95% of people, and this doesn't happen to 95% of people. Now, the other question is, and you can give me a range for your mother. Is she over 50 or under 50?

Interviewer: She's over 50.

Dr. Jones: Okay. Great. So this is an older person. Now, do I think this is an infectious problem? It's been happening for a month. It hasn't gotten a lot better, but it hasn't gotten a lot worse and there was no instigating cut or bite or anything. So we don't think it's infectious. Is it a contact thing? Meaning did she get her finger into something that causes a superficial contact, kind of like poison ivy or poison oak or something in the kitchen? Well, it's possible, but this is a month and it's continuing on. Now, what has she done? She went to see somebody?

Interviewer: She did. She finally went to see her family physician, surprisingly enough gave her painkillers. That's obviously not working.

Dr. Jones: Gave her what kind of painkillers?

Interviewer: I'm not too sure.

Dr. Jones: So something that's worthwhile trying are any of the prostaglandins inhibitors, and that would be aspirin, Motrin . . .

Interviewer: She has tried aspirin.

Dr. Jones: . . . Naprosyn, all in that kind of category of things that decrease inflammation. That's a good thing to try. Narcotics would not be indicated or useful on this.

So when someone has one finger that feels like this, you begin to think about, "Is this tendonitis?" In other words, does she have something in her tendon sheath that's inflamed that's hurting her finger? Because then it would be more or less irritated depending on how much she used it. And it could get swollen. So people who have tendonitis in their finger, sometimes their whole finger is swollen. And it could have been aggravated, and she is a woman who's used her hands a lot in the past. You've told me that she has been a chef. So tendonitis or inflammation of the tendon sheath of that finger can make the whole finger pretty swollen.

So is it life-threatening? Does she need to go to the ER today? This is the way doctors think. No, she doesn't need to go to the ER today because she's been doing this for a month. Is it going to be treated with painkillers? No, but anti-inflammatories would be helpful. And a three to four-day course of ibuprofen or Naprosyn, that she takes two to three times a day to see if that makes it better, would be useful.

If that doesn't get better, this is an important finger for her. So what kind of doctor would she see? Well, she's been to her primary care doctor. Now, the primary care doctor thought this might just go away. And so you think you've done a great job because they don't come back, and you don't know that actually you did a bad job and you don't know whether they're not any better. If she goes back to him, then he starts thinking, like I am, about a different set of things, like tendonitis or something like that.

So who deals with the hand? This doesn't sound like an orthopedic problem, but they know about stuff that affect joints and fingers. So an orthopedic doctor who does hands would be an expert to see.

The other kind of person who deals with finger and skin that gets swollen and joints that get hurt when you bend them are rheumatologists. They're specialists in joints and skin and fingers. Because sometimes people can get a weird result of a pinched nerve and the radial nerve feeds the thumb and the first digit and the middle finger and half of the ring finger. And so sometimes that could be a neurologic problem in the hand. But this could be a tendonitis of her tendon sheath that it just isn't getting better.

But you've got a swollen single finger and it's been going on for a month and it sometimes hurts a fair bit, but sometimes it doesn't hurt so much, but this is an important finger. So this is not normal. You need to probably go back to the doctor, and you may need to see a specialist for this particular problem.

Interviewer: How to handle a knee injury. Dr. Julia Rawlings practices primary care sports medicine and also pediatric emergency medicine, and she is one of the physicians that you would find at the walk-in orthopedic clinic at University of Utah Health. I wanted to talk about knee injuries and young athletes actually. What are some common ways that young athletes can injure their knees? What specific sports or activities do you see?

Dr. Rawlings: Yeah. So it's really common to have a knee injury when you're playing sports, particularly contact sports. But severe injuries, including the ACL, don't always have to be from contact. So we typically see knee injuries that are acute, meaning they happen from a trauma, when you're doing an activity where there's either contact or you change directions quickly, so you're pivoting, you're shifting, you're changing your weight, and the knee can kind of buckle on you and get injured. In people that do more endurance-type sports, like cross country runners, we tend to see more chronic knee pain just from overuse.

Interviewer: Got you. So you kind of covered some of the common injuries to the knee. What could be handled at home without a clinic visit? And then we'll get to when you should perhaps consider coming in.

Dr. Rawlings: Yeah. So starting with an acute injury, meaning that's something you were out doing your sport, you were doing something, and all of a sudden you felt the knee pop, or you twisted it, or something happened. A couple of clues that I would give to go ahead and come in to be seen is, one, if you're having a hard time walking on your leg, then we would really like you to be seen sooner rather than later. We'd like to get X-rays and make sure there's nothing that's broken and then do a good examine and check out the ligaments and the meniscus of the knee.

Another clue is if your knee gets pretty swollen, then that means that there's something significant going on in your knee that should be seen sooner rather than later. Two more other clues, things that I like to ask people about and look for. If your knee feels like it's buckling under you, it's giving out when you walk, then there's the potential that every time it buckles, that we're doing more damage. And in that case, we'd like to get you on crutches and get you into a knee brace. Or if the knee is getting stuck or locked, meaning you can't bend it or you can't straighten it very well without kind of forcing it, those are all things that we'd want to see you sooner rather than later for.

Interviewer: And then when somebody comes into the clinic with some of those more serious symptoms, as you said, what does the clinic do?

Dr. Rawlings: Yeah. So if you have, say, a big swollen knee and we're worried about bigger injuries to the ACL or to the meniscus, something like that, what we would generally do is start off with X-rays, make sure there's nothing that's broken, and then we would do our exam, get a feel for what we think is going on, and then generally get you set up in a knee brace that's appropriate for the injury you have, plus or minus crutches. And then often, patients with significant injuries we'll get set up for an MRI to check out the soft tissue structures, which we can't see on X-ray, and get a definitive diagnosis. And then depending on what we see on our exam, we'll either get you set up with one of the non-operative sports medicine providers for follow-up or our sports medicine surgeons. My practice myself is I typically just let people know what their MRI shows, and then depending on what they need done, I'll then schedule the appointment with the appropriate follow-up person.

Interviewer: And when people come in, how often would you say that they could just come into the clinic and that's kind of it? It's just going to take a little bit of rest, and they're going to recover from their injury.

Dr. Rawlings: You know, it depends a little bit, I think, on the age demographic. So we do see a fair amount of people that come in with an acute knee injury that have just flared arthritis, and they don't actually have an injury to the ligament or something that we would need to do an MRI or surgery for. And those patients we really treat with physical therapy, maybe a steroid injection, and kind of getting them back to functioning, hopefully, so that we can prolong the longevity of their knee. In those cases, then, yeah, all they need really is just that visit in the orthopedic injury clinic and then a follow-up appointment down the road with a primary care sports medicine person or a sports medicine surgeon.

Interviewer: Are there any final thoughts you would want a listener to know about the clinic, or knee injuries, and how to handle that or take care of it?

Dr. Rawlings: I think definitely when in doubt, especially when it's an injury that's happened within the last day or two, come on in. We'll be happy to take a look at it. And if you're getting a chronic injury from training for a marathon, or in kids, they can often get growth plate injuries, again, if they've happened in the last three months, we're happy to see you in injury clinic for more of a chronic developing problem as well.

Interviewer: When should you consider University of Utah Health's Orthopaedic Injury Clinic over perhaps a visit to the ER or urgent care, or is it something you can handle on your own? That's what we want to find out today.

Dr. Julia Rawlings is a primary care sports medicine and also practices pediatric emergency medicine, but it's that sports medicine doctor that we really want to talk to today. So the first thing I want to find out is what are some of the common orthopedic injuries a person should consider using the Orthopaedic Clinic versus an ER or urgent care?

Dr. Rawlings: The Orthopaedic Injury Clinic is a great place to go if you have an acute injury, meaning that you have had an injury that you've sustained recently. We're actually willing to see people that have had an injury anytime in the last three months, but preferably not something that's chronic and going on. We'd rather you go ahead and make an appointment with a regular physician during regular hours, although it can be at the Orthopaedic Center.

Specifically, things that are good for the Injury Clinic. So we see a lot of injuries from the ski slopes. We see people that have been playing different sports, or running, biking. We see some football injuries. Anything that's kind of acute. Anything that could go to an urgent care can go to the Orthopaedic Injury Clinic if it's a musculoskeletal injury.

A couple of things we don't see at the Injury Clinic. We don't do stitches there. So if you're bleeding and you think you need stitches, an urgent care or the emergency department would be more appropriate. Also, if your bone is pretty crooked, it's probably a better idea to go to the emergency room. We can do some local numbing medicine to set some easy broken bones, fingers, and things like that, but larger fractures would need to be seen in the Emergency Department for sedation.

Interviewer: And what kind of diagnostic tools do you have there that kind of makes you the choice for some of these as opposed to perhaps an emergency room or an urgent care?

Dr. Rawlings: Yeah. So the Injury Clinic is fantastic because we have access to x-ray on-site, and we can see those images back as soon as they are done. And depending on the time of the day, we actually can often get the reads back from a musculoskeletal radiologist within a few hours. Sometimes those reads don't come back until the next day. We don't have the capability to do CT scans at the Injury Clinic. We do have access to scheduling MRIs in the building, but that's not done the same time as the visit.

So one great thing about the Injury Clinic is you get kind of a full package. So you get your x-rays. You could get an MRI set up. We have all of the braces and everything that you would need, crutches, things like that. And then, we can get you set up with a specialist, whether that's a sports medicine surgeon, foot and ankle surgeon, or one of our non-operative primary care sports medicine physicians. We will actually make that appointment for you while you're there for follow-up.

Interviewer: So the clinic, it sounds like a better option than perhaps making an appointment. It can be difficult to get in sometimes with an orthopedic doctor at times. So this clinic, it's primarily walk-in, is that how it works, or do you have to make an appointment?

Dr. Rawlings: It is walk-in. It's a little bit tricky right now with coronavirus going on, but, typically, it is walk-in. They are switching to appointments during this period of time, but that's going to be very temporary. Generally, it is walk-in, first come, first served.

Interviewer: How can a person decide if an injury is something that they can treat at home or they can just try to see if it's going to get better versus coming into the clinic or seeing a professional?

Dr. Rawlings: Yeah. So we're always happy to check anything out if you're not sure. A couple of tips that just come to my mind. One is if you have an injury that's bad enough you can't really walk on it or bear weight on it, that's something that should be seen, probably get an x-ray, make sure you haven't broken a bone. Or if you really can't move your shoulder or can't move your arm in some way. If you twist your ankle, and you're walking on it okay, and it gets a little bit swollen, that's something that you could probably wait on at home and see how you do. But, yeah, if you have a hard time moving a body part, that's a good time to go in.

Interviewer: All right. Are there some injuries that really you do want to have looked at, otherwise it could affect you and your mobility in the future?

Dr. Rawlings: Yeah. So there are definitely, particularly injuries that involve the joints. We often like to get a sooner look at what's going on rather than a later look, just because things can happen down the road that can lead to arthritis if they're not treated early. That being said, a lot of musculoskeletal injuries aren't emergencies. Meaning, even if you get something like a torn ACL, which is considered a pretty big injury in the sports world, if you're diagnosed several days after that happens, in general, that's okay. It's not something that absolutely needs to go to the emergency department or into the Injury Clinic even the same day you have it. You'd really be okay to get yourself a pair of crutches from the garage and come in a couple of days later.

Interviewer: For the particularly injury-prone that might have some crutches?

Dr. Rawlings: Exactly. There are a lot of people with crutches in their garage from siblings, so.

Interviewer: Any final thoughts that you have when it comes to the walk-in Orthopaedic Clinic? It's such a great resource. I was able to utilize it. I had a shoulder injury. I'm not even going to go into how that happened because it was not cool, it was not athletic. But it was great because I could go in, they were able to look at it, make sure that I didn't, you know, do any permanent damage, which I didn't, and then, you know, gave me a reference to go to a physical therapist to do some exercises to rehabilitate it, so.

Dr. Rawlings: I think it's a fantastic clinic. I mean, it's staffed by people that are trained in musculoskeletal medicine, so we have a little bit of an advantage over lots of the urgent cares that are more kind of general medicine, that we treat a lot of musculoskeletal injuries. We can get you set up with physical therapy pretty easily. And one or two days of the week, we actually have a physical therapist with us in-clinic. So if your injury is appropriate for that, we can even get you started on physical therapy the night that you come in. So I think it's a fantastic resource.

Dr. Miller: Can you have a fracture without seeing it on an X-ray? We're going to talk about that next on Scope Radio.

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Dr. Miller: I'm Dr. Tom Miller, and I'm here with Dr. Joy English. She's a professor of orthopedics here at the University of Utah.

Joy, do you always see a fracture on an X-ray, or can you actually have a fracture without being able to see it on an X-ray? And if that's the case, what's that called? What is that?

Dr. English: So that's actually a very common question, I guess. Very often, I would say most often, I get asked that question by parents. So one of the more common fractures that isn't seen on an X-ray is a growth plate fracture.

Dr. Miller: Who gets those?

Dr. English: So growth plate fractures can occur in any child that has growth plates, which is where you grow from on the ends of the bone, and usually that's kids and adolescents ages up to about 15 to 17.

Dr. Miller: But what happens after 17 with that growth plate? Does it just fuse with the rest of the bone and you don't see it any longer? Is that right?

Dr. English: Yeah, that's about right. So as soon as the child is done growing, those two ends of the bone close together and they look exactly like the rest of the bone.

Dr. Miller: So, are children more susceptible to growth plate fractures, these types of fractures than adults? I mean adults don't have growth plates per se, but are children then more predisposed to fractures, I guess would be the question.

Dr. English: I don't know that they're more predisposed to fractures, but there is this thought that the growth plate is a weaker part of the bone and so it is very common to actually get a fracture through the growth plate, especially when kids are growing.

Dr. Miller: So back to that question. I mean you could take an X-ray and perhaps not see a fracture that you would typically see in an adult, but you might make the assumption or the prediction that there is a fracture there. Is that correct?

Dr. English: Yeah, and part of the reason that it is very difficult for us to see fractures through the growth plate is because the way that the growth plate looks on in X-ray is the same as fractures look in an adult. And so when we look at the bone on X-ray, the bone looks bright white, but the area of the growth plate appears dark black, or darker than the rest of the bone. In adults, a fracture appears exactly the same way, so it's a dark area amidst a bright white bone. And in children, the growth plate, even though it looks that way, it may be normal.

Dr. Miller: So you have to make this diagnosis many times, I suppose, based on your clinical judgment.

Dr. English: Exactly. So even though we see a dark line amidst a bright white bone, I can say that's a normal appearing growth plate, but if your child is tender directly over that growth plate after an injury that can cause a break, then a lot of times we would diagnose you with what is called a Salter-Harris I, or a growth plate fracture.

Dr. Miller: So I suppose for the parent who takes their child to see a physician, gets an X-ray, and is told that that X-ray is normal, but the child continues to have pain in an area where, you know, they fell or hurt themselves, maybe they should seek additional advice.

Dr. English: That's correct. I think that's very good advice. And often a lot of emergency medicine physicians or urgent care physicians are very good actually about placing your child into a splint or a cast, even if they don't see a fracture on an X-ray. And I would trust that that's the right thing to do, especially for a week or two, until they can follow up and have a repeat examination.

Dr. Miller: So if you make this clinical diagnosis of a fracture in a child, basically would you treat it the same for the same length of time?

Dr. English: Yeah, I would definitely treat it for a period of between four and six weeks, depending on where the growth plate fracture is located.

Dr. Miller: So, bottom line, if you have a child that's had an injury say to the wrist or to the leg and that area is painful and swollen, and even if the X-ray appears normal to a radiologist, you might want to have that checked out by another physician, especially a sports med physician or an orthopedist.

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Interviewer: This week's listener question is with Dr. Emily Harold. She's a sports medicine expert from the University of Utah and the question is: "Ice or heat for a sprained ankle?"

Dr. Harold: That's a very good question. I get this question a lot in clinic. So, typically, ice decreases blood flow to an area, which causes less swelling, whereas heat will bring blood flow to an area which can cause more swelling. Usually, in the first two to three days after an injury, we would recommend ice only. You put the ice on for about 10 to 15 minutes.

Make sure you put something between the ice and your skin so you don't freeze your skin because you can then get freezer burn. Take the ice pack off and once your skin re-warms, you can re-ice the area. So you could ice it as many times as you want during the day as long as you follow those rules.

Once it's been about three days, you can put heat on the injury. Especially for muscle injuries, that tends to help warm up the area and make it a little easier to walk and get around during the day. The heat is also 15 minutes, put the barrier between the hot pad and your skin and let your skin go back to normal temperature before you would use heat again.

Typically, the rule of thumb for us is after three days, you would ice after you do an activity and you would heat prior to doing the activity. That way, you bring the blood flow before the activity and warm up the area. And then after you are done, you put the ice on the decrease on the information that might develop afterward.

Interviewer: How long is it until we can stop icing or putting heat on it?

Dr. Harold: Typically, I let pain be the guide. For a lot of people, within a few days, they don't need to ice or heat the injury anymore, although for some people that have some persistent pain that will last for a few weeks. And they tend to heat before activity and ice at the end of the day.

Interviewer: When is it time to go to the doctor if this doesn't stop?

Dr. Harold: If it's been about one to two weeks and you don't feel there's any difference in your pain, then I think it's time to be evaluated.

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updated: July 18, 2018
originally published: January 26, 2017

Dr. Miller: You jammed your finger? Is that just it or is it something else that you ought to worry about? We're going to talk about that next on Scope Radio.

I'm Dr. Tom Miller and I'm here with Nikolas Kazmers, and he's a specialist in hand surgery and orthopedic surgeon here at the University of Utah, in the Department of Orthopedics. Nik, a lot of times we get jammed fingers and we stub them on stuff, or we play sports and we smack the ends of them, and then the joints swell up in the fingers. Most of the time, maybe we don't think about that as we should. What's the downside of not coming in to be seen for a jammed finger?

Nikolas: More often than not, when somebody jams their finger, that swells and it's painful, usually it's just that, just a jammed finger.

Dr. Miller: Usually.

Nikolas: Usually. Occasionally, it can represent a more significant injury, such as a fracture, or broken bone, or dislocation, basically where the joint comes apart. And that warrants further treatment.

Dr. Miller: Maybe there's really no way to know that.

Nikolas: That's right. Early on, the finger hurts, it's swollen, you don't want to move it. Whether it's something like just a jammed finger, whether there's no more significant damage than just that. But you're exactly right. If there's a more serious injury, oftentimes that looks exactly the same for the first few days or even first few weeks.

Dr. Miller: So should everyone with a jammed finger be seen by a physician and have an X-ray, or is there a way to tell whether your jammed finger might be worse, to the point that it ought to be evaluated for a fracture dislocation. How do we do that?

Nikolas: Good question. I don't believe every jammed figure needs to come in for evaluation, but any patient that's concerned should seek further evaluation. It's relatively easy to get an X-ray to make sure that there's no more serious underlying injury for that. Every patient knows their body and knows their pain tolerance more than any physician out there does. So I think that can be an important guide. If things seem abnormal, aren't working normally for you, it's definitely worth coming in for a quick evaluation.

Dr: Miller: How about duration? If it goes on beyond a certain number of days, would you advise that that be taken care of? I believe that if you wait too long, then you might have your irreparable damage and not being able to move that finger like it should be moved in the future.

Nikolas: That's true. I've had patients who have, unfortunately, not sought medical attention immediately, and they turn out to have a fracture or dislocation, say, eight weeks down the road. At that point, it's very difficult to treat. If this was something that we had seen a week or two after the injury, it would have some excellent treatment options. But down the road, we lose some of those options, and that can affect the outcome, meaning the patient is more likely to have a stiff finger, more likely to have pain, or if the fracture is within the joint surface itself, they might have a higher chance of getting arthritis down the road as well.

Dr. Miller: So let's say they come to see you or the patient is referred to by one of their family practice docs, you take an X-ray, you find out that there's a dislocation. What do you do, actually?

Nikolas: The first step would be to realign that or what we call reduce it, where you realign the joint. Depending on if there's a fracture or not or exactly which joint is involved, the treatments can vary somewhat. But there are certainly more treatments available if we catch this early than down the road. It's usually less invasive if we deal with these injuries early rather than late as well.

Dr. Miller: Now, this might be a crazy question, but what would be the most common ways people jam their fingers? Playing baseball, I think, might be one of them.

Nikolas: Yeah, baseball is a common one. Baseball or football. Sometimes just motor vehicle type of collisions.

Dr. Miller: So it sounds like the bottom line is if you have a jammed finger and it's sore after several days, you out to have it checked out, get an X-ray, and then make your way to a specialist on hand surgery, or someone who's very competent in dealing with these kinds of dislocation. If you don't do that, you could end up with arthritis and immobility and the finger is the worst, way too long.

Nikolas: I would definitely agree with that, and if it's just a jammed finger without any of these other more serious injuries, it would be great to meet with us anyhow, because these joints tend to get stiff even without a fracture, without a dislocation or more serious injury. And we can have you meet with a certified hand therapist to work on a therapy program, splinting, we can work on pain control measures, swelling control measures. So, even if there is not a more significant injury, we still can help these patients.

updated: March 24, 2021
originally published: January 31, 2017