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Scot: Welcome to "Who Cares About Men's Health." It's the first of our month-long series on getting rid of your stuff to improve your emotional health. So the challenge was laid down that we were going to do some minimization. We were going to get rid of some clutter in our lives and see if that improved our mental health.

If you haven't listened to that episode with Dr. Chan, be sure to go back and listen to it, it's the one right before this one, so you get the premise of what we're doing. But essentially, we have made an agreement, all four of us, that we are going to try to get rid of some stuff and see if it improves our mental well-being.

So my name is Scot, and I am the manager of thescoperadio.com, and I care about men's health. And let's go to Troy, Mitch, and Dr. Chan.

Troy: I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I'm struggling with this challenge, but I do care about men's health.

Mitch: I'm Mitch Sears. I'm a producer at The Scope Radio, and I've been getting rid of tons of stuff already.

Scot: Yeah. I think Mitch is going to be the success story for this episode. I think there are going to be some winners and some losers.

Mitch: It's a process. It's not a competition.

Troy: It's a competition and you already won, Mitch.

Scot: Dr. Chan, how are you doing so far?

Dr. Chan: I'm Dr. Ben Chen. I'm a child and adolescent psychiatrist, and I teach in our medical school, and I too care about men's health. Yeah, I've gotten rid of something big and I'm happy to talk about it and explore it. And I agree. It's a journey, not a destination.

Scot: All right. Well, if it's a journey, then I'm looking at your guys' backsides way ahead of me, because I'll talk about my failures here in a bit.

But let's go to Mitch because I think Mitch's story . . . I already know a little bit about it. It's pretty incredible what he's done in just this one week. So, Mitch, go ahead and tell us your experience so far with decluttering your life.

Mitch: All right. So it started out pretty interesting. I was looking around, because I've gone through this purging process before, and I was just like, "What are the things that are lingering, causing me a little excess stress that is really not necessary, and it would be better just to get rid of?"

And one of the things that actually helped out first was . . . I've had a broken down Mazda since last summer. And I was just like, "I've been putting it on the market. No one wants to buy it. It can't drive out of its parking space." It was about time for the registration to come up and I'm like, "I am not going to pay for this again." So I just sold it to a junkyard. I kept telling myself, "Oh, it'll sell for more. Oh, it'll sell for more. Oh, if I just repair it. Oh, if I do whatever."

I'm in an apartment complex. I'm paying for parking. It's just an extra level of stress. So I just got rid of my 2006 Mazda 6 to start this whole off.

Scot: Nice.

Troy: That's huge. That should count as 500 items right there. I mean, if broken down in all its components . . .

Scot: That's right. There's a radio. There are four doors. There are how many spark plugs?

All right. So tell us how you feel after getting rid of it. So I find it intriguing because I think we all do that. We might have something we think we can get a little bit more money for, so we hold on to it longer than we think. So how are you feeling now having taken less money?

Mitch: So, for me, I just sat down and I did the actual math, like, "How much am I paying for a parking spot every single month for a car that I cannot use? How much am I paying for a second parking spot for the new car, the old beater that I'm driving right this very moment?" And I when I finally really thought about it, looked at how much I was actually spending, and how much I would do for re-registering for something I wasn't even using, it wasn't that big of a deal to sell it for less than I was asking for originally.

But to have it gone, to not have to see it every day I go on my morning run, that was it too. Every day I'd go on my little morning run that I've been doing, I would run past the Mazda and I'd be like, "Ugh, I've got to get rid of that thing. Ugh, what do I have to fix on that thing?" And just to have that gone, load off.

Scot: That's good.

Mitch: It's a load off. It's one less thing to worry about every single day.

Scot: All right. That's not all, gentlemen. That's not all of Mitch's success stories. Mitch, tell us how you turned a guitar into a recording closet.

Mitch: Yeah. So we're still finalizing the deal right now, but my old guitar from my punk rocker days back in high school, my Godin Solidac, I have not played that thing in five, six years. And the original owner who had gotten rid of it for one reason or another would like it back, and so I'm getting rid of something that was . . . That's the most emotional thing that I've gotten rid of the last week, was this guitar.

Scot: Was it an identity thing?

Mitch: Yeah. That guitar was what made me a musician in middle school and high school. I was in a band called "One Way Sidewalk" for a hot minute there, and it was just hanging out with the friends and wearing my black shirts and studded belts and everything. There was so much of my identity wrapped up in this object. And there was a moment when I'm taking pictures of it, when I'm getting all wrapped up for this guy, that it just . . . man. And I had to realize that's not my life anymore.

Scot: Dr. Chan, would you like to help Mitch deal with the fact that he just gave away a big part of his identity? That can't be easy, can it? Do you encounter people that have to go through that?

Dr. Chan: Yeah. Just listening to your story, Mitch, that sounds really hard and sounds like . . . we joked at the beginning it's a process. But it sounds like you're in a better space for it and especially if it's . . . You said you sold it back to the original person?

Mitch: Yeah, and that feels good too.

Dr. Chan: It's like the cycle of life.

Mitch: Yes.

Dr. Chan: That's beautiful. So you know it has a good home.

Mitch: It does.

Dr. Chan: It's being played and used. And I don't mean to anthropomorphize inanimate objects, but we could have a "Toy Story" moment here. It sounds like this guitar is in a happier place.

Mitch: Yeah, rather than under a bed in a box not being played. Absolutely.

Scot: Yeah. Do you have other stories you'd like to share? Because I think the spotlight really is on you this week.

Mitch: Well, in making myself this podcast hole, I got rid of all the duplicate cables that I have, and there were almost 100 of those. More just clutter removal stuff this week. Next week, I'm looking at clothes in closet. So I probably have some stories for that.

And that was it too. I think that . . . and I've done this before, but there's a real joy in suddenly getting rid of the old things, getting rid of an old identity, and using some of the money that I've made to invest in my identity now. I have career aspirations. These podcasts that have been something really enjoyable and a way to touch base with journalism again. And so being able to get rid of a past self, a past identity, and invest in my current identity, as woo-woo as it may sound, it's great. I'm so excited to be in this podcast hole. It's good.

Scot: It's just a cool little space that you have now. That's neat.

Mitch: Yeah, all my own.

Scot: So what was the formula you chose to get rid of your stuff? Did you go with the one thing the first day and then doubling it each day? So 1, 2, 4, 8, 16, 32? Or what did you do?

Mitch: No, because that math gets out of control.

Scot: All right. Fair enough. Who wants to go next? Do you, Troy, or you, Ben?

Troy: Maybe Ben should, because I'm probably the worst example here. So we'll save me for last.

Dr. Chan: Yeah, I'll go next, and then I have to hop off in about 15 minutes. So the item that I targeted was an old mattress, box spring, and headboard. You can't really donate this stuff. If any of you out there have tried to donate a mattress, box springs, and headboards . . . I don't know if it's because of concerns about infectious disease. I don't know. But Goodwill, DI, they won't take it. They don't want it.

And these items are large. And nowadays if you buy these foam mattresses, it comes in these . . . Amazon will ship it to you and you'll open it up and it'll grow with time. That's beautiful, but then we have a full-fledged old mattress that really doesn't fit into cars. And I know this is a men's podcast, but I really don't recommend putting on top of the car and trying to put your arm up there and driving it somewhere.

Troy: Tie it on with a piece of twine.

Dr. Chan: Yeah. So I would venture some of you right now or a lot of you that are listening have an old mattress, box spring, headboard in some corner attic/basement/cellar of your house, and it's just taking up space. And so my goal, and I'm halfway there, I moved all of them out of the basement and I need to find a company or rent a truck to get rid of . . . because they recycle them now. There are a lot of recycling pieces within the mattresses.

I was just looking up that every day . . . and I don't know if this for shock value or if I'm just being a shrill for big mattress companies. But I read that 50,000 mattresses are disposed of a day, which sounds to me like a lot. They're just taking up space in landfills, so they really recommend recycling them, but you have to pay for someone to recycle it, which I'm fine with doing.

So that's what I'm letting go of is an old mattress, box spring, and headboard. It takes up a lot of space. They're old.

Scot: And it's a lot of effort to get rid of it. It's like electronics in a way. You want to get rid of this stuff, except for yours is huge, right? So then you've got to pay money. I had to hire a company to come pick up some stuff, and it was like $75, and I'm like . . . So there's some activation energy that you have to get over there as parting with that cash to get rid of that stuff.

Dr. Chan: Yeah. But it feels good because it's created more space in the house. Why do we hold on to the old pieces of furniture that . . . obviously, it's broken down. It doesn't work as well.

Scot: Why did you? What were you thinking when you decided not to get rid of it? Or was it the hassle of getting rid of it?

Dr. Chan: We have kids, and so we have, "Oh, the kids might want this one day or this could be a good college starter set when they go off to college." Or when you have Aunt Billie, when they visit, it's easier just to get a mattress and throw it down on the ground. There's this utility factor, but all of it is just inconvenience. How do we donate something this large? How do we donate large furniture items?

Scot: So I found if you put that stuff on ksl.com and just very specifically say, "Bring your pickup and bring buddies to load it . . ." If you price it low enough, people will show up. And sometimes that's the value for me. I might make a few bucks on selling it, but it's more about I'm getting somebody to take it out for free, essentially, on that bigger stuff.

Plus also, when you do this, it makes you pause for a second and think next time you buy. It's like, "Do I really need this, and what happens when I have to get rid of it?" Because when you go through this process of "what a pain it is to get rid of some stuff," it slows your roll when you're doing the purchasing in the future. At least that's what I've found.

It sounds like, Dr. Chan, you're doing some strategic targeting. You're not doing the doubling, the 1, 2, 4, 8, 16, 32. Right? Is that your game plan?

Dr. Chan: Yeah, I went for size. I went for big items.

Scot: And then next week you'll have some other big items or . . . I guess we'll have to wait for next week.

Dr. Chan: Oh, yeah. The moment of anticipation transcends the moment itself. So I'll leave you hanging.

Scot: All right. So I tried the double every day. That means that in this first week, I had to get rid of 127 things in the first week alone, and it's only going to keep getting bigger and bigger. So I think I may have bitten off more than I can chew. I've got a grand total of 79 of the 127 things that I said I'd get rid of. And that's counting each individual sock, not socks as a pair. So it's a little bit of a lame strategy there, but I inventoried the things.

Plus, also, we were out of town last week. So I was really scrambling today to do this.

What I learned is it takes a little bit of time if you're going to do it at that kind of scale. I need some time to think about this, but here's my list. Are you ready? And if there's anything on this list you want to learn more about afterwards, let me know. So 10 inflatable novelty microphones.

Troy: I'm already intrigued.

Dr. Chan: Inflatable?

Scot: Yeah.

Mitch: Like regular size or mini size?

Troy: And novelty.

Scot: Yeah. They look like a regular microphone, but you blow them up. They're inflatable. Wait. Hold your questions.

Troy: Where would one purchase these?

Scot: Hold your questions to the end, gentlemen. Hold your questions to the end.

Mitch: Why so many?

Scot: Ten inflatable novelty microphones, two two-terabyte hard drives, one Tamagotchi, eight network cables, four coax cables, one wall patch kit, two magnetic hooks, one timer, two light bulbs, one pair of ice walkers, one XLR cable, three masks, eight tripods, five mic holders, four dress socks, one Super Ball, five tube socks, four greeting cards with five envelopes, which I counted separately, two worn out running shoes, one Eddie Bauer pullover, three white ribbon lapel pins . . . I did keep one, however . . . one "Star Wars" popcorn pail that's been used as a garbage can until we got our dog who takes things out of the garbage can, so I had to get a better solution. One four-gigabyte SD card, one busted screen protector for my iPhone, and two non-working iPhones. Questions?

Dr. Chan: You win.

Troy: Wow. You totally win. I'm impressed.

Dr. Chan: What's a Tamagotchi? What's that?

Scot: I'm reaching for it. Back in the '90s, they were these virtual pet key chains.

Dr. Chan: That's what I thought. Oh, wow.

Scot: Yeah. So it's not one of the original '90s ones. I got rid of those a long time ago, or they broke, but I saw in a store this Tamagotchi. I don't know how many years ago. Ten years ago? And I thought, "That's cool. I liked that at the time." Probably this was 15 years ago. And it's still in the box. It's still in the box. I never opened it, never messed with it. I've kept it on a display case just to show off and I just decided, "You know what? That means nothing to me. There's no sentimental value to that whatsoever, so I'm just going to get rid of it." So that's the Tamagotchi.

The inflatable novelty microphones I got because I was going to use them in my radio broadcast class. So they say when you're doing a class, if you throw something around like a ball . . . like, if you ask a question and then you throw the ball to a student, then the student has to answer the question, and then they throw it to somebody else for the next question, that keeps the energy up. I thought I'd do this with inflatable mics, but it just never really worked. So I bought those on amazon.com. Probably came from China or something.

I'm going to talk about the hardest thing that I'm still debating about. This is a common theme in my life. That's why I'm going to share this. So around birthday and Christmas, I can be hard to buy for. And sometimes I will say, "Oh, that'd be kind of cool to have." And then I get the thing and I realize it isn't as cool. So now it's hard to get rid of because it was a birthday present or a Christmas present from somebody that's close to me.

So I have this pair of blue suede shoes that I have never worn. Around here in Utah, what good is suede? I even actually went out and got a can of suede protector because I read in order to protect them, to keep looking nice, I should do that. I sprayed them down. Still have never worn them. They don't even have shoelaces anymore because I took the shoelaces out for another pair of shoes when my shoelaces in those broke.

I just about put them in the box, but I'm like, "Well, maybe I'll try to wear these," because they're kind of cool. But I've tried to get rid of them three or four times, and here I am again trying to get rid of these shoes that were a gift. Gifts are tough.

I've really watched my mouth now talking about things that would be neat to have because I've learned around here you might end up with those things. So that's my one story.

Troy: So you have gotten rid of the blue suede shoes then?

Scot: No. I pulled them out. They're sitting separately from the big pile that I'm giving away. I'm still vacillating on those.

Troy: You're still deciding.

Scot: I still think I'm going to put shoelaces in them and wear them, but I probably know better.

Dr. Chan: Scot, I'm the psychiatrist, I guess, here on this call. How do you feel? How does it make you feel?

Scot: I think this was low-stake stuff.

Dr. Chan: My non-minimalist side to me when I hear about the Tamagotchi and your "Star Wars" trash can, I start thinking, "Those are collector items. No, Scot, don't do it." But then I'm trying to combat that with the spirit of what we're trying to do.

Scot: Yeah. And to me, they might be collector's items, but if I really think about it, they're not. They don't really mean anything to me. So it's not that big of a deal on these, I think.

I'll let you know how I feel when I'm getting rid of my four ceramic pigs. I'll tell you more about those in another week.

Troy, your turn.

Troy: As you know, this is something I struggle with and I admitted it upfront. I'm definitely a packrat. I'm not a hoarder in the sense that I would be on the "Hoarders" show, but I do hold on to stuff. I'm fortunate to have a spouse, Laura, who does not do that and very often encourages me to declutter. She heard about this challenge and we talked about it, so she has fully embraced it. And she's getting rid of stuff. So I'm counting her stuff in my total.

Mitch: That's cheating.

Troy: That's fair game, Mitch.

Scot: I don't know. I don't think so. I don't think it's cheating.

Troy: Yeah, it's part of the entire household.

Mitch: All right.

Troy: It's like "what's yours is mine," and if you're getting rid of it, I'm definitely counting it. So I'm definitely counting items that she is getting rid of.

She's really made some headway with this, but she has several times now -- I shouldn't say offered -- has stated that she is going to go through my stuff and get rid of stuff, and I said, "Don't do that. Not yet. Let me go through it and decide."

So, as I've started going through stuff, it's been backfiring on me. So I found these old covers I had for my shoes to protect them from rain, and I was like, "Wow, I haven't used these in years. I should try using them." And so I tried using them and they tore, so I got rid of them. But then I bought a pack of 50 disposable rain covers. So I failed on that. I went from one pair of disposable covers for the shoes to now 50 pairs.

I found an old Bluetooth earpiece that I thought, "Oh, this would be great when I'm listening to audiobooks around the house. I could use this." It doesn't work very well, so I got rid of it and bought a new one.

Mitch: Oh my god.

Troy: And then I found an old water bottle that I was going to get rid of, but I was like, "I need another water bottle." So now I've washed it and I'm using it.

I don't know, Scot. This is not going super well for me.

I did count my pairs of running shoes. I have at least 30 pairs of running shoes, 5 of which I actually use. I definitely have some sentimental attachment to a lot of these shoes because I've run a lot of races in them. But I'm starting to come around to saying, "Hey, I'm not going to wear these shoes." They're worn down. I'll probably get plantar fasciitis if I try and run in these shoes at this point. So I think I'm going to succeed in really narrowing down that stock.

But like I said, my success so far has been due to Laura's efforts and definitely not mine.

Mitch: It's funny that you mentioned that because as I've been moving . . . I also live with a partner and I have this box of "maybe probably going away stuff" as I was going through all my tech stuff especially. He's been going through and throwing things out. He'll be like, "Why are you getting rid of this?" I'm like, "Oh, well, I don't use it." "Well, maybe I'll use it." And so there's suddenly a new pile being invented as the things I try to get away keep getting pulled out. So we'll see how that counts toward my total.

Troy: That hits too close to home.

Scot: Troy, I love how he's whispering right now. You can hear him whispering.

Mitch: I am. I'm in my own special soundproof room now, and I'm still going to whisper.

Troy: Yeah. He can't hear. I love that you shared that, Mitch, because this isn't the first time this has happened in my household. There have been boxes in the garage that were scheduled to go to DI, and I will admit I have gone through those boxes and have pulled items out of those boxes. I relate to Jonathan.

Scot: They say that one of the strategies that you should employ if that happens is once you've made that decision, then you need to get that stuff to Goodwill or wherever you're going to take it immediately.

Troy: Oh, yeah.

Scot: You can't leave it out there and then go back through it a couple of weeks later. Once you make the decision, you've just got to live with it.

Anyway, how's everybody feeling? Dr. Chan, looks like he had to check out, so he's bailed on us. We'll check in with him next week. But how's everybody feeling so far? Mitch, I think it sounds like this has been a great week for you.

Mitch: Absolutely. I can go on a run without worrying about what's happening to the car. I have a space that I'm excited about that I'm going to be utilizing. Yes, I bought a thing or two. I now have foam, whatever. But at the same time, it's finding the stuff in my life that stresses me out and turning it into something that can help me succeed moving forward. That's been my strategy.

Scot: Cool. Troy, how are you?

Troy: Scot, this is funny. We've talked about so many things on this podcast, and I have embraced a lot of those things, like sleep. We've talked about diet, all that, and it's been great. I've been a little shaken by this and it's been an interesting experience to realize, "Wow, I really do hold on to a lot of things."

And maybe it's partly their sentimental value. Maybe it's my background as a history major. I like artifacts. I like these things that represent our past, and I think there's some value in it when clearly there's probably not. So I'm working on it. It's definitely a process.

Scot: I've been through this process before, so I think that's why it was particularly challenging. That, and the fact that I put it off last minute. But I found success in this process before. I've enjoyed it. I think what I need to do is go out to the garage. That's going to be where I'm going to really be able to conquer.

My goal is eventually to drywall and insulate the garage and put up some storage stuff, but make it clean storage. Not have every nook and cranny dedicated to storage. And just try to have the storage for the stuff that we use on a regular basis so it's easier to access. And so when you see it, you're like, "Yeah, that brings me happiness. That's useful in my life."

So I think when I get there, I'll be happy. But right now, it's still a little stressful.

All right. Well, we will check in next week and see how everybody's doing with the minimalization challenge. I look forward to hearing how Mitch progresses in the next week because I think he's made a lot of progress this week. I suspect he might slow down, but he might not. Troy, I look forward to finding out how you continue to cope with getting rid of things or if you keep pulling stuff out of boxes.

Troy: Or I just keep buying more stuff.

Scot: Yeah. Exactly.

Troy: And just keeping more stuff. But yeah, not a good trend so far. Definitely, there's a lot of room for improvement for me.

Scot: All right. Well, guys, thanks for partaking in the challenge. And if you would like to partake in the challenge, you can go to facebook.com/whocaresmenshealth. If you want to post any pictures . . . we'll post some of our pictures of our stuff. And if you'd like to join the challenge or communicate with us, go ahead and let us know.

Before we go, Mitch, your dad actually gave us a tool that might help us in the future. Tell us what this tool is. Your dad is part of this now.

Mitch: Yeah, so my dad, and my parents, avid listeners. My father decided to put an Excel sheet because he was focused on the math that you proposed, a doubling of an item every day. I think I sent it to you. How many items is it going to actually be at the end of the month if you double every single day? It's one of those math problems where, "If you keep a penny in a bank for this long."

Scot: This can't be right.

Troy: What's the total number? I need to know this, because I know you talked about this doubling and I know it's an astronomical number. I just need to know what the number is.

Mitch: It's ridiculous.

Scot: No, this can't be true.

Troy: I'm sure it's true. Mitch's dad calculated it.

Mitch: He knows math.

Troy: I know it's a huge number. When you told us, "Double every day," I was like, "That's a gigantic number." That's like an infinitesimal amount of things.

Scot: What am I looking at here?

Troy: You're approaching infinity.

Mitch: So the first column is the day, the second is how many new things you need to throw away, and then the third column is cumulative, how many things you have thrown away by adding each one so far.

Troy: What's the number at Day 30? That's all I need to know. How many items?

Scot: I must have misheard on their on their on their thing because this is . . .

Troy: Again, Scot, when you told me this, I said, "This number is gigantic."

Scot: This is impossible. I can't . . .

Troy: What's the number?

Mitch: On the 30th day, you will need to throw away 536,870,912 items.

Troy: I knew it.

Mitch: By the end of the month, you will have thrown away 1,073,741,823 items.

Troy: I knew that, because when Scot said it's doubling every day, I knew the number was just . . . it approached infinity, which is basically what it does. Scot, I think it probably doesn't double every day. Maybe it's just the number of items of that day, like maybe Day 1 is 1, Day 2 is 2, Day 3 is 3. It's impossible.

Mitch: I don't even think I have a billion things in my life.

Troy: I don't think I do either.

Scot: Okay, so there are some flaws. No wonder it felt overwhelming.

Troy: See, Scot, I didn't want to say anything though. I just wanted you to continue to do this to see if you had anything left at the end of the month, like if you had just stripped your house bare and took every screw out of the wall so you could meet this number.

Scot: Yeah, I'm going to have to look this up. I must have misunderstood something, obviously.

All right. Well, gentlemen, I look forward to next week. I'm going to redo my math and try to figure out something more sustainable.

Troy: Clearly a radio personality and not a math major.

Scot: Yes.

Troy: It's all right.

Scot: That's a good joke, right?

Mitch: Thanks, Dad.

Scot: If I couldn't become a math major, which major would I become?

All right, guys. Thanks for listening and thanks for caring about men's health.

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