Search for tag: "sports medicine"
Spend enough time outside during the summer months and you may feel tired, thirsty, or a little nauseous. These are relatively common symptoms of heat exhaustion. But if your body temperature gets…
July 23rd, 2021
Interviewer: So during the summer months, temperatures are rising, people are getting out more, and you might be getting a little concerned about heat exposure and how it might be impacting your health.
We're here with emergency room physician, Dr. Troy Madsen. And Dr. Madsen, when it comes to heat exposure, what do people need to be concerned about?
Dr. Madsen: Well, the biggest thing with heat exposure is just your body overheating. That's where you really start to see issues not just with feeling uncomfortable, but potentially having even a life-threatening situation. Some people . . . you know, you may be familiar with just being out in the heat, you've been hiking or on your bike, or you know, whatever you might be doing, and you're probably familiar with that feeling of just feeling thirsty and tired and maybe a little bit nauseous and maybe a little bit of a headache. Well, at that point, you may be experiencing what we call heat exhaustion. But the big risk becomes when you move beyond that, and your body temperature continues to rise. And then you can experience what's called heatstroke. And that becomes a much more serious thing.
In those situations, your body temperature is often very high. You can have damage to the organs in your body, meaning damage to the kidneys, even potentially the heart, the brain. And in some of those situations, when you hear about these stories of people in places where there is just extreme heat and people are dying of the heat, it is often because of heat stroke that that's happening.
Interviewer: Yeah, we hear about these deadly heat waves and things on the news. And it's, you know, what does that even mean? We're talking like organ damage. Like the heat is getting so high that . . . are you talking brain? Are you talking heart? Who is at risk, and what is it actually doing to the body?
Dr. Madsen: It's exactly that. The body is getting so hot that it is leading to damage and breakdown of the tissues in the brain, the heart, the kidneys. Sometimes part of that is dehydration that's contributing to that as well where that's affecting your kidney function. But in terms of risk, there are a few groups who are really at risk of this. Number one is people who are experiencing homelessness, who may be out in the heat, aren't in a cool place. Other people who are out doing outdoor activities. And maybe you find yourself in a situation where you're out, you're exposed, you know, there's no way to really cool down, maybe you didn't bring enough water along on your hike or your bike ride.
But then there are also certain groups that are really at risk. And these are the very young and the very old. So young babies, infants, and then older people have a tougher time regulating their body temperature. So you might be out, and let's say you take your baby, you know, in a stroller, you're out on a walk, or you go to the zoo or something and you're feeling okay, or maybe you're feeling just a little bit of a headache or a little bit hot. Your baby could be experiencing very severe symptoms in that situation. So if you live with the very young or the very old, just be aware that if you're not feeling great, they're probably experiencing a whole lot more of the heat and much worse effects than you are.
Interviewer: So it sounds like heat exposure affects basically anyone and everyone if you don't, you know, take the right steps. What are some of the ways that a person can, say, prevent heat exhaustion and then later heat stroke?
Dr. Madsen: Well, the biggest thing, you know, is to try and be in a situation where you can cool down. If you're out on a hike or you're out somewhere in the outdoors, try to go in shaded areas, ideally areas that have a water source, something where you can cool down if you need to. Carry plenty of water, you want to make sure you have lots of water with you. The general rule of thumb is 16 ounces of water per hour. I tell people start with at least eight ounces if you're just doing moderate activities. Sixteen ounces can be a lot to carry if you're out on several hours, but try and do that if you can, or at least know where you can get some water.
The big thing I would suggest too is if you have elderly parents, relatives, friends, neighbors, check in on them. One of the sad things that sometimes happens is older people, especially right now, may not have checked their air conditioner, may not know if it's working, or it may work and then it stops working. And sometimes a very sad thing we see is people in this situation then are either embarrassed to reach out for help or don't know who to call for help. And the house temperature gets very hot, and they experience severe symptoms with heatstroke or even death. So check on those people. If you have babies as well, just be aware that they can experience these heat symptoms much more than you may be experiencing at that same time.
Interviewer: So heatstroke, something to keep in mind, something that could be very, very dangerous. ER-worthy if it gets bad enough?
Dr. Madsen: Absolutely, yep. If it's bad enough, if you have a family member or yourself who's just confused, not feeling well, absolutely, get to the ER. Try to get cooled down quickly. Call 911 if you need immediate help.
Spend enough time outside during the summer months and you may feel tired, thirsty, or a little nauseous. These are relatively common symptoms of heat exhaustion. But if your body temperature gets too high, you may experience potentially life-threatening heatstroke. Learn how to protect yourself and your loved ones from severe heat exposure.
For baseball pitchers, a little bit of elbow soreness is normal—after all, there's no crying in baseball. But for pitchers experiencing frequent moderate pain after six innings, it may be…
June 16th, 2021
Interviewer: So a little bit of elbow pain if you're a pitcher in baseball is okay, but if it starts to get pretty severe, you're going to want to do something about that.
Dr. Chalmers, how much elbow pain for a pitcher is acceptable? And what's kind of the threshold that you maybe want to have somebody look at what's causing that pain?
Dr. Chalmers: Yeah, we've done some studies that have helped to inform of us of that. And I think one thing to understand that it's not a normal human motion to pitch a baseball. There's nothing we're evolved to that makes us good at pitching a baseball. And there's a lot of adaptations pitchers undergo, as they pitch through adolescence, that help them to become better at it for sure.
But we've done two studies that I think help and inform our thinking about this. We did a large study of youth baseball players, kind of youth and adolescent baseball players, where we asked them whether or not they have pain. And about 30% of kind of normal, uninjured players will say they have regular pain with play. Now this study we did, though, I think is even more informative is we took pitchers and we had them throw through a simulative game. So they threw 90 pitches kind of in simulated 15 pitch innings. And what happened is that . . . and we collected pain scores and fatigues scores, and what we found is that as pitchers get towards that sixth inning, pain scores start to creep up to somewhere around 1 or 2 out of 10, which just kind of still qualifies as minimal to mild amount of pain but not zero pain.
So I usually tell pitchers, if you're throwing and you're getting above a 2 or a 3 out of 10, that that's not normal, it's not expected, it's not something that can be just swept under the rug with the classic saying of, "There's no crying in baseball," and that it's something that probably you should look into. But if you're having a little bit of soreness, 1 or 2 out of 10 with heavy use six innings of pitching, that's probably very normal and something that you could expect with this particular sport.
Interviewer: How do you, when you do the 1 to 10 ranking, help somebody understanding like what a 1 what might be? Because somebody's 1 might be somebody else's 6.
Dr. Chalmers: Well, no, I think you're right. I mean, I think this is always the issue with pain is there's no objective measure of pain. We have no way to measure that in a way that can be comparable between patients. We have the subjective scale. Usually, the ways that we qualify that are, you know, the number, which can be hard, the words which to say mild, moderate, severe, mild being kind of a 0 to 3, moderate being 4 to 6, and severe being 7 to 10. And then the other way we use this is the scale called the Wong-Baker Scale. It has this . . . you know, starts with a smiley face at zero and like a very unhappy face at 10. I usually think of 2 out of 10 as being a place where there's still maybe a little bit of a smile if you have a really good game, but definitely there's some grimacing if things get bad. And if you start to get to the place where there's no longer a smile on your face, then probably it's too much.
Interviewer: And that's during. What about pain afterward? How long until that pain would go away for kind of the average player?
Dr. Chalmers: Well, usually what I tell people is that you should be able to do what you're doing in a reproducible way every other day. So if you feel like I could pitch like this every other day, then that's a right amount. If you feel like, "Ah, I need four days to recover from this pitching outing because it was so painful or took that much recovery," then what you're doing is too much.
Interviewer: And you said, you know, the saying is, "There's no crying in baseball," and sometimes pitchers tend to be a little tougher than the rest. If somebody is having elbow pain above the threshold you described, what are some of the downsides to not having that looked at?
Dr. Chalmers: Yeah, there are definitely downsides to just pitching through significant pain. The significant pain can be a sign of a substantial injury to the elbow. So, for instance, if you do have ligament tear and you're trying to just work through it, I've definitely seen players that years later have developed arthritis in their elbow or they have bones spurs that have worked to kind of help the elbow to stabilize even though the ligament is not functioning properly. So there's definitely a downside to thinking, "I'm just going to push through this."
Interviewer: And then, what about the repair? Some of these elbow surgeries can take a long time for patients to recover. Do you think that plays into why perhaps sometimes pitchers choose to play through it, because they don't want to be out of the game for any period of time?
Dr. Chalmers: Yeah, I think that's definitely part of it, is that pitchers think, "Oh, I can't afford to take 12 to 18 months off." So, if you know that there's a solution that can get you back in six months, that's the length of the offseason, and I don't think you need to worry so much about, "Oh, I'm going to lose next season." So it's definitely worth if you're having pain thinking, the very least get it looked at the end of the season, to see maybe if there is something that can be done that could still you get back in time for next year.
Interviewer: Yeah, and new procedures are coming along all the time that have shorter recovery periods. So even if you are of the opinion or if you've heard, "Well, if I get this done, I'm going to be out for 24 months," that might not be the case anymore.
Dr. Chalmers: Oh absolutely. And not only that but if you're listening to this and it's two years from now, let me tell you, it's going to be even better, because we've got all sorts of things coming down the line that will help to bring down recovery periods for pitchers in the future.
For pitchers experiencing frequent moderate pain after six innings, it may be time to see a professional. What to look for and why it’s important to get that pitcher’s elbow looked at so you don’t miss a season.
An elbow injury used to mean a lost season for baseball pitchers. Ulnar collateral ligament (UCL) replacement - or the Tommy John Surgery - can take up to 18 months before a return to the pitch.…
May 5th, 2021
Interviewer: Yeah. So, if you have some elbow pain while you're pitching, there is something you can do about it and actually something you should do about it. And there's a new procedure that might be the thing that you need.
Dr. Peter Chalmers is an orthopedic surgeon. He's an elbow specialist. He's also the current team physician for University of Utah baseball and Salt Lake City Bees Triple-A baseball. So if somebody does have elbow pain while they're pitching, where do you start with that diagnosis, Dr. Chalmers?
Dr. Chalmers: Yeah. Absolutely. So elbow pain during pitching, it's not normal to have really, really a sore elbow with pitching. And there can be a couple of different causes, and some of them can be problematic for the future for a pitcher. So, definitely, I think it's worth, after a period of rest, if the pain doesn't go away, seeing someone to be fully evaluated with, you know, having someone take a look at the elbow, and then potentially getting an MRI to take a look at the cartilage and the ligaments within the elbow.
Interviewer: All right. And if the condition happens to be something called an ulnar collateral ligament injury, then there's a procedure that's been used for a long time called Tommy John surgery. Tell me a little bit about that, and then we're going to talk about the alternative, which could be better for some patients.
Dr. Chalmers: Yeah. Absolutely. So, for a long period of time, if you tore your ulnar collateral ligament, the ligament on the inside of the elbow that basically holds the upper arm and the lower bones together when you pitch a baseball, if you don't have that ligament, those bones try and fall apart, and it's basically not possible to pitch a baseball. If you tore that ligament, historically, then your career was just over.
And there was a pitcher named Tommy John, who had that injury, and he went to a surgeon who said, "Well, there's got to be something we can do," and they invented this procedure to reconstruct or rebuild the ligament using a tendon graft. And that actually works pretty well, but it has a very long recovery. It takes about a year to get back to play because the new tendon has to become a ligament over the top of the old ligament. And that process is very slow.
So that was the historic way that we would treat ulnar collateral ligament injuries, and the pitcher that first underwent it, his name was Tommy John. So they're commonly referred to as the Tommy John ligament or Tommy John surgery.
Interviewer: And now there's a new procedure. So I've heard that considered called reconstruction, and now there's a new procedure that actually just repairs the ligament and has some better outcomes. So tell me a little bit about that.
Dr. Chalmers: The good thing about many of these ligament tears is often the ligament is torn right off of either the upper arm bone or lower arm bone side. And the ligament itself is still good quality tissue. So, historically, we would replace that whole ligament with a new tendon graft.
The new procedure is to repair the patient's own ligament and allow their own ligament to serve as their ligament going forward. That has a much quicker recovery and can get pitchers back to play in six months. So that's been a huge advance in our treatment for this injury and has certainly, for a lot of our players, granted them ability to get back to another season or even sometimes to get two seasons in depending on the timing.
Interviewer: So, when you're working with a pitcher, how do you determine which one of these two that you're going to use?
Dr. Chalmers: So there's a number of factors that go into that. Certainly, the appearance of the ligament on the MRI and the location of the tear play a role, but often during surgery, we'll also assess the quality of the tissue. And if the tissue is robust enough, then we can use the patient's own tissue to do the repair.
Interviewer: If it is an option, then is it just as good as the Tommy John surgery? You said, definitely, you could get back to playing faster. Is it as a robust of a repair?
Dr. Chalmers: It may be better.
Dr. Chalmers: Some of our early data suggests that the rates of return to play may be higher after repair than they are after reconstruction.
Interviewer: And I understand another advantage of the ligament repair is if you have a younger athlete, that this would be an option where Tommy John surgery would not be an option. Tell me about that.
Dr. Chalmers: Yeah. Definitely, younger athletes have the highest capacity for healing. And so, in a younger athlete, this surgery can work very, very well, and that's who it's been performed in mostly to date. But in someone who's really young, if they have open growth plates, you may be concerned about performing a surgery with a ligament graft, where we may have to drill tunnels in the bone that may disrupt the growth in the future. So this is a nice option for that patient population.
Interviewer: And what does the recovery look like then? You said that the recovery is faster. You know, Tommy John surgery could take up to a year. How fast is this recovery, and what's the rehabilitation process like?
Dr. Chalmers: So as early as two weeks out from surgery, the patient begins moving their elbow. About a month from surgery, they begin strengthening. And the whole goal here is that you have to start strengthening early because as early as three months out from surgery, the pitchers will start throwing again.
Dr. Chalmers: And the goal then is to get back to full play with full velocity, pitching full games by six months.
Interviewer: That sounds pretty amazing. Is that pretty amazing from your perspective as an orthopedic surgeon?
Dr. Chalmers: It's a huge advance. It's a huge change over the year, sometimes 18-month recovery we saw historically with reconstruction surgery.
Interviewer: Are there downsides to this type of repair?
Dr. Chalmers: Well, it's a relatively new option, and so we don't have 5 or 10-year outcomes with it so far. But so far, it appears to have few downsides as compared to the reconstruction. There had been some concern that if you do this surgery, it may make another surgery in the future more difficult. And so far, those have not appeared to be true, but there have been very few of those performed because it works so well.
Interviewer: And it sounds like this is a very specialized procedure still at this point. What advice would you have for somebody choosing an orthopedic surgeon to do this type of procedure?
Dr. Chalmers: Well, I think that one of the most important things patients need to understand is that surgery itself is a technical skill, and it's important to find a surgeon that you feel like performs enough of those procedures to feel competent at it. So, as a result, I think when you look for a procedure that's less common like this, you need to find a surgeon that feels comfortable and performs enough of them, that they'll have already worked through the kinks and make sure that they're not going to have any problems performing this procedure for you.
That's one of the benefits of coming to a place like the University of Utah, where you have specialists in a large variety of areas. It allows each of us doctors to find a smaller niche and then, as a result, to be better at what we do.
Interviewer: I want to talk a little bit about this procedure. So what is, in your mind, the youngest patient that you would do this type of a procedure on?
Dr. Chalmers: One of the things that is unique about this area of the elbow is that right above the ligament is a growth plate. So for people who are skeletally immature, it's very rare to have the ligament be injured. And the vast majority of those that are skeletally immature, the growth plate itself sees most of the injury, if there is an injury. As a result, we very rarely perform this procedure for anyone under the age of 14 really.
Interviewer: Is there anything else about this procedure that you feel that a patient or a patient's parents would be interested in hearing that I missed?
Dr. Chalmers: One of the things that I think is really interesting about this procedure and really important for people to understand is that we've talked historically about the reconstruction and the tissue within the reconstruction as though we can make you a new ligament. But I will tell you that the tissue that we bring in from somewhere else is not the same as what you were born with. It doesn't have the same nerve fibers. It doesn't have the same pressure fibers.
And we demonstrated that actually pretty elegantly recently in a study we did with the Angels, where we looked at the changes in reconstructed ligaments as compared to non-reconstructed ligaments over the course of a single season or off-season on ultrasound, and found actually that the ligaments that had undergone a prior reconstruction respond differently to stress than native ligaments. And I think that's probably because they don't have all of their normal sensors within them.
So one of the big benefits of this procedure is that it preserves all that. It preserves all the normal pressure sensors and nerve fibers within your own ligament and allows it to respond normally to stress in the future. So that's a real benefit of this procedure over the reconstruction, and one reason why I think we're probably going to head more and more in this direction in probably a lot of areas of our field in the future.
An elbow injury used to mean a lost season for baseball pitchers. Ulnar collateral ligament (UCL) replacement - or the Tommy John Surgery - can take up to 18 month before a return to the pitch. Orthopaedic surgeon Dr. Peter Chalmers, explains how the recently developed UCL repair procedure could help injured baseball players get back to full throwing speed in just six months.
Resistance bands are a great exercise and physical therapy tool—but can sometimes be dangerous. Emergency physician Dr. Troy Madsen talks about the types of eye injuries caused by exercise…
April 6th, 2021
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.
Types of eye injuries caused by exercise bands and how to protect yourself.
For many athletes, a little pain comes with the territory. But sometimes, that seemingly minor injury could actually be a sign of something significantly more serious. Athletic trainer Travis Nolan…
March 3rd, 2021
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.
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."
For many athletes, a little pain comes with the territory. But sometimes, that seemingly minor injury could actually be a sign of something significantly more serious. Athletic trainer Travis Nolan explains what types of injuries you can ice and rest, and which should be seen by a professional.
For runners, athletes, and other active people, shin splints can be a common soreness or pain that you learn to work through. Stress fractures can have similar signs and symptoms and shin splints,…
February 12th, 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.
The difference between a splint and a fracture and when you should seek a professional evaluation.
Dr. Chris Gee answers listener questions: what does KT tape do, rotator cuff rehabilitation without surgery, and why do I get muscle cramps and how can I make them stop? Producer Mitch has a question…
January 26th, 2021
This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.
Scot: "Who Cares About Men's Health," providing information, inspiration, and motivation to better understand and engage in your health so you feel better today and in the future.
All right. Time to do a little roll call here. I need to know who cares about men's health. My name is Scot. I am the senior producer at thescoperadio.com, and I care about men's health. Who wants to join me?
Troy: I'll join you, Scot, because I think it's my turn next. I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.
Dr. Gee: And I'm Dr. Chris Gee. I'm a sports medicine physician here at the University of Utah, and I care about men's health.
Scot: All right, Dr. Gee. Welcome back to the show. Next time, I need a little bit more enthusiasm, though. Say like you mean it, okay?
Dr. Gee: All right.
Troy: Say it like your life depends on it.
Scot: That's right. Today, we're going to do a listener question episode. Some listeners have sent us some questions for Dr. Gee, who is a sports medicine physician. Why do I get cramps in a muscle, and can I fix that? We're going to talk about rotator cuff rehabilitation without surgery and is KT tape for real?
But before we get to the main topic, I have a question for you, Dr. Gee, or Chris, or whatever you want me to call you. Do you do time-restricted eating? Do you even know what that is? Like, fasting?
Dr. Gee: I've done some fasting, but I'm not very good at it. I hate fasting, let's put it that way.
Scot: So what does fasting look like? Because it means a lot of different things to a lot of different people.
Dr. Gee: The basic premise behind this is that it's probably not great for our bodies to get huge boluses of food and to eat just kind of grazing all through the day. And so the idea is to have a time for your body to kind of process things. Some religious groups do it routinely with monthly fasts and ceremonial fasts. But obviously, the time-related eating is more that you eat certain times through the day, and then at night, you stop eating overnight, or whatever it is that you decide to do.
Scot: Yeah, that's exactly right. It's that time-restricted eating. We've had another guest on who's a nutritionist. He's a big proponent of it, like 12 hours of eating, 12 hours of not eating. Or if you want to try to lose a little bit more fat, you can make that 10 hours of eating, the remainder not eating, or 8 hours. So you have done that time-restricted eating and just don't like it?
Dr. Gee: Yeah. I am probably the worst nutritional person out there as far as my diet is just not great. I've done a little bit of it and tried it and I have a hard time. Let's put it that way.
Scot: Yeah. What's your challenge to that? Because I just started doing it again. I did it for a couple weeks before COVID and then COVID came along, and every routine I had went out the window. But I felt better even after two weeks, and I feel good now after just a few days of doing it. So how did it impact you?
Dr. Gee: For me, whatever the problem is, I tend to be really great with a diet or with some time restriction or something like that for a couple of days. And then it just goes out the window for whatever reason. I'm just like, "Oh, I'll just have this snack. I'll just break it this one time." And so I don't know. I've kind of done that. I know I need to kind of adjust that, but for me getting through the first day or two is just hard.
Scot: Yeah, it is a little tough. Troy, have you been sticking with it? I know you had talked about doing it.
Troy: I have been sticking with it, yeah. I do 12 hours, Scot. That seems to work for me. And I just tell myself I'm not going to eat after 8:00 p.m. and I'm not going to eat before 8:00 a.m. Just restricting it to 10 hours of eating, I think, would be really tough because then I'd be looking at stopping eating at 6:00 p.m. So I find 12 seems to work and it seems to be working okay. But I agree, it's tough.
Dr. Gee: Can I ask Troy a question?
Dr. Gee: How do you do that with your shifts? Do you still do a number of shifts in the ER?
Troy: I do, yeah.
Dr. Gee: I always have a hard time with that.
Troy: You're right. Yeah, that's what really throws me off, is if I work . . . As you know, Chris, we'll do these shifts that are evening shift. We call it an evening shift, but you get out of there at like 1:00 or 2:00 in the morning and get to bed at 3:00. So those days, I'm probably not eating after 11:00 p.m. and I'm not eating before 11:00 a.m. So it's probably still working out to 12 hours because I'm trying to do better at eating at work. That's what I found. If I don't eat consistently at work, I get home and it's like 2:00 a.m. and I'm so hungry that I eat a ton, and then my stomach just hurts when I go to sleep and I can't sleep well. So that's how I've tried to adjust it, just by bringing plenty of food for work and trying to be consistent about eating so I don't come home hungry. But it's hard. With shift work, it's really hard.
Scot: And have you noticed a benefit, Troy? What does it do for you?
Troy: I have, Scot. When I first started doing it, I did feel like it did reduce my body fat somewhat. The other thing I like about it, I feel like I don't have to pay as much attention to what I eat. I know that's bad, but I kind of feel like it kind of gives me a little wiggle room there where I'm like, "I can eat more stuff that I was a little more concerned about eating before."
And then just going to bed, sometimes I would eat at 9:30 and then maybe I'm asleep at 10:30. And it wouldn't be until about 1:00 or 2:00 in the morning that my stomach would really feel okay, because that food just kind of sat there. So I felt like it's helped my sleep as well.
I feel like it's made a difference, and I feel like I've done okay with it. I've tried to do this since we first talked to Thunder about this. It must have been a year ago or so. And it's one of those things I've kind of taken from these talks we've had with Thunder that I feel has definitely been beneficial.
Scot: Well, I just was curious because I was curious to know, Chris, if you did anything like that as well and what your challenges were. I guess now we know. I feel like I wake up a little bit more clear-headed for sure and a little bit more alert.
By the way, I did see a documentary that talked about fasting. And there's some research out there that says even if you do it five days out of the week and two days you're not as religious, you still get the same benefits. So for somebody who works Monday through Friday, and then the weekends maybe they let themselves go a little bit. Maybe that would help. Chris, you think we can get you onboard or just no way?
Dr. Gee: You're tempting me for sure. I'll have to try it.
Troy: Maybe just three days.
Dr. Gee: I need to have a new plan. And so that'll be good. If I can only do a few days a week, maybe I'll start with that.
Troy: Scot, if there's benefit to five days, there's got to be benefits just to even three days, you know.
Scot: You would think.
Troy: You'd think so. Maybe you could say, "Hey, this is going to be my Monday, Wednesday, Friday thing," and start there. Don't eat after 8:00 p.m. Don't eat before 8:00 a.m., or whatever works, 7:00 p.m. and 7:00 a.m. Because I feel like 12 hours for me is doable. I feel like beyond that like, to consistently do it is . . . there are definitely days where I'm maybe restricted to 10 hours, but it's hard to do that consistently.
Scot: All right. Let's get to the topics here. So our listener questions, lots of ways you can get in touch with us. There's email, there's our listener line, and that's how we got a hold of these questions right here.
Dr. Gee, let's go ahead and start out with listener question number one. This individual says they get cramps, and they're wondering why they get cramps. What does a cramp mean, and is there something you can do to fix it if you have a muscle that's kind of consistently cramping? I've had this with my legs, my calves, for example.
Dr. Gee: There are a number of different reasons why a person may have cramps. First of all, and the most common, are related to maybe dietary things, or you're dehydrated, or you've been working out a lot and at a certain point during your workout or your run or whatever, you're getting cramps. So those are more nutrition-based recommendations where make sure that you're well hydrated, that you're not getting dehydrated through the course of your day or your workout.
Also looking at making sure that you're getting electrolytes with that, so some kind of Gatorade or something like that, that you're using to replenish those electrolytes as you are sweating.
But then the second group of cramping, the way I look at it at least, is that there are times where your muscle maybe isn't as strong as it should be. And so, if you imagine maybe you've got a calf cramp or something like that, and as you start to run and work out, maybe you're well-hydrated and you have good electrolytes, but the muscle is a little bit fatigued, it can't quite keep up with the demand that you're putting onto it, and it basically has to go into a bit of a spasm to hold the demand that you're putting onto it.
And that will often happen during workouts and things or even kind of after the fact as people are walking around. Those cramps, depending on where they are and what's going on with them, they can benefit from doing some more dedicated directed exercise at those areas.
There are different types of strength within muscles. A lot of times, the way we think of strength, we think of, "Oh, I can pick up this really heavy weight," and that is a type of strength, but there's also dynamic strength, which is basically where your muscles are holding your joints and your body through the course of motion. And if they are fatigued, if they are not up to where they need to be, they will basically have to go into spasm to try to hold that dynamic control, and that's oftentimes when people will start getting cramps.
Troy: Chris, imagine that you're mountain biking somewhere or you're running or competing in some kind of event, and your leg just cramps up. It's kind of like related to what Scot said. Do you recommend just stopping at that point and trying to massage it, or stretching, or just slowing down a bit, or just pushing through it? What's your typical advice when that happens?
Scot: What I love about that is Troy never, ever said, "Or just quit?" He never even offered that as an option.
Troy: I'm imagining, Scot, you're somewhere where you probably have to get home. You're on a trail. You can't just call Uber. You've got to get home somehow. So, yeah, how do you get through that?
Dr. Gee: Yeah, that's the next version of Uber, the mountain bike Uber.
Troy: The mountain bike Uber, just a little trailer on back.
Dr. Gee: That's a really good question. And I think all too often as weekend warriors and just recreational athletes, we tend to push through those things. And what I find is that that tends to make it worse. You really tend to have more problems as you continue to work out. And so I do suggest that you stop, you rest, try to stretch out that muscle, do a little massage. Think back on what you've been doing with your hydration. Have you been hydrating well enough? Have you urinated recently?
That's always a good sign to see where you're at with your hydration. If you've been pounding a ton of fluids and you're urinating really clear, you might be going a little too hard hydrating. But if you haven't peed for a while, and when you do try to go it's really dark, then you need to really try to push some fluids and recover and then kind of build your way back into your exercise. Try to maybe go just below that threshold at which you were cramping before, which can definitely be difficult if you're pretty far out and you're trying to work through a cramp as you're trying to finish.
Scot: So, in that situation, just want to make sure I understand correctly, and it's cramping, you should stop. Did you say you should rub it, try to massage? No, stretch it. You should stretch it.
Troy: And massage it sounds like, yeah.
Dr. Gee: Both. Yeah. Oftentimes, I find that when it's acutely in spasm . . . so we'll have an athlete come off the court or the field and they're acutely in spasm, really the only thing that's going to help or the thing that helps the fastest is to stretch that muscle. So really just try to stretch it back out, and then some gentle massage to try to work fluids around through that muscle to kind of break down some of the more tight areas that might be more likely to spasm.
Troy: That's good to know, though. Yeah, start with the stretch, though.
Dr. Gee: I've had people try, both personally and professionally, to just massage that cramp, and it takes a while to get it to release. And so I find stretching it first and then working into a massage is probably a better route.
Scot: If hydration was the issue and you started drinking some water, then would that clear itself up pretty quickly, the cramp, or not very quickly?
Dr. Gee: It can definitely help, but it's really hard, I find, once you start cramping to kind of turn that around, or at least within that exercise or that particular workout window. Usually, it's going to take some time for your body to try and correct the electrolytes and the fluid balance as such that it's going to ease it up.
So even as a recreational athlete, really listen to your body and know at what point you're going to start feeling that cramp come on. And if you can get to that point and say, "Okay, now I'm pushing it a little too hard," and start correcting those either fluid issues or technique issues, making sure that you're not pushing beyond that, it usually helps to prevent you from having cramps throughout the workout.
Scot: All right. Question number two. Boy, this is probably going to be a tough one. Rotator cuff rehabilitation without surgery. So do you see a lot of rotator cuff injuries? I find it fascinating that the rotator cuff is called one thing, but it's actually four different muscles.
Dr. Gee: Exactly.
Troy: This really hits home for me, because in high school I injured my rotator cuff. I never saw anyone for it, but I'm certain that's what it is. And I've convinced myself over the years, "I can do this without actually seeing someone for it." So I'm curious what you have to say, Chris.
Scot: You can hurt your rotator cuff like doing sports, but even if you fall, you could hurt it, right?
Dr. Gee: Exactly. Yeah, it's a very interesting joint. And it's one of those things that I see a lot of. We all hit the new year and we say, "Hey, I want to lift and get some definition in my body." So we go and we overdo it with shoulders and start getting some pain in the shoulder, or even getting out and biking and things like that we'll have people crash and have a trauma to the shoulder.
So, in general, just as kind of an educational piece with the rotator cuff, basically, when you look at the shoulder, you have the ball and socket joint. Now, the socket is really very shallow. I make the analogy it's more like a golf ball and a tee. So you have a big humeral head, or a big ball, that's trying to fit into this small little depression of the shoulder blade. And so there's a group of four muscles that come off the shoulder blade, and they surround the humeral head, and they move it around.
Now, because there's not a lot of bony restriction, it gives us great motion of the shoulder, but it's at the compromise of stability. And so that's always the problem, is that if those rotator cuff muscles aren't working together, and they don't have that dynamic strength and control I was talking about earlier, they will allow that ball to slide off the socket and cause things to get stretched and cause pain and impingement and other problems.
And so, when we're younger, when you're in high school and you injure your shoulder, usually that rotator cuff will just stretch. It'll stretch out. It'll cause some instability problems. But unfortunately, as we get older, ages . . . the rough estimate is 35 to 40, which that throws me in the old category. I don't like that. But as we get older, the rotator cuff doesn't tend to stretch as well, and it tends to tear.
And so those little things that maybe you can recover in a day or two as a teenager are going to do more damage as an adult and you can tear part of the cuff, and that may require more treatment than what you had as a youngster.
Troy: So when you say treatment, are you saying you definitely need surgery, or is it something where physical therapy or strengthening or those kind of things are going to help you recover?
Scot: Yeah, this listener is hoping without surgery.
Troy: Hoping you're going to say no surgery.
Dr. Gee: Honestly, I find the vast majority of these do not have to have surgery, which is great.
There are a few different buckets that these fall into with these rotator cuff injuries. If you're young and otherwise healthy and you haven't . . . like I said, it takes a lot of force to tear the rotator cuff when you're young. So most of the time, we'll put those people through some physical therapy working on rebuilding the rotator cuff. Working on shoulder blade positioning and posture helps with that rotator cuff, and that allows them to progressively get back to normal.
Even when you have an older patient that maybe . . . I've had patients that are in their 70s that are just pulling up something, maybe the sheet on the covers of their bed, and they've torn part of the rotator cuff. So, at that point, as everybody's rotator cuff gets weaker, believe it or not, you can do therapy with that group too. So getting out and getting some physical therapy, strengthening that rotator cuff, what's left of it, or the muscles around it, will actually calm their symptoms down and they do pretty well.
It's really the ones that have an acute traumatic injury. You fall really hard when you're skiing or you dislocate the shoulder and you acutely tear the rotator cuff. Those are the ones that more often need surgery. And the rest we're pretty successful with being able to rehabilitate the muscles and maybe doing an injection to calm down inflammation, but they do fairly well.
Scot: And I also think it's just always good if you have hurt yourself to go see somebody just because you start making those accommodations and then who knows 20 years down the road where that's going to get you. I think it's kind of gotten me into a bad place, and I'm trying to undo some of those things. It's not going to get better if I don't do some actively with it.
Dr. Gee: Exactly. Yeah.
Scot: All right. Question number three is KT tape for real? So this KT tape, this is the tape that sometimes you see athletes . . . I went to a chiropractor once and they put some KT tape on me. They cut it up and made it into some tribal looking design on my shoulder and my bicep. Is that the real deal? Is that legit or not?
Dr. Gee: KT tape has kind of been the rage over the last number of years and you see a lot of athletes doing it and Olympians doing it. When you look at really what it's doing, it's not going hold the joint into place because it's not connected to any muscle. It's not connected to any bone or anything like that. What it is doing, though, is giving a little bit of feedback through the skin, through the nerves that are in the skin, just to kind of remind you a little bit about that position.
So, for example, in the shoulder again, it's probably not going to keep your shoulder from sliding out. It's not going to prevent you from using your shoulder wrong. But what it can do is remind you as you start to slip into maybe a bad position, you start to feel a tug on your skin, and you go, "Oh, okay, I've got to bring my shoulder back, and I have to kind of get that better position."
The way I try to use it is maybe using it early on just to remind people of positioning. We'll use it sometimes around the knee and the shoulder just to kind of help people to think about positioning and activation of muscles. But over the long term, I definitely want people to get dynamic control and strength of their joints so that they don't have to use those things.
Troy: And do you find, Chris, it's more helpful than just wearing an Ace wrap or some sort of thin brace on your knee or something? I mean, does it seem like it does better than that kind of thing to provide that reminder that maybe you need to do things differently as you're going through those motions?
Dr. Gee: It can help in certain scenarios. So, for example, if somebody has an unstable knee, meaning their kneecap is kind of wanting to drift off to the side, sometimes taping it a certain way can help to encourage that to stay back and it can remind people. But you can get the same effect with even a sleeve over the knee that has a hole in the front that kind of encourages that kneecap.
So, as far as when you look at studies, they really say that any kind of proprioceptive feedback with an Ace bandage or a sleeve or a brace can help just to remind you of positioning of that joint, and it doesn't necessarily have to be the tape.
Troy: Duct tape?
Dr. Gee: Yeah, there you go.
Scot: I think it doesn't stretch as well as KT tape, right?
Troy: Maybe not as good, but . . .
Scot: In a pinch? All right. Dr. Gee, again, awesome job answering our listener questions. Sure do appreciate having you on the show. And thank you for caring about men's health.
Dr. Gee: Yeah, it's always a pleasure to be here. I love getting the questions and hopefully got some things answered.
Scot: All right. Welcome Producer Mitch to the show. I guess Producer Mitch has a question for Dr. Troy Madsen. Mitch, what was your question?
Mitch: I've been going to doctors and I've been reading the after notes in my chart. Is "generally pleasant" code for anything? I've been described by two doctors now as a "generally pleasant 32-year-old male."
Troy: That is great. It's not code for anything.
Mitch: All right.
Troy: It just cracks me up when people use that.
Scot: Hold on. This is in your chart? What medical purpose does this description serve, Troy?
Mitch: It's at the top, right?
Troy: It's so funny. Yeah. I never use adjectives like that to describe anyone because it's just . . .
Scot: In the ER, do you have to describe people?
Troy: I never use that. No, some people just do that. It's just habit, I think, just because the average person who is nice, who comes in, who they enjoy talking to, they will describe as, "This is a pleasant 30-year-old male who comes in with a chief complaint of," whatever. It's just habit for them.
It is not code for anything. It doesn't mean they think you're weird or something. Yeah, it's funny when it's in there because when I see that, I always think, "What are they going to say about the person who's not pleasant? Are they going to say, 'This very unpleasant, 40-year-old man'?"
Mitch: And that means something.
Troy: Yeah. Exactly.
Scot: I love how they use the word "generally." Mitch, does that concern you that in that short interaction that there was possibly a moment where you were not pleasant?
Troy: That is the one piece that jumped out to me. Typically, they'll say, "This is a very pleasant 30-year-old man." The fact that they said generally, yeah, that's a little bit of a red flag, Mitch.
Mitch: Oh my god. It was an ENT too. I'm like, "What did I do?"
Troy: Yeah. "What did I do wrong? What do I have to do to get very pleasant?" Ask them that the next visit, like, "What does it take to get a very pleasant description?"
Mitch: "What do I have to do?"
Scot: Yeah, "What can I do to just have you drop generally, just so it says a pleasant?"
Troy: Yeah, just need "a pleasant." "This is a pleasant."
Scot: Oh my gosh, that's fantastic.
Troy: Oh, yeah. It just cracks me up when I see that. It's kind of like this old-school thing. Yeah, like I said, I never use adjectives like that, but it's just funny.
Scot: But some doctors do and there's no purpose to it, Troy?
Troy: Yeah, there's really no purpose to it. It's not like I look at that and say, "Oh, good. I'm so glad I'm going to see him now, because if he hadn't said pleasant, I would not want to see this patient in my clinic." So it's not some code between doctors. Don't worry.
Mitch: Well, it's almost embarrassing, because I'm trying to read all their instructions, but I can't. In that first line, I'm like, "What did they mean? What did they mean by generally pleasant?"
Troy: You're trying to decode it.
Scot: You don't actually make it to the important stuff about your health.
"Just Going To Leave This Here." It could be a random thought, it could be something to do with health, or it might just be something that really couldn't find its place elsewhere on the show that we wanted to share.
So, on Instagram, I follow some health accounts. They're not your typical health accounts. This one is @letstalk.mentalhealth, and they have this little graphic that I love because I think it sums up the things that we're never taught that we should have learned at some point in our life that are so crucial.
This says, "What I learned in school: How to multiply eight times seven, and what H2O stands for. What I wish I learned in school: The importance of mental health, mindfulness, self-esteem, reframing negative thoughts, self-care, emotional regulation, personal finance, and the importance of sleep." And that's why we talk about some of those things on this podcast and some of those other things that we don't talk about. It's never too late to learn something new about any of those areas. They will pay dividends.
Troy: I'm going to add two more to that list: home maintenance and car maintenance. I wish they taught those things.
Scot, I'm just going leave this here. I'm just going to let you guess. What is the top-ranked diet of 2021?
Scot: Well, if you're bringing it up, I know you're a fan of the Mediterranean diet, and you probably want to give it some props. So that's my guess, Mediterranean diet.
Troy: No, it's the see-food diet. I see it and I eat it. Just kidding. It is the Mediterranean diet. We always come back to the Mediterranean diet. It's come up many times as we've talked about different diets. It is the number one ranked diet of 2021 by "US News and World Report."
The thing I love about the Mediterranean diet is it's such a straightforward diet. It makes sense. And then there's good research to back it up looking at heart benefits, weight loss, general health, all those sorts of things. Really good research to back it up.
So, if you're looking for a diet for 2021, and trying to switch things up a little bit, look into the Mediterranean diet. Again, we've talked a lot about it. But it's a very straightforward, great diet.
Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it in a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE, and leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.
Troy: You can contact us, email@example.com. We're on Facebook, facebook.com/WhoCaresMensHealth. Our website is whocaresmenshealth.com. Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.
Scot: Thank you for listening. Thank you for caring about men's health.
Is a pulled hamstring—also called a strained hamstring—something you can treat on your own, or should you see a doctor? Athletic trainer Travis Nolan shares how to determine when you…
December 7th, 2020
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.
How to determine when you should seek help for pulled hamstrings, why it is essential to do the proper stretching and physical therapy, and how long it takes for hamstring strains to heal.
Sports medicine physician Dr. Christopher Gee answers listener questions about back pain between the shoulder blades, whether a meniscus will heal on its own, and arm care for kids who play baseball.…
October 13th, 2020
This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.
Troy: I told Laura I'm just like the Ed McMahon to Johnny Carson, and she's like . . .
Scot: No, you're not.
Troy: She said, "Don't give yourself that much credit." I said, "I'm just here just for the da-da-dum."
Scot: No, you're not. I mean, you are funny, but you bring information. Most of the time you're funnier than I am.
Troy: I'm just here to . . .
Scot: Which really bugs me. We're going to talk about that some time.
"Who Cares About Men's Health," providing information, inspiration, and motivation to better understand and engage in your health so you feel better today and in the future. My name is Scot Singpiel. I'm the manager of thescoperadio.com, and I care about men's health.
Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.
Dr. Gee: And I'm Dr. Chris Gee, and I'm a sports medicine physician at the University of Utah, and I care about men's health.
Scot: Dr. Gee, it's great to have you back on the show. We had Dr. Gee on last season, when Mitch rolled his ankle, to talk about what it's like to deal with a sprained ankle. So if you've ever had that happen, we've already had that conversation with Dr. Gee, so you can go back to our last season and find that out.
But today, we wanted to do kind of like a sports medicine doctor Q&A. Before I get started, though, I wanted to know, Dr. Madsen, what'd you think when I said we're going to have a sports medicine doc on? What was the first thing that went through your mind?
Troy: Sports. Thinking about sports. Well, I think that's what a lot of people think. Chris, I'm sure you hear this a lot, but I think a lot of people hear sports medicine . . . I'll see an 80-year-old in the ER who has an injury and everything, maybe X-rays show a fracture or maybe they don't, but I'll refer them to sports medicine, and it's like, "Sports medicine? I'm not playing sports." So I think maybe that's people's first impression, that your primary target here is athletes, like college or high school athletes. I think that's often what goes through people's minds. Dr. Gee: For sure, yeah. It's one of those things you end up . . . I get a lot of patients that come in and say, "Why are you seeing me?" or don't understand really what the specialty is. It's really kind of more activity medicine and being active, but I guess that is where we're at.
Scot: So activity medicine, do you deal with stuff like back pain, that sort of thing?
Dr. Gee: Yeah, we do. We'll see some pain . . . basically kind of any joint in your body, anything that's non-surgical orthopedics is kind of the way I put it.
Scot: All right. So you're on an expert on the bones and the ligaments and the muscles and how they all work? Is that what a sports medicine doc kind of really knows?
Dr. Gee: Yeah, that's basically it. And we work on all ages, so anybody kind of from a weekend warrior, professional athlete, or even just somebody trying to get that knee to not act up as they're walking around the block.
Scot: All right. Sounds good.
Troy: And we know you're a great doctor, Chris, because you got Mitch through his 5k. He had his sprained ankle, you saw him, you cared for him, he did his rehab, and he got through the 5k. He did it.
Scot: Let's go ahead and hit the questions here. So we've got three questions we're going to try to get through for Dr. Gee, our sports medicine doctor on "Who Cares About Men's Health."
There are a lot of different ways that people could have gotten these questions to us. They could have emailed firstname.lastname@example.org, they could have gone to our Facebook page, facebook.com/whocaresmenshealth, and direct messaged us, and then we also have a listener line nowadays, where you can call and leave a message, and that phone number is 601-55SCOPE. That's 601-55SCOPE.
So here's the very first question from our listener line. Here's a listener that had a question.
Man: Hey, guys. Love the show. Hey, I have a question. I have a pain that I experience kind of in between the shoulder blades. It's been kind of off and on for the past, I don't know, I'd say maybe five years. I don't really remember injuring it. I work in an office. It's not so bad that I need to . . . I don't know. I don't know what to do about it. Thanks for letting me know.
Scot: All right. Dr. Gee, do you have any advice for that individual? Do you see a lot of back pain? Is that something that you do see? I did bring that up earlier, but I didn't quite catch what your answer was.
Dr. Gee: Yeah, we do. You tend to see a fair bit of back pain in a lot of different patients, a lot of different environments. In this case, what it gets me thinking, particularly if it's sitting in an office and having to kind of sit forward, that's a tough position on the shoulders and on the upper back. And over time, spending all that time in that position does tend to weaken the muscles around the upper back and particularly around the shoulder blades.
And so as those muscles kind of get a little weaker, they put the shoulder in a bad position, and then those muscles are trying to kind of hold it back and it can definitely cause some discomfort.
It's something I'll see pretty regularly that people will have some pain or problems with their muscles that stabilize the shoulder, and so putting them through some therapy and some exercises to kind of work on those muscles as well as just working on position, looking at your desk and making sure you're trying to sit in a good posture as much as you can, or even getting up and walking around a few times an hour can help just to kind of break up that monotony.
Scot: Hey, if I wanted to do a little bit of research for some exercises, what are the muscles that we're talking about back there?
Dr. Gee: So particularly the scapular stabilizers are the ones I'm thinking of, the rhomboid major and minor, some trapezius, and even some of the rotator cuff muscles through there. And then there are some very important muscles in the upper spine, the erector spinae muscles, that kind of help to keep us upright.
Scot: And those muscles that you mentioned, with the exception of the erector spine . . . the erector what muscles? Spinae?
Dr. Gee: Yeah, erector spinae.
Scot: The erector set muscles?
Troy: This guy, haven't you been working out your erector spinae muscles lately?
Scot: No. I've neglected it.
Troy: Isn't it part of your routine?
Scot: That was actually my question. Those other muscles you mentioned, the rhomboids and the trapezius, in our kind of day-to-day life, if we're not doing any sort of activity, those are kind of ignored muscles in general. We're not really exercising those, are we?
Dr. Gee: You look at just what we do through the course of the day, and so much of it is just right in front of us. You're holding your phone right in front and your shoulders are sloping forward, and your upper back is sloping down, and you basically put those muscles kind of into a stretch and they're never having to really engage. And so doing some exercises to increase the activity of those muscles and really bring them back into position just helps to open that up and decrease pain.
Scot: Is there such a thing as a muscle falling asleep? Like, because you don't use it enough, it kind of forgets to fire and you've got to kind of reawaken it, so to speak?
Dr. Gee: Sort of. Basically, muscles are worked by activity and exercise, and when they are used, they hypertrophy and those neural pathways get a little more prominent. And if they're not used a lot, they get weaker as well as if they are having pain, they'll get inhibited, and so they're not used as appropriately as they should be.
Troy: Now, Chris, I don't know if you know, but Scot is really into kettlebells now.
Scot: I'm not really into it. I just got started.
Troy: I'm guessing some good kettlebell swings is going to work a lot of those muscles. I don't know if you're familiar with the kettlebell swings, but . . .
Dr. Gee: Yeah, they can work some things out, but you have a high risk of injury, so maybe you'll end up seeing Troy. I don't know.
Troy: Drop it on your foot.
Scot: There can be. I've been exercising with strength training for a long time, and I'm really a stickler for form, so I'm being very careful with the kettlebells.
Dr. Gee: That's perfect.
Troy: So what about an MRI? Would you tell this person, "Hey, it's been five years. Let's get an MRI and see what's going on in your back"?
Dr. Gee: It all depends on the symptoms that they're developing. It does tend to be less common to get thoracic vertebrae problems or disk problems just because it's a more stable area. Oftentimes, we'll put people through some therapy first and see how it will do, but eventually, if it's not improving, they may need other imaging, something like an MRI, to see if there is something else causing the symptoms and the pain.
Troy: And what about surgery? Are you ever recommending surgery in these patients, like if he's just like, "Hey, this has been going on long enough. I want to get this fixed"? Or any kind of injections?
Dr. Gee: Yeah, injections are usually the next step. Let me step back. There's a bursa or a little sac that sits underneath your shoulder blade, and sometimes that can get inflamed and be a source of pain. So sometimes doing injections there or even surgically debriding it can be helpful. But a lot of those muscles get tired. They can get trigger points, they can have a lot of irritation, and so doing injections into those muscles can be helpful.
Scot: And when you say therapy, is that just short for physical therapy? Is that what you mean?
Dr. Gee: Yeah. And physical therapy involves a lot of things, anything from manual therapy where they're doing actually massage and stretch or dry needling all the way up through and including exercises to kind of strengthen areas.
Scot: I've had the exercises for a couple of issues, and I've got to say it's amazing how well they work after a couple of weeks. It really is.
Dr. Gee: For sure, yeah. I've always found that pretty interesting too. I'll get very skeptical looks from people when I tell them, "Hey, this is what you need to work out." But once you do it, you realize, "Wow, it's stabilizing that joint, increasing the control of the muscles over it. Really helps a lot."
Troy: And you mentioned massage, Chris. Is that something you're telling people, "Hey, go to a massage therapist. Try this out and that'll make a difference," or is it more of the PT, the exercises, that kind of thing?
Dr. Gee: I do like massage as far as a modality to treat some of the pain. The hard part is that a lot of insurances don't cover it, and so it's a little tough. But yeah, different kinds of massage can help, particularly if you're having muscles that are having to go into spasm to try to hold position in your back or neck or shoulders. They get really tired, and so kind of working them out can alleviate a fair bit of the pain.
Scot: All right. Our second question here, this is actually a sports question. Boy, this could be a really involved answer, so we'll go ahead and just give this a listen here. Question number two for Dr. Gee, our sports medicine expert on "Who Cares About Men's Health."
Man: Hi. I've got a question for your sports medicine doc. I'm just wondering what's your opinion on arm care for baseball players? What should be the limit for how much kids throw, and do you ice, do you heat? What's your opinion on best way to stay healthy?
Scot: All right. So I wanted to tease out there. It sounded like he said arm care, baseball players, and then he said something about kids, so . . .
Troy: Yeah. He's probably got some kid he's trying to get into the Major Leagues.
Scot: It's his retirement policy is what it is.
Troy: Exactly. He's like, "I've got to make money off this kid."
Dr. Gee: What's happened with youth sports over the past 10, 15, 20 years is that when I was kid, we used to just play a season and then you were done and you'd go out and mess around. Now, kids are getting to the point where you play with your high school team, and then you have a competition team, and you have another competition season, and they'll go away to tournaments, and they end up playing throughout the entire year and giving no chance to really rest the arm.
Particularly in pitchers it becomes an issue. In younger pitchers, there are growth plates. So the bones basically expand at these growth plates, and those growth plates have muscular attachments to them. And so when they're throwing really hard, oftentimes that muscle is pulling off of that growth plate and it can cause stress injury to the bone. They can even tear ligaments and cause a lot of problems.
And so there are some great recommendations out there looking at limiting number of innings pitched for pitchers, limiting the number or types of pitches that are thrown. Curveballs tend to be a little more of a dynamic stress on the elbow and on the shoulder, and so they have them hold off of that for a period of time until they hit a certain age, and gradually over time looking at building that up.
So it's something we'll see a fair bit of, and most of the time, you've got a coach that may be good about limiting what his athlete is doing from game to game, but they don't know about all the other games these guys are playing in. And so, as parents, you have to be really careful about how much your kid is pitching, how much your kid is involved in the sport.
Troy: Chris, it sounds like parents looking at regulating pitch counts and the types of pitches thrown, it sounds like that could be pretty involved. Are there any sorts of guidelines, particularly for different age groups and numbers for those groups?
Dr. Gee: Yeah. There are some really good guidelines out there that have been looked at and published and reviewed routinely. You can find those under USA Baseball online and also Major League Baseball. MLB.com has some of those published guidelines, depending on your age and what kind of position that kids are playing.
Scot: Does this arm care just . . . is that mainly for people that are in a pitching position?
Dr. Gee: Yeah, it is. That's the biggest concern is that as they pitch that many hard throws, it just puts stress on their arm. But the other thing you definitely have to think about with these kids is that if they're going from . . . maybe, say, they're playing as pitcher and then they're going to play first base, the rest as first base, they're still going to be throwing quite a bit. And so you've got to really look at how much volume you're putting on this kid's arm.
Troy: I think one of the parts of the listener's question was about icing, and maybe that's a bigger question in general I think probably all of us wonder about. Do you recommend people routinely ice their joints if you're working out a lot? Some people like ice baths, things like that. Is that something you routinely recommend?
Dr. Gee: For sure. Yeah, it's one of those things that what we believe is happening is that as you're working out, you're getting small little tears and little bits of inflammation within the joint and within the muscles. And so placing a little ice on the joint after working out is a good idea. It just decreases the inflammation that's there, allows that to recover.
I'll usually tell people if you're doing a hard workout, ice down for 10, 15 minutes afterwards. And then maybe if you're feeling stiff or tight as you're starting to work out, doing a little heat before a workout just to kind of warm it up should be helpful.
Troy: Okay. So heat before, ice after. You don't recommend if you've got a hot tub necessarily jumping in the hot tub right after your workout?
Dr. Gee: No, not necessarily. There's not a lot of hard science behind it. Most of the research says that icing is most helpful after an acute injury for about a week period, but what most people will do is end up using ice after kind of a workout to try to decrease the inflammation they've developed.
Scot: Is that the secret weapon, if you will, of all of these professional athletes you work with? I see those ice bathtubs that they hop into, which look wonderful.
Troy: Yeah. How did they get in those things, though? I mean, it's . . .
Dr. Gee: Torturous, right?
Troy: I can't imagine.
Scot: You just grit your teeth and do it man, right?
Dr. Gee: Right. Have you seen Kevin Hart's podcast where he puts athletes into cold tubs and then interviews them as they're sitting there?
Troy: I haven't. That sounds great.
Dr. Gee: That's a new idea for The Scope Radio. You guys should get in the ice tubs.
Troy: There we go. We've got to put every one of our guests . . . just put them in an ice bath and see how they do.
Scot: I have a hard enough time getting guests anyway because of schedules and whatnot. If we're putting them in an ice bath, that's going to making it even harder.
Troy: Yeah, nothing like ice baths. I'm sure that'll go well.
Scot: All right. Our last question here is an email from email@example.com. This is from Val it looks like, so a woman listening to the podcast, which is cool. It's "Who Cares About Men's Health," but we . . .
Troy: Well, it could be a man's name too. It could be a man's name.
Scot: Oh, it is? Oh, maybe it is.
Dr. Gee: True.
Scot: I guess I don't know. Can a torn meniscus heal on its own? If it's not surgically fixed, will it cause a lot of future problems? So, first of all, what's a meniscus? Is that in my nose?
Dr. Gee: Not quite.
Troy: That's mucus, Scot.
Scot: Oh, okay.
Troy: Meniscus is different.
Dr. Gee: "Menucus." So a meniscus is a piece of cartilage that sits in your knee, and it kind of acts as a shock absorber between the bones. As they hit together, instead of hitting the articular cartilage or the lining of the joint against itself, it hits against this meniscus and that absorbs some of the shock.
The meniscus, however, doesn't have great blood supply to it, and so it tends to not heal very well. Some of that depends on where in the cartilage it is. If it's in more of a peripheral zone, where the blood is transmitting a little closer, it can heal, but most oftentimes I'd say they don't heal over time.
The treatment, though, doesn't always have to be surgery because what we want to do is basically allow that meniscus to be in there and act as a shock absorber without having to remove it as long as that meniscus lays down and doesn't get caught in the joint. So every time you flex the knee, it's popping, or it even bends over and kind of gets locked in the knee, then that's something that has to be fixed. Otherwise, oftentimes, I'll recommend we trial injections and some therapy and see how much we can get it to calm down without having to go in surgically on it.
Troy: And it seems like that's a common thing with skiing and that sort of thing. It seems like you hear a lot about meniscus tears here.
Dr. Gee: Oh, for sure. It's a really common injury. They are at a lot of risk. Whenever you're squatting down, bending, twisting, you're just kind of pushing against that meniscus, and so that's why it gets injured so often.
Scot: When my knee pops, is that my meniscus popping always?
Dr. Gee: Not necessarily. It can be the kneecap kind of shifting along as it's moving through the trochlear groove. The meniscus does shift a little bit as you're moving your knee, and so sometimes it is just kind of getting a little catch and it'll just pop. As long as it's not painful and doesn't swell up after it, you can kind of just leave it alone.
Troy: And is this one of those things where physical therapy can make a difference, or are you really looking at injections at that point?
Dr. Gee: Yeah, you can start with some physical therapy with those. The idea with that is, obviously, it's not going to necessarily make that meniscus heal, but it's going to stabilize the musculature around the knee, help it to move more easily and unload the pressure on that meniscus. And as long as it's calming down on its own, you don't have to do anything more. I usually use an injection as sort of getting pain under control so that they can do some exercises and therapy.
Scot: All right. Troy, do you have anything else? I think that was our three questions.
Troy: No. I think it's great information. We covered the back, we covered the arm, we covered the knee, so I think it's a pretty thorough review.
Scot: Yeah. We did all right there. Dr. Gee, are you feeling pretty good about this?
Dr. Gee: Yeah, I feel good about it. It's been good.
Scot: All right. Well, thank you very much for answering our listener questions. We sure do appreciate it, and thank you, Dr. Gee, for caring about men's health.
Dr. Gee: You're welcome. Glad to be on.
Scot: Time for "Odds & Ends" on "Who Cares About Men's Health." Got a couple of items here, Troy, that I'd like to throw out there for "Odds & Ends."
The first item is really excited about next week's show. We're going to be talking to a gentleman named Lorne and also psychologist Andrew Smith. Lorne, we're going to find out what his story was in hopes that maybe if you're struggling with alcohol dependence that it will help you.
One thing we learned during the episode, because we've already recorded it -- like many podcasts, we pre-record a lot of our things -- is that it's not necessarily about the drinking. That's just a symptom of a lot of other problems, and that was very eye-opening for me in that episode.
Troy: Yeah, me too. That was the point I think we're going to see really come out in this is that there's a whole lot more to this. And interestingly, that's what the therapy focuses on. It doesn't focus on the alcohol. It focuses on the underlying issues that the alcohol is used to try and cope with. Yeah, really interesting perspective.
I think regardless of where you're coming from, whether you think, "Maybe I do have an alcohol use disorder," or if you're saying, "Hey, I don't even drink alcohol. Why would I care about this episode?" I think it has a lot to it in terms of other things we might do in our lives and maybe other habits we have and how those . . . It's not about that habit. It's about what that is trying to deal with, and then finding that and addressing that. So I think that was the larger point of the . . . that's the big thing I think we're going to hear.
Scot: Item number two, we had Nick Galli on last week. He was our sports . . . he's a mental performance coach. He works with the U.S. Speedskating team, and I've already been able to use some of his advice from his last episode about performing like a pro.
Troy: Nice. You've got people's names right now? I know that was your concern. We had this come up.
Scot: I've had other things that I would like to perform well at, and normally I would get in my own head over. I just try to keep his advice in mind. And a couple pieces of advice that he had in his episode is this thing that you're doing that you're going to gonk yourself at, reframe it. Don't think of it in terms of "This is the most important thing in the world." Think of it as "I'm really lucky to have this opportunity to share this information with somebody" or to share this story.
And then also, just realize you're human, and if you screw up, it's fine. You're in a room with other humans. Just experience that moment together. And it made all the difference in the world. I didn't gonk myself and I didn't have any major problems, but I knew if I did, I'd be able to handle them.
Scot: Check out that episode from last week with Nick Galli and how to perform like a pro.
Troy: And I would sing it, but I . . .
Scot: Na-na-na-na-na-na-na, Thunder! Troy, do the honors of singing, "You've been Thunder Debunked."
Troy: I can't do that, Scot. Come on.
Scot: Thunder Debunked.
Troy: I have to maintain some sense of dignity.
Scot: Thunder Debunked.
Troy: I'm sorry, I can't . . . I think you already did it.
Scot: All right. This segment is called "Nutrition Myths: Thunder Debunked with Thunder Jalili" on "Who Cares About Men's Health." Thunder Jalili is our nutrition expert, and we've got him back for another question. We're going to give him some kind of fitness advice or something you might read somewhere, and we're going to find out if it's truth or if it's going to become Thunder Debunked.
Today's question: How many meals should I be eating throughout the day to boost my metabolism? Is there a magic number? I've heard lots of small meals throughout the day boosts your metabolism when you're pursuing weight loss versus only two or three meals.
Thunder: So let me just clarify because people always talk about metabolism and boosting metabolism, but I guess I'm a little ignorant. I'm never quite sure what people mean by that. So do you mean as a way to help you lose weight? Is that the idea?
Scot: I believe that that's what . . . when I hear people say this, that's what I would think as well. So metabolism meaning "Is there something I can do to my body that makes it burn more calories or more calories more efficiently?"
Thunder: Yeah, that would be exercise. So the idea of having six small meals a day, or one meal a day, or three meals a day, or whatever, if you're trying to lose weight, the more important concept there is to eat in a finite period of time, to make sure you have a fasting period in each 24-hour cycle. Sixteen hours is an amount that has been identified that has been a good tool for weight loss. Doesn't have to be 16 hours. Just for caloric maintenance, 12 hours, I think, actually works too. But to have six meals a day, if you have it in that time period, that's fine. It could be three meals a day. It doesn't really matter.
Where I think six meals a day becomes more helpful is not to lose weight but to gain weight. If someone wants to lift weights, wants to build muscle mass, and wants to gain weight, easier to do that if you have more meals because each time you eat, you have protein in that meal, and that protein stimulates muscle protein synthesis. You release insulin, which is an anabolic hormone that leads to synthesis of tissues, including muscle protein synthesis.
So to have increased hits of food and protein and insulin is better to help you gain weight, but I don't really see how that would help you lose weight. So, for losing weight, I go back to the time-restricted feeding and not really care how many meals I'm eating during my allowed eating time.
Scot: So eating six meals throughout the day to boost the metabolism, that has just been Thunder Debunked.
Thunder: Or at least Thunder Modified.
Scot: Thunder Modified. You need to come up with a catchier name, Thunder Modified.
Thunder: Yeah. That's so boring.
Scot: "Just Going to Leave This Here," it could have something to do with health, or it could just be something that's on our mind, or something we want to share. Troy, why don't you start off "Just Going to Leave This Here"?
Troy: Well, Scot, I'm just going to leave this here. I got something that I've got to tell you about it because I don't know if you've ever used this kind of thing. I got a percussion massager. It's one of these things, you hold it and it looks like a speed gun like some police officers hold.
Scot: Oh, yeah.
Troy: Yeah, like holding a radar or speed gun or something.
Scot: Yeah, my chiropractor has one of those. A lot of people will experience those in their chiropractors, and it kind of goes "do-do-do-do-do."
Troy: Exactly. Yeah. And you can buy it online. They're fairly expensive, but you can find some less expensive options. Mine wasn't super expensive by any means, but it's great. I've never used one of these things before. I've had some massagers, but not like this. This really works the deep tissues. I've just got these sore spots I continually deal with. We've talked about IT bands and rolling and all of that. Using it on my IT band, using it on these sore areas on my hip and all of that, and it's great.
So if you've got some sore spots, consider it. I've enjoyed it, and it's working well for me after about a month, and that's what I'm going to leave here.
Scot: Just going to leave this here. Of course, last week, the Vice President of the United States was in Salt Lake City for the vice presidential debate, and I got stuck because of the motorcade. So I'm trying to go through this intersection, and all of a sudden, two motorcycle police cops pull up, and each one of them gets off their bike, and one goes to one side of the intersection, one goes the to other side of the intersection, and then they stop us. So I know immediately, "Oh, the motorcade is going to be coming down the road." Have you ever seen a presidential or vice presidential motorcade?
Troy: I have never had that experience.
Scot: It was crazy. So you've got these cops that did that, that blocked this road. And as soon as they blocked it, two other motorcycle cops, or actually a bunch of them, go zooming by. I don't know how fast they were going on this 35-mile-an-hour road. Presumably doing the same thing, right? I'm sure they're just kind of leapfrogging each other going from intersection to intersection. And then 30 highway patrol motorcycles came rolling down.
I'm going to tell you now that I actually looked this up because I was curious how many vehicles are in a motorcade and how they get all those SUVs and stuff here. So I looked this up and I just want to share it because I'm just nerding out about this. The president could visit three places in a day, which means they might have to have three separate motorcades in three different locations, which blew my mind, first of all. So they transport these vehicles by military planes, like big C-17 military planes.
Troy: Oh, wow. They're not renting from the local Enterprise?
Scot: No, they're not. I don't think the Hertz has exactly what they're looking for.
Troy: Hertz's dollar rental does not carry these SUVs? Okay.
Scot: So, as I'm watching this, you see the police motorcycles, the highway patrol motorcycles, you see police cars, and then you get to the real deal part of the vice presidential motorcade. And they've got all these black SUVs, and they've got one that's for electronic countermeasures, so it jams communications and remote-detonating devices. I saw that one.
Troy: So did your cell phone stop working?
Scot: No, I didn't know at the time. This was in retrospect. I looked it up and I went, "Whoa, that's what that was." And then they've got a truck kind of thing, and that's for hazardous materials mitigation. And it's got sensors to detect nuclear, biological, or chemical attacks, so I saw that.
Troy: So it's actively sensing as it's going past?
Scot: I guess. So I saw that one. And then another SUV comes by and it's a communications vehicle because it has all these antennas on it, and that's exactly what this one was.
Scot: And then you get some of the cars that come by. You don't know which one is carrying the vice president. That's part of the smoke and mirrors, right?
Troy: Are they just a bunch of limos or . . .
Scot: Yeah, there are identical limos and you don't know which one the president is in, and apparently they will switch positions periodically to just keep . . . like a shell game.
Troy: To be clear, this was a motorcade for the vice president?
Scot: Yeah, which I'd imagine is probably very similar.
Troy: It's the same process.
Scot: Yeah, I would imagine. I mean, I don't know for sure. And then towards the back, two ambulances are following this thing. And then you've got a whole . . .
Troy: Were they local ambulances or were they brought in?
Scot: I'm not sure about that.
Troy: Were they Salt Lake Fire or who they were?
Scot: Yeah, I couldn't tell that.
Troy: Couldn't tell? Okay.
Scot: Yeah. And then you've got a whole bunch in the back, a whole bunch more cops and stuff. I mean, this was just an incredible sight. It was just crazy. So I will put a link to the article that I read about it because I thought it was just fascinating, I guess, in a guy geeky sort of way, what it takes to transport this one individual from Point A to Point B.
Troy: That's pretty remarkable.
Scot: It was just crazy. So, yeah, check that out on the show description page. I'll put that up there if you want to check that out.
Troy: The only thing I can compare to that is . . . some of the greatest satisfaction I get from running is running a race, and you've had this too, Scot, running through a city and having the police officers stopping all the traffic and seeing cars lined up like 20-long just waiting for you to run past them. It's not exactly a presidential motorcade, but it is a certain amount of satisfaction. "You guys can wait on me. I may not be going fast, it's Mile 23, but you can wait."
Scot: All right. It's time to say the things that we say at the end of podcasts because we are at the end of our podcast. Troy, go ahead.
Troy: Thanks for listening. Please be sure and subscribe wherever you get your podcasts, whether that's iTunes, Stitcher, Spotify. We're on all the podcasting platforms.
Scot: And then we also have a listener line. You can leave a message at 601-55SCOPE. That's 601-55SCOPE. Thanks for listening, and thanks for caring about men's health.
We all have moments in our professional or personal life we need to perform, whether it's a presentation at work or a weekend softball game. How can you avoid getting inside your head and…
October 8th, 2020
This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.
Scot: Just go to facebook.com/WhoCaresMensHealth.com. That'll get you there.
Troy: Dot com.com/.com.
Scot: You don't have to have a Facebook page, Troy.
Troy: You just threw it in several dot coms.
Scot: All right, take two. I love how the guy that doesn't even have a Facebook page is lecturing me on how I did it wrong.
Troy: I know too many dot coms when I hear it. I know that much.
Scot: The podcast is called "Who Cares About Men's Health." We provide information, inspiration, and motivation to better understand and engage in your health so you can feel better today and in the future. My name is Scot Singpiel. I am the manager of thescoperadio.com, and I care about men's health.
Troy: I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.
Dr. Galli: I'm Dr. Nick Galli, an Associate Professor in the Department of Health and Kinesiology at the U, and I care about men's health.
Scot: Today's show is called "Perform Like a Pro." So whatever it is that you do when there's that moment that you've got to do it and you've got to do it well, but maybe you don't all the time, are there some things that we can learn from professional athletes and how they have to perform when they're on the spot? And that's one of the things Nick does. Do you continue to work now, still with the U.S. Olympic speed skating team?
Dr. Galli: I do. Yeah. I'm a performance consultant for short track and long track national speed skating teams. They're based out here in Kearns, Utah.
Scot: Yeah. And you were at the Olympics four years ago?
Dr. Galli: Yeah, almost. Yeah, two and a half years ago in 2018.
Scot: So they've got their own physical coaches and probably their speed skating coaches, but they take you along to help with the mental performance aspect. Do I have that right?
Dr. Galli: Correct.
Scot: I sure hope so, because this is the whole basis of this episode. So some of the other things that Nick does not only consulting the U.S. Olympic speed skating team, he's a certified consultant for the Association of Applied Sports Psychology. He has a PhD in the psychological aspects of sports from University of Utah, a master's in sports study, a degree in psychology. He's a professor and a researcher at the University of Utah, and the last time I think you got a full eight hours of sleep was like six years ago. Sounds like you're awfully busy. You getting that sleep you need, because it is one of the core four?
Dr. Galli: Yes. I think I do a pretty good job with that.
Scot: So when you're working with athletes, what are some of the mental things that you encounter with these high-level performing athletes?
Dr. Galli: In some ways, it's very similar to the challenges that a lot of us face every day in our other roles, but these athletes, they spend the majority of their time across several years preparing for this thing, you know, really this once every four years thing, and for some of them, they'll only get one opportunity for it. So, you know, it's this they have everything dialed in, but there's still the matter of can I bring my best performance when it matters the most.
And in a sport like speed skating, there's a lot of differences between a normal performance, certainly a practice and performing at a world championships or Olympics, because it's not a big spectator sport. So all of a sudden you have eyes on you, there's more media, there's just more buzz about the performance than you're used to, and it feels different. And so, you know, being able to acknowledge that, recognize that, even welcome that, but also just, you know, do your thing. That's the trick.
Scot: Do these athletes get inside their own head, like I get inside my own head when it's time to do it?
Dr. Galli: Absolutely.
Scot: And what does that look like? What are some of the things that you run into there that you have to work them through?
Dr. Galli: Sometimes it's a matter of, oh, it just doesn't . . . I don't feel 100% perfect today. This thought that they have to feel 100% perfect or look at that guy or look at that guy or look at that lady, you know, look how good they look going around the track or how good they look warming up or, you know, in a sport, like speed skating and there's some others too.
Ooh, my equipment doesn't feel totally dialed in, You know, there's these just little seeds that under stress can, you know, become much larger issues if the athlete's not prepared to deal with them.
Troy: And what's the . . . yeah, I guess I kind of imagine this scene before, you know, an event. I'm wondering, are people just like super anxious? Do they look pretty chill or they just have headphones on relaxing? Like what's the usual vibe in that sort of scenario?
Dr. Galli: It's a range. For some, you wouldn't know by just looking at them, you know, that they're nervous. Some are pretty casual. Some will isolate. Generally, you are going to see a more intense look in the hour or two before they have to get to the line. And for the most part, at that point, the work is done and the athletes are just, you know, most folks other than maybe their coach, you kind of lay off of them and let them do their own thing.
Some do like to socialize a little bit more, and that's actually part of the challenge that we deal with is it's an individual sport, but all these athletes train as a team and they also have to learn how to deal with one another on these high-pressure days, because some people will like a little bit of small talk and chat. Others just don't want to be messed with at all. And so we have to help them learn about each other's tendencies and preferences as well.
Troy: That's what I wondered. Yeah. I read a book recently and it talked about Michael Phelps' routine prior to events and, you know, he'd have this period I think about . . . . Well, he had the exact same routine he would go through every time and then, you know, had about a period, I think, of an hour where he just, you know, got his music in. And then when the time came, he would step on, there was the same process. So I just wondered if that's something speed skaters incorporate that you see, or if it's just kind of a range.
Dr. Galli: The good ones do. The good ones do. I mean, in terms of like within-person, right, they're going to be doing the same thing again and again because that's what's comfortable. And at the same time, they're also flexible and know how to adjust if they have to, because, at an event like the Olympics, things never go completely as planned.
Scot: So you talked about, you know, some people just look completely chill, like they're not even phased by it. Is that because they've done training with a coach like yourself, or is that more of a personality thing? Or can it be a combination of both? Is this a skill you can learn?
Dr. Galli: Absolutely. It's a skill you can learn. There are some who are gifted. I mean, we have some athletes who actually require very little work with me. We might chat on about specific things that come up, but, you know, they've been fortunate to have the genetics and the life experiences that have empowered them to really know how to control their emotions and focus. And so, you know, they may be nervous on the inside and that's okay, but they're also in some ways unfazed, and some are just kind of gifted in that way and others need a lot more help.
Scot: You said that the really good athletes do the same things. They have a sequence of events. They do the same things over and over again. Why is that? What is it about that sequence that's powerful?
Dr. Galli: Well, I think some of it is, you know, as simple as these are the things that I need to do to feel ready. I've got to eat, have these nutrients. My body has to get warmed up in this way. I've got to prime myself for performance. So some of it is just like it's what works, but there's also the psychological effect of this is what's familiar, this is what's comforting.
And that's something I preach to our athletes. You have to find that sequence of events early, and you have to be using it even in, you know, benign situations like, you know, go into practice so that when you bring it to a foreign environment or an environment that's very different, when everything else feels unfamiliar, the routine still feels familiar and comforting.
Troy: And one thing I heard too along those lines in this, like I said in this book I read, they talked about how when Michael Phelps, who was like, by the time he was on, you know, up there ready to start his race, you know, he was already, you know, 90% of the way through his routine. Like his previous routine, everything had been successful in that, the race was just the next step in that.
So it was almost like, you know, this preconditioning something he imagined many times in his mind, the success in the race, following his success and going through this routine beforehand. So I thought that was kind of interesting that it, you know, kind of played into that of saying, "Hey, you know, I've already succeeded up to this point. Now I just go out and do my race and I finish it up."
Dr. Galli: One interesting thing about him was that he had a coach who really knew and understood what Phelps would need to be able to do. I mean, he knew that Phelps obviously was physically gifted, but he also knew what type of preparation Phelps needed mentally so that he would be totally unfazed.
So Phelps' coach would really test his focus. He would break his goggles, hide the backup pair. I mean, and these are only things that you would only do if you had a pretty solid relationship, of course, with your athlete, because sometimes we'll throw this stuff out, you know with the coaches and athletes I work with, but, of course, you have to be careful when you do things like that.
But he wanted to make sure that Phelps not only would be prepared in the event of kind of an unthinkable circumstance, but also as importantly was that Phelps knew in his mind that he could handle anything that might come up because sometimes it's the fear of what might come up that actually holds you back more than something that actually does come up.
Scot: They would . . . the goggles thing. Would he do that in . . . he wouldn't do that during competitions. That was practice, right?
Dr. Galli: I think practice. I'd have to go back . . . maybe like a lower-level competition. No, probably not like the most important.
Troy: In the Olympics. Hey, let's mess with Phelps, guys.
Scot: That's not the time.
Scot: All right, Nick, let's pivot this here for a second. Now you work with athletes who, you know, like you said, prepare for four years for one performance. The rest of us sometimes have to perform. We know that maybe we'll get another shot, but still, it's, you know, just as stressful. Troy, do you have any instances in your life where you have to perform like a pro while you have to go and just, you have to get it right.
Troy: Yes, I do.
Scot: Now, you're an ER doc, so I'd imagine that that's probably going to be your story.
Troy: The answer is yes.
Dr. Galli: No, not really.
Troy: Yeah. It's pretty chill at my job. It's pretty low stress. Yes, I do. Obviously, I have a lot of very high-stress scenarios I deal with, but there's one in particular that I think for me, you know, certainly raises my anxiety and I think across the board raises people anxiety.
And if there's one time I have to perform and I just have to get it right is intubation. So intubation is a procedure where you stick a breathing tube into someone's throat down through their vocal cords. Typically, I'm doing that if a person is unable to breathe, you know, they're struggling, or they're so out of it, either from a head injury or some reason that I have to put that in to protect their airway.
And it's a high-stress procedure. I mean, it's one of those things, oftentimes, you know, people are really, sick or else there's a lot of chaos in the room, it's in traumas, but it's . . . yeah, I think if there's one procedure I would say where it's like, okay, let's do this and let's get this right, that's it.
Scot: And you probably already have that figured out after your years in the ER, I'd imagine,
Troy: You know, I do, but it's one of those things I practice it on a regular basis. And the reason I do that is for exactly these reasons. It's one of those things when you're in that situation, you just want it to feel like, okay, I've done this, I've done it many times. I'm comfortable with this.
And, yeah, there are a lot of different variables that can go into this. Maybe this person is actively vomiting. Maybe they have blood coming up from their stomach, you know, stuff I'm having to deal with. But when it comes right down to the procedure, I want to feel comfortable with it.
But it's . . . yeah, it's one of those things, when I was in residency, it was probably the most anxiety-provoking thing for me was being comfortable intubating and doing that, because essentially, when I do that procedure, I take away a person's ability to breathe. I give them a medication that paralyzes them, and the only way they're going to be able to breathe if I can squeeze a bag and squeeze air into their lungs. And if that bag doesn't work and I can't get air into their lungs, I got to get some way to get a tube in there. So it's something that often has to happen quickly and you have to get it right.
Scot: You practice this? Like, you'll just go in on your own time. Like an athlete would practice their sport and practice this procedure?
Troy: I practice it every day. And this is a funny thing probably for even my colleagues if they heard me say this, but it is a procedure, like I said, over the years caused enough anxiety for me. I practice it every day, and I have a little simulation, you know, sort of things I have that I just go through that muscle memory of, okay, here's the laryngoscope. I get my laryngoscope, I get my endotracheal tube. These are the medications I'm giving. I preoxygenate, give them oxygen before the procedure. Just to walk through that process and I spend a couple minutes every day just practicing it.
And I know it's again if my colleagues are listening to this are probably laughing, but it's one of those things. It is the procedure probably in my profession that can go south pretty quickly and as is probably the most anxiety-provoking procedure. So yeah.
Scot: Producer Mitch, why don't you grab a microphone and join us? So the plan on this show is for each one of us to talk about, you know, that moment that we have to perform like a pro, but I don't want to follow that one. So Mitch, what yours?
Mitch: You're going to make me follow it?
Scot: Yeah. Maybe we don't. Maybe we just go to Nick's advice at this point, because I have a feeling Troy does a lot of the things that Nick might recommend. Like what's yours? What's yours, Mitch? Go ahead. I'll do mine.
Mitch: For me, I always try to . . . I maybe even over practice. I find myself preparing for when I give my lectures in class. So I teach at the community college these days, and I'm teaching a new course that I haven't taught before. And it's a curriculum that I haven't done myself, and I find myself having even nightmares sometimes about like, oh no, am I going to say the wrong thing? Am I going to sound stupid? Am I not going to remember some of the facts that I'm trying to share?
And so I find myself reading the content over and over and over again. But for me, at least, I don't know if it's actually helping. I find myself still kind of stumbling every now and then when . . . you know, I had a student ask, quiz me on some riot that I did not remember that was in a strange sidebar in the textbook I didn't get. So I don't know.
Scot: All right. Mine is kind of silly, but so difficult words to pronounce or difficult names stress me out. And I've been in performance long enough that when I see one, I will practice it before it's showtime. I will say it out loud numerous times. And then in the moment leading up to where I know on the sentence before now I'm in the sentence, I'm coming up on that word, I'm going to screw it up. And a lot of times I do, and I really wish that I could get away from that because I just totally psych myself out.
So, Nick, let's go over just kind of all three of these stories and give us some tips on what regular people, Troy excluded because he's like some sort of superhuman, ER doc.
Troy: I'm not.
Scot: What regular people . . .
Troy: I'm far from and that's why I practice every day.
Scot: What regular people can do in these situations where they have to perform to maybe, you know, help them not necessarily guarantee, but help them, you know, do better.
Dr. Galli: Yeah. I mean, and as I hear these three stories, it's great because there's contrast there. There are some similar things that would benefit all three of those scenarios, and then I think there's also a slight variation there unique maybe to Troy's experience.
One thing that there really is no substitute for is to prepare and practice, and that's what Troy was saying. You have to make sure that you feel comfortable and confident in what you're tasked with doing, and you also have to try it out maybe in different circumstances and situations with distractions, without distractions, maybe handicap yourself.
You have to really not only to keep it interesting for yourself, but also just to make sure that there's some transfer from, you know, the practice to the performance, and that's something I talk with my athletes a lot about is that's great that you can go out there and nail it in a very casual, low-key environment, but why don't we try and amp up the energy and practice a bit so that it more closely simulates what you're actually going to feel and see in a competition. So no substitute for preparation and varied preparation.
Troy: Yeah. I always enjoy the stories like a football team is practicing with the loudspeakers out there, just with this loudest like it can possibly be, so they can't hear anything. And, you know, like you said, it's one thing to do it in a low-pressure situation where there's no crowd noise or not that intensity of it, you know, some sort of Olympic event, but certainly something else when you throw those variables in.
Dr. Galli: The way I describe it is, you know, we're never probably going to be able to completely replicate the emotion that comes with high-pressure performance in a practice setting. And at the same time, we're never going to be able to make that high-pressure performance setting feel like a practice setting, but is there a way that we can . . . and if you could see me right now, I'm using my hands. Is there a way we can take that high-pressure situation, make it feel a little bit more comfortable, and take the really low-pressure settings and make them feel a little less comfortable so that, you know, we close the gap between them and they're not such different situations.
Scot: So number one there is prepare. It applies to Mitch. It applies to myself. It applies to Dr. Madsen Troy. What are some other tips that you would have?
Dr. Galli: Another tip would be to just, you know, take a new perspective on the situation. And I think even for Troy, I mean maybe especially for Troy, it's like, yeah, this is a big deal and it's very important, but again, this is also a really privileged position to be in, to be trusted to essentially save people's lives, or for Mitch, you know, it's a privilege to be able to sort of guide the learning process, or for Scot, it's a privilege to be able to, you know, give people a voice and educate the listeners.
So, you know, being able to take a step back and think about your situation in less of a threatening way and more of a way that, hey, this is a challenge that I look forward to tackling.
Troy: That's great, yeah. I love that advice because then it is sort of takes it off you. It's like, hey, this is not all about me. This isn't all about my performance. This is about someone here. Think about the people you're trying to reach out to, the people they're trying to help. I'm trying to help this person, or I'm trying to reach out to these people or connect with them, and I think that I agree. I think that really helps performance is like, hey, you know, this isn't about me. It's about me helping them, and this is about them.
Scot: Yep. I wonder if that perspective too might contain . . . sometimes I get a little self-involved. I don't have quite the right word, but I think, "Oh, I'm the DJ, I'm the one interviewing. I should get this right." And maybe that is a little, maybe I should take it a little less seriously that way maybe.
Dr. Galli: In psychology, we call that shoulding on yourself.
Scot: Well, I'm covered in should.
Dr. Galli: Can we leave that in?
Scot: Yes. We're leaving that in. So prepare, develop a new perspective so it doesn't seem quite so threatening. It's more of a privilege. What else do you have there?
Dr. Galli: Where we start to diverge a little bit, for Scot and Mitch in that situation, you know, I feel it's appropriate to, you know, make sure that you're also, you know, enjoying the experience, having fun with it, being a bit lighthearted.
I think that looks a little bit different in Troy's circumstance, because certainly you can't make light of the situations that you find yourself in, but I think have fun or enjoyment maybe it means something different. In that setting, it's more being fully immersed. You know, it's that flow experience of like, you know, the balance of skill challenge, and really, you know, just feeling at one with what you're doing.
So it's not like ha-ha this is fun, giddiness necessarily, but it's more like this is, you know, what I was put on this earth to do, this is what I was meant to do, and I am lost in this right now. So I still think it's about getting fulfillment and enjoyment, but it maybe looks differently across those situations.
Troy: It's interesting though, Nick, you mentioned that. And something I noticed, when I started my training in medicine, is that we would be in very, very high-intensity situations like codes. So you've got people you're doing CPR and you're doing these procedures, intubation, central lines, like all these high-pressure things, trying to get someone back to life essentially. And people would be cracking jokes sometimes. I mean, they were focused on the task, but, you know, it was almost like this pressure relief valve.
Dr. Galli: Yeah. That's true. They were talking about the possibility of my wife, you know, before having our first child, you know, for, in case of a C-section, you know, talking about do you want the doctors listening to music and chatting? And she was adamant that, "No, I don't want that. I want them to be focused." And my input was, "Well, you know, if that's what they do, then that's what you should want them to do." So I'm glad you brought that up.
Scot: It kind of comes back to the Michael Phelps thing, right? Trying to create some sort of normalcy in abnormal situations. Something that's familiar and comfortable.
Dr. Galli: Yep.
Troy: One of the more surreal experiences for me in med school was being at Johns Hopkins, you know, in inner-city Baltimore. And being in the surgery suite, doing these kind of high-intensity surgeries with the chief of surgery there, and he's got country music jamming. He had his favorites, Garth Brooks jamming there while we're in surgery, you know, in the operating room. And that's how he performed his best is, you know, having something like that to diffuse the tension a little bit.
Scot: All right. So prepare, try to bring a new perspective, think of it in a less threatening way, have fun, be lighthearted, or try to get into the task that you're doing. If you're Troy, get into that flow state, just be totally in the moment. It sounds like what you're talking about there. And how about a fourth one? How about one more?
Dr. Galli: This is where I feel it will be interesting to get Troy's take on this one as well, where it diverges also. I think as a teacher, as a host, I think it's okay to be vulnerable. And, you know, Mitch, I can really relate to your story because teaching is something I do a lot of and I've done a lot of for the last decade. And I can remember early on feeling like, man, I cannot make a mistake in that room. I'm going to kill my credibility.
But actually, you know, almost always I did know more, I was mostly one step ahead of my students. But the other part of it was at some point I let go of, okay, this is 2020, Dr. Google is really in charge of the facts. Everybody has access to the facts and the dates. That's not my job anymore. My job is to help my students learn how to ask the right questions and to think about things in different ways.
That takes a lot of the pressure off, and it's not my job to always get it right. But when I get it wrong, it is my job to acknowledge that I was wrong and talk about why I might have been wrong, and how we can get the right information.
Be okay being vulnerable, be okay with that. And I'm not saying try to make a mistake, but acknowledge that you're human. People appreciate that. People appreciate when their teachers are, when there's that power differential knowing that, like, that person's human too and that they're going to make mistakes.
And then similarly, Scot, for you, even if you've prepared for the name, there's still some trepidation about I might get this wrong. So it's okay. I think when you're going to introduce somebody to sort of couch it in, "Okay, I want to make sure I get this right. Is it . . ." And then you almost sort of build in some leeway to you're acknowledging that, like, you're not totally sure you have this and maybe you do nail it and then you look great. And if you don't, at least you didn't give the sense that, oh, you thought you knew it and then you didn't know it.
Scot: Or didn't care or whatever.
Dr. Galli: Or didn't care. Now I think, and this is maybe where I'll be interested in Troy's point of view, if I was in the kind of situation that Troy finds himself in, I really want to be talking myself up a little bit more and making sure that I understood for myself I'm the best person to be doing this right now. This person needs me, and I'm going to deliver because that's what I do. And, you know, there's not maybe as much room for that outward expression of vulnerability in the ER. But let's hear Troy's take on that.
Troy: Yeah. That's an interesting point you make Nick, and it's funny, something I have learned to do over my career and I have consciously tried to do, and I've told myself is allow yourself to make mistakes. And by that, I mean recognize that I will make mistakes and feel comfortable apologizing for that or reaching out in those situations where I've made a mistake.
I used to beat myself up over those things. I used to expect perfection of myself. And if someone contacted me and pointed out a mistake, I would sometimes become very defensive, and I think that affected my performance.
So honestly, I think that, you know, you talk about not expecting perfection of yourself. I think being able to acknowledge when you make mistakes and feel comfortable doing that, then helps performance because, you know, you say to yourself, "Yeah, I could make a mistake," but at the same time, like you said, you tell yourself, you know, "I've got this. I'm comfortable with this, I'm going to give this my best shot and do my very best with this." And then, you know, again, I think the outcome is often better than if you're just telling yourself, "I can't screw this up. I can't screw this up," when you're thinking that.
Dr. Galli: And there's degrees of mistakes. I guess maybe that's what I was missing there. And that's kind of the nuance that goes with different, you know, fields of expertise. In my mind, it's like, wow, you can't afford to make any mistakes, but really there's also a range even in the work that you do.
And I like what you said about kind of combining the, yeah, I've got this, I'm trained for this, I'm ready for this. And you know that you might slip up, but you've also got a team around you to help you, and you know that you're good enough that most mistakes or slipups you make, you're going to be able to rectify those.
Troy: Exactly. Yeah. And that's what I think is helpful. You don't want to make the big mistakes. You don't want to do it.
Dr. Galli: Which could happen because you're guarding against, you know, some mistakes. That's sometimes what happens.
Troy: Yeah, exactly. Or because you're so focused on the little things and not screwing those things up that, you know, you kind of lose the forest for the trees, that kind of thing, where it's just you get so worked up about the small stuff that you'll lose that big picture and like, hey, this is what really matters.
Scot: So some solid advice, I think, from the athletic world to the personal world. So prepare, try to take a new perspective, have fun, be lighthearted if at all possible, or at least in the moment. And then be okay, be vulnerable, realize that you might make a mistake. If it's a high stakes situation, you know, then realizing you might make a mistake, it's save somebody's life, because now you're going to start to account for it. So that's good.
Mitch, do you have anything you'd like to add? Do you feel a little bit better going in the classroom tomorrow? Are you going to be able to use any of this, do you think?
Mitch: I think so. I think that the idea of, you know, being able to be vulnerable and, you know, I don't have to know anything. That's right, Dr. Google exists. So why am I putting so much pressure on myself to be absolutely perfect? It is. It's really helpful.
Scot: All right. And Troy, you learn a little something today?
Troy: Oh, absolutely. Yeah. I think just talking through these things, it kind of helps reinforce for me a lot of, you know, a lot of what I think. I've learned the hard way honestly. A lot of this stuff has just been stuff, you know, over time I've just said, "Hey, I got to find a better way to deal with this. I've got to find a better approach." And so it's nice to have, you know, really, I think for anyone listening, have Nick just summarize this stuff that's been sort of a long process for me to try and learn.
Scot: Nick, you have a podcast that you participate on as well called "Becoming Headstrong." You talk about a lot of this kind of stuff.
Dr. Galli: Yeah, absolutely. Myself and three colleagues of mine. We put out three episodes a week, and they're typically very short, 5 to 10 minutes, and it's sort of designed for the athlete, but also just the regular person and tips on how to perform your best when it matters most.
Scot: All right. So check that out wherever you get podcasts, "Becoming Headstrong." Nick, thank you so much for being on the show, and thank you for caring about men's health.
Time for odds and ends on "Who Cares About Men's Health?" And we've got one item that we want to talk about. The Urology Q and A, where we asked for your questions for our urologist, went so well we've decided we're going to do it with a sports medicine doctor this time, because I know that there's a lot of people that have different types of orthopedic, muscular issues, bone issues, those sorts of things that they might want to learn a little bit more about.
Troy, I need you to clarify though what does a sports medicine doctor do and, you know, help our listeners too so they can start thinking about the kind of questions to ask.
Troy: You know, it's interesting. I think sometimes people misunderstand a little bit what they do because it's called sports medicine. So I think people think, well, these are for athletes, like high school, college, you know, whatever. Really the best way to think about sports medicine is just orthopedics doctors who don't go to the operating room. It's kind of like John Smith, our urologist, who described himself as a non-operative urologist. He's a urologist who doesn't work in the operating room. He sees patients in clinic.
Sports medicine, same kind of thing. They don't go to the operating room, but they'll do all sorts of procedures in clinics. So if it's anything you would want to see an orthopedic surgeon for anything to do with the bones, the joints, the muscles, the ligaments, the tendons, you know, your neck, your back, any sort of bony or muscular structure, that's what they do. That's their specialty.
Scot: All right. So I have cramps in my calves, sports medicine doctor could help me with that?
Troy: Absolutely. Cramps in your calves, back pain, knee pain, wrist pain, you know, anything like that. That's what they do.
Scot: All right. Mitch, what would you ask a sports medicine doctor?
Mitch: I slept weird and I feel old and because now everything hurts.
Scot: Oh, that's something that you could ask a sports medicine doctor?
Troy: They might want some more specifics, Mitch.
Mitch: All right. Well, we'll get a referral.
Troy: What hurts? Your neck? Your back? Everything hurts. We do get that in the ER occasionally like, "Okay, let's start somewhere. Like help me out here."
Scot: What about like tingling extremities, like randomly tingling? A sports medicine doc would understand that because they look at nerves and musculature, right?
Troy: Yeah. They would understand that, you know, sometimes tingling we think with more neurologic things, but if it's more just like tingling in one hand, absolutely. If it's like tingling all over your body, that's a little bit more neurologic. So, but yeah, like tingling in your hand, like weakness in your hand.
Like I've got this pain in my left hand that I finally got x-rayed and I didn't break it. I thought for sure I'd broken my hand, but, you know, that's the kind of thing I'd see a sports medicine doctor for. I've had this pain for two years. What do you think it is? What should I do about it?
Scot: Even though it wasn't even sports-related so that's good.
Troy: It was sports-related.
Scot: Oh, it was. What'd you do?
Troy: Or if it wasn't, I fell while I was trail running, but it's like one of those things, but I could say it's not because every time I type a lot, I feel it in my thumb. So yeah, so maybe it's . . . yeah, even though at this point it's nothing related to sports, they'd be great people to ask about that.
Scot: Okay. So you can ask your questions by a lot of different ways. The way that would be cool is we have this listener line. You can record your message at 601-55SCOPE that 601-55SCOPE. If you want to email us, you can do firstname.lastname@example.org and you could also do it at our Facebook page, facebook.com/WhoCaresMensHealth. Did I cover all the ways to get ahold of us, Mitch?
Scot: They're increasing. There's more and more of them. So it really you're taxing my memory here. Mitch keeps going, "We should let our listeners contact us this way." Like, who cares?
Troy: Maybe we should just give out our personal numbers. Let's just throw it out in there too.
Scot: Troy's cell phone number is . . .
Troy: Here's my number.
Mitch: You can follow us at TikTok. No, let's never get onto TikTok.
Scot: All right. So get those questions to us, and then next week, we will have them on the show. Just going to leave this here. It might be something to do with health. It could be something totally random. Troy, do you want to start, or you want me to start? I know you told me last time you feel the pressure of always going first. So I, you know.
Troy: I'm ready. I am ready. Trust me. I listened to what Nick said, and I prepared and I visualize what I'm going to say.
Scot: All right, go for it. Let's hear it.
Troy: I'm going to say it. So I'm just going to leave this here. You know, Scot, we've had Thunder on here, and one of my favorite episodes we've done was hidden sugars. So I tried to use hidden sugars to my advantage. Before I go out on a long run, it's funny like, you know, if you're running, you really fuel yourself with sugar. I don't know if you did that when you did your marathon, but, you know, you eat a lot of gels. You drink Gatorade. It's really just a lot of sugar.
And before I run, I like to have something with sugar in it and something with a high concentration of sugar. So I tried to find the one thing that's reasonably palatable that has a ton of sugar in it that I could eat before I run. And I didn't want to be eating candy, I didn't want to be eating gels. Guess what I found, best stuff to have before you run?
Scot: Wow. Okay. So a good food with hidden sugar that's not candy. It's not a sports bar. There's nothing like that. I'm just going to say, like a yogurt. Was that it?
Scot: Oh, okay.
Troy: Cinnamon applesauce. Ounce for ounce, the cinnamon applesauce I found has the same amount of sugar as a Mountain Dew. It's remarkable.
Scot: Wow. That's crazy.
Troy: It's crazy. This is stuff that people are putting in their kids' lunches for school. Like, hey, here's your serving of fruit for school. Ounce for ounce, same amount of added sugar. I'm talking added sugar. Yeah. There's the natural sugar from the apple in there. This is the stuff that's added on top of it. And you can find variations across brands, but this is one of the most popular brands of applesauce. But like I said, I've used it to my advantage. That's what I eat before I run now. It tastes good. Sits well on my stomach. But the flip side of that is prior that episode with Thunder, you know, I never would have thought about this, but I looked at applesauce because of some of the stuff he told us about some of these foods we never would think of with sugar, and I was amazed at how much sugar was in it.
Scot: Just going to leave this here, do you have any white crew socks, Troy?
Troy: I have just kind of short ankle socks. I do not wear the white crew socks.
Scot: I've worn those pretty much my whole life. I think I might be retiring white crew socks for good.
Troy: Please tell me you wear white crew socks with like Birkenstocks.
Scot: No, I don't.
Troy: And shorts.
Scot: I wear them in the appropriate times, but I might be off white socks forever. I'm down to my last few. And it's hard to find a pair anymore because the levels of dirtiness don't match. So I might have one that's . . .
Troy: It's a bit more like a gray sock now.
Scot: One that's a little bit more white than the other.
Troy: Gray-ish, yeah.
Scot: They're starting to get pretty thin in the bottom. So I might be getting socks, other types of socks at other places, so I might be off white crew socks.
Troy: Well, you know, Scot, I don't know what this says about this podcast or about us, but this is now the second time one of us has used socks for our just going to leave this here.
Scot: It's the one fashion thing I think guys have permission to talk about.
Scot: We can talk about socks.
Troy: We can talk about our socks. Well, I've got black socks now. I went with the black socks, the black kind of ankle socks and I like them. They feel good. They're nice.
Scot: Yeah. And they hide the dirt so that's good.
Troy: They're great for dirt. Yep.
Scot: All right. It's time to wrap this up with the things that people say at the end of podcasts because we're at the end of ours. Go ahead, Troy.
Troy: Thanks for listening. Be sure and subscribe. You can subscribe anywhere you get your podcasts, whether it's Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you. We'd love to hear from you. You can contact us at email@example.com or reach out on Facebook, facebook.com/WhoCaresMensHealth.
Scot: And the phone number if you want to reach out now, this is not toll-free, but if you're calling on a cell phone, a lot of cell phone, you know, have unlimited long distance, it's 601-55SCOPE, 601-55SCOPE. And if you have any feedback, leave a message right there. Thanks for listening and thanks for caring about men's health.
For young athletes, injuries happen—from sprained joints in sports like soccer or track, to dislocated shoulders on the football field. Orthopedic specialist Dr. Julia Rawlings talks about…
August 12th, 2020
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.
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.
Three most common injuries in young athletes and why some of these injuries should to be seen by a doctor sooner than later.
Knee injuries are extremely common for young athletes in any sport. Whether it comes from a hard hit or a bad pivot, many knee injuries can be serious and may need immediate treatment. Sports…
July 7th, 2020
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.
Knee injuries are extremely common for young athletes in any sport. Whether it comes from a hard hit or a bad pivot, many knee injuries can be serious and may need immediate treatment. Learn what symptoms you need to be on the lookout for to make sure your athlete can get back in the game.
Step 1: Stop trying to look like the muscle bros on magazine covers. Focus on how you can live an extraordinary life. Dr. Ernie Rimer works with top college athletes, but he shares a simple 5…
December 17th, 2019
Dr. Ernie Rimer is the Director of Sports Science for the University of Utah Athletics Department. He works with elite athletes to help them get in fighting shape for game day. But it came as a surprise to Troy that Ernie isn't built like a line-backer.
Ernie explains that he's a sports scientists and a self-proclaimed "recovering strength and conditioning coach." 10 years ago, he worked out to look big. His goal was to be one of those massive guys, but as he focused more on the science of fitness and matured, his goals have changed.
Ernie says, "I stopped caring about how I looked when it comes to my fitness and I started caring more about what fitness does for me in my normal life."
For Ernie. Health means having the proper physical fitness and mental state to live an extraordinary life and career. For him, it's about having the physical fitness to pursue the things in life he enjoys and be in the right frame of mind to engage in fulfilling activities on a daily basis. The Health Benefits of Strength Training
The US Department of Health and Human Services recommends American adults should engage in strength training at least twice a week. For best results, these workouts should be moderate to intense in difficulty and target all muscle groups.
Currently, only 30% of Americans are actually getting that exercise in every week.
A lack of strength training in men can have real consequences. Without strength training, after age 30, men start losing 3-5% of their lean muscle mass. Not only will that impact a guy's day to day functionality, but lean muscle is also the body's metabolic engine. Less muscle means fewer calories burned every day.
On the flip side, regular consistent strength training can provide a lot of benefits:
Additionally, moderate strength-training just a couple of times a week may help you live longer. According to the American Journal of Epidemiology, strength training is just as important, if not more than cardiovascular training. Moderate strength training can lead to a 23% risk of death from any disease and a reduction of 31% of cancer-related deaths. Start Your Training At a Level You Can Maintain
Ernie is used to working with elite athletes, but that doesn't mean he can't pull from his experience trying to build programs for family and friends. Years ago, he used to give his friends and family the same crazy strength and conditioning programs similar to the ones he gave his athletes. He found that there was no way for a non-athlete, regular guy to keep up with these types of regimens, so his approach changed.
"Your strength regiment has to be sustainable," says Ernie. For him, the plan needs to be something he can keep up with regularly and feel good about. He's no longer looking to punish himself - or his friends - in the gym anymore. And more importantly, it's important to find a plan that isn't so time-consuming or intense that it begins taking away from the things he loves to do in life.
So should a regular guy start? Ernie doesn't recommend anyone go out, buy an expensive gym membership and try to "crush it." Especially if they are relative sedentary now. The best strategy is to start with trying to increase your current activity level at least a few times a week. Shoot to do a little bit of basic resistance training two to three times a week. Keep the training plan short and simple to begin with. It's important that you can get comfortable with a basic routine before you start taking your lifts "to the extreme."
Remember, just because you're working out harder, doesn't mean you're getting more benefits. While a moderate resistance training plan can provide a ton of benefits and reduce mortality, research has shown that too much strength training can have an increase in all-cause mortality. There's a sweet spot to strength training. Shoot to find yours. The 5 Strength Exercise Routine the Scientist Recommends
Dr. Ernie Rimer suggests a relatively simple routine of five exercises to help anyone, at any level to reap the health benefits of a strength training program. The plan focuses on multi-joint exercises that work multiple muscle groups and joints in the body. "They give you more bang for your buck," says Ernie. These are the exercises he suggests everyone start with first:
The number of reps and sets of this routine should be custom to where you currently are in your physical fitness. Focus on taking one step forward in your fitness at a time. Remember, just a moderate amount of strength training twice a week can have huge benefits.
A beginner should start with a number of sets and reps they can sustain and stick with it for a prolonged amount of time. Even if it's just one set of each exercise, one time a week. If that's a step forward for you, then start there.
"We want to get you further," says Ernie, "But it's important to take a step you can commit to and sustain."
As you get into a routine of strength training, you can eventually work towards two to three sets of each of the exercises, two to three times a week. Do These Exercises Anywhere with Any Time You Have
You don't need to carve out a couple of hours a week in your busy schedule or spend a lot of money on a pricey gym membership to start strength training. These exercises can be done at home with bodyweight with whatever time you have available.
Look around your place and get creative. There are plenty of ways you can complete the five exercises without much equipment. For the athletic component, find some stairs in your house or a sturdy chair or coffee table. If Ernie's kids can jump up and down from a coffee table why can't you?
For the other exercises, try bodyweight exercises. Simple squats can work the lower body. Good-mornings for your posterior chain. Pushups and pull-ups for the push and pull of the upper body. Start with exercises you can easily do next to your bedside in the morning.
Additionally, bodyweight exercises are a great place to start. In strength training, form is key. If you're lifting a heavy weight with bad form, you can seriously injure yourself. Bodyweight exercises are much safer to begin with. You can get quite intense without as much risk of injury. Bodyweight exercises are also a great way to learn the correct form of an exercise before you add weight.
You don't have to devote hours of your week to this training to get in shape. For example, Scot is currently in a master's program and a lot of his time is spent doing course work. He takes a short 5 minute break every hour when he's studying. He fits in a few bodyweight exercises during his breaks to keep his body strong.
According to Ernie, these small bouts of training can be as effective, if not more, than a solid block of training time. "Exercise Microdosing" is a big area of research today in sports medicine. Sports scientists have seen results that several short doses of strength training in a day may be more beneficial for bone health, muscle development and joint health than a longer, sustained amount of time.
Keep it simple. Fit it in when you can. Aim to improve. How to Get Motivated and Stay Motivated
For a lot of guys, getting motivated and staying motivated to do any strength training can be difficult. If you're going to see the results, you need to be able to keep with a strength training regiment long term. Not just a few weeks.
Dr. Rimer says there are a few strategies he suggests you try to stay motivated:
Producer Mitch has tried strength training in the past and completely lost motivation. He searches online and finds plans and workout videos made by "internet muscle bros." He's tried their fitness crazy plans, choked down the supplements, watched his macros, and he still feels miserable and ends up quitting. He sometimes thinks he'll never be "one of those guys."
Dr. Ernie, he explains that this is the major disconnect a lot of guys face when they first start strength training. It's easy to try and make your goals focused on "looking strong," to aim to get the type of physique you see on the cover of magazines. But according to this sports scientist, that look shouldn't be the thing that motivates you.
"An exercise regimen should be about maintaining the fitness you need to facilitate an extraordinary life," says Ernie. Make your extraordinary life your primary motivation.
Ernie says that the "internet bros" online can be helpful in finding a strategy that works best for you. Focus on the advice they give, rather than what they look like. Focus on how their strategies can best benefit you and - most importantly - how their method can facilitate what you want to do with your life. Dr. Rimer's Megaphone Moment:
"This is Dr. Ernie Rimer on the first-ever Megaphone Moment on The Scope. Today I want to say if you want to get started. Make it simple. Sustainable. And make sure that it facilitates and extraordinary life." Just Going to Leave This Here
On this episode's Just Going to Leave This Here, Troy has been working with a dog trainer and wonders if the same strategies can be used to train dogs can be used to train himself. Meanwhile, Scot is currently researching the very notion about men not caring about their health and finding it's way more complicated than he suspected. Talk to Us
If you have any questions, comments, or thoughts, email us at firstname.lastname@example.org.
Kids are active, spontaneous—and bound to eventually get hurt at home. What are the most common injuries, how do they happen, and how you can prevent them in the first place? Dr. Cindy Gellner…
December 2nd, 2019
Dr. Gellner: Kids are bound to get hurt at home. It's inevitable. So what are the five most common pediatric home injuries? How do you treat them and what can parents do to prevent them from happening in the first place?
Announcer: Keep your kids healthy and happy, you are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.
Dr. Gellner: If you have kids, you know how active they can be and how despite how hard you try as a parent to protect your kids, unless you have them in one of those inflatable bubbles, they're going to get hurt. There are five common home injuries that actually can be fatal but are quite preventable.
The first is drowning. It's the leading cause of death in one to four-year-olds. Whether this is because there's a swimming pool that they have access to or they're left alone in the bathtub, little kids can drown in just inches of water. If your home has a pool, make sure there is a gate around your pool that is locked and that your child can't open the lock. Some parents install pool alarms to be able to detect if something is in the pool. As for bathtubs, if your child is taking a bath, stay with them. Don't leave, not even for a second. Stay with them until they're old enough to bathe themselves or shower themselves.
The second injury is actually the overall leading cause of death for children at home and that's suffocation. That's why we recommend nothing in a baby's crib or bassinet. They can roll right into a teddy bear and can't roll away. Older preschoolers can get caught up in cords for blinds or drapes. There are hooks that parents can install higher up than a child's reach to keep the cords out of the way and prevent this.
Third are fires and burns. It's amazing how many parents don't keep up with changing the batteries on their smoke detectors. That's a simple way to protect the whole family. Thermal burns are trickier because kids are really fast at getting into things you don't want them touching like hot beverages, soups, and hairstyling devices. Close supervision in the bathroom and kitchen are crucial with young children. In the bathroom, there's also the risk of thermal burns with hot baths. Never leave a child in a bathtub with water in it, and make sure your hot water heater is set to 120 degrees Fahrenheit to prevent hot water burns while bathing little kids.
Next is falling, specifically downstairs. Baby gates at the top and bottom of stairs are a must if you have a little person in the home. We get calls at my office all the time about how parents turn their backs for just a second and their toddler fell down the stairs, and parents are concerned about concussions. While kids are tougher than we give them credit for, hitting their head on something hard at just the wrong spot can cause significant injuries. And also remember windows. Many parents think that if a window has a screen on it, it's okay, but screens are not meant to bear the weight of a toddler or a preschooler. And if they fall out of a second story or higher window, it could be fatal.
Finally, poisoning. Each year over 10,000 calls are made to the Poison Control Center. Many of them are for children. If you think your child has gotten into anything potentially toxic, call Poison Control at 1-800-222-1222. Don't wait and call your pediatrician's office as that may delay treatment. We have a saying in toxicology, "The dose makes the poison." The experts at the Poison Control Center will be able to tell you how much your child will need to have ingested or gotten onto their body for it to be a concern and will be able to give you advice on just what to do, whether it's something that you can do at home or if they have to go to the emergency room and we don't recommend syrup of ipecac anymore.
The best thing is to keep anything dangerous or poisonous out of sight and out of reach of curious little kids. Cleaners should be kept high up or behind locked kitchen cabinets. Medications, even children's vitamins should be kept where kids can't get to them. Remember, for all of the hazardous situations, the best thing you can do as a parent is prevent them from happening in the first place.
Childproof even before your baby is able to crawl. Get down on your hands and knees and see what your baby or toddler sees from their point of view to get a better idea of how high you need to put things out of reach. Be sure to lock doors and cabinets that need to stay shut and above all else, keep an eye on your child. It's hard work to always be right there, but it is so worth it to make sure your child is safe.
Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.
Learn how to prevent the most common injuries your child may suffer from in the home.
It may seem like a given—if you run long distances regularly, then you’ll eventually need a knee replacement. But from a doctor's perspective, that's actually not true.…
June 15th, 2018
Interviewer: Running from a doctor's perspective, that's next on The Scope.
Announcer: This is "From The Front Lines" with emergency room physician, Dr. Troy Madsen on The Scope. On The Scope.
Interviewer: When emergency room doctor, Troy Madsen, was thinking about running as his main exercise a few years ago, he was concerned about how it would affect his knees. So he did the research like any good doctor would do. And Dr. Madsen, what did you find out?
Dr. Madsen: Well, you know, like you said, my concern in running was, "Okay, great. I'm going to start running more." I said I'm going to run every day, do a couple miles every day, go from there, but in 10 years, I'm going to need a knee replacement. This is what I thought. This was what I grew up hearing. This is what people said. So I said to myself, you know, "I work in medicine, certainly I can look and see what kind of evidence there is for this. Are there any studies that have been done that show that runners have a much higher risk of needing knee replacements?" So the big concern here would be that you run a lot, you wear down the cartilage in your knees, you get osteoarthritis, which is bone on bone, and then at that point, it hurts too much, you need to have your knees replaced.
So it's a tough thing to study. You know, ideally, you would take a group of people and say, "You guys are going to run every day, you guys aren't. And then 10 years, we're going to see how your knees are doing." You can't do that. It's not practical. So you really just have to rely on people reporting how many knee issues they've had. Look at runners, look at non-runners.
Interestingly enough, at the time I looked, there were a few studies that had been done looking at this, and just this month, an editorial came out in the British Medical Journal that addressed exactly this question. So they summarize all the research that is out there. The bottom line is there is no convincing evidence that will tell you that runners have a higher risk of knee osteoarthritis and knee replacements.
The only thing they found, they said, okay, one study showed that in elite runners, they had a higher incidence of osteoarthritis where it was this bone on bone. This was one study that was done in the early 1990s. These were elite runners, meaning runners who had competed in Olympic marathons, and they had a little bit higher risk of this issue. I found studies that actually suggested in runners, they're 50% less likely to have any issues, meaning that maybe this running is actually helping the knees potentially helping build this cartilage up. You know, certainly, if you're having other injuries like ACL injuries or tearing ligaments, things like that, that's a different issue.
But just the whole wear and tear of running or this idea that you're just tearing your knees up, I can't find anything convincing that says, "Yeah, you're tearing your knees up, you're going to get bone-on-bone knees, and then in 10 years, you are going to need a knee replacement."
Interviewer: So had you found evidence to the contrary, would you be a runner right now?
Dr. Madsen: It's a great question. I don't know.
Interviewer: I'm trying to figure out if you're putting your money where your mouth is on this deal.
Dr. Madsen: Yeah, you know, at the time, and I think for a long time, that was my excuse for not running. I'll tell you the reason I ran is because my wife made me commit to run a marathon because we're moving, and that was part of the deal, "If we're moving, you have to run a marathon." I think she thought I was going to say that there's no way I'm going to run a marathon, but I committed to do it, and I've kept running since then. I think partly knowing that, "Hey, you know, this is a great exercise. It's a great sport. It's a great life-long sport. And the whole knee issue, I'm convinced that, you know, based on the evidence I can find that running isn't going to tear your knees up." I just can't find anything that absolutely says, "Yeah, you're going to have lots of knee problems because of this."
Interviewer: What about like somebody's weight or other issues like that? How is that taken into account in these studies?
Dr. Madsen: Yeah, it's tough. Again, these are not ideal studies.
Dr. Madsen: I mean, they're small studies. They're combining these studies to create what's called a meta-analysis where you combine data from lots of different studies. I don't know that they can really control for those factors for weight and look at a person's weight. Because you're talking about people who've been running for 20 years, can you account for their weight 20 years ago versus now? What different effects are there? I don't even have an answer.
Interviewer: Yeah, yeah. I would imagine, too, something else maybe to keep in mind. So I think this is good that if running is something that you do, that's great, continue to do it. If it's something you want to do, there doesn't seem to be a lot of compelling evidence it's going to cause knee issues. But I'd imagine it would be smart to be safe and, you know, make sure that you're in with a reasonable weight, and maybe even make sure that you're running form is good, that you're not heel striking and doing some of those sorts of things. Because the runners in the study conceivably would be doing those things.
Dr. Madsen: Exactly. You don't want to force yourself into a sport. You want to make sure your heart is in good shape, that you're going to be able to handle it. Don't just go off the couch and go put in seven or eight miles. Like you said, you've got to consider all those factors. Find a sport you enjoy. But I think the bottom line from this is if you enjoy running, don't tell yourself you can't run or you can't run more because you're going to have major knee problems down the road. I just can't find anything that suggests that's the case.
Interviewer: And since you started years back, when you first started running, when you did this research, you've since run marathons, and how do the knees feel?
Dr. Madsen: Knees are great. Don't ask me that question after a marathon, but today the knees feel good. You know, after long runs, there's always the aches and pains.
Interviewer: Yeah, but not knees, right? It's usually muscular or . . .
Dr. Madsen: Yeah, it's usually muscular, it is. It is not the knees so much. Well, I'll take that back. I'd say usually about mile 24, 25, everything hurts.
Dr. Madsen: And I'm telling myself, "I will never do this again." But, you know, you give it a day, you start to feel a little better, and then you're back at it.
Interviewer: And then for individuals that maybe currently run and they're thinking about wanting to run a little bit more, maybe they're kind of in this three to five-mile range, and they're afraid to go beyond that. Again, the research shows that probably not going to negatively affect you?
Dr. Madsen: Exactly. I think that's the big take home. But at the same time, keep in mind that if you're happy just doing three to five miles, keep doing it. You're getting the health benefits. And that's a whole different discussion. But if you're doing three to five miles, three times a week, you're doing great. And if you like it, if you're happy with it, keep doing it. If you want to increase those miles, maybe do a half marathon or something, feel free to do it.
Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.
Olympians face a lot of pressure when they compete. The world is watching as they attempt to pull off nearly superhuman feats. How do they keep confident to go for the gold? On today's Health…
February 15th, 2018
Announcer: The Health Minute, produced by University of Utah Health.
Interviewer: You don't have to be an Olympian to deal with pressure like an elite athlete. Sports psychologist Nicole Detling, what's a good strategy to deal with performance anxiety just for a regular person trying to, say, nail a big presentation or speech?
Dr. Detling: So something athletes hear me say all the time is, "I don't care who you are, what sport you do, how good you are. If you look for reasons to fail, you will find them. But on the other hand, if you look for reasons to succeed, you will find those reasons as well." And so, thinking about it in terms of just reframing the thoughts in your mind from looking for reasons to fail, to looking for reasons to success, that's one strategy.
Interviewer: So whether I'm an Olympic athlete, or giving that presentation, are my strategies going to be same?
Dr. Detling: The things that I teach Olympic athletes are the exact same things that anybody out there can use when they're dealing with stress and pressure.
Announcer: To find out more about this and other health and wellness topics, visit thescoperadio.com.