Most athletes have a straightforward goal after suffering an ACL injury – to return to sports. Many athletes would experience rotational instability of the knee and feel their knees buckle or give way with turning or landing, which would prevent playing effectively. Surgery to make a new ligament aims to restore stability.

One of the common questions I receive from weekend warriors and others who suffer these injuries centers around the development of osteoarthritis. But does ACL reconstruction actually prevent degenerative changes in the knee?

A study in the December 2011 issue of The American Journal of Sports Medicine actually suggests the opposite might be true. Ryan T. Li et al. looked at 249 patients who had undergone ACL reconstruction at an average of 7.8 years after surgery and found that 39% had developed radiographic evidence of osteoarthritis. They then looked at some of the underlying risk factors to attempt to determine which subgroups of patients were at increased risk of arthritis after undergoing these surgeries.

Among their findings, the authors found that the strongest predictors for its development included increased body mass index (BMI), having had or currently undergoing partial meniscectomy (trimming part of a meniscus tear out), presence of articular cartilage damage in the medial compartment (side of the knee closest to the midline), and increased time from injury to surgery.

Note the diffuse fraying of the articular cartilage, significant of early arthritis changes.

The biggest factor that predisposed for osteoarthritis in this study was a high BMI. This essentially means that larger or overweight patients were more at risk. This fact makes sense in that these patients place more stress not only on the ACL grafts but also the menisci and articular cartilage. While it isn’t possible to affect changes to BMI after injury, it might be one of a number of reasons to try to keep weight optimal for sports.

Lastly, athletes love to play sports. Regardless of whether osteoarthritis develops in the years after injury, they still mostly want to get back on the field or court. For these athletes, and people who love exercise or physical activity, ACL reconstruction can be a good idea to allow them to do what they love. Is there a risk of developing degenerative changes in the knee? Yes, but even so, they likely have a good chance of returning to play – even if that means they could need further knee treatments in the future.

Well, now there might be evidence that these video games systems might benefit older adults too. And the benefits might not be limited to physical ones.

A new study published in the February 2012 issue of The American Journal of Preventive Medicine shows that exergames might improve cognitive function in older Americans and slow or prevent the onset of dementia. Cay Anderson-Hanley, PhD, et al. compared the use of traditional stationary bicycles to those incorporating virtual reality tours (“cybercycles”) among older adults from retirement communities. In addition to evaluating exercise effort and fitness, the authors studied executive function, cognitive impairment, and plasma brain-derived neurotrophic growth factor (BDNF).

The researchers found significant differences between the groups. The adults who used the virtual reality-enhanced cybercycles for three months demonstrated greater cognitive benefit and less cognitive decline than those who expended similar effort on the traditional stationary bicycles. The authors felt that navigating three-dimensional landscape, competing against other competitors, focusing and making decisions helped to stimulate cognitive function more than standard exercise.

The authors conclude, “The implication is that older adults who choose exergaming with interactive physical and cognitive exercise, over traditional exercise, may garner added cognitive benefıt and perhaps prevent decline, all for the same exercise effort.”

I think this study is encouraging for a number of reasons. First, these exergames can be performed just about anywhere. Assisted living facilities and nursing homes can encourage their patients to use these games indoors with supervision, where there is less chance for injury. Since little equipment is needed, these systems could be relatively inexpensive when used for many participants. Plus they could provide a source of entertainment and promote camaraderie.

Exergames that involve sports or dancing can provide moderate physical activity.

Now I still believe in cross training and variety and would never advocate exergames as a lone source of fitness activity for most people. I think that alternating between several different types of exercise can help to avoid overuse injury, and the variety can decrease the chance for burnout.

Having said that, I think that the potential benefits for exergaming to both older adults and everyone else could be significant both physically and mentally.

Episode 24 of The Dr. David Geier Show is available! I am excited that more and more people are not only listening to the show, but more of you are actively contributing questions and comments. Please keep them coming!

Please remember that the show is available on iTunes, so please click here to subscribe.

In the Zone
Most athletes, parents, and coaches assume that sleep deprivation is detrimental to sports performance, but why does it hurt? And how can youth and adult athletes alike improve their sleep, and possibly, their success in sports? (starts at 2:54)

That’s Gotta Hurt
Rob Gronkowski – New England Patriots TE (starts at 20:35)
Sports Injury Locator – Syndesmosis Injuries (“High Ankle Sprains”)

Ahmad Bradshaw – New York Giants RB (starts at 24:08)
Sports Injury Locator – Fifth Metatarsal Fracture (Jones fracture)
Episode 11: Ahmad Bradshaw (starts at 31:34)

Osi Umenyiora – New York Giants DE (starts at 26:54)
Sports Injury Locator – Articular Cartilage Injuries of the Knee
Sports Injury Locator – Syndesmosis Injuries (“High Ankle Sprains”)
Episode 1: Osi Umenyiora (starts at 20:09)

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Can I play golf after surgery for a meniscus tear and arthritis of the knee? (starts at 29:56)
Sports Injury Locator – Meniscus Tears
Sports Injury Locator – Meniscus Tears – Recovery
Sports Injury Locator – Articular Cartilage Injuries of the Knee

When can I walk comfortably at college after ACL reconstruction? (starts at 32:58)
Sports Injury Locator – ACL Tears
Sports Injury Locator – ACL Tears – Surgical Reconstruction

Can snapping triceps cause forearm pain? (starts at 34:28)
Sports Injury Locator – Ulnar Neuritis (Ulnar Nerve Compression)
Sports Injury Locator – Flexor-Pronator Strain

Options for iliotibial band syndrome (IT band syndrome) in a triathlete? (starts at 37:13)
Sports Injury Locator – Iliotibial Band Syndrome

Return to sports after quadriceps injury in football? (starts at 39:57)
Sports Injury Locator – Rectus Femoris Injury (“Hip Flexor Strain”)
Sports Injury Locator – Quadriceps Contusions

Surgery or physical therapy for a first-time patellar dislocation? (starts at 41:30)
Sports Injury Locator – Patella Dislocations

Fan Favorites and Trash Talkers (starts at 44:43)
This week, a listener in Barcelona sends her thoughts, and listeners comment on playing through pain, cartilage injuries in runners, and concussions in football.

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

David

Courtney Sanders asks on Twitter:

Hey! @DrDavidGeier just found out I have been running w/o an ACL for almost 10 yr and now have torn meniscus and arthritis stage 3. Will I run pain free again?!! I’m only 26. ;(

Thanks for the question, Courtney!

That is actually a more complicated question than you might think. First of all, it is certainly possible to run without an ACL. Sports like soccer, football, or basketball that involve rapidly changing directions, twisting, cutting, and landing from jumps are next to impossible without an ACL due to rotational instability. Running, however, is a forward motion. I have known several runners in their thirties who decided not to have surgery and were able to run without much change.

Having said that, if an athlete, even one who doesn’t play a cutting or pivoting sport, is having the knee give way or buckle, we usually recommended surgery to reconstruct the ACL. And having a meniscus tear probably makes sports medicine surgeons more inclined to treat the knee surgically, as the pain from the meniscus tear usually limits the patient’s activity. These are generalizations, so much of the decision is based on the specific symptoms.

As far as returning to sports and exercise after ACL surgery, it is a long process. As I have described elsewhere on this blog, the rehab process involves 5-6 months of physical therapy. First the patient and therapist work to restore full knee range of motion and then lower extremity strength. Gradually the therapist will allow the patient to start some exercise, such as stationary biking and then possibly an elliptical trainer. Jogging is usually withheld for 10-12 weeks to avoid repetitive stress on the ACL graft. Roughly around three months after surgery, the patient starts more functional training that involves plyometrics, balance, proprioception, and other skills that will get the athlete back to sports successfully.

Now unfortunately nothing is ever guaranteed with surgery, and that fact is especially true after ACL surgery. While most sports medicine surgeons do feel that return to sports is likely, there are some recent studies that show return-to-sports numbers closer to 60-70% instead of the 90% or so that we usually cite. I will discuss this data in an upcoming post, but many factors might be involved. Most important to these lower return-to-sports numbers seems to be psychological factors and apprehension about reinjuring the knee. Now these issues might not be as important in returning to jogging, which does not involve rapid twisting and landing from jumps. But it still must be remembered that return to a sport at the pre-injury level is never guaranteed.

Lastly, the presence of a meniscus tear and arthritis changes can be important. What specific treatment is needed for the meniscus can have a large effect. Most meniscus tears cannot be repaired (meaning sewn back together). The vast majority of meniscus surgeries involve trimming out the torn part, as the tear configuration and location is such that a repair would not heal. In theory, removing some of the meniscus, which acts as a shock absorber in the knee, could lead to arthritis changes down the road.

Also, the presence of arthritis changes at the time of surgery could suggest that the athlete will have some pain even after he or she has returned to full activity. As we have talked about in other posts, surgeons can look at the degenerative changes to the articular cartilage and try to smooth them out with a shaver. But this does not restore them to normal cartilage. While we have some treatments that might help small areas of cartilage damage, we have nothing reliable that reverses more diffuse changes back to normal cartilage. That doesn’t mean that the athlete cannot run, but it is important in a long-term sense.

The action sports world was stunned this week by the death of one of its stars. Canadian freestyle skier Sarah Burke died Thursday at the University of Utah after an injury while training in the Eagle Superpipe at Park City.

Burke, a six-time Winter X Games medalist and winner of the Women’s Ski Superpipe in 2011, was preparing to defend her title at the Winter X Games Aspen later this month. Toward the end of a training run where she landed what would later be described as a normal trick, she fell and hit her head. Despite a fall that snowboarding star Gretchen Bleiler later remarked that seemed like it “shouldn’t even have caused a concussion,” she was quickly airlifted to Salt Lake City after going into cardiac arrest.

Tests showed a tear in one of her vertebral arteries. Dr. William T. Couldwell, the chairman of neurosurgery at the University of Utah, repaired the tear, and neurointensivists monitored her progress. After nine days in critical condition, Burke died Thursday. According to a statement released by her publicist, “Sarah sustained severe irreversible damage to her brain due to lack of oxygen and blood after cardiac arrest, resulting in hypoxic ischemic encephalopathy. Sarah passed away peacefully surrounded by those she loved.”

While sports fans everywhere are shocked at the loss, the frightening reality is that these injuries can actually occur to all athletes and non-athletes as well. I interviewed Raymond Turner, MD, Co-Director of the MUSC Stroke and Cerebrovascular Center at The Medical University of South Carolina, and I was surprised that these aren’t just freak injuries.

He explained that the vertebral arteries are at risk for injury from whiplash-type injuries because they run inside the bones of the cervical spine and are therefore tethered in relation to the head. “Mrs. Burke has been reported to have a tear in the vertebral artery, also called a dissection. The symptoms of a bleeding vessel in the head can cause severe headaches, confusion, weakness, and if severe enough, coma and death. Repair of this tear should be done urgently to prevent further bleeding.”

The reality that we must remember, though, is that these whiplash injuries can result from much less dramatic events. He points out that contact sports, such as football and hockey, and sports where falling is common, such as skateboarding and skiing, are not immune from these injuries. He points out that he has even seen several vertebral artery injuries from chiropractic neck manipulations.

Since he adds that no specific group of people seemed to be predisposed to these injuries, preventing vertebral artery dissections is likely impossible. What might be more important for athletes of all sports, and their parents and coaches, to remember is that it is critical to take all head and neck injuries, even the seemingly mild ones, seriously. Symptoms such as confusion, headaches, and dizziness might seem insignificant but can be life threatening.

“Interruptions in the blood flow in these vessels can result in brain injury that may be minimal, such as short term coordination problems or dizziness, or something that is life threatening. This type of injury can be fatal in some cases, however fortunately that is not always the case, and many patients can recover in weeks to months,” Dr. Turner stresses.

Sarah Burke leaves behind a tremendous legacy. In addition to being a champion of her sport on the slopes and in the halfpipes, she brought it into the mainstream sports world. In part due to her lobbying efforts, halfpipe skiing will make its debut at the 2014 Winter Olympics in Sochi, Russia. And in her dying moments, her organs were donated to help save the lives of others. Her memory will live on in the hearts and minds of skiers and athletes everywhere. Let’s hope that part of that memory serves to remind us of these dangerous injuries as well.

On the eve of its biggest spectacle, we are reminded that professional football is experiencing unparalleled popularity. Sunday’s game and its likely 100 million viewers, $3.5 million television ads, and extravagant halftime entertainment will reinforce the idea that football is the premier sport in this country. So what could knock the NFL off its pedestal? Two media features recently make me wonder if concussions in football could ultimately lead to the sport’s demise.

Jonah Lehrer and Dr. Sanjay Gupta suggest that the real danger of concussions might affect the potential stars of tomorrow – our kids. Lerner, in a column appearing in Grantland entitled “The Fragile Teenage Brain,” and Dr. Gupta, in his television special, “Big Hits, Broken Dreams” both demonstrate how serious concussions are for adolescent athletes.

Lehrer presents data from several studies showing long-term effects from multiple concussions among youth athletes. Players who suffered two or more concussions had much higher rates of headaches, dizziness, and sleep disturbances. Players with three or more concussions were more likely to exhibit loss of consciousness and amnesia. And players with multiple concussions had more memory deficits and difficulty processing visual stimuli. This damage can have a practical effect, as kids who suffer multiple concussions have lower average grades.

Lehrer shows how even a minor impact to the brain can initiate a dangerous chemical cascade. The sudden release of neurotransmitters from billions of cells leads to a frenzied process by which the brain tries to restore equilibrium. Dizziness, headaches, sensitivity to bright light, feeling of being in a fog, and many other symptoms after concussions serve as evidence that the player has not yet reached this baseline. Youth athletes take longer to return to baseline than adults. And they are likely much more susceptible to catastrophic brain injuries after second blows to the head because their brains are still developing.

Dr. Gupta details one such injury in a high school running back in Greenville, NC. Jaquan Waller was injured in practice after a forceful tackle and was carried off the field. Since an athletic trainer was not available, a first responder diagnosed him with migraines despite headaches and balance problems. No doctor evaluated him or cleared him to play.

In a game two days later, Waller suffered a seemingly mild blow but quickly lost consciousness. He was rushed to a local hospital but died about 72 hours after the first hit. It was later determined Waller died of second impact syndrome, characterized by massive brain swelling due to successive blows to the head without time for the brain to recover.

Another equally frightening outcome of brain injuries, called chronic traumatic encephalopathy (CTE), has garnered attention recently. This is a degenerative condition of the brain marked by depression, mood alterations, and memory loss that develops with repeated blows to the head. Dr. Gupta notes that football players experience approximately 650 subconcussive blows to the head each year. While CTE can only be diagnosed by autopsy after death, Lehrer points to a 2009 study which showed memory-related diseases were diagnosed among former NFL players at rates 19 times higher than the general population.

Despite increasing media attention and the NFL’s attempts to improve safety, its players largely don’t seem to care. Kris Dielman, who suffered a seizure on a Chargers’ flight home after a game, said after that event that he would risk his health to win a Super Bowl. And Brian Urlacher raised eyebrows recently telling reporters that he would not tell the team’s medical staff if he suffered a concussion. The potential rewards of playing with a concussion might be too great to change their attitudes.

But it is high school players, who likely will never make it to the pros regardless of injury, who are the ones who suffer far more concussions with more lasting consequences. I would argue, though, that there are so many changes parents, coaches, and doctors can make that could help. Athletic trainers at every school, preseason baseline testing, mandatory physician clearance prior to returning to play – these are only starting points. We need more than fancy helmets and tackling education. We need to critically examine every aspect of youth football and find ways to make it safer.

As we watch the Super Bowl Sunday, let’s try to remember all of the young players dreaming of one day playing in this game and pledge to do whatever we can to keep them healthy.

Episode 23 of The Dr. David Geier Show is here! I am excited to be back in the studio after some time off recently. I think this is another great episode, and as always, I want to hear from you!

Please remember that the show is available on iTunes, so please click here to subscribe.

In the Zone
Is it acceptable for a professional athlete to play through pain? What about playing through a specific injury? What about high-school or college athlete or youth or recreational athlete? Can it be harmful? (starts at 2:58)
Time to see the doctor?

That’s Gotta Hurt
Ali Kreiger – US Women’s National Team soccer star (starts at 14:06)
Sports Injury Locator – ACL Tears
“If you had ten minutes”

Dirk Nowitzki – Dallas Mavericks F (starts at 18:32)
Sports Injury Locator – Patellofemoral Pain
Sports Injury Locator – Patellar Tendinitis

Baron Davis – New York Knicks G (starts at 24:10)
Sports Injury Locator – Herniated Disk

Brian Urlacher – Chicago Bears LB (starts at 29:11)
Episode 20: Kris Dielman (starts at 24:27)
It’s time to change players’ attitudes toward injuries

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Why does my knee squeak more as I get older? (starts at 35:13)
Sports Injury Locator – Articular Cartilage Injuries of the Knee

What exercise can I do with chronic exertional compartment syndrome? (starts at 39:31)
Sports Injury Locator – Chronic Exertional Compartment Syndrome
Ask Dr. Geier – Chronic Exertional Compartment Syndrome

What exercise can I do that won’t aggravate pain from Achilles tendinosis? (starts at 42:55)
Sports Injury Locator – Achilles Tendinopathy

How can I reduce a nursemaid’s elbow? (starts at 46:54)

Fan Favorites and Trash Talkers
Listeners respond to my previous discussions of chronic exertional compartment syndrome and ACL prevention programs and share opinions on other topics and the show in general. (starts at 52:08)

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

I thought it would be fun to write a post listing some great tweets that I’ve found about a variety of topics in sports medicine. I got the idea from a regular post by Jane Friedman listing the Best Tweets for Writers. I haven’t decided if I will make it a regular column (or how frequently, if I do write it regularly), so let me know if you like it. And if there is a tweet I missed or someone I should follow who writes great sports medicine tweets, leave it in the Comments section below.

@SportsSafety
The increase is single sport focused young athletes has one mom especially worried…and she hopes you are too

@sanjayguptaCNN
Why @sanjayguptacnn wanted to tell the story of concussions in young players. via @cnnhealth

@OHSUSPORTS
Learn more about Platelet Rich Plasma therapy via @hjluks

@MomsTeam
Top ten nutrition tips for sports active kids?

@PatCarone
Possible link between #music and #pain control

@ReneeMclaughlin
Ability is what you’re capable of doing. Motivation determines what you do. Attitude determines how well you do it.

@theRotater
KT tape instructions for rotator cuff…are you a believer?

@DrJustinRoe
Suggestions for first aid treatment of an injured knee include: Stop your activity immediately. Don’t work through’ the pain.

@HPSMTO
Being pregnant doesn’t mean you can’t keep up an #exercise routine. Here’s a great article on training thru #pregnancy

@active
Triathletes: Try these tips for staying warm in the pool, on the bike, and on your runs this season

@SportsandPT
A hop, skip and a jump can help slow bone loss in woman over 30!

@youthfitnessguy
Forcing kids to be active may satisfy adults in the short term but does nothing to turn kids on to a lifetime of physical activity

@human_kinetics
Understand the general principles of periodization.

@DrJoesphAiello
Study shows combination treatment with PRP improves chronic tendinopathy pain

@spinesportsnyc
10 Foods and Food Tips That Will Help You Sleep

@MomsTeam
What is an effective and affordable way for youth athletes to train w/o spending tons of money?

@sportslegacy
Read the latest on evolving technology aiding in concussion detection.

@PhysSportsMed
Participation in Athletic Activities May Be Associated w/ Later Development of Hip and Knee Osteoarthritis

@MikeRyanFitness
Running Foot Pain or Foot Stress Fracture?

@WKyPT
ACL Injury Prevention Training n Female Athletes: A Syst Rev of Injury Reduct and Results of Athletic Performance Tests via @Sports_Health

@TheTrophyMom
7 Tips for being the parent that every coach (and kid) loves! via @Coach4Youth

@hjluks
Partial versus Complete Anterior Cruciate Ligament (ACL) Tears

@msaxolotl
A public health perspective on physical activity after total knee arthroplasty for osteoarthritis via @thekneedoc

@NATA1950
Watch last night’s discussion between Dr. Sanjay Gupta & Dr. Drew about youth concussions.

@myorthodoc
When you see the humeral head almost touching the acromion bone above, Dx is massive rotator cuff tear.

@YouthSportInst
Courts designed for 10&under tennis play – Great vision toward progressive long-term athlete development and health!

@DrVondaWright
70% of how we age is directly controlled by the lifestyle choices we make …we R NOT victims of the future…we own it…GET OFF the COUCH

@D1_Sportsdoc
The latest 11 Blade Blog is up! My take on platform training shoes.

@YourSportsMD
Well Blog: How Exercise May Keep Alzheimer’s at Bay via @nytimeshealth

@kburnsmd
Surgeons: Sometimes wrong, but never in doubt.” We’re actually usually right. #justsayin in reply @medschooladvice @WomenSurgeons

@AOSSM_SportsMed
Looking for a sports med doc? Take care of what ails ya and find someone in your area with our search

@Vince_Burke
@DrDavidGeier great topic one that I great concern about. #Onesporters make trainers money, give me patients and you surgery & retire early

Comments? Questions? Share your thoughts below or follow me on Twitter! I want to offer special thanks to Stephanie Coffin for assistance with this post and Odette Rousseau for its title.

For those of you apprehensive about the risk of cardiac arrest in marathons and half-marathons, there is some news that hopefully will allay some fears. A study published in the January 12, 2012 issue of The New England Journal of Medicine examines cardiac arrests that occurred in marathons and half-marathons across the United States from January 1, 2000, to May 31, 2010. A prospective database of cardiac events occurring during or immediately after these races across the Unites States was developed, and the data was analyzed and published by Jonathan H. Kim, M.D. et al.

There were several interesting findings from this study that I would like to share.

-There were 59 cardiac arrests during this period, and 40 occurred in marathons and 19 in half-marathons. The incidence rate of cardiac arrest in these events was 1 in 184,000 participants. Male marathoners made up the highest risk group.

-42 of the 59 runners who suffered cardiac arrest died (71%). Therefore, the incidence rate of sudden death in these events was 1 in 259,000 participants. Again sudden deaths were more common in males than females and during marathons rather than half-marathons.

-Of the runners who died and where complete medical information could be obtained, hypertrophic cardiomyopathy was the most common underlying cause. HCM is a condition where the heart muscle lining of the ventricle is thickened. It is a very common cause of sudden death in young athletes. It appeared to have a poor prognostic factor in this study, meaning that runners with HCM who suffered cardiac arrest frequently died.

-Coronary artery disease (atherosclerosis) was the most common underlying condition in those who survived.

-The strongest predicting factors for survival of these runners after cardiac arrest was bystander initiation of CPR and an underlying diagnosis other than hypertrophic cardiomyopathy.

-The rates of sudden deaths from marathons and half-marathons in this study compare favorably to other sports and exercise:
College sports – 1 death per 43,770 participants per year
Triathlons – 1 death per 52,630 participants per year
Healthy middle-aged joggers – 1 death per 7620 participants

-The fatality rate of deaths after cardiac arrests during marathons and half-marathons (71%) in this study is significantly lower than has been shown in prior studies of fatality rates with out-of-hospital cardiac arrests.

Now for the roughly 2 million people who compete in marathons and half-marathons each year in the United States, this study should come as relatively good news. While cardiac arrests and deaths can and do occur in these long-distance running events, they are unlikely. They appear to be less common adverse events than would occur with college sports or even casual jogging. But this study does shed light on a few points that might keep runners even safer.

Know cardiopulmonary resuscitation (CPR). The rate of deaths after cardiac arrest appear to be much lower than those that occur everywhere else, other than at hospitals. This increased survivorship most likely has to do with bystanders immediately nearby starting CPR and medical personnel on site. And the authors did show that runners who underwent CPR quickly were more likely to survive.

Therefore, I think it is imperative for runners and their families, as well as spectators generally, to know how to administer CPR. And race officials might consider working with the medical teams covering the race to have personnel trained in CPR spread out along the course to perform it if needed, rather than having all personnel in a medical tent at the finish line. Whatever decreases the time between the cardiac event and the initiation of CPR would be helpful.

Undergo a physical before running a marathon. One could make a compelling argument that someone considering training for a marathon or half-marathon should see his or her doctor and undergo a thorough physical and obtain labs and tests if needed. This recommendation seems especially applicable to males. As this study showed, hypertrophic cardiomyopathy is a significant risk factor for sudden death in these races, just like in all sports. And frequently athletes suffer sudden death without ever knowing they have HCM. A good physical exam, plus an electrocardiogram and echocardiogram if deemed necessary by the physician, can detect this condition.

Another interesting point that this study suggests could become a helpful option is the idea to screen marathon and half-marathon participants the day before a race. Whether some sort of easily administered stress test is feasible or financially possible is unknown, but if the race’s medical personnel could identify those at risk for cardiac events before they occur, it might be worthwhile.

Runners with any symptoms at all need to see their doctor. Anyone with symptoms of chest pain, shortness of breath, lightheadedness, or anything unusual needs to have it checked immediately.

Do you have any other suggestions for preventing cardiac arrests during marathons? Or do you have any comments about the findings of this study? Share them here!

While the lack of snow at some of the larger ski resorts in the United States has been disappointing, it seems to be picking up. And with the snow come the skiers and snowboarders ready to hit the slopes. But it is important to keep some tips in mind to try to avoid some of the head injuries that can unfortunately occur. And it is not just the experienced snowboarders performing the dangerous tricks that should worry about head injuries.

A study published in the December 2011 issue of The American Journal of Sports Medicine, Shinya Koyama, MD et al. look at the differences between head injuries in beginner snowboarders and those of intermediates and experts. Some of the findings were expected, in that beginners were more likely to suffer these injuries after falls on gentle slopes and intermediate runs, while the advanced snowboarders were more often injured during jumps.

There were some surprising results, however. More beginner snowboarders needed surgery for head injuries, usually acute subdural hematomas, than the expert groups, but the intermediate and expert snowboarders were more likely to suffer amnesia and loss of consciousness.

Of the 959 beginner snowboarders who suffered head injuries, 10 (1.04%) required surgery. 4 of the 10 were first-time snowboarders, and 7 fell on flat or beginner slopes. 2 of the 10 died, and in both cases, they had become separated from their friends, so more than 30-60 minutes elapsed before they were found. Of the 1408 intermediate and expert snowboarders with head injuries, only 5 (0.36%) required surgery. Of note, two of the five collided with trees and one fell outside of a run.

In both the beginner groups and the expert snowboarders, knit caps were the most common head protection. Beginners were also more likely to wear no cap at all, while experts were more likely to wear helmets. Interestingly, a higher percentage of intracranial injuries in the expert group were suffered by those who wore helmets than ones who didn’t. One could argue, though, that snowboarders who wear helmets are more likely to try more dangerous stunts. No patient who worse a helmet required surgery in this study.

So what can we learn from this data? Unfortunately at least to some extent, head injuries are part of snowboarding. But there are some measures that we can take to minimize our chances of suffering one or hopefully decrease its severity and increase our chances of complete recovery.

Take head injuries seriously. We all need to understand that any level of snowboarder can suffer fatal head injuries, not just those performing dangerous stunts. In this study, there were more surgical cases, moderate disabilities, comatose patients, and deaths in beginners than in the intermediate/expert snowboarders.

Take lessons when learning to snowboard. Beginners especially should take lessons not only to learn proper techniques for traveling down the slops but should learn proper falling techniques to minimize the chances of hitting their heads.

Stay close to family and/or friends. As the two deaths in the group of beginners with head injuries demonstrates, the time between the injury itself and treatment can be critical. A delay in diagnosis and treatment can be fatal. Stay with family and friends to help recognize if and when someone in the group has fallen and gotten injured and notify ski resort personnel for transport immediately.

Stay within the marked boundaries. Three of the five intermediate and expert snowboarders who suffered intracranial injuries and required surgery were hurt snowboarding in dangerous areas – either colliding with trees or falling out of the boundaries of the run. Not only are these areas more dangerous, but also it will likely take much longer for ski patrols to find and rescue snowboarders in these areas quickly.

Try to avoid collisions with skiers and other snowboarders. Maintain enough distance on the slopes and in the halfpipes to avoid contact with others.

Pay attention to the weather conditions. If there is any question about the visibility on the slopes, stay off the mountain.

Wear a helmet. They won’t prevent every head injury. But Sulheim et al. showed in an article published in the Journal of the American Medical Association in 2006 that wearing a helmet reduced the risk of head injury by 60% in skiers and snowboarders.

Seek medical evaluation for any blow to the head. Even if it is seemingly mild, any symptoms should be evaluated by medical personnel, including headaches, blurry vision, dizziness, disorientation, nausea, and others. Some findings, such as loss of consciousness and amnesia, likely warrant emergent transport to an emergency department.

Do you have any suggestions for ways that snowboarders can avoid head injuries and stay safe on the slopes? Share them here! Or offer your feedback for my suggestions!

Episode 22 of The Dr. David Geier Show is now available! This show starts on a sad note, as I discuss the news of the death of freestyle skiing star Sarah Burke. I also want to thank all of who responded to the discussion about potential dangers of yoga. If you want to hear those opinions, please check out Fan Favorites and Trash Talkers! And send you comments!

Please remember that the show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
Sarah Burke’s death is a rare tragedy in sports, but what, if anything, should we do about it? (starts at 2:31)
Action sports stars rally around fallen hero

That’s Gotta Hurt
Andrea Petkovic – WTA tennis star (starts at 17:03)
Sports Injury Locator – Spondylolysis

Joel Zumaya – Minnesota Twins pitcher (starts at 21:28)
Sports Injury Locator – Olecranon Stress Fracture

Derrick Rose – Chicago Bulls guard (starts at 26:37)
Sports Injury Locator – Turf Toe

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Should I worry about ankle pain after starting a running program? (starts at 29:26)
Sports Injury Locator – Calcaneus Stress Fracture

Return to firefighting after ankle fracture? (starts at 31:42)
Sports Injury Locator – Ankle Fractures
Sports Injury Locator – Syndesmosis Injuries

Continued pain after a fasciotomy for chronic exertional compartment syndrome? (starts at 36:02)
Sports Injury Locator – Chronic Exertional Compartment Syndrome

What sport has the highest rate of meniscus tears? (stars at 37:53)
Sports Injury Locator – Meniscus Tears

Safer after ACL surgery: skiing or snowboarding? (starts at 40:10)
Sports Injury Locator – ACL Tears – Surgery in Kids?

Fan Favorites and Trash Talkers
Listeners react to the New York Times article on yoga “dangers” and my discussion last week, and share opinions on other topics. (starts at 42:34)

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

For action sports stars accustomed to leaving fans breathless with acrobatic aerial stunts, those same athletes are now in shock themselves.

Canadian freestyle skier Sarah Burke remains in critical condition at the Neuro Critical Care Unit of the University of Utah Hospital in Salt Lake City after a seemingly unremarkable fall Tuesday. Burke, a six-time Winter X Games medalist and winner of the Women’s Ski Superpipe in 2011, was training in Park City and preparing to defend her title at Winter X Games Aspen later this month.

She reportedly landed a jump toward the end of a training run but fell and hit her head. Peter Judge, CEO of the Canadian Freestyle Ski Association, emphasized that Burke was not trying unusually difficult tricks. “It was nothing out of the norm, nothing on the extreme end of the spectrum.” However, within minutes, she was airlifted to Salt Lake City.

According to a press release, Dr. William T. Couldwell, the chair of neurosurgery at the University of Utah, operated on Burke to repair a tear in her vertebral artery. “With injuries of this type, we need to observe the course of her brain function before making definitive pronouncements about Sarah’s prognosis for recovery,” Dr. Couldwell stated.

Dr. Safdar Ansari, the neurointensivist coordinating Burke’s care, addressed her care later that week. “With traumatic brain injury, our care is focused on addressing the primary injury and preventing secondary brain damage, as well as managing other injuries sustained at the time of the accident; all of which requires close monitoring and intensive care. At this moment, Sarah needs more time before any prognosis can be determined.”

I discussed Burke’s injury with Raymond Turner, MD, Co-Director of the MUSC Stroke and Cerebrovascular Center. He explained that the vertebral arteries are at risk for injury from whiplash-type injuries because they run inside the bones of the cervical spine and are therefore tethered in relation to the head. “Interruptions in the blood flow in these vessels can result in brain injury that may be minimal, such as short term coordination problems or dizziness, to something that is life threatening,” Dr. Turner stated.

As for Burke’s surgery, he described how these dissections can be surgical emergencies. “Ms. Burke has been reported to have a tear in the vertebral artery, also called a dissection. The symptoms of a bleeding vessel in the head can cause severe headaches, confusion, weakness, and if severe enough, coma and death. Repair of this tear should be done urgently to prevent further bleeding. This type of injury can be fatal in some cases, however fortunately that is not always the case, and many patients can recover in weeks to months.”

So as we wait to see if Sarah Burke recovers, we can wonder why these injuries happen. But honestly, we know the answer to that question. This is the nature of these action sports. The halfpipes are getting bigger. The stunts are becoming riskier, with more height and flips. And yet, it is the athletes themselves pushing to perform more dangerous stunts.

Even if I wanted to do so, there would be no sense for me to argue that the sports’ governing bodies should regulate them more closely. These athletes know exactly what they are getting into. Snowboarding star Gretchen Bleiler wrote in espnW.com, “As pro snowboarders, skiers, etc., we all know that what we do is risky. But when accidents produce results like this we’re left praying and asking ourselves questions. Is it worth it? Why did this happen? What are we doing?”

Ironically, the Superpipe in Park City is the same one where snowboarder Kevin Pearce suffered a traumatic brain injury two years ago. And Burke herself is no stranger to injury, having missed a large part of the 2009 season after fracturing a bone in her lower back.

Now the freestyle skiing and snowboarding community is rallying around one of its pioneers. Twitter hashtags #believeinsarah and #prayingforsarahburke are being used worldwide to spread messages of support. Burke has been admired for her poise, confidence, and strength. The former ESPY winner for Best Female Action Sports Athlete will now need every bit of those qualities to recover.

Sarah Burke’s success shows not only in the medals she has won in halfpipe skiing but also in getting the sport itself accepted. She lobbied for its inclusion in the Olympics, and in 2014, the sport will make its debut in Sochi, Russia. Burke, long thought to be the favorite for the sport’s first Olympic gold medal, might now just be lucky to watch it as a spectator.

Episode 21 of The Dr. David Geier Show is now available. This week I share my thoughts about an article in The New York Times sharing his opinion that yoga is a dangerous form of exercise. I posted it on my Facebook page and received a lot of opinions. I want to hear from more of you, so after you listen, please go to Facebook and Twitter and join us in the conversation!

Please remember that the show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
Is yoga dangerous? Are injuries with yoga inevitable? And many more thoughts of mine on instructors and ways to stay healthy in yoga. (starts at 4:54)

That’s Gotta Hurt
C. J. Mosley – Alabama Crimson Tide LB (starts at 22:16)
Sports Injury Locator – Hip Injuries

Marquis Maze – Alabama Crimson Tide WR (starts at 29:20)
Sports Injury Locator – Hamstring Strain

Derrick Rose – Chicago Bulls G (starts at 33:10)
Sports Injury Locator – Turf Toe

Stephen Curry – Golden State Warriors G (starts at 37:43)
Sports Injury Locator – Ankle Sprains
Sports Injury Locator – Lateral Ankle Instability
Episode 20: Stephen Curry (starts at 20:49)

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Functional brace after ACL reconstruction? (starts at 41:01)
Return to snow skiing after ACL reconstruction? (starts at 46:05)
CPM and physical therapy after ACL reconstruction? (starts at 48:45)
Sports Injury Locator – ACL Tears
Sports Injury Locator – ACL Tears – Surgical Reconstruction

Fan Favorites and Trash Talkers
I respond to your questions and comments. Let me know what you think about topics I’ve discussed on the show, and send questions about particular athletes and injuries. (starts at 52:56)

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

While a perfect outcome of any surgery, even an arthroscopic surgery that we typically perform in sports medicine, is never guaranteed, it has been my experience that most of the frustrations patients have after surgery come from a discrepancy between expectations and reality. And therefore, the underlying theme with all of the following tips is the idea that patients need to ask the appropriate questions and become as informed as possible. While the list below is in no way meant to be a checklist of questions to ask or meant to be comprehensive, it does cover some of the major points some patients fail to consider. I hope it helps.

Research your doctor. Ask friends who performed their surgeries. Would they recommend him or her again? Go online for information. While not every doctor, especially those who have been in practice longer, has a blog or participates in social media, there are almost always informational pages and reviews of any doctor practicing in your area. No information is perfect, and certainly all reviews can be biased, but the more opinions and information you obtain, the more likely you will be satisfied with your choice.

Research the diagnosis and both surgical and non-surgical options. With a very few exceptions, at least in sports medicine, surgery is usually not the only option. Little of what we do with respect to knee and shoulder injuries or other problems in athletes or active individuals is likely to cause permanent damage or death. Giving the problem more time to heal, modifying activities, medications, braces, or more are almost always options. Surgery might be more desirable for a number of reasons, but it is always a good idea to know what other treatments are possible.

Discuss the procedure itself. What exactly does the surgery entail? A huge number of people who undergo meniscus surgery claim to have had a meniscus repair (meaning, sewing the meniscus back together). Instead, they likely had a partial meniscectomy (trimming part of the meniscus out). It might not seem like a big distinction, but it does have a large impact on postoperative weightbearing restrictions and potential long-term degenerative changes of the knee.

Discuss postoperative restrictions. Can I put weight on my leg after surgery? Can I drive? And ask any others that apply to your specific situation. I am always surprised when I tell patients that they will be required to wear a sling at all times for 3-4 weeks after surgery, but they still expect to be able to drive a car. If you aren’t sure, and if the answer will affect your ability to perform daily activities or work or school activities, ask before the surgery.

Ask about and plan the return to school or work. While most of the time patients can return to their jobs in either full duties or with short-term job restrictions, occasionally that isn’t possible. Manual laborers, for instance, have a difficult time working if they have to use crutches. On the other hand, many patients can return and focus on desk duties such as computer work. Likewise, students often can arrange to leave class a few minutes early to avoid crowded hallways. Talk to your boss or teachers ahead of time and work together to minimize time missed.

Discuss anesthesia options. While most surgeries are done under some form of general anesthesia, that option isn’t always required (and occasionally it is not medically advisable). Ask if regional anesthesia to make the arm or leg numb is reasonable. Or are there other options, like spinal or local anesthesia?

Inquire about the return to sports or particular exercise programs. Many athletic people are determined to return to sports or a certain form of exercise. It is important to know roughly how long to expect it will take to return to that activity. In addition, knowing if there are ways to get exercise before that time can be helpful. For example, runners are often frustrated if they are kept from running for 2 weeks, let alone 2 months. Discussing options for exercise after surgery, such as a stationary bike or elliptical machine, can ease the anxiety for weekend warriors and athletes alike.

Ask if there are ways that you could injure the surgical procedure. Recovery from surgery involves a balance between increasing activity as fast as you can without damaging the procedure done. As surgeons, we would love to allow bartenders to go back to work as soon as possible after shoulder surgery, but we know that lifting cases of alcohol in the first six weeks could disrupt the repair. Knowing what normal activities you do that could be harmful to your surgery is critical to a good outcome.

Discuss the risks of nonoperative treatment. Many injuries do not become progressively worse with time, while some do. For example, I have heard many patients who have undergone surgery for a meniscus tear who weren’t symptomatic at the time say that they were told that their knee would develop worse pain and arthritis if they did not undergo surgery (I don’t necessarily agree).

Discuss the risks of delaying surgery. Let’s face it. We can’t always plan our injuries around our busy schedules. But not every surgery has to be performed immediately. It’s important to ask the surgeon. Fractures and tendon ruptures often need to be fixed within about two weeks, while many other injuries can be treated later. Often I will suggest that a patient consider waiting until after a personal vacation, busy period at work, or final exams at school to undergo knee or shoulder surgery. Frequently patients can have equally successful outcomes with less disruption to their personal lives.

Project the time for full or complete recovery. No surgery is “no big deal,” even ones like I do arthroscopically, through 2 or 3 tiny incisions. Patients are often surprised to hear that it can take patients 4-5 months to reach maximum improvement after a knee arthroscopy to trim out part of the meniscus. Or it might be a full year before an athlete feels normal after ACL reconstruction or shoulder stabilization. While you might be back doing all of your desired activities much earlier, it is helpful to know roughly when to expect to be as good as you are going to be.

What tips or advice do you have? Are there any questions you feel like you should have asked before surgery? Please share your thoughts!

Episode 20 of The Dr. David Geier Show is now available. I hope everyone is having a great start to 2012 and making great progress on any New Year’s resolutions! I also want to take a second to thank everyone who is interacting on Twitter and Facebook. The growing community discussing sports medicine topics is really encouraging, and I want more of you to join us!

Please remember that the show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
Why is the rate of ACL injury higher for female athletes than males? And what can we do about it? (starts at 3:10)
Sports Injury Locator – ACL Tears
“If you had ten minutes…”
Ask Dr. Geier – Injury Prevention Programs

That’s Gotta Hurt
Manu Ginobili – San Antonion Spurs G (starts at 13:22)

Zach Randolph – Memphis Grizzlies F (starts at 17:17)
Sports Injury Locator – Medial Collateral Ligament (MCL) Tears

Stephen Curry – Golden State Warriors G (starts at 20:49)
Sports Injury Locator – Ankle Sprains
Sports Injury Locator – Lateral Ankle Instability

Kris Dielman – San Diego Chargers guard (starts at 24:27)
Episode 13: Kris Dielman (starts at 39:31)
Will Kris Dielman’s injury lead to increased NFL oversight?
It’s time to change players’ attitudes toward injuries

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Knee pain after surgery for a tibial shaft fracture? (starts at 31:10)
Sports Injury Locator – Tibia Fracture

MRI or physical therapy for shoulder and elbow pain with minimal trauma? (starts at 35:08)
Sports Injury Locator – Rotator Cuff Injuries
Sports Injury Locator – Shoulder Impingement

How long should it take for patellofemoral pain to improve? (starts at 38:40)
Sports Injury Locator – Patellofemoral Pain

Options for recurrent shoulder instability? (starts at 43:40)
Sports Injury Locator – Shoulder Dislocations
Ask Dr. Geier – Shoulder Dislocations

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

David

Carrie Martin in Liberty, Missouri asks:

My 15-year-old son had a meniscectomy on both menisci of one knee. One meniscus was shaved a little, and the other meniscus had 60% removed. Is it still safe for him to do the triple jump in track? Of all of his sports, that is his favorite, and I have heard that is bad on the knees. His surgery was in August, and his recovery has been good. He has some locking, and a little pain, but rarely any swelling any more. I just don’t want to let him do TOO much. Since my son was so eager to get back into football, and now has been playing basketball, is there such thing as “too much”?

Carrie, that’s a great question. First of all, I will say that you will get different opinions on that same question if you ask several sports medicine physicians.

The premise of the idea that an athlete could do “too much” after a partial meniscectomy is based on the idea that the meniscus is a shock absorber in the knee. Each one lies between the femur and tibia and absorbs some of the stress with impact, protecting the articular cartilage and bone. When a meniscus tears, it almost never heals. (That doesn’t always mean that every patient with a torn meniscus needs surgery, but that is a subject for a different post.) Therefore, in a symptomatic athlete, sports medicine surgeons usually treat the meniscus tear surgically.

The options for surgery involve either a meniscus repair (sewing the meniscus back together with stitches and/or anchors) or a partial meniscectomy (trimming the torn part of the meniscus out). Which of those two options is necessary depends on the location and orientation of the tear itself, and the patient and surgeon have little ability to affect that outcome.

Obviously, if the tear is repairable, that is good in the long term, although the rehab and overall recovery take longer and there is unfortunately a sizeable percentage of those repairs that don’t heal. But if the repair heals, the surgeon has preserved the entire meniscus to serve as a shock absorber.

If it is the more likely scenario where part of the meniscus needs to be removed, that is a much shorter recovery and return to sports. And return to sports and exercise is very likely, especially in the short term. They get back at the same or higher level far more often than not.

The concern, if there is one, about trimming part of the meniscus out comes years later. What effect will removing part of that meniscus have? Like I said earlier, that is for the most part out of the hands of both the surgeon and patient, so one could argue that the worry is unnecessary. You can’t do anything about it anyway.

Potentially problems could result from removing some of the shock absorber in an athlete or exercise fan who continues to engage in repetitive impact. Over time, in theory that impact will start to take a toll on the articular cartilage and later, the bone, and lead to degenerative changes. But how much would a surgeon limit that athlete, if at all?

I typically don’t shut these patients down. If it is a high school or college athlete, I aim to get them back to sports. If it is an adult weekend warrior or someone who loves to run, I try to do that. I might suggest to someone that runs 6 or 7 days per week, for example, that she run 4 days a week and add non-impact activities like cycling, swimming, rowing, or weights into her routine the other days. But I don’t have someone stop playing a sport or give up a certain form of exercise. After all, that sport or form of exercise is usually what he or she likes to do. And the health benefits far outweigh the potential risk of earlier degenerative changes in the knee, in my opinion.

“The bottom line is: You have to be able to put food on the table. No one’s going to sign or want a guy who can’t stay healthy. I know there will be a day when I’m going to have trouble walking. I realize that. But this is what I signed up for. Injuries are part of the game. If you don’t want to get hit, then you shouldn’t be playing.” – Jacksonville Jaguars RB Maurice Jones-Drew

“You want to continue to play. You’re a competitor. You’re not going to tell on yourself. There have been times I’ve been dinged, and they’ve taken my helmet from me, and … I’d snatch my helmet back and get back on the field.” – Washington Redskins FB Mike Sellers

“It doesn’t take a rocket scientist to figure out if (you have) a concussion, you’re probably damaging your brain a little bit. Just like if you sprain your wrist a bunch, you’re going to have some wrist problems down the road. Yeah, I’d still play through it. It’s part of it. It’s part of the game.” – San Francisco 49ers DL Justin Smith

These are some of the quotes from a recent Associated Press article. 44 NFL players, including one from each team, were interviewed to gauge attitudes about playing through concussions. The article reveals some scary, but unfortunately expected, insight into the players’ mindsets. It’s this attitude I feel that we need to work to change.

These quotes ironically come at a time when there are at least a dozen lawsuits involving more than 120 former players suing the NFL, according to Ken Belson of The New York Times. Among the claims of these former players is the notion that the NFL did not warn the players of the consequences of head injuries.

But the shield of claiming ignorance to the dangers of concussions is disintegrating. The seizure of Kris Dielman, the apparent lack of evaluation of Colt McCoy (Episode 17, starts at 16:44), the fines for helmet-to-helmet contact, and overall media attention to these injuries have shed plenty of light on the risks of concussions in football.

I do agree with Jones-Drew that injuries are part of sports, and especially football. Yes, players know exactly what they’re getting into. I’m not advocating that we get rid of football or shut a player down forever for one headache. But I want players to realize that they need to let doctors know if they are having symptoms.

Maybe it will lead to the team doctor holding them out of that game, and yes, maybe more. But avoiding a second blow to the head before he has fully recovered might prevent a premature end to his career, or worse, permanent brain damage. And if you don’t believe me, there are several examples of our best football and hockey players that have experienced, or are currently experiencing, this problem right now.

Young pitchers with shoulder or elbow pain should see a doctor to ensure it's not serious.

To all athletes: If you have pain, get it checked out. So many athletes resist going to the doctor for fear of being shut down from sports, or worse, fear of needing surgery. But most sports injuries actually don’t need surgery. And despite what you think, sports medicine doctors generally don’t want to shut you down. We want you playing and competing for titles. Having your injury evaluated might get you back playing sooner and with less fear of worsening the problem.

Please don’t misunderstand what I’m writing. I love sports. I think sports have tremendous benefits for all athletes – professional to little league, male or female, young or old. These benefits obviously include health improvements, but there are emotional and socialization benefits as well. I just want athletes healthy enough to actually play them.

“I’ll probably pay for it later in my life, but at the same time, I’ll probably pay for the alcohol that I drank or driving fast cars. It’s one of those things that it just comes with the territory.” – St. Louis Rams safety Quintin Mikell

It’s time to change these attitudes.

Happy New Year! Episode 19 of The Dr. David Geier Show is now available. We start off 2012 talking about New Year’s Resolutions. I offer tips to achieving your health and fitness goals as well as suggestions from “experts” – and I share my personal goal for this year. I encourage all of you to share your goals here as well. Plus listen to my discussion of giving us updates on my Facebook page so we can encourage you and offer support and advice. It might fail miserably, so you might just get my weekly updates!

Plus, in this episode I extend my sincere appreciation to listeners who have been so supportive and so many people who have helped me in this journey in 2011 (check out the Fan Favorites and Trash Talkers segment). I couldn’t and wouldn’t do any of it without you!

Please remember that the show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
New Year’s resolutions: Tips to achieve yours in 2012, my personal resolution for the year, and ways we can help each other (starts at 2:50)
New Year’s resolutions: Tips for success
New Year’s resolutions: Mine, in one word

That’s Gotta Hurt
Adrian Peterson – Minnesota Vikings RB (starts at 20:33)
Sports Injury Locator – ACL Tears
Sports Injury Locator – ACL Tears – Surgical Reconstruction
Sports Injury Locator – Medial Collateral Ligament (MCL) Tears
Sports Injury Locator – Meniscus Tears

Alex Rodriguez – New York Yankees 3B (starts at 27:49)
Sports Injury Locator – Articular Cartilage Injuries of the Knee
Episode 6: Stem Cell Treatments and Much More (starts at 3:25)
Episode 3: Imitating Famous Athletes and Much More (starts at 3:58)

Brook Lopez – New Jersey Nets C (starts at 34:35)
Sports Injury Locator – Fifth Metatarsal Fractures (Jones Fractures)

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Should a runner with a plica band continue to run while rehabbing? (starts at 38:26)
Sports Injury Locator – Plica Syndrome

What are the surgical options for hallux rigidus? (starts at 42:21)
Sports Injury Locator – Hallux Rigidus

Surgery or walking boot for a Lisfranc injury of the foot? (starts at 46:30)
Sports Injury Locator – Lisfranc Injuries

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

Well, the goal can be summed up in one word. The explanation requires a few more.

I’ve had a very productive and successful 2011. Even the eternal pessimist in me knows that I have made tremendous career progress this year. The success of my sports medicine column in The Post and Courier. Exponential growth of the blog. The launch and growth of The Dr. David Geier Show. AOSSM Public Relations Committee Chairman. Continued growth of MUSC Sports Medicine and my practice, despite declines in many fields of medicine due to the economy. And probably my biggest accomplishment hasn’t been realized but is a work in progress.

But all of that success comes at a cost. It’s called work. A lot of work. And for those of you who call me lucky (yes, it gets back to me), I would agree with you. But the harder I work, the luckier I seem to get. It’s funny how that works.

That work and the accomplishments that follow come at a cost too. And in 2012, I aim to at least start to remedy that situation. And therefore, my 2012 New Year’s resolution can be summed up in one word.

Sleep.

It seems crazy, right? Ask anyone (and I mean absolutely anyone) who knows me well, and they will tell you that I need to sleep more. I don’t track it regularly, but I bet that I average somewhere between 4 and 5 hours of sleep each night during the week and maybe 6 on weekend nights. But I have plenty of 2- or 3-hour nights of sleep. It’s been that way for a long time, but it’s time for a change.

This isn't me (obviously). But I don't want to end up like this, do I?

But I also need to start thinking about my overall health (Yes, my resolution and this post do have a health component. It just took me a while to get there.). As Dr. Donnica Moore, a women’s health physician featured frequently on Dr. Oz told me a few months ago, my days of staying up all night to blog and write articles will end soon. I physically won’t be able to do it. Plus, I am hoping that sleep will help me accomplish more when I am working. And hopefully it will keep me looking healthy (yes, I admit that I care about my appearance – roll your eyes all you want).

And so my New Year’s resolution for 2012 is to get more sleep. I have a Sleep Cycle app for my iPhone that I plan to use to keep me on track. It’s pretty cool. I put it under my bed sheets on my mattress and turn it on when I lie down. It uses the accelerometer in the iPhone to gauge when I’m asleep. It records sleep cycles, monitors the length of sleep sessions, and follows trends over days and weeks. My plan is to have it tell me that I averaged 6 hours of sleep per night over the course of each week (hey, it’s a start!).

Yes, I still plan to work on and expand this blog and my show and columns, and I have other projects to start soon. But it will mean cutting back on parts of my life and career that just don’t mean as much to me, because I physically and emotionally can’t do everything.

Plus, I will ask friends to remind me periodically, and nag me incessantly (see accountability in Part 1), to go to bed. No tweeting at 11:30 PM. No emailing at 4:00 AM. I know it’s not a “Do Epic Shit” type of goal, like Charlie Gilkey recommends, but it’s something I badly need to do.

Let me know what you think of the tips to achieving your resolutions or to my sleep goal specifically. And feel free to share yours! Leave your comments below or on Facebook or Twitter.

I am not a self-help expert, and I won’t pretend to be one. But I’ve worked with and learned from some amazing people in 2011. While some of this advice was given to me with completely different goals in mind, I think that they can apply to anything (physical goals, career plans, or any vision of success or dream you have). So for those of you with exercise, fitness, or wellness goals for 2012, here are some suggestions to create a healthier you.

Announce it to the world.
It might seem like a no-brainer to tell people what you are trying to achieve this year, but the act of announcing it has more value than simply an answer to give at a cocktail party. Write it down. Email people. Post it on your blog (I’ll convert some of you to blogging yet…). Just let people know. It might seem scary to open up, but trust me, you’ll be surprised at the support you receive.

Create accountability measures.
This idea goes hand-in-hand with telling the world (or at least friends and family). Develop some system of updating your progress. Yes, writing what you did each day in a journal is good for creating accountability for yourself, but take it one step farther. Let your friends, family, and people everywhere know what you’ve achieved. Or what you haven’t. Update your progress on Facebook or Twitter. Call people. Email them. Or better yet, create a system where they call you or email you if they haven’t gotten your progress status. And if you don’t want to annoy people with daily messages, make your system weekly. But having to tell people you chose to hit snooze four days one week instead of getting out of bed and running might make you think twice.

Work with others.
Having a partner (or several) join you on your journey to a new you in 2012 will increase your chances of success in a couple of ways. First, accountability is great, but honestly, your friends might become annoyed with weekly email updates about your progress unless they are doing something similar. Create a give-and-take system where you encourage each other. Plus, we all know the feeling of not wanting to go to the gym on a given day, but we do it because we had already arranged to meet someone else there. Make that motivation automatic.

Also, there is true synergy and momentum created by collaborating with others. It’s the whole 1+1=3 idea. Maybe you just want to join a gym and go every day. If several of you start together and make it fun, the next thing you know, you might all be signing up for boot camps or CrossFit programs.

Just do it already.
Get started. Seriously. Don’t overanalyze (one of my greatest flaws actually, so I need to take my own advice). Don’t wait until the timing is perfect or everything possible is perfectly lined up. Start now and adjust course along the way. For example, don’t put off training for that marathon in September because it is too cold outside now. Go ahead and get started. Just open the door and go run. If it’s too cold, then jump on the treadmill or find an indoor track. But don’t wait.

Do something every day.
Not every goal has a clear path or set of instructions, but that shouldn’t stop you from making progress. Setting a goal of losing 20 pounds is great, but that milestone doesn’t always help you know what to do to get there. While there is never an absolutely correct process for any accomplishment, acting in some way every day is critical. Even if it is a really small step, do something that helps you get closer to your goal.

Go big. Really big.
Let’s be fair. It is much easier to accomplish a goal that is relatively easy. You might get some satisfaction for making your goal to lift weights every day, even though you’ve worked out your whole life and have just missed the last couple of weeks due to a hectic schedule. Congratulations, you got back on the wagon.

Instead, pick a goal that seems impossible. One that almost terrifies you. Maybe you’ve never run a day in your life. Make your goal to run a marathon. Yes, it will take longer and far more effort to achieve it, but imagine the boost in confidence and self esteem you’ll get by making something happen that seemed crazy at the time. Even one month in, while you’re still miles from the ultimate goal, you’ll be amazed at how far you’ve already come. And you’ll be even more enthusiastic because that impractical, irrational dream will seem much more possible now. And even if you later realize that you might not climb the entire mountain, your view from the higher altitudes will have you craving more “unrealistic” goals.

Achieving success with your New Year’s resolutions

Click here for full episodes or subscribe on iTunes.

Here are some other suggestions suggested by readers. Feel free to suggest your own in the comments below or on Facebook or Twitter (please mention me to ensure I’ll see it). Also, I want to hear your health, wellness, exercise, or fitness goals for the coming year. I’ll share mine tomorrow, and I would like to include yours!

Matthew Roberts (Facebook): I think the most important thing (for me at least) is to reintroduce the word “accountability” into your everyday lexicon. We expect a lot from others whether it’s family, coworkers, friends etc but our we doing everything to be the best person for ourselves and them as well? You can not have a successful resolution without accountability..It’s my personal word of the year..

Michael S. Smith (Facebook): yes, first don’t make resolution, set goals with five steps to each goal in what you’ll do to achieve them.

Sarah Johnson (Facebook): I set very realistic goals/resolutions for 2012. I’ve started typing my list and I’m going to put one copy on the fridge, one on a mirror in my bedroom, and keep one taped on the inside cover of my daily planner! Most of my resolutions are fitness oriented so I need frequent reminders to stick with the program!

I’d like to acknowledge Jenny Blake, Charley Gilkey, and Ash Ambirge for some of the ideas listed above. Jenny leads a phenomenal course that is truly inspiring, and I read both Charlie’s Productive Flourishing blog and Ash’s The Middle Finger Project blog voraciously.

Episode 18 of The Dr. David Geier Show is here! I hope everyone is having a wonderful holiday season with family and friends. Please have fun and stay safe! In the second holiday episode next week, we will discuss New Year’s resolutions, so let us know if you have any exercise or health goals for the coming year!

Please remember that the show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
Should paramedics and an ambulance be mandatory at all football games? And if so, how do we achieve that goal? (starts at 2:51)
Should EMS be required at football games?
A “must have” checklist to prepare for sports emergencies?

That’s Gotta Hurt
Jacki Gemelos – USC Trojans guard (starts at 17:30)
Sports Injury Locator – ACL Tears
Sports Injury Locator – ACL Tears – Surgical Reconstruction

Kobe Bryant – Los Angeles Lakers guard (starts at 24:02)
Sports Injury Locator – Hand/Wrist Injuries

Ben Roethlisberger – Pittsburgh Steelers QB
Sam Bradford – St. Louis Rams QB (starts at 27:28)
Sports Injury Locator – Syndesmosis Injuries (“High” ankle sprains)
Episode 16: Ben Roethlisberger (starts at 34:35)
Episode 9: Sam Bradford (starts at 27:53)

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Is two weeks after the injury too late to have surgery for a pectoral tendon injury? (starts at 32:43)
Sports Injury Locator – Pectoralis Tendon Rupture
Episode 16: Chronic pectoral tendon injuries (starts at 48:14)
Episode 5: Pectoral tendon injuries (starts at 42:54)
Ask Dr. Geier – Pectoral Tendon Injuries

Can an athlete develop chronic exertional compartment syndrome of the thigh? (starts at 36:27)
Sports Injury Locator – Chronic Exertional Compartment Syndrome
Episode 15: Chronic exertional compartment syndrome in cyclists (starts at 33:59)

When should a runner with hip pain worry? (starts at 38:56)
Sports Injury Locator – Femoral Neck Stress Fracture

Should a runner with heel pain see the doctor? (starts at 42:40)
Sports Injury Locator – Calcaneus Stress Fracture

Surgery for a chronic posterior sternoclavicular dislocation? (starts at 46:44)
Sports Injury Locator – Sternoclavicular Dislocations
Episode 15: Sports after sternoclavicular dislocations (starts at 37:16)
Episode 12: Surgery for sternoclavicular dislocation (starts at 46:10)
Episode 1: Sternoclavicular dislocations (starts at 27:05)

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

Every year, millions of athletes across the country undergo routine preparticipation physical exams for sports. Some stand in long lines in crowded gyms. Others visit their regular doctor. But most of them grudgingly undergo the exam because by rule, they cannot play without one. If anyone wonders why we enforce this rule, I ask you to consider Boston Celtics forward Jeff Green.

Green was preparing to start his second season for the Celtics, who obtained him in a midseason trade last year for Kendrick Perkins and Nate Robinson. Fans were frustrated with the former Georgetown swingman, who was the fifth pick in the 2007 draft, as he struggled to find a role with the team. He averaged only 9.8 points and 3.3 rebounds but he was expected to improve and be a major contributor this season. The team recently signed him to a one year, $9 million contract.

Days after the contract was finalized and training camp started, observers noticed that Green was not much more than a spectator. He was seen shooting but was never involved in any of the team’s full-contract drills. The reason? He did not pass his physical.

Head coach Doc Rivers expressed his concern to the media at that point. “Usually you pass your physical by now. Listen, I’ll give you guys more tomorrow for sure. But I’ve been around long enough to know that if you haven’t passed your physical yet, then there’s something going on. I just haven’t found out, but I’ve been around long enough to know there’s something going on.”

On Saturday the Celtics announced that Jeff Green has an aortic aneurysm, which was detected during his physical. Green then consulted with cardiac specialists at The Cleveland Clinic, who reportedly advised him that he needs surgery. Green is expected to miss the entire season. According to the Celtics’ news release, the operation “should completely repair Green’s condition and that he can expect to resume his NBA career next season”

“An aortic aneurysm happens when the aorta, the large blood vessel that comes off the heart and delivers blood to the entire body, dilates to a size greater than 50% over what is normal,” says John Ikonomidis, M.D., Ph. D., Chief of Cardiothoracic Surgery at The Medical University of South Carolina and Director of the Thoracic Aortic Surgery program there. “As the aorta expands, the pressure on its wall increases, increasing the risk of rupture.”

Green was prepared to start his fifth season in the NBA, and he has played numerous years of basketball at various levels with no mention of symptoms. He surely has undergone a number of preparticipation physical exams in his young career, so I was somewhat surprised that an aortic aneurysm wasn’t detected earlier, with Green now 25 years old.

“Usually these aneurysms grow slowly over a long time, and most people with them are asymptomatic,” Dr. Ikonomidis states. They often do not even know they have them and are at risk for rupture. A physician might detect a heart murmur if the aneurysm causes the aortic valve to become incompetent, but these murmurs do not always exist. “Often patients go to the doctor for a cold or some other illness, and an aneurysm is detected on a chest x-ray performed for that purpose,” he points out.

Green will undergo surgery soon at The Cleveland Clinic. Dr. Ikonomidis explains the typical surgery for a thoracic aortic aneurysm. “The surgeon will place the patient on bypass and arrest the heart. He will cut out the diseased portion of the aorta and replace it with a synthetic graft made out of Dacron.” If the surgery and recovery go well, patients get back to running in a few months and ultimately return to all prior activities.

Green tweeted a message to fans expressing his thanks and determination to return to basketball Saturday. “Thank u everyone for ur thoughts and prayers…much appreciated love u all..and I’ll be back soon stronger and better than ever I promise.”

As an NBA fan and a sports medicine physician, I was shocked by the news, knowing the serious nature of the condition and the surgery. I completely agree with the Celtics head coach, who even before the team’s announcement, suggested that there are more important things in life than basketball. “It’s life, you know. So let’s just hope he’s good.”

Episode 17 of The Dr. David Geier Show is now available! This episode focuses on the media pressure on team physicians. It is a topic that especially interests me, so I incorporate the scrutiny of the team physicians into both the opening In the Zone discussion and the individual topics of pro athlete injuries in That’s Gotta Hurt. Please share your thoughts on this topic, as i want to hear what you think!

Please remember that the show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
Media scrutiny of professional and college team physicians (starts at 2:24)
Being NFL team doctor not all fun and games
Could or should Jay Cutler have played?
What’s a team doctor to do?
Greg Oden to miss season for microfracture surgery (again!)

That’s Gotta Hurt
Colt McCoy – Cleveland Browns QB (starts at 16:44)
Sports Injury Locator – Concussions
Will Kris Dielman’s injury lead to increased NFL oversight?
Episode 13: Kris Dielman (starts at 39:31)

Greg Oden – Portland Trail Blazers center (starts at 22:32)
Sports Injury Locator – Articular Cartilage Injuries of the Knee
Greg Oden to miss season for microfracture surgery (again!)

Brandon Roy – Portland Trail Blazers guard (starts at 28:08)
Sports Injury Locator – Meniscus Tears
What’s a team doctor to do?

Sidney Crosby – Pittsburgh Penguins (starts at 34:39)
Sports Injury Locator – Concussions
Episode 8: Sidney Crosby (starts at 19:58)
Episode 12: Taylor Twellman (starts at 29:02)
Colts’ Collie should serve as a warning to all athletes

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Surgery for an elbow fracture in a youth baseball pitcher? (starts at 38:13)
Sports Injury Locator – Little Leaguer’s Elbow

Surgery for a multiligament knee dislocation? (starts at 42:34)
Sports Injury Locator – Posterior Cruciate Ligament (PCL) Injuries
Sports Injury Locator – Medial Collateral Ligament (MCL) Injuries

Surgery for a type III AC separation in a high-school quarterback? (starts at 46:33)
Sports Injury Locator – Shoulder Separations

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

Does heading the ball lead to brain damage?

According to a press release from the institution and the abstract from the presentation (I cannot find the actually study, if it has been published), they did find that players who headed the ball frequently had brain injuries similar to a concussion. On the neuropsychological tests it was shown that players with the highest heading frequencies were more likely to have poorer verbal memory and psychomotor speed.

The MRI scans of the players reportedly showed damage to all areas of the brains, but most of the affects were seen in the frontal lobes and temporal-occipital regions. The researchers pointed out that these regions of the brains are vital for memory, attention, executive functioning, and higher-order visual functions. In fact, the study’s lead author, Michael Lipton, M.D., Ph. D. noted that there seemed to be a threshold of 1000 to 1500 headers a year that resulted in detectable brain injury.

Now I have a few initial thoughts, and again I want to point out that I don’t have the actual study to review. My observations and opinions might turn out to be unfounded if the authors did address some of these study design issues.

First of all, the average age of the 38 participants was over 30 years old, and the players had participated in soccer since childhood. Like I pointed out in my Abby Wambach column, what seems to be more important than repetitive contact with the ball in heading is a history of more traumatic injuries. By that I mean true concussions. Athletes who have been playing for 20 or more years likely have suffered concussions, and often many of them. The press release and abstract do not mention whether the authors take a history of concussion into account. And I am guessing that they did not do so in the study.

Are traumatic head injuries or repetitive heading more dangerous for long-term brain injury?

Second, there is no mention of how age plays a role. While they point out that young players often use balls that are the same size as adults (and therefore would have a potentially higher risk of injury to their developing brains), they don’t show that heading at a certain age had more affect than at a later age. It might be true that this is a problem for younger players more than older ones, but we don’t know.

Now, while I am not sure if I agree that repetitive heading is necessarily a problem in soccer solely based on this information, I still think it is a step in the right direction. We need more information to decrease the risk of brain injuries in all sports. And the idea that there is a threshold above which the risk of brain damage goes up significantly is intriguing. It reminds me of the study published earlier this year which showed that youth baseball players who pitched more than 100 innings per year were 3.5 times more likely to suffer a shoulder or elbow injury.

Hopefully this study will spur further research into concussions. I believe that we need far more data to help us as sports medicine professionals make decisions about whether to allow athletes to play after a concussion. But we also need to focus on prevention. We need to find methods to decrease the risk of these injuries without fundamentally changing each sport, if possible.

Do you think heading the ball is a problem in soccer? Share your thoughts! Of if you have had issues with concussions or hard injuries in soccer, please feel free to share your experiences!

Episode 16 of The Dr. David Geier Show is here! I think this is another information-filled show, and I want your feedback. Let me know what you think of the discussion about important qualities for physicians and reasons to consider finding another one. Also as I ask on the show, please let me know if you have suggestions for topics, new delivery methods, etc., as I want to bring you new sports injury, treatment, and prevention information however you want it.

Please remember that the show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
How do you choose a doctor, and what signs should make you think of finding a new one? (starts at 3:44)

That’s Gotta Hurt
Former players sue NFL (starts at 20:58)
Sports Injury Locator – Concussions
Will Kris Dielman’s injury lead to increased NFL oversight?
Episode 13: Kris Dielman (starts at 39:31)
Episode 12: Taylor Twellman (starts at 29:02)
Episode 8: Sidney Crosby (starts 19:58)
Are repeat concussions a problem in the NFL?
Colts’ Collie should serve as a warning to all athletes

Joe Mauer – Minnesota Twins catcher (starts at 28:09)

Lucas Leiva – Liverpool midfielder (starts at 32:29)
Sports Injury Locator – ACL Tears

Ben Roethlisberger – Pittsburgh Steelers QB (starts at 34:35)
Sports Injury Locator – Syndesmosis Injuries (“High Ankle Sprains”)

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

When is it safe to run after ACL surgery? (starts at 38:06)
Sports Injury Locator – ACL Tears – Surgical Reconstruction

Can persistent fluid around the knee that resulted after a fall be drained? (starts at 41:13)
Sports Injury Locator – Prepatellar Bursitis
Episode 9: Bursitis after knee injury? (starts at 42:44)
Ask Dr. Geier – Prepatellar Bursitis

Are x-rays a good idea for leg pain in a runner? (starts at 44:58)
Sports Injury Locator – Shin Splints (Medial Tibial Stress Syndrome)
Sports Injury Locator – Tibial Stress Fractures
Episode 15: Cycling with a stress fracture (starts at 31:04)
Ask Dr. Geier – Tibial Stress Fracture

Is surgery possible for a chronic pectoral tendon or muscle injury? (starts at 48:14)
Sports Injury Locator – Pectoralis Tendon Rupture
Episode 5: Pectoral tendon ruptures (starts at 42:54)
Ask Dr. Geier – Pectoral Tendon Injuries

Is surgery possible for a chronic distal biceps tendon injury? (starts at 52:18)
Sports Injury Locator – Distal Biceps Tendon Rupture
Episode 9: Return to sports after distal biceps surgery? (starts at 38:23)
Ask Dr. Geier – Distal Biceps Rupture

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

As I always mention in this column, I cannot give specific medical advice in any format, email, this blog, or on my show. And this column will be no different. I use the question, though, because athletes and athletic patients ask me a similar question very frequently. So it is a good opportunity to clarify the idea of a partial ACL tear.

For those of you that enjoy these types of posts, where I answer readers’ sports injury questions, please consider subscribing to The Dr. David Geier Show. Each week I answer 3-5 of these questions, and I can usually give much more information. I keep receiving terrific questions from all over the world (including Rohan’s here from Bangalore), and I am humbled and grateful. Thank you all for being enthusiastic readers and listeners!

David

Rohan Kumar in Bangalore asks:

Dear Sir,
I want to know information about my ACL injury. Eight months ago, I was playing football and got an injury in my right knee. The MRI report says it is an ACL injury. Specifically the MRI report says…
1. Partial-thickness interstitial tear in the anterior cruciate ligament
2. Grade 1 tear in the posterior horn of the medial meniscus
3. Traces of a joint effusion
When I ask my doctor, he told me that my ACL has been 50% damaged. How will it become normal – either it requires surgery or it will be good by medicine. Thanking you.

There is a lot of misconception about ACL tears, and more specifically partial ACL tears. What is a partial tear? Does it need surgery? Will it heal on its own? Can I just brace my knee? Can I play sports with a partial ACL tear?

Part of the problem stems from the fact that the term is a radiology one. By that I mean that it is based on the fibers of the anterior cruciate ligament and what percentage of them are torn. Obviously in a complete tear, the ligament and all of its fibers are torn. But in a partial ACL tear, 30% of the ligament fibers might be ruptured, or 80% might be torn. It is based completely on the MRI images. And as such, a “partial” ACL tear diagnosis is only part of the story.

What is more important, at least to me, is whether or not the ligament is functional. The role of the ACL in general is to provide translational and rotational stability to the knee. An athlete can have 50% of the ligament intact and still have a stable knee, or she can have her knee give way with cutting or changing directions even though 50% of the fibers (as estimated by MRI) are intact. When the initial injury occurs, some of the fibers might become stretched out, despite remaining intact, so in essence they are not providing the necessary stability to the knee.

So to me, a “partial” ACL tear means nothing. It gets back to what I just said that what matters is whether or not the ACL is functional. And that is more of a clinical diagnosis. If the athlete is feeling that his knee is buckling with activity, then that “partial” ACL tear still needs reconstruction because it’s not doing what it needs to do. Yes, there are some signs that a ligament with some fibers still intact is essentially nonfunctional, such as a specific pattern of bone bruising that you see on MRI. But sports medicine physicians can also determine it by examining the knee and testing its rotational stability.

And to be honest, I don’t think a partial ACL tear, where some of the ligament fibers remain intact, is actually that common. In my experience, when patients come in to see me after an injury in soccer, football, basketball, cheerleading, or many other sports with the classic description of an ACL injury, and the MRI they bring has a radiology report that describes a “high-grade partial tear of the ACL,” examination of the knee almost always reveals that it’s unstable.

Have any of you in Charleston or elsewhere had a “partial” ACL tear? Hopefully it wasn’t a bad injury and you did well, but I’m excited to hear your stories. Please share them here!

When the Dallas Mavericks beat the Miami Heat to clinch its first NBA Championship, interest in the sport was at its highest point in many years. Maybe it was all of the marketable young stars in the league or fans rooting hard for, or against, LeBron James and the Heat’s orchestrated dynasty. So how did owners and players respond to this surge in popularity?

They ended negotiations on a collective bargaining agreement, and the lockout ensued. Brilliant.

Now that the sides have tentatively come to an agreement, NBA Commissioner David Stern would like the season to begin on Christmas Day. Reportedly there would be an abbreviated preseason and training camps, and the teams would play a 66-game regular season.

Much attention has been paid to the lockout earlier this year in the NFL and a perceived spike in injuries, most notably Achilles tendon ruptures. Will the NBA suffer a similar fate once teams take the court?

Well, maybe. For one thing, basketball is a different sport than football. Size and strength are more important for at least many positions in the NFL, whereas balance, coordination, and agility might be more valuable in the NBA. But the sports differ in terms of the nature of injuries as well. Football injuries are much more frequently acute, traumatic ones from tackling, blocking, and other contact. Many NBA injuries, on the other hand, are overuse injuries that develop over the course of a long season.

I received a number of comments after the NFL lockout column related to the notion that those are the best athletes in the world. As such, they should come into training camp in shape, whenever it starts. And I agree, and that idea is true with NBA players as well. But I would point out that great overall physical conditioning is not the same as being in game shape. Cutting, pivoting, and explosive jumping are difficult to replicate in the weight room, and it is especially tough to recreate the fatigue of doing those activities for 48 minutes at full speed. And without a long schedule of preseason games to slowly build up their playing time, injuries such as hamstring strains and other muscle and tendon injuries might occur.

Where I could see the lockout potentially affecting injuries could come later in the season. With an 82-game season, the league did its best to spread its games and road trips out. But there were still stretches where teams might play three games in four nights. And successful teams always seemed to rest key players, especially veteran stars, for part or all of one of those games to keep them healthy at the end of the year. With a more compact schedule and only 66 games, each regular season game becomes more important. It might be more difficult for teams to rest players.

And finally, the lockout and adjusted schedule could affect teams and players differently. Will the bodies of younger players without a history of many long seasons hold up better? Will veteran players know better how to manage the physical demands of a long season with less rest? We will soon find out.

I don’t know if the lockout will ultimately lead to more injuries this season. As a fan, I certainly hope it doesn’t. But it seems reasonable that the shortened season and altered schedule could affect the health of the players and teams and ultimately play a role in determining the champions.

Episode 15 of The Dr. David Geier Show is here! I am really excited about this episode, so I hope you like it! I made a few subtle changes which I think turned out well. Plus I successfully finished a brutal call weekend (at least Sunday) and spoke at Frontiers In Pediatrics. So just getting the show finished is a victory for me!

Please remember that the show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
Can a regular schedule of exercise help you sleep better and feel more rested? (starts at 4:49)
Episode 12: Exercise and Brain Health and Much More (starts at 3:37)
Episode 2: Adding Years To Your Life and Much More (starts at 3:20)

That’s Gotta Hurt
Russell Okung – Seattle Seahawks LT (starts at 13:04)
Sports Injury Locator – Pectoral Tendon Injuries

Matt Leinart – Houston Texans QB (starts at 17:33)
Sports Injury Locator – Clavicle Fracture
Is surgery next after Tony Romo suffers clavicle fracture?

Peyton Manning – Indianapolis Colts QB (starts at 21:55)
Episode 3: Imitating Famous Athletes and Much More (starts at 30:39)

Ryan Broyles – Oklahoma Sooner WR (starts at 25:47)
Sports Injury Locator – ACL Tears
Sports Injury Locator – ACL Tears – Surgical Reconstruction
Episode 11: Caffeine In Sports and Much More (starts at 36:00)
Heartbreaking end to stellar college career
Medical evaluation of players critical at NFL Combine

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Cycling with a stress reaction and/or stress fracture of the tibia? (starts at 31:04)
Sports Injury Locator – Tibial Stress Fracture

Chronic exertional compartment syndrome in cyclists? (starts at 33:59)
Sports Injury Locator – Chronic Exertional Compartment Syndrome

Return to sports after surgery for a sternoclavicular dislocation? (starts at 37:16)
Sports Injury Locator – Sternoclavicular Dislocations
Episode 12: Exercise and Brain Health and Much More (starts at 46:10)
Episode 1: Youth Sports Injuries and Much More (starts at 27:05)

Surgery for a scaphoid fracture in a rugby player? (starts at 40:30)
Sports Injury Locator – Scaphoid Fractures

Follow up to ACL and peroneal nerve injury (starts at 44:42)
Episode 10: Swimming Injuries and Much More (starts at 43:25)

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

What is conditioning?
In psychology, conditioning is the process of modifying a person’s behavior. It refers to the use of a particular action to influence an individual’s learning. When it comes to sports and exercise, conditioning usually means the training that an athlete or athletic individual uses to improve his or her physical fitness or sports performance.

Physical conditioning usually has multiple components, including power, strength, speed, balance, agility, coordination, and endurance. Not every sport or form of exercise requires each component in equal proportion, if at all.

Improving an athlete’s conditioning
When an athlete wants to improve his or her physical conditioning, the first step is to design the program with the goals and needs of the sport in mind. The training program of a sprinter will differ significantly from that of a long-distance runner, for example. Football running backs might need more agility training, and gymnasts might need more balance work. Endurance is felt to be important in all sports and exercise, but even with endurance, some athletes might need more muscle endurance rather than cardiorespiratory endurance.

A strength and conditioning specialist can help by creating training programs that optimize performance and minimize the chance of injury. These trainers can evaluate athletes and their current levels of fitness, strength, and endurance and design programs based on specifically what each athlete needs.

Another key component to conditioning programs involves crosstraining. Training with different types of exercise creates different physical stresses to the body than those to which the body is normally accustomed. These different stresses might help improve the athlete’s overall performance, but it also might decrease the chance of suffering an overuse injury.

Risks of conditioning
Injuries can and often do occur with conditioning programs. Acute musculoskeletal injuries, such as muscle strains, fractures, and dislocations typically involve a traumatic event. Treatment of these acute injuries depends on the nature and severity of the specific injury, but often more than simply rest from training is needed. Rest from the activity while applying compression and cold therapy and elevating the body part are the first treatments. Surgical fixation or repair, casts, splints, and many other treatments might be involved if the injury is more severe.

Overuse injuries also occur with training programs. Increasing the frequency, duration, intensity, or resistance to the training too rapidly can put too much stress on a part of the body. Examples of these overuse injuries include stress fractures, shin splints, and tendinitis around certain joints. Rest from the offending activity is the mainstay of treatment of overuse injuries, but other interventions might be needed depending on the type and severity of the specific injury.

Preventing conditioning injuries
Athletes should design their training programs with the end goal in mind. For instance, if a runner plans to run a marathon, she should give herself enough time to properly accelerate her training to have her body ready by that date. Trying to achieve the goal too quickly might force her to increase her distance run each week too rapidly and put her at risk for an overuse injury such as a stress fracture.

Athletes should also consider adding exercise or resistance programs that differ from their normal routines. This variability not only might improve strength, power, agility, or other fitness areas they might lack, but it might decrease the repetitive stress they apply to the one or two body parts that their maintenance program applies. For instance, a swimmer training for an upcoming meet might benefit from a long run once a week to decrease stress on her shoulder.

While many athletic individuals participate in conditioning programs to lose weight, they need to ensure that they are eating enough calories and obtaining the proper vitamins, minerals, fluids, and supplements to meet the needs of their training. Consulting a sports nutritionist can be helpful. Also, ensuring that the athlete is getting enough sleep and enough rest between exercise sessions can help to optimize performance.

Before starting any exercise or fitness program, athletes or athletic individuals should consult with their medical doctor or a sports medicine physician. School or team athletes often undergo preparticipation physicals, and these concerns can be addressed at that time. Patients recovering from surgery or an injury should ask the treating physician or physical therapist about how to safely work back into sports. And anyone with an underlying medical condition should always make sure that it does not pose too high a risk with a certain exercise program.

Finally, while many avoid going to the doctor when suffering aches and pains for fear of being told to stop training, letting an injury go untreated can occasionally lead to worse problems. If an athlete has pain or another symptom with activity that is so severe that he can’t exercise at all, he should definitely go to his doctor. But if it is subtler, such that some symptom impairs performance even mildly, such as knee pain running down hills or trouble locating fastballs due to tightness in the shoulder, it is still a good idea to consult with a sports medicine specialist.

Episode 14 of The Dr. David Geier Show is available. I hope everyone here in the U.S. had a wonderful Thanksgiving holiday! Please check out my Thanksgiving post for my favorite Thanksgiving sports memory. In this episode, I expand on my thanks for those people who have helped me so much this year.

Please remember that the show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
Injuries are unfortunately common in skiing and snowboarding. What injuries are most common, and what can people heading to the slopes this winter do to stay safe? (starts at 3:04)

That’s Gotta Hurt
Jay Cutler – Chicago Bears QB (starts at 25:03)
Sports Injury Locator – Hand/Wrist Injuries

J.R. Smith – Denver Nuggets (starts at 33:38)
Sports Injury Locator – Knee Injuries

Updates
Matt Schaub – Houston Texans QB
Sports Injury Locator – Lisfranc Injuries

Sidney Crosby – Pittsburgh Penguins
Episode 8 (starts at 19:58)
Sports Injury Locator – Concussions

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Is the opposite knee the preferred source for the graft in ACL surgery? (starts at 41:32)
Sports Injury Locator – ACL Tears – Graft Options

Soccer after “turf toe” surgery? (starts at 43:52)
Sports Injury Locator – Turf Toe

Short arm cast for a distal radius fracture in a young athlete? (starts at 48:40)

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

Growing up, I always loved watching sports, especially football and basketball. My brother didn’t care about watching sports like I did, but he and I liked to play in the backyard.

It was the Thanksgiving weekend of 1984, and we had spent almost all day that Friday playing football with friends outside. My parents had friends over that day, and they were watching some game on TV that we weren’t all that interested in. But as it grew dark, we heard more and more cheering coming from inside. We had just decided to call it a night, so we went inside to watch.

We walked in about 10 seconds before the final play of the game between Miami and Boston College. I looked at the score and immediately realized that I must have missed an incredible game, not realizing that the game’s lasting memory still hadn’t occurred.

I squeezed in between adults who by now were standing in anticipation to see how the game would end. I knew very little about Boston College, but since I attended a Catholic grade school at the time, most of the people at my house that day were cheering for this underdog team. And this team was led by a true underdog, a quarterback who was dwarfed by everyone else on the field.

I won’t go into details of the last play, because I expect that most of you, like me, can remember exactly where you were when Doug Flutie’s 48-yard Hail Mary touchdown pass gave BC an unbelievable last-second win. I still remember the TV announcer’s words as he realized Gerard Phelan had caught the ball.

Needless to say, for the rest of that weekend and for many more, our backyard football games recreated that final play. “He did it! He did it! Flutie did it!”

Now let me quickly thank a few people. This list is by no means everyone who has meant so much to me…

The Room 7 operating room team at Rutledge Tower: Chris, Melissa, Heather, Diana, and I always say we would make the best reality show on TV. One day I am going to do a video for the blog, introducing you to my OR team and a typical surgery day. The five of us have worked together now for almost 4 years, and I hope we can for many more.

The athletic trainers, physical therapists, and physicians of MUSC Sports Medicine: They provide terrific care for athletes in the Charleston area, and I continue to receive compliments from coaches and parents.

Jenn Simpson and her team: I continue to receive emails or have people tell me in person how impressed they are with the blog and show, and they are largely responsible.

Cliff Ravenscraft: Without his tremendous advice and assistance, The Dr. David Geier Show would still be a dream in my head.

Public Relations at MUSC: I can’t tell you how much it means to have Heather, Tony, and Sarah and the rest of Public Relations supportive of all of my efforts.

Lisa Weisenberger, Joe Siebelts, and the American Orthopaedic Society for Sports Medicine: Lisa nominated me for Chairman of the Public Relations Committee for AOSSM, and she has been a fantastic resource for me both with Public Relations and the STOP Sports Injuries campaign. They have all been so helpful with my efforts, and I try to help AOSSM in any way I can – great people and a tremendous organization!

Malcolm Dewitt, sports editor at The Post and Courier: He took a chance on someone who had never written for a significant publication. I had no idea when we agreed to a biweekly sports medicine column how much I would enjoy doing it. Now I consider it one of my proudest accomplishments, and for his support I am extremely grateful.

Brittany: I don’t know what I would do without my incredible medical assistant. Patients continue to compliment her for being so helpful and caring. And with everything I’m doing, she keeps my MUSC work on track and running smoothly. She puts up with me when I get frustrated or stressed, and she helps to make clinic days enjoyable.

My mastermind group, my extended support network, and my parents: This one is intentionally vague, but people in these groups know who I’m talking about. Those of you in the mastermind group have given me so much guidance and support in the last few months. You mean the world to me. I couldn’t be doing what I am without your encouragement. The extended network has helped in so many different ways, and my parents have not only been supportive but have put me in touch with many in the support network. Unbelievable!

Thank you all so much!

Happy Thanksgiving! And please share with me your favorite sports memories!

In retrospect, it will be one of the most analyzed plays of the 2011 season, although few people noticed it at the time.

It was a seemingly innocent block early in the fourth quarter of a game on October 23. A Pro Bowl guard fell to the ground after a block of Jets linebacker Calvin Pace. He staggered to his feet as CBS’ Jim Nantz told viewers that the player was “a little shaky and wobbly.” He appeared to wave off the umpire as if to say he was able to continue playing, and he remained in the game.

So why has the play and the television footage of it now been scrutinized by the NFL, the NFL Players Association, doctors representing the union and the league, and media all over the country?

Hours after the game ended, on the team’s flight home to San Diego, Chargers left guard Kris Dielman suffered a grand mal seizure.

Dielman was reportedly hospitalized overnight and later released. He has continued to experience lingering effects of the concussion, so the Chargers placed him on injured reserve. Fortunately though, his tests were said to be normal. Doctors have told him that that he should fully recover without complications. He is expected to return to play next season.

Now as scary as a season-ending concussion and seizure are, that isn’t the aspect of this incident that has drawn so much attention. The evaluation of Dielman’s concussion, or apparent lack thereof, has drawn criticism from many observers.

Much of the outrage stems from the fact that television cameras showed Dielman visibly stumbling. Footage also seemed to show umpire Terry Michalek witnessing Dielman as he struggled to get off the ground. He supposedly started to whistle an injury time out, but the player waved him off.

The Chargers doctors and trainers did not pull Dielman out of the game. Reportedly their view of the play was obstructed, and they were tending to another injured player. Doctors did not diagnose Dielman’s concussion until after the game. ESPN’s Chris Mortensen even reported that the team wasn’t alerted to the injury until a teammate brought it to their attention.

I am not at all criticizing the Chargers’ doctors because I don’t know what they saw in that last 12:30 of the game or in the locker room. It is very possible that with as many players, coaches, staff, and television personnel on the sidelines, the doctors could not see Dielman’s loss of balance and coordination. And it is football, so the medical staff is often very busy evaluating and treating many players.

This event highlights one of the problems with concussions, though. Players are simply not reliable for pulling themselves out of a game. They understandably want to play, and they likely will downplay their symptoms to stay on the field.

The NFL responded by trying to educate game officials on the signs of concussions. While critics argue that officials are not doctors, I would argue that few additional pairs of eyes to see what doctors on the sidelines might not has to be a step in the right direction. Instead of being waved off by players intent on playing through a concussion, officials could simply alert the medical staff.

But I expect that educating officials is only the beginning. NFLPA medical director Dr. Thom Mayer wants a medical observer in the NFL command center, where all games are viewed on big-screen monitors, to look out for players exhibiting signs of concussions. The NFL is said to favor placing an independent neurologist on the sidelines of each game. Other ideas that are being debated include mandating that any player who suffers a concussion undergo a CT scan the same day and creating guidelines to determine if players are allowed to fly home with the team.

I’ve always admired professional athletes for their determination to play, often despite tremendous pain. But as this incident demonstrates, physicians, trainers, coaches, officials, and the league must be able to protect the players from themselves when necessary. Hopefully Kris Dielman’s injury sparks changes that prevent future concussions from having even more catastrophic consequences.

Do you think the NFL does enough to decrease concussions? What can the league and its players and doctors do better? Share your thoughts!

Episode 13 of The Dr. David Geier Show is now available! I really want to thank everyone who sent responses to the discussion of sports medicine and why they chose to go into the field. I really appreciate all of the comments and questions that I received this week.

The show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
Why do people chose to go into sports medicine? What are the different fields and what does it take to get to that point? (starts at 3:28)
National Athletic Trainer’s Association
American Orthopaedic Society for Sports Medicine
Episode 9: The Importance of Athletic Trainers and Much More (starts 12:00)

That’s Gotta Hurt
Novac Djokovic – men’s world number one tennis player (starts at 33:55)
Sports Injury Locator – Shoulder Injuries

Kris Dielman – San Diego Chargers guard (starts at 39:31)
Sports Injury Locator – Concussions
Episode 12: Exercise and Brain Health and Much More (starts at 29:02)
Episode 8: Barefoot Running and Much More (starts at 19:58)

Updates (starts at 45:51)
Sammy Watkins – Clemson Tigers wide receiver
Sports Injury Locator – Shoulder separation
Shoulder sprain likely not serious for Clemson, Watkins

Sidney Crosby – Pittsburgh Penguins defenseman
Sports Injury Locator – Concussions
Episode 8: Barefoot Running and Much More (starts at 19:58)

Marcus Lattimore – South Carolina Gamecocks running back
The long road to recovery for Marcus Lattimore
Sports Injury Locator – ACL Surgical Reconstruction

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Knee and leg pain after a tibia fracture? (starts at 49:46)
Sports Injury Locator – Tibia Fracture

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

David

Amanda Bruff in Union City, Tennessee asks:

My soon to be 15-year-old son has been diagnosed with a navicular stress fracture. He was casted for 6 weeks, and after that he just walked on it for 4 weeks. He was recently released to activity and after 1 1/2 weeks, he is beginning to feel pain again. He has been running but not more than a mile at time (If that much). What to do? Also he has severe heel pain on the bottom of both heels. I thought it was plantar fasciitis, but the foot doctor said Sever’s disease? Could these two pains be related? Please help. My son is at the end of his rope with all this pain. His was out of football and does not want to miss baseball season.

General location of pain in athletes with a navicular stress fracture

Knowing when an athlete can return to walking, let alone running and sports, after suffering a stress fracture can be difficult. Due to the risky nature of these injuries going on to nonunion, I often order a CT scan or an MRI to better determine if it has healed. Often plain x-rays are too inconclusive. Also, if the athlete is still having pain, I think it’s safe to hold off from stress on the bone. Running and certainly sports are delayed in these situations.

The location of pain in Sever's disease (larger red arrow) versus plantar fasciitis (smaller yellow arrow)

Plantar fasciitis is not common in high-school aged athletes, but we do see it occasionally. Again, the location of the pain is different, and the symptoms are different in terms of timing of the pain and inciting events. Another problem worth considering in an athlete of a running sport is a calcaneus stress fracture.

Episode 12 of The Dr. David Geier Show is now available! I again want to thank all of you for your continued support and encouragement as well as all of you who continue to send great questions and comments!

The show is available on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
In episode 2, I discussed how exercise can add years to your life. New research shows that it might have many benefits to your mental health as well. (starts at 3:37)
Episode 2: Adding Years To Your Life and Much More (starts at 3:20)

That’s Gotta Hurt
Gerald McCoy – Tampa Bay Buccaneers DT (starts at 18:58)
Sports Injury Locator – Distal Biceps Tendon Rupture

Bruce Taylor and Jeron Gouveia-Winslow – Virginia Tech Hokies defensive players (starts at 22:55)
Sports Injury Locator – Lisfranc Injuries

Taylor Twellman – former New England Revolution star
NFL asking referees to monitor for concussions (starts at 29:02)
Sports Injury Locator – Concussions
Episode 8 – Sidney Crosby (starts at 19:58)
Episode 6 – Nolan Brewster (starts at 17:35)
Baseline concussion testing critical for later management
Are repeat concussions a problem in the NFL?
Colts’ Collie should serve as a warning to all athletes

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Prophylactic knee braces in sports? (starts at 36:12)
Sports Injury Locator – Medial Collateral Ligament (MCL) Injuries
Do knee braces prevent injuries in football?

Knee brace for tendinitis? (starts at 42:45)
Sports Injury Locator – Patellar Tendinitis
Sports Injury Locator – Iliotibial Band Syndrome

Surgery for dislocated clavicle? (starts at 46:10)
Sports Injury Locator – Sternoclavicular Dislocations
Episode 1 (starts at 27:05)

Platelet-rich plasma for a high-ankle sprain? (starts at 49:52)
Sports Injury Locator – Syndesmosis Injuries (“High Ankle Sprains”)
Episode 3: Imitating Famous Athletes and Much More (starts at 3:58)
Episode 9 – Sam Bradford (starts at 27:53)

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

For Clemson fans, the news brought the second sigh of relief of the day. Shortly after Chandler Catanzaro mad a 43-yard field goal as time expired to cap a comeback win over Wake Forest, coach Dabo Swinney told reporters that Sammy Watkins has a sprain of his AC joint and that he might play against N.C. State.

Midway through the third quarter, the freshman wide receiver was injured on a kickoff return. The team’s medical staff examined Watkins shoulder and ribs on the sidelines before taking him to the locker room.

Tigers fans already anxious with their team down by 14 points to the Demon Deacons were seen on television noticeably worried as they watched the Heisman candidate walk off the field. Patrick Sapp reported on the radio broadcast that Watkins’ x-rays were negative. Gene Sapakoff tweeted, “Re: Sammy Watkins: Clemson has an X-ray machine at Death Valley but not an MRI machine. Expect an update soon..” He soon announced by Twitter, “Sammy Watkins update: ‘Upper body injury’ and will not return. Doesn’t sound good.”

Notice the vertical separation (orange arrow) between the tip of the acromion and end of the clavicle in this more serious AC separation.

Television cameras showed the medical staff examining Watkins’ shoulder. Usually with AC separations, a doctor can make the diagnosis by physical exam. If the injury is severe and there is vertical separation between the bones at this joint, one can see a bony prominence there. If there isn’t a noticeable bump but the athlete has pain when the doctor presses directly at this joint, or when he positions the player’s arm across his body, he likely diagnoses a mild AC separation.

X-rays are appropriate for these injuries to help make the diagnosis and determine its severity but also to rule out other injuries, such as clavicle fractures. Sapakoff is correct that Death Valley, like most stadiums, have x-ray capability for exactly this type of situation. The x-rays being negative suggests that this is a mild AC separation, where the ligaments stabilizing the joint are sprained instead of ruptured. The lack of vertical separation on x-ray suggests that the ligaments are not torn.

Coach Swinney noted that Watkins won’t need an MRI. Again, if the x-rays showed no displacement vertically between the end of the clavicle and the acromion, it is likely that most of the ligaments stabilizing the joint are intact. An MRI wouldn’t change the treatment plan. And while Death Valley might not have an MRI machine, it wouldn’t have been feasible to perform one anyway. The 30 minutes lying in the magnet plus time on either side taking off and putting on the pads and uniform would have taken too long to return even if the stadium did have one.

The problem with AC separations, even mild ones, is that they hurt. Often the pain at that joint makes lifting and using the arm painful. And it can be difficult to predict how long it will be until that pain subsides. Clemson athletic trainers and possibly physical therapists will work diligently to decrease his pain with ice, electrical stimulation, and ultrasound, and work to restore his muscle strength. As his pain decreases and strength improves, they will allow him to try to practice. They might try to pad that area for upcoming games, although if the injury hasn’t fully healed, a direct blow there can still cause a good deal of pain.

The team will wait and see if this process will take 3 or 4 days or 3 or 4 weeks. I’m guessing by these reports that his recovery should be a quick one, but I would not be surprised if Swinney and the medical staff hold him out next week at N.C. State for precautionary reasons if he isn’t 100%. But the news that the Tiger star should return soon should relieve Clemson fans dreaming of a BCS berth.

Researchers at The Children’s Hospital of Philadelphia presented the results of a review of the medical records from that institution from 1999 to 2011. Examining knee injuries that resulted from sports treated there revealed that not only have knee injuries in athletes under the age of 18 skyrocketed, but also the types of knee injuries have changed in recent years.

During that time period, 914 anterior cruciate ligament (ACL) injuries and 996 meniscal tears were seen, while 155 tibial spine fractures were seen. Tibial spine fractures increased approximately 1% per year, while ACL tears increased by over 11% and meniscal tears by nearly 14% over that time.

What I find interesting is the shift to more ACL tears from tibial spine fractures. Essentially tibial spine fractures are a variation of an ACL tear where instead of the ligament failing in its midsubstance, the ligament pulls the bony attachment off of the tibia. It has always been thought that young kids, especially before puberty and skeletal maturity, suffer tibial spine fractures, while high school and college athletes and adults suffer ACL tears.

This data suggests that younger kids are getting the injury traditionally seen in mature athletes. “Since tibial spine fractures were once thought to be the pediatric equivalent of an ACL tear, this continued rise in ACL tears in children suggests that injury patterns are changing and that the true incidence of these injuries is increasing,” notes J. Todd Lawrence, MD, PhD, the orthopaedic surgeon leading the study.

What is hard for me to know without seeing the actual data and just relying on the press release is the age breakdown of the injuries. One would expect ACL tears in high-school aged athletes, so looking at all knee injuries in patients under age 18 could be skewed toward a rise in injuries among patients aged 14 to 18. So whether the shift from tibial spine fractures to ACL tears is real is hard for me to know, but regardless, the rate that knee injuries from sports increased is still worrisome.

There has been a lot of attention lately focused on ACL tears and surgery for skeletally immature athletes. It has been somewhat conventional wisdom over the years that delaying surgery to reconstruct the ACL in skeletally immature athletes was a good option, if not the preferred one, to avoid the risk of creating a leg length discrepancy or angular deformity of the knee by drilling holes in the growth plate. But that approach has been questioned in recent years, as several studies have shown a significantly higher incidence of meniscal tears and articular cartilage damage in kids who waited to have surgery.

In fact, a study published in the American Journal of Sports Medicine by the same authors at The Children’s Hospital of Philadelphia showed that meniscal tears that were no longer repairable and damage to the articular cartilage in the lateral compartment (outside) and patellofemoral compartment (under the kneecap) were much more common in kids who waited 12 weeks or more from the time of injury to ACL surgery. That suggests that the continued knee instability from the ACL injury will continue to tear up the young athlete’s knee, especially if the parents wait years. Plus, in my experience, it is really hard to keep kids out of sports for years, and often they are still too active just with playing with their friends to completely avoid the risk of further damage.

So while these studies are certainly worrisome, I would caution against any urge to keep kids from playing sports. Again, in my opinion, the benefits far outweigh the risks. But there are two points I would emphasize. First, consider signing your young athlete up for an injury prevention class with a sports medicine group. Learning proper ways to land from a jump and ways to turn, as well as spending time with coaches learning proper techniques for the activities of that sport, might have a dramatic effect in reducing some of these knee injuries.

Second, I would encourage parents to take these injuries seriously. I know very well how much parents and coaches (and the kids themselves) want to play. But if a knee injury is keeping your son or daughter off the field or court or even just keeping him or her from playing as well as usual, it is worth seeing a sports medicine doctor and having it examined. Knowing that the athlete won’t make an injury worse or treating it appropriately from the beginning is crucial to keep kids in sports and healthy for many years to come.

I didn’t need to see the play or hear the announcers to understand the devastation felt by Ryan Broyles. The tears rolling down his face painted a vivid picture of pain and disappointment.

In the third quarter of Saturday’s game against Texas A&M, the Oklahoma Sooners’ star wide receiver caught a pass and tried to elude defenders. As he planted his left foot and spun to try to gain extra yards, he twisted awkwardly and fell to the ground, clutching his knee.

Team doctors immediately examined Broyles on the sidelines. From the emotion clearly captured by television cameras, it was apparent that doctors shared their suspicions of his injury. Later head coach Bob Stoops confirmed that Broyles had in fact torn his anterior cruciate ligament (ACL). His season and college career were instantly over.

Ryan Broyles holds the FBS record for career receptions. He could have left Oklahoma for the NFL after last season. At that time, many experts projected him as a top 40 pick. In the current environment where it seems that so many mediocre college athletes jump at the first hint of a pro contract, Broyles surprised many by instead returning to Norman with dreams of winning the Biletnikoff Award for the nation’s top receiver and to help Oklahoma win a national championship.

Broyles will undoubtedly undergo surgery in the coming weeks, which will end not only his season but also the remainder of his college career. But the injury also casts in doubt his future at the next level. The rehabilitation after surgery will preclude him from participating in the NFL Combine workouts and possibly from his future team’s offseason minicamps. Most likely, if all goes well, he can hope to return in time for training camp in late summer.

In retrospect, returning to Oklahoma likely will cost Broyles financially. First, he missed out on a year of salary with possible first-round pick guaranteed money. But now this injury will probably have teams debating whether to use a first- or second-round pick on a player with an uncertain surgical outcome.

It is easy to say that players get back to pro football after ACL surgery all the time. And many do return and play at a high level. But unfortunately those of us who treat these injuries all the time know that success is never guaranteed. Broyles very likely might return to play as well as he did earlier this season. But it is not impossible, or even unlikely, that he could end up a step slower or without quite the ability to cut and change directions quickly. He could go from a team’s number one receiver for the next decade to a player simply fighting for a roster spot. It remains to be seen.

I’ve heard fans criticize top collegiate players for their greed and selfishness when they leave early and head to the pros. But I just don’t understand that sentiment. These are kids blessed with unbelievably rare combinations of skill, speed, agility, and other physical tools. And these abilities can vanish in one play.

Like it or not, football is their job. An injury can hinder, if not permanently end, their careers in the same way a serious illness or injury can keep any of us from ever working again. Except I would argue that career-ending injuries are much more likely in the business of football than in almost any of our professions.

So who am I to question a player for deciding that he needs to leave college early to sign a professional contract? The risk of losing the dream to play professional sports, and the financial security that comes with it, is unfortunately real.

I wish Ryan Broyles luck overcoming his injury. I very much hope that one day we will remember how fortunate he was to return and ultimately become a star receiver in the NFL. But as I watched his tears flowing on the Sooners’ sidelines, I couldn’t help but wonder how much of his emotion was not just pain, but fear and regret.

Episode 11 of The Dr. David Geier Show is here. I planned this episode during a weekend trip to Gainesville, Florida, so it is another stream-of-consciousness episode. But after seeing the Gators and watching LSU-Alabama and missing my alma mater, Wake Forest, play against Notre Dame, I decided I need a sports “bucket list” of must see games, stadiums, and events. Let me know where you think I should go!

I really hope you enjoy the show and continue to listen and participate. I’m thrilled that the numbers of comments and questions continues to rise. Thanks to all of you!

The show is now on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
How common is caffeine use in sports and exercise? Why would athletes use it? Does it work? And are there risks? (starts at 5:33)

That’s Gotta Hurt
Ahmad Bradshaw – New York Giants RB (starts at 31:34)
Sports Injury Locator – Fifth Metatarsal Fracture (Jones Fracture)

Ryan Broyles – Oklahoma Sooners WR (starts at 36:00)
Sports Injury Locator – ACL Tears
Episode 4: Tennessee Volunteers WR Justin Hunter (starts at 14:31) and Jamaal Charles (starts at 19:49)

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

ACL graft that could get a college athlete back to soccer as soon as possible? (starts at 42:19)
Sports Injury Locator – ACL Tears – Surgical Reconstruction
Sports Injury Locator – ACL surgery – Graft Options
Ask Dr. Geier – ACL Grafts

Infection after attempted drainage of prepatellar bursitis? (starts at 47:50)
Sports Injury Locator – Prepatellar Bursitis
Ask Dr. Geier – Prepatellar Bursitis
Episode 9: Bursitis after knee injury (starts at 42:44)

Which is the best certification for strength and conditioning and fitness trainers? (starts at 51:50)

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!

Inline skating is a popular form of exercise that can burn as many calories as running or cycling while potentially placing less stress on the joints of the lower body. It is thought that over 17 million Americans participate in the sport. Unfortunately, the U.S Consumer Product Safety Commission estimates that over 61,000 injuries resulting from inline skating were treated in emergency departments or doctors’ offices in 2007.

Common Injuries
The majority of injuries seen are musculoskeletal in nature, including fractures, dislocations, strains, and sprains. The wrist is the most frequently injured body part, making up 37% of all injuries. Two-thirds of wrist injuries are fractures. Head injuries comprise about 5% of inline skating injuries.

Treatments
Treatment of inline skating injuries depends on the nature of the specific injury. Since inline skating leads to mostly traumatic injuries instead of overuse ones, many of these injuries require more than just taking a break from skating. If the injury seems mild, using standard initial treatments for common sports injuries, like rest, applying ice or other cold therapies, use of a compression wrap or device, and elevating the injured body part to decrease swelling are appropriate first steps.

If there is obvious bony or joint deformity, which could suggest a fracture or dislocation, the athlete should seek medical evaluation. Wrist fractures occasionally can be treated with reduction in the emergency room, but they often require surgical treatment. Other injuries might be treated with splints, braces, casts, or surgery depending on the body part and severity.

Prevention
Injuries are inevitable to some extent with inline skating, as falls are not uncommon. People unfamiliar with the sport should consider taking lessons, as novice skaters suffer approximately 14% on all injuries. Learning to stop, as well as balance and speed control, can be very important. In addition, those new to the sport should consider staying in safe environments and avoiding areas with traffic, hills, obstacles, and uneven surfaces.

This young skaters wears necessary protective gear, including elbow pads, wrist guards, knee pads, and a helmet.

Skaters should select the appropriate skate for their skill level. While experienced skaters could use high-performance, five-wheeled skates, beginner or intermediate-level skaters should consider three- or four-wheeled skates. The skates must fit snugly and be in good condition.

Do you have any other ideas for decreasing the frequency or severity of injuries with inline skating? Have you ever gotten injured doing it? Let us know!

Resources
National Safety Council. Inline Skating Safety.

American Academy of Pediatrics. In-line Skating Injuries in Children and Adolescents. Pediatrics. 1998;101(4):720-722.

Schieber, RA et al. Risk factors for injuries from in-line skating and the effectiveness of safety gear. The New England Journal of Medicine. 1996;335(22):1630-1635.

Episode 10 of The Dr. David Geier Show is here. I think this is one of the better shows in terms of topics, with information to help decrease injuries, a human interest story, and a controversial idea to decrease severe injuries. I apologize that several topics I mention in the introduction did not make the final cut, as we ran very long with several discussions.

I really hope you enjoy the show and continue to listen and participate. I’m thrilled that the numbers of comments and questions continues to rise. Thanks to all of you!

The show is now on iTunes, so please click here to subscribe.

Here is a list of topics discussed on this episode:

In the Zone
Why does competitive swimming have a seemingly high injury rate? Are there underlying risk factors involved? And are there simple measures in the offseason and during the season that can keep swimmers in the pool and out of the training room? (starts at 4:22)
Keeping swimmers in the pool and out of the training room
Give Me 10 – Give your rotator cuff some support (ESPNw article)

That’s Gotta Hurt
Eric LeGrand – former Rutgers football player (starts at 26:03)
Sports Injury Locator – Head and Neck Injuries

Chris Pronger – Philadelphia Flyers defenseman (starts at 33:33)

Ask Dr. Geier
Please remember my disclaimer that I cannot offer specific medical advice on this show, in the blog, or by email.

Nerve injury after an ACL tear? (starts at 43:25)
Sports Injury Locator – ACL Tears

Pain and numbness years after a shoulder separation? (starts at 49:37)
Episode 7 (starts at 43:48)
Sports Injury Locator – Shoulder Separation
Sports Injury Locator – Herniated Disc
Sports Injury Locator – Labral Tear

I want people here in Charleston, across the United States, and all over the world to participate, so get your questions and comments to me. Call the show’s listener line for questions and comments. That phone number is 843-628-7150. You can email me at SHOW@DRDAVIDGEIER.COM. You can use Twitter as well. Send a tweet with the hashtag #askdrgeier. Or leave a comment on my Facebook page.

Let me know what you think! Leave your comments here. I might even read them on the show!