Search for tag: "sports injuries"

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Scot: All right. So we're out here at the pickleball courts. We've got Dr. Chris Gee, sports medicine. Have you ever played pickleball?

Dr. Gee: Not really.

Scot: Not really. Okay. We've also got Dr. Dwayne D'Souza, and you're our expert. He's the guy that brought the paddles, and in the email, he said, "I have enough balls." That was his words, not ours.

Dr. D'Souza: That's true.

Scot: Got Producer Mitch. Troy couldn't make it. And I'm Scot. So let's talk about pickleball briefly. Fastest growing sport. Might be a great way to get some physical activity for young and old. It's kind of getting stereotyped as old people play it, but that's not true, is it, Dwayne?

Dr. D'Souza: Yeah, I think when pickleball started it was originally that because it was a way for people to transition from tennis to kind of a less running, moving sport that's less hard on your body.

But I think because of the pandemic specifically, and just before that, people started playing a lot more because it was an easy way to get outdoors. There'd be more and more courts built on the West Coast moving towards the east. And I only started playing, I guess, last September. That's because my housemate's dad, who's 75, plays twice a day.

Scot: Wow.

Dr. D'Souza: He takes a little nap in the afternoon and goes back. And so he's like, "You have to come play." And I played one day and I got addicted. And I've been watching YouTube videos and trying to learn. I mean, when you go to Fairmont, especially post-work time, like 4:00 p.m. to 5:00 p.m., it's all younger 20s, 30s, 40-year-olds playing.

Scot: Got it.

Dr. D'Souza: And it's pretty fun.

Scot: Cool.

Mitch: What makes it more fun than, say, tennis?

Dr. D'Souza: I think it's because you can pick it up very quickly and it's a very inclusive sport, so anyone can play basically starting right away. Within one game, you can learn the rules very simply. And since there's less movement from side to side or court coverage, it includes a lot more people. So I'll be playing against 80-year-olds, like 20-year-olds versus 80-year-olds, and it's an even game.

Scot: It's a little less harsh, but I mean, you can still get hurt, right? I've been reading . . . See, I don't want to get hurt. I've never played court sports, so I know there are going to be some movements my body is not used to, like lateral movements, stopping, starting, that sort of stuff. But in my brain, I'm like, "Well, old people play it. It's cool." But you've still got to be careful.

Chris, could you maybe tell us a little bit about what your take is on injuries or what we want to watch out for since I haven't played court sports before?

Dr. Gee: Yeah. I mean, I tend to see . . . I'm sure Dwayne's seen similar stuff, but I tend to see a lot of calf injuries and things like that from pickleball kind of stuff. And it is some of that . . .

Scot: Is that from quick starting and quick stopping?

Dr. Gee: Yeah, stop/start kind of things.

Scot: We're just not used to it. I mean, that's not something that a lot of it of us have ever done.

Dr. Gee: Exactly. Yeah. It's an easier sport because it's smaller court, but you're still going to do some movement. And I think some people maybe aren't ready for that and get injured a little bit.

Scot: So start out kind of slow. I don't plan on being a pickleball hero today. There's not going to be lunges or dives for me.

All right. Dwayne, you mentioned that you knew somebody whose older dad played it, and plays it a couple times a day. That's another injury I read about too, is you get older people that haven't really ever done a ton of activity, even if they have done activity. Now all of a sudden, there are overuse problems, right? Because he's playing a lot. Tell me a little bit about an overuse injury.

Dr. D'Souza: Yeah. I mean, I tend to see, at least so far, a lot of planter fasciitis, Achilles tendinopathy/tendinitis type stuff where you're constantly cutting or pivoting and you're just not used to that. So there's no warm-up or gradual buildup that you've done to get used to playing that frequently.

And then because it's a paddle sport, you're using your arm a lot. We see a lot of classically tennis elbow, which is a lateral epicondylitis. We see, especially in some older people or people who quickly ramp up to the sport, a lot of shoulder-related, rotator cuff, swinging through the ball, going all out, trying to hit it as hard as they can. They start pulling things. They start having these shoulder-related issues.

But it mainly seems to be kind of shoulder, elbow, and then lower extremity, knee down type of stuff. Don't see a ton of hip-related issues, core-related issues. And every once in a while, if people have not played and they are running back and they're not used to that, they'll . . . Older people will trip and fall as well, which is unfortunate.

Scot: Yeah. I've read some broken bones. Is that kind of a less thing that happens, or a lot, or what?

Dr. D'Souza: I would say the broken stuff happens much less frequently than the overuse and not properly taking care of your body, allowing yourself to recover type of thing.

Scot: Okay. All right. So, as we play here today, what advice do you have for me? Do I need to warm up? Do I need to stretch? Is my headband positioned correctly? My wrist sweatbands? Does everything look good here?

Mitch: There's a guy in khakis here. I think we're okay.

Dr. D'Souza: Yeah, I think you'll just see how it goes. Most people kind of warm up by just hitting the ball back and forth a few times and don't do any of the movement. I, in general, just try to move everything just to keep it going. But there probably is a specific way to warm up, and I'm not a pro, so I don't do that.

Scot: All right.

Mitch: Which one should I grab?

Dr. D'Souza: Yeah, that one is fine.

Scot: Let's grab that paddle. All right. So tell us, what are the rules here?

Dr. D'Souza: So you can play singles or doubles. We have four of us. We'll play doubles today. Basically two on each side of the court. Essentially, the goal is to . . . You can only score a point on your service. So if you're on defense and you don't score or you don't . . . If you don't fault and you don't cause any issues, essentially . . .

Scot: So it's like tennis or volleyball.

Dr. D'Souza: Yeah. I would say it's basically Ping-Pong, but you're standing on a court, if that makes sense. And you serve cross-court. So, from that baseline, the green area over there, you have to serve across. This area is called the kitchen.

Scot: And that's the area closest to the net, to the first set of white lines.

Dr. D'Souza: Yeah, seven feet on either side. And essentially, you can't volley the ball, so you can't take the ball out of the air from within this area. It has to bounce before you can hit it or come into here.

So most people will stand essentially right here and try to do everything, unless the ball bounces in. Then they'll come in and hit it from here.

The only other big rule is you serve it, it has to bounce on the other team's opposite square.

Scot: So not in the kitchen, the other square.

Dr. D'Souza: Other square.

Scot: What are those called?

Dr. D'Souza: I don't actually . . .

Mitch: The other squares.

Scot: The other squares.

Dr. D'Souza: Yeah, I don't actually . . . I don't know.

Scot: Okay. Well, I mean, I'm looking at this . . .

Dr. D'Souza: This is the kitchen. This is the . . .

Scot: I'm looking at this $200 paddle. I figured you'd at least know . . . I mean, you're kind of all-in.

Dr. D'Souza: That's true. Yeah, I got a great deal on this paddle. The only other rule is when you return the serve, the serving team has to let it bounce before they can hit it. After that, it's a free for all. No longer do you have to wait for it to bounce. And that gives the defensive team a chance to move forward. Otherwise the serving team could just run up and just smash everything.

Scot: Okay. Got you. Well, you guys, you think you know what's going on?

Mitch: Sure.

Scot: I say let's just try it.

Dr. D'Souza: I think the best way is just hit the ball.

Dr. Gee: That's what everybody does, right?

Scot: All right. Dwayne is on my team.

Mitch: Sure.

Scot: No, it doesn't matter.

Dr. D'Souza: We can also warm up if you guys want to get used to hitting the ball.

Scot: Yeah, let's do that.

Mitch: So then a bounce and then a . . . Oh, sorry.

Dr. D'Souza: No, you're good.

Scot: Do we need to know how to hold the paddle?

Dr. D'Souza: Oh, good question. Yeah. I mean, you can hold it whatever is most comfortable for you. The most common way is kind of this grip where you have a V.

Scot: Yeah. I can see how tennis elbow and wrist stuff would . . . On a day-to-day, I don't do any of this. My forearm is already starting to burn.

Mitch: Already?

Dr. Gee: And it's just an underhand serve?

Dr. D'Souza: Oh, yeah. All serves have to be underhand.

Mitch: You can't smash them?

Dr. D'Souza: You can't smash them, yeah. And it's got to be an upward motion below the navel.

Scot: Gosh, that just doesn't move very fast.

Dr. Gee: It's different, right?

Mitch: Oh my god. It doesn't have nearly as much give as a tennis racket.

Dr. D'Souza: Yeah, you guys also have wooden paddles, so . . .

Mitch: Oh, okay.

Dr. D'Souza: I don't want to judge, but . . .

Scot: Whoa.

Dr. Gee: That's way out there.

Scot: That's how you get your exercise.

Dr. D'Souza: Yeah, and the ball doesn't travel as fast or . . .

Mitch: At all.

Dr. D'Souza: . . . as far because it's basically a fancy whiffle ball.

Mitch: I wasn't good or anything, but I played a bit of tennis in high school PE, and this does not feel anything like it.

Dr. D'Souza: Yeah. The ball just doesn't do that thing.

Scot: Geez.

Dr. Gee: I guess I'm breaking the rule.

Scot: I didn't know what to do there. If it hits the line, is it out?

Dr. D'Souza: Good question. So lines are in except this kitchen line on a serve. This line counts as in. All the lines count as in.

Scot: Man, it doesn't fly super straight.

Mitch: Sorry, man.

Dr. Gee: Yeah, it kind of catches the wind a bit.

Scot: It kind of hovers a little bit.

Dr. D'Souza: Yeah, it's all about your paddle face when you make contact with the ball.

Scot: Oh, it's all about the paddle face?

Dr. D'Souza: All about the paddle face.

Scot: Let me see your paddle face, Mitch.

Mitch: I got none.

Dr. D'Souza: It's true. I mean, so many people think of pickleball as a sport that is very easy just because of the type of people that play. It takes a lot to get used to.

Dr. Gee: Right?

Dr. D'Souza: I mean, within one game you can learn the rules very simply.

Scot: Apparently, I've turned into a pickleball hero, Mitch. Are you going to jump in and play at some point? Oh, you've got flip-flops on.

Female: I didn't really . . .

Scot: Actually, yeah, that's a good question. So I read that shoes are kind of important, and shoes can cause injuries. And you're supposed to have court shoes?

Dr. D'Souza: I would recommend court shoes. A lot of people play with tennis shoes or whatever, but something comfortable that is supportive. Court shoes are the best option.

Scot: I've got running shoes. Is that a bad call?

Dr. D'Souza: I think he'd be fine for a couple days, but if you did it every day for a couple weeks, you might regret it.

Mitch: What would he regret?

Dr. D'Souza: I think you're just going set yourself up . . . If you're not used to the cutting and pivoting and they're not built for side-to-side movement, you're going to get some issues with sore feet, blisters even, and sometimes you can even start developing some of those plantar fasciitis-type injuries where the sole of your foot is all irritated and inflamed with some pain in the morning.

Scot: Okay. So shoes do matter.

Dr. D'Souza: I think if you're playing seriously and playing more than a couple times a week, it probably matters.

Scot: So just casual, regular shoes is fine. If you start getting into it a little bit more, maybe that's the first thing you would want to look into, is some decent shoes, some court shoes.

Dr. D'Souza: Yeah, because the startup costs for pickleball . . . I mean, you can get paddles for $30. You can get kits for your family for $40 or $30 with the balls, and that's all you really need. And if you want to keep going further in it, it gets exponentially more expensive.

Scot: Sure. Like anything, right? All right. Do we want to try playing?

Mitch: Okay.

Scot: Mitch is not sure. Does Mitch have proper pickleball hair? He's been working growing out his hair.

Mitch: I was about to say.

Dr. D'Souza: Good flow today. I'll serve first

Scot: And I can stand anywhere in here then? Except for I can't go into the kitchen.

Dr. D'Souza: You can't go in the kitchen. My advice on the serve is if you are the receiving team, you have to let it bounce. So if they hit it to here, you have to wait. So most people on the serving team are always back.

Scot: It's easier to move forward than backwards.

Dr. D'Souza: Definitely. You're not going to fall. You're not going to get injured that way. And then Chris, because I'm serving to you and you have to let it bounce, you should be all the way in the baseline. And then Mitch, you should be up because it's not coming to you. And you win this game by being here. You take away so many angles. So if you can already start at the line, then it helps your partner because Chris should be trying to get up essentially.

All right. 0, 0, on the 2.

Scot: Oh, look at that. We're playing pickleball, folks.

Mitch: Paddle face, paddle face, paddle face.

Scot: Well, then you have to switch.

Dr. D'Souza: So then you and I switch. Yeah.

Scot: Oh, and then you serve from that side.

Dr. D'Souza: I'm serving towards Mitch.

Scot: So you keep serving. We just switch.

Dr. D'Souza: Yeah. Until they break our serve.

Scot: And then they would serve and then when we break theirs, then I serve.

Dr. D'Souza: Then it would be coming to you, yeah.

Scot: Okay.

Dr. D'Souza: All right. So 1, 0, on the second serve.

Mitch: And I've got to let it bounce.

Scot: Just keep giving it to Mitch.

Mitch: Okay. All right. But I always serve to Chris, right?

Scot: The only difference is we started serving. Otherwise it'd be like, "Keep giving it to Scot."

Dr. D'Souza: 2, 0, 2.

Scot: Oh, boy. Okay. All right. I totally whiffed it. My first big pickleball opportunity, I didn't even hit the ball.

Dr. D'Souza: And that was Mitch's serve coming to you, because Chris just . . . we broke Chris's serve.

Mitch: I'm not following the serving thing, but that's okay.

Dr. D'Souza: So Chris served.

Mitch: And he was one.

Dr. D'Souza: He was the one. So you're the second serve and you serve . . .

Scot: Oh, so unlike volleyball where if you break the serve or whatever . . . Gosh, I'm quoting games I don't know the rules.

Mitch: So it's like golf.

Scot: So when somebody's serve is broken, then their partner gets to serve. So each team gets two opportunities to serve.

Dr. D'Souza: Correct. Except for the . . .

Scot: Except for the first.

Dr. D'Souza: Also the first one, yeah.

Scot: Okay. I got it.

Dr. D'Souza: Chris, You are going to want to back because you have to let it bounce. Otherwise we'll just hit it right at you and you'll just be like . . .

Dr. Gee: Oh, got you. Okay.

Dr. D'Souza: You could stay there.

Mitch: All right. So 0, 2, on the 2.

Dr. D'Souza: Correct. That's perfect.

Mitch: Nailed it. Basically a pickleball master.

Scot: The talking part Mitch is really good at.

Mitch: Announcing?

Scot: So was that a fair serve?

Dr. D'Souza: It was not because . . .

Scot: It's in the kitchen.

Dr. D'Souza: . . . it landed in the kitchen. All right. 2, 0, on the one.

Dr. Gee: Oh, got it.

Mitch: Got it.

Dr. Gee: Oh, sorry. Sorry, Mitch. He was frightening me up there. I thought he was going to . . .

Dr. D'Souza: Intimidation.

Dr. Gee: How long did it take you to kind of get the hang of the rules and stuff?

Dr. D'Souza: Oh, probably one game.

Dr. Gee: All right.

Mitch: Oh, okay.

Dr. Gee: So I'm slow.

Dr. D'Souza: I think you can get it within your first time playing, because it's 11 points in the first three games or so. You kind of make sense who you serve to. I think the scoring thing might take a couple reminders usually for most people. Go for it.

Scot: But it was in the kitchen, so . . .

Dr. D'Souza: No.

Mitch: Not on the return.

Dr. D'Souza: On the return, it doesn't matter because the court is opened.

Scot: So I blew it.

Dr. D'Souza: Eh, that's all right.

Mitch: You didn't blow it. We're learning.

Scot: All right. So what are we? 7, 0 . . .

Dr. D'Souza: 7, 0, 2. You're the second server now.

Scot: I'm 7,0 on the 2. And when you serve, you serve underhand?

Dr. D'Souza: Underhand, and you can't . . . So basically underhand with the paddle angle below your navel. You have to make contact below your belly button.

Scot: Oh, is that a rule?

Dr. D'Souza: It's a rule.

Scot: So I can do it underhand like . . . Oh, that's not below my navel, though.

Dr. D'Souza: So the most angle you can have is like that, because this has to be below your . . .

Scot: The top of the paddle below the navel. So I'm going to be more like this.

Dr. D'Souza: Yeah, as long as it's an underhand motion. So you can let it go and drop like that, or you can drop serve it where you can't push it down, but you can let it go because the ball will never bounce above your belly button just based off how they're built, and then hit it like that. So different ways to serve. You just can't do it overhand or completely side arm.

Scot: All right. So tell me if this would be a legal serve. This is just practice, guys.

Mitch: Unless I make it.

Dr. D'Souza: That's perfect.

Scot: That's okay? Okay.

Dr. D'Souza: You should have kept it.

Scot: All right. Here it comes for real, guys.

Dr. D'Souza: All right. 10, 0, 1.

Scot: Oh, wow.

Mitch: He's done playing around. And that's game, right?

How are you feeling, Scot? You got a sweat? What's going on?

Scot: Yeah, I'm sweating a little bit. I'm glistening. It's a hot day. It's a beautiful day here in Salt Lake City. This is a beautiful set of courts . . .

Dr. D'Souza: It is.

Scot: . . . up on the side of the foothills. You can see the whole valley.

Mitch: How do you think Troy would be doing?

Scot: He'd be doing great. He doesn't do anything wrong.

Dr. Gee: You get all practiced up and then you bring him out and crush him.

Scot: That's brilliant.

Mitch: Oh, Part 2.

Dr. D'Souza: All right. 5, 0, on the one.

Dr. Gee: Ideally, you want to play more up here if you can, right?

Dr. D'Souza: Yeah. So the way to win the game is . . .

Mitch: Now you share that?

Dr. D'Souza: . . . you kind of . . . if both your teammates are up here, there's only so much that they can do because if they hit it above the net, you can basically smash the ball.

Scot: Because it just doesn't go that high generally.

Dr. D'Souza: Correct. So if you're up here, they have to essentially hit it short. And so you just wait for them to make a mistake. You guys are at the point of the game where you're kind of just learning the rules, but it gets much more advanced. The rallies last 50, 60 shots.

Dr. Gee: Really?

Dr. D'Souza: And people are super patient because they're just hitting these things called dinks, which is a very light shot over the net that kind of doesn't bounce very high, and it forces them to always hit up on the ball. And anything that's elevated above the net, someone is going to attack it.

Mitch: So you keep it low.

Dr. D'Souza: So if you keep it low, that's how you win. And you do that by being up here and forcing the shots like that. You just do that back and forth.

Dr. Gee: But I hit that one too high.

Dr. D'Souza: Yeah, I would've . . .

Dr. Gee: You would've smashed it. Yeah.

Dr. D'Souza: Right? And so you hit at people's feet. The rule is red light for attacking is here to knees. Yellow light, if you're pretty good, is knees to hips. Anything above your hips is attackable. It's a green light. And so that's for attacking the ball. And it gets pretty advanced from there.

Mitch: My personal goal is to be able to hit the ball back.

Dr. D'Souza: Yeah, exactly.

Mitch: Seventy-five percent of the time.

Dr. D'Souza: There's a reason I didn't go into that detail.

Scot: I mean, we're just having fun right now.

Dr. D'Souza: I was like, "There's a lot more." And these rallies are ending pretty quickly because you guys are getting used to the ball, but they'll go for 10, 20 shots a rally once you guys get there.

Scot: Mitch, it's like anything else, right? Play the pickleball you want to play. It's what we talk about on the podcast all the time. You don't have to play super competitive if you don't want to. If you get a group of people, you just want to hit the ball around a little bit and move, that's great.

Dr. D'Souza: Anyone can play. People show up with music, they show up with their dogs, they put them in the corner. People bring a beer.

Scot: I heard people talking as they were paddling back and forth. I mean, you choose how you want to play.

Mitch: Well, that's just it. I think with the ball being as slow as it is, the couple of times I've played tennis, I am completely beat by the end of the first round. I'm feeling active right now. I don't feel like I'm killing myself.

Dr. D'Souza: You can play for a couple hours without any issues usually. Well, once you build up to that, but . . .

Scot: Guys, huddle.

Mitch: Are you huddling up?

Scot: Actually, yeah, before we started this next game, I wanted to point out a couple things. One, I don't know if you've noticed this, but the guy in the khakis is now playing against two people.

Mitch: Is he killing it?

Scot: So he's a sleeper.

Dr. Gee: I think he's got long sleeves and . . .

Mitch: He's a shark.

Dr. Gee: He looks like he'd be at the office.

Dr. D'Souza: I don't think I would be playing in that. That is not appropriate pickleball attire.

Scot: But it works for him.

Mitch: It is.

Scot: Okay. So we've played a couple games here. From a "how you're feeling standpoint," Mitch?

Mitch: My heart rate is up. I don't feel like my joints are dying.

Scot: Okay. That's good.

Mitch: And I'm having a good time.

Scot: Is there anything, as you were playing, you were like, "Oh, I could see how maybe I might hurt myself trying that"?

Mitch: There was a time that I went to swing back and my foot stopped, but my body kept going, and I had flashbacks to my ankle injury.

Scot: You were going backwards?

Mitch: Yes.

Scot: Okay. So is that backwards we . . .

Dr. D'Souza: Yeah. So the key is when someone lobs the ball like that, a lot of people are used to just backpedaling. That is not what you want to do because you're backpedaling and trying to hit it. That's how you fall. So the thing that everyone should do so they don't have an injury is rotate and slide, because that way you're hitting it straight without leaning back and falling.

Scot: So turn side and . . .

Dr. D'Souza: You need to pivot and get there versus backpedal and fall and hit it.

Scot: Okay. That's good advice.

Dr. D'Souza: I see a lot of people a little bit older get hurt.

Mitch: Hey, young people can get hurt.

Dr. D'Souza: That's what I'm trying to say, is anyone can do that, but you kind of have these balance issues as you get older.

Mitch: I don't want to end up back in Chris Gee's office. Luckily, he's here this time.

Scot: That was good thinking. I don't know if this is a deal or not, but I think maybe as a younger person, the perception could be, "Oh, a lot of older people play this, so it's going to be fine for me." But everybody can get hurt the same way, especially if you haven't done a lot of activity, court sports, that sort of thing.

Dr. Gee: Yeah, I agree. I'm feeling good, enjoying kind of moving around. There are definitely times where I'm reaching for a ball and I'm like, "Oh, that's a new movement that I haven't done for a while." But yeah, I think as long as, like Dwayne said, I'm getting my body in the right position, I think that'll help.

Scot: Oh, interesting. Body in the right position. Anything at one point where you're like, "Oh, I could have hurt myself there, or I could see how that could be a problem"?

Dr. Gee: Yeah. I've been running a lot more lately, and so this whole cutting, pivoting, twisting is new on my ankles. I feel a little like, "Oh, yeah, I could see I've got to strengthen some things there."

Scot: Yeah. But it's good, right? Because you're getting more of that functional movement.

Dr. Gee: For sure.

Scot: We tend to stay in that . . . What is that plane? The back and forth plane? The sagittal or linear?

Dr. Gee: Yeah, a linear plane.

Scot: Running, biking, all those things. This moves you around. Anything for you?

Dr. D'Souza: From this game?

Scot: Yeah.

Dr. D'Souza: I mean, I played three hours last night and three hours the night before, so . . .

Mitch: Oh, no big.

Dr. D'Souza: I'm sore in general just from playing that much, but not really. Not right now.

Scot: Yeah. For me, I think it's the sudden stopping and starting, and then maybe trying to do . . . When you kind of try to lunge and you've got your . . . that's not a movement I'm normally used to doing. All right. Break.

Dr. D'Souza: The thing I'm impressed is everyone now knows the scoring pretty . . . You guys pick that up within like two games.

Scot: All right. Dwayne, I want to know . . . This has been a lot of fun, but one of the reasons I was able to show up in confidence today is because I knew you have played before, you understand the etiquette. It could be intimidating, right? There are some barriers to playing this game. Where do you play? Does it have to be a dedicated pickleball court or can you play at a tennis court? Are they the same thing?

Dr. D'Souza: It should be a dedicated pickleball court. The only reason is that, as you can see just looking here, you can fit two pickleball courts on each tennis court. Sometimes four if they map it out. You can actually put four on there.

The nets are different heights. So tennis nets, I think, are 36 in the middle and a little higher on the sides, 40 on the sides. And pickleball, I think, is 34 and 36. So it's a smaller court, different net. But tons of people will still go and practice on a tennis net and can still use the facility if they wanted to.

Scot: Sure, as long as they're abiding with the rules. Probably if a tennis player shows up, you've got to yield it if you're a pickleball practicer.

Dr. D'Souza: Probably, yeah.

Scot: Yeah, they are definitely different. We're here at a pickleball court/tennis court. You can definitely tell the difference.

Dr. D'Souza: And now, a lot of courts are being converted from tennis to pickleball, and there are a lot more courts in Salt Lake. There are lots of apps online that can show you where there are courts, where they're free, where they are for fee. And there are even Facebook groups for, "Hey, I'm going to go play here at this time. Come." And so it's pretty inclusive in that sense.

Scot: All right. So some, you probably could reserve. These courts, you could not reserve. You just have to show up. What if you show up and the courts are full? How can you confidently know it's your turn?

Dr. D'Souza: Yeah. So every court has a different kind of waiting system. The rules are actually posted right on the door and they'll usually say . . . Here, it basically is an hour play per court. And the way you wait is you just put your paddle up in a line. And so the first court that's available, the next group with their paddles up gets to jump on it.

At Fairmont, the way it works is they have six of these paddle holders. And so every game to 11, you saw how quick those were, less than 5, 10 minutes. Basically, as soon as you're done with your game, you rotate off and the next group . . . There's an arrow that tells you who's next. That group goes on your court and you put your paddles up on the paddle holder, and it just rotates super quick.

It's nice because you can show up with a group of four and you can play with your foursome, or you can just show up solo and jump on with a group that needs one, and just put your paddle up and just jump in.

I'm here by myself, and so most of the time at Fairmont, just show up by myself, put my paddle up, jump in with the group, and you kind of go from there.

Scot: Cool. Chris, did you have any questions? I asked your question. I shouldn't have.

Dr. Gee: No, that's what I was going to ask. If you're alone and you want to go play . . .

Dr. D'Souza: Yeah, it's pretty easy. There are a bunch of groups online and you can also . . . I literally just show up after work or if I have a random morning off, I'll just go and there are people playing. And if it's just solo or three people, you can just hit the ball back and forth or come up with . . . There are varieties of games you can play with less than four people. And then if not, you just put your paddle on the thing and wait and you're good to go.

Scot: Are there other barriers anybody can think of? Anything else that would've stopped you from coming today had we not all kind of group planned this?

Dr. D'Souza: I mean, you can play indoors or outdoors, right? So indoors are usually you have to pay for those, but outdoors is kind of weather dependent. You really don't want to play in the wind. But in the winter, my housemate's dad rides his bike, brings a shovel, and shovels off the snow, and we play with a different ball that doesn't break as easily in the cold. I mean, people play in the 20s and 30 degrees all the time.

Mitch: Well, I'm glad that I came here because one of my constant barriers is I'm always a little anxious I'm not good enough, or I'll come and I will be the awkward guy on the field, whatever. But just to have actually come here and seen there are so many different types of people here. There are men, there are women, all ages, they're all playing together. Yeah, it really took the intimidation factor of and it's been good.

Dr. D'Souza: Yeah, as soon as you play once, you'll be like, "Oh, I know what to do."

Mitch: Kind of.

Dr. D'Souza: So there's this whole ranking in pickleball of . . . Like, 5, 0 is the best in pro level. And there are all these rules for it. But if you know the rules, you're already at the 2.5, 2 level. And so that's just knowing the score system. And so you already can say that essentially.

Mitch: I will never say that.

Scot: A barrier for me might be . . . So if I showed up with a couple people, you'd be playing against a couple other people maybe. I mean, I guess you just end up on the court you end up. But what if the people you're playing against are super serious? Or for the most part, is everybody kind of chill and play to the lowest level?

Dr. D'Souza: Everyone is usually pretty chill. You can find some people that are very competitive and they tend to stick around in their group because they only want to play highly competitive games. But for the most part, because it's so inviting, you'll frequently play against generation differences, skill differences, and everyone is just encouraging and trying to get you better.

So I think you'll quickly learn. Like, you're at a game and you're like, "Oh, wow, I can't do that shot," and you'll learn. And maybe the next game you might rotate to a different group.

Scot: Got it.

Dr. D'Souza: Things like that. You can even sometimes tell by their paddle.

Scot: How do you know?

Dr. D'Souza: If you have all wooden paddles, you're probably a beginner and you're probably going to be playing with some beginners. I mean, you can just kind of . . .

Scot: As a group of people, though, for the most part, pretty friendly?

Dr. D'Souza: Oh, yeah. I think it's the most welcoming because you can play with anybody, any time, and just show up and be like, "Hey, do you guys want to play?" A lot of times, two people will show up, they'll be playing singles, another group of two will show up, and they'll be like, "Hey, you want to play fours?" And then you just play. It's super fun. People let you borrow paddles, balls, like, "Bring it back next week. I'll see you next week." You just kind of use their stuff. It's pretty welcoming.

Scot: It's been a lot of fun. Dwayne, thank you so much.

Dr. D'Souza: Yeah, of course.

Scot: Dr. Gee. Thank you so much, Chris. Mitch . . .

Mitch: Thank you.

Scot: . . . thank you. Don't know what else to say.

Mitch: Thank you for caring about men's health.

Scot: Do we have time to play a couple more deals or . . .? Where are we at?

Dr. Gee: Yeah, let's do it.

Mitch: Sure. I'll play a little bit.

Dr. D'Souza: I'm good.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Miller: Strains, sprains and fractures. How do you tell which is which? We're going to talk about that next on Scope Radio.

Hi, I'm Dr. Tom Miller and I'm here with Dr. Emily Harold. Emily is a Professor of Sports Medicine here at the University of Utah in the department of Orthopaedics. Emily, tell me the difference between . . . well, what do we do? What do we start with? Is there a difference between strains and sprains and . . .

Dr. Harold: Yeah, there is a difference. So, typically, when we talk about a sprain, we're talking about an injury to a ligament. A ligament is a structure that connects one bone to another bone. When we talk about a strain, we're talking about an injury to a muscle. So they vary in terms of what we're describing and they also vary a little bit in terms of treatment.

Dr. Miller: So ligaments are the tough, fibrous tissues that connect joints together? Would that be fair?

Dr. Harold: Yes, that's fair.

Dr. Miller: So you have them in your ankles, your knees, your hips, any major joint?

Dr. Harold: Any major joint. It's a tough, fibrous tissue that connects the two bones together.

Dr. Miller: And yet a sprain is a problem between the tendon and the muscle?

Dr. Harold: Exactly. So, typically, sprains can either be located at where the tendon and the muscle connect, or sometimes they'll be within the muscle themselves.

Dr. Miller: Which is more common, sprain or strain? And also, why is it important to know the difference between the two? Is that something that the general audience should be familiar with or is that more something that a physician needs to know?

Dr. Harold: I think that it's important to know the difference because when we talk about an ankle sprain we're talking about injury to a ligament that connects the two bones. And therefore, the recovery and the treatment for that injury is going to be a little bit different than when we're talking about a hamstring sprain, which is an injury to the muscle itself.

Dr. Miller: Treatments are different?

Dr. Harold: Treatments are different. When we talk about an ankle sprain or ligament sprain, we grade those one through three, with one being just a very mild injury to the ligament and three being a complete tear in the ligament.

Dr. Miller: So, obviously, a complete tear would result in a lack of function or a severe impairment of function.

Dr. Harold: Exactly, and depending on the joint, the treatment is a little bit different. So when you hear of an ACL sprain, a complete tear of the ACL, which would be a grade three sprain, typically results in a surgical intervention.

Dr. Miller: How about the minor stage one and stage two? Are those treated with physical therapy, typically?

Dr. Harold: Typically, those are treated more with physical therapy to help get the joint moving again. Ice, anti-inflammatories. And they take about two to four weeks to recover, whereas a grade three sprain can take up to six weeks to recover.

Dr. Miller: So you're a sports medicine physician. You treat a lot of athletes and also weekend warriors, I imagine. Tell me a little bit about what are the major sprains that you see, and then later on the major strains.

Dr. Harold: So the major sprains I see would be an ankle sprain, as well as, a lot of times, knee sprain. So MCL, different ligaments in the knee that can get sprained. The major strains I see are rotator cuff, which are the muscles in the shoulder, and then I also see a lot of calf and hamstring.

Dr. Miller: So let's take a sprained ankle. That's a fairly common injury, I would think, among athletes and just people who are exercising on a day-to-day basis, and step off a curb incorrectly. Do you always need an x-ray of that? I mean, how does one proceed? Let's say they have swelling, they have pain, does that need to be evaluated by a physician? And how would they know?

Dr. Harold: That's a good question. So there is a set of rules called the Ottawa Ankle Rules, that came out of Canada, where they looked at a lot of patients who had an ankle sprain and they tried to determine which ones were at risk for a fracture and which ones were at risk just for a ligament injury. And so there are some rules you can follow. One is if you can walk on your ankle right after the injury, that's a good sign.

Dr. Miller: Bear weight and walk.

Dr. Harold: Bear weight, exactly. The other is we look for tenderness on either side of the ankle on the bony prominences, both on the inside and the outside of the ankle, as well as if anyone has tenderness on the outside or the lateral part of their foot.

Dr. Miller: And if you have either of those debilities, what next?

Dr. Harold: Then you should come in and get an x-ray, just to make sure that you don't have a fracture with the injury.

Dr. Miller: So you could go to an urgent care clinic, you could go to your primary care physician or even a sports medicine physician?

Dr. Harold: Yeah, all three would be able to handle that with an x-ray and let you know if it's a fracture or just a sprain.

Dr. Miller: So sometimes, there's this difficulty in distinguishing whether it's a fracture or whether it's actually just a sprain?

Dr. Harold: Yes.

Dr. Miller: Okay. Other joints that are concerning for either fracture or strain? I think of ankle, most commonly, and then knee is one where . . .

Dr. Harold: Ankle, knee, I think wrist.

Dr. Miller: Wrist?

Dr. Harold: I'll see some people who fall on their wrist and there's concern whether it's a fracture, or whether it's a sprain or a strain. And that doesn't have a set of rules to guide x-ray so, typically I'd say if it's really swollen and if you have limited movement, those are the times that I would get an x-ray.

Dr. Miller: So if you're lacking function in that hand because of swelling and pain, that needs to be checked out, especially if it goes on any longer than maybe a day. Or if it just hurts incredibly, it needs to be checked out. Okay. So let's talk about strains. You've mentioned hamstring.

Dr. Harold: Yes.

Dr. Miller: And is that the most common that you're familiar with or that you deal with on a day-to-day basis?

Dr. Harold: Because I treat a lot of the younger athletes, I see that probably most commonly.

Dr. Miller: And what do you do to rehabilitate that? What's the main treatment there?

Dr. Harold: The main treatment there is to keep from over-stressing it when it's still injured. So usually, we start with some gentle stretching, usually some physical therapy. Avoid any kind of sprinting or any kind of activity that really stresses it until it slowly heals with time, and that can take up to a month.

Dr. Miller: I imagine you work very closely with physical therapists?

Dr. Harold: Yes.

Dr. Miller: And so a person with either a sprain or strain would end up maybe going to a physical therapist if it was a non-operative injury?

Dr. Harold: Yeah, absolutely, and I would say at least 90 to 95% of all of them are non-operative.

Dr. Miller: That's great to know.

Dr. Harold: So most injuries require physical therapy, some time off from the activity that really bothers it, but very few ever go on to require surgery.

Dr. Miller: Emily, you mentioned something earlier, talking about non-steroidals. Could you talk about that and what a non-steroidal is?

Dr. Harold: Yeah, a non-steroidal is a drug that helps with inflammation. If you get them over the counter, brand names like ibuprofen, Aleve, or naproxen, Advil, those are medicines that people take to help with inflammation. Now, I think it's worth noting that it hasn't been shown to heal anything quicker, it's more of a pain alleviator.

Dr. Miller: Should they go to the drug store and pick up ibuprofen or Naprosyn, common non-steroidals that are available without a prescription? Or do you have a certain way that you prescribe them or tell them how to use them so that they don't overuse those types of medicines? Because they do have side effects.

Dr. Harold: Yeah. I typically tell my patients that if they have a lot of pain, they should take the dose that is written on the over-the-counter bottle and take that for pain only. And once their pain starts to get better, they should stop the medication as they tolerate it. There are some doctors who will tell people to take it constantly for one or two weeks. Again, I don't think there's any data behind either option. I think it's more of a physician and patient preference.

Dr. Miller: So, Emily, we just talked about sprains, strains and fractures. Could you just summarize what we said? And we said quite a bit but I think, for the audience, a little bit of a recap would be good.

Dr. Harold: Absolutely. So a sprain is an injury to a ligament, which is a piece of tissue that connects a bone to a bone. A strain is an injury to where the muscle and tendon are connected. And a fracture is any break in the bone, regardless of how many pieces it is in or how big it is. All of these are treated a little bit differently, and . . .

Dr. Miller: I think, as you said, 90% of them . . .

Dr. Harold: . . . most of them are non-operative.

Dr. Miller: . . . that don't require procedure and operation to heal.

updated: December 21, 2022
originally published: October 4, 2016