Common Sports Injuries: When to see a Doctor
Transcript:
Guest: Dr. David Geier – Orthopedic Surgery
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking, today, with Dr. David Geier who is Director of MUSC Sports Medicine. Dr. Geier, anybody who plays a lot of sports is going to get injured from time to time. What are some of the things to think about in deciding whether or not an injury is serious enough to seek medical treatment?
Dr. David Geier: I think it’s a difficult idea to generalize, exactly when for each person. It’s not uncommon to have somebody turn an ankle on the field or while they’re running and decide, maybe I need to see go somebody, right then and there versus somebody that hurt their shoulder lifting weights and thought it would go away and a year later it bothers them. So, I don’t think any one rule is applicable to everybody. But I do think when the pain or when, say, the locking or catching of the knee or popping in the shoulder, when those symptoms get to where they limit your ability to do whatever recreational activity or sport, when your activity is limited, I think that’s a reasonable time to decide to see somebody. And not that you can’t do the activity at all, necessarily, but if you’re not able to run as quickly as you’d like, if you’re not able to throw a pitch as hard or with the same accuracy, if your performance is somewhat limited, I think that’s a reasonable time to see a sports medicine physician.
Dr. Linda Austin: So, let’s just take those two examples. If somebody comes to you and says, gee, I had an injury several months ago, now I just don’t seem to be able to run as fast, what could that be?
Dr. David Geier: The question is, do they have an acute injury or is it a nagging problem continuing over time, some kind of overuse injury? It’s a little tough to generalize.
Dr. Linda Austin: But what’s the range? What are some examples of the kinds of injuries that could be significant that could cause that?
Dr. David Geier: Say, for runners, for instance, it could be something very simple, iliotibial band syndrome, some kind of shin splints, that kind of thing. But there are some things that if you do keep running through it, there could be problems, such as stress fractures of the tibia, the foot, or the hip. You could have a meniscus tear in your knee that you could be running on and potentially be making worse. I think, one, if it’s limiting your ability to perform or if it’s just not getting better, or it’s getting worse, I think it may be time to be seen by someone.
Dr. Linda Austin: For a typical injury, let’s say you’ve turned an ankle on the field or you hear something pop and then it’s sore, or you’re limping afterwards, or there’s some swelling, what are some good first aid strategies, I guess, to employ?
Dr. David Geier: Sure. I think this is valuable knowledge for everybody because you can’t play sports or do recreational activities without getting some kind of injury at some point along the way. Say, for instance, you turn an ankle, this really applies to most injuries, the first thing is, if you’re really uncomfortable, you get off of it. Say it’s your lower extremity, try to avoid putting weight on it. If it’s something maybe not impeded by weight bearing but it’s still uncomfortable, that’s the whole idea of rest, avoiding the offending activity that’s making it worse. And then ice is really the athlete’s best friend to help get the swelling down. The sooner you get the ice bag on, whatever the injury, the quicker that swelling and pain dissipates. Elevation, say it’s an ankle or a knee, lying on a couch, put two or three pillows under the foot to get that ankle or knee above the level of the heart to get some of that swelling down and an Ace bandage to compress the injury. The acronym we use is RICE: Rest, ice, compression, and elevation. Some people add a P for PRICE, for protection, crutches and non-weight bearing, that kind of thing. Those are some simple things you can do to manage the first 24, 48 hours.
Dr. Linda Austin: We’ve all seen, I think, at the Olympics, examples of athletes going for the gold who’ve fractured an ankle and nonetheless they keep on and win the gold medal, and so we think that that’s a very heroic thing, to stay in the game despite a bad injury.
Dr. David Geier: Right.
Dr. Linda Austin: It sounds, from what you’re saying, that may not be such a swift idea though.
Dr. David Geier: Right. The Olympics, it’s hard to turn down that opportunity. Unfortunately, most of us are not at that level. And, yes, there are times that you don’t want to run through problems. Hopefully, they’re not that dramatic. But, obviously, it should go without saying, if there’s a bony deformity or you’re unable to use your arm or your leg, or whatever it is, you should not only not continue to play, you should also go to the emergency room, or to a physician.
I think if you’re having really sharp uncomfortable pain, and shin splints versus a stress fracture is a perfect example of that, if you’re really uncomfortable doing your activity, you can make that problem worse and, really, potentially cause a real displaced tibia fracture, for instance, or have a stress fracture that sets you back four, five, six months. So, this concept you hear at the high school level, and even younger, you need to play through pain, it’s not always the best idea.
Dr. Linda Austin: What are the signs and symptoms of a fracture? I’m sure sometimes it’s obvious that the bone is sticking out, but other times, especially with a smaller bone, it can be more subtle.
Dr. David Geier: Absolutely.
Dr. Linda Austin: What are some of the typical symptoms?
Dr. David Geier: And I can tell you this from personal experience, from when I was running in college and stepped on a curb wrong and inverted my ankle. I thought, oh, I sprained my ankle, and six hours later, when I couldn’t walk, I went to the ER. Yeah, it’s sometimes very difficult to tell. I mean, it’s not always that the bone in your leg or arm is crooked. I wish it was always that straightforward, but it’ not. If you have a lot of bruising and your skin around it turns red or blue or black, obviously, that’s worrisome. If you have point tenderness, it’s not so much hurting all over the ankle or the wrist, but there’s one particular point that’s just excruciatingly painful, that’s certainly worrisome. Obviously, some swelling is not necessarily a bad thing, but really swollen extremities are worrisome, and then the inability to use, say, an ankle. Most ankle sprains, you can put some weight on. It’s uncomfortable but it’s not such a big deal. But if you can’t put any body weight on it at all, that might clue you in that you may have a fracture.
Dr. Linda Austin: What, exactly, is a sprain?
Dr. David Geier: A sprain is, in varying degrees, injury to the ligaments around a joint, from just stretching it out, kind of a mild sprain, so to speak, to a partial tear, to a complete tear. There are various grades depending on which joint it is, which ligament it is. But it’s, essentially, some degree of an injury to a stabilizing ligament of a joint.
Dr. Linda Austin: What do you recommend for pain relief for, let’s say, not terribly serious but nonetheless uncomfortable injuries?
Dr. David Geier: I think early on, certainly, Tylenol and the anti-inflammatories, like Advil or Aleve, are helpful. I think for the swelling plus the pain component, anti-inflammatories, typically, are a little bit better, so, Advil, Aleve, Celebrex, a prescription variety, are probably a little bit more helpful. But, usually, at least for sports injuries, over-the-counter medications are sufficient. As much as any thing, the ice and compression, the elevation, are as effective, if not more important for pain relief than just the medication per se because a lot of times the swelling of the extremity is more uncomfortable than the injury itself.
Dr. Linda Austin: Dr. Geier, thank you very much.
Dr. David Geier: Absolutely. Thank you.
