March 2015

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3/28/15 – Episode #529: Go Hogs, Go Into the Wild Blue Yonder

Why do astronauts take a bicycle on the space station? Degeneration can happen quicker than you think without movement and resistance, such as after a muscle injury or surgery. Dr. Souryal hosts Sports Medicine Specialist Dr. Brad Bellard today. They discuss the best college fight songs, the value of rehab, why there isn’t a quick fix for muscle injuries, and repair vs. excision. Dr. Bellard explains the difference between eversion and inversion ankle sprains, advises to not come back to sports too early after a muscle strain, and also that “it’s never too late to rehab, my friend.”

Respect this injury! Sports Medicine 101 continues last week’s topic of fifth metatarsal fractures which can look innocuous but about 5% of cases are very tricky to heal, indeed. The Business of Medicine segment goes off on a tangent. Medicine is both a science and an art. Part of the art is tailoring the medicine to the patient and knowing the patient is critical; the new “shift medicine” loses some of this art by downplaying the patient-doctor relationship.

Throughout the show, there are some great answers to some really great questions. A flatfooted caller questions whether he can regain strength ten years after an injury when he didn’t do rehab correctly at the time. The next caller wants an opinion on going to a Doctor of Osteopathy for his mom’s frozen shoulder, a man waiting for surgery on his large “bucket handle” meniscus tear asks if he should he use crutches in the meantime, and a caller with a recent hernia diagnosis wonders if he can live with it. Sure, unless it gets strangulated, or his guts come out. Frequent guest Dr. Blumenthal calls in to set the record straight about next week’s Fight Song Bracket Challenge, a turkey trotter has a heel injury, and a runner for life has spondylolisthesis and wonders about possible effects of running down the line.

Can you take a compliment, dear listener? Dumb people don’t listen to this show. Bet you didn’t even blink at “spondylolisthesis”!

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The NFL takes five (baby) steps towards player safety

The NFL owners meeting in Phoenix, AZ has failed to reach a consensus on several big issues, but they did manage to agree on a few big rule changes for player safety. After a slew of rule changes in recent years protecting quarterbacks and wide receivers, owners are now turning their focus towards protecting vulnerable defensive players.

The following is an overview of the five rule changes, and whether they will matter.

THE MEDICAL TIMEOUT

A certified athletic trainer will have the authority to stop play and evaluate an injury with a medical timeout.

Should we care?

Yes. Before Wednesday’s rule change, only the head coach and the players on the field had the power of the TO. Even after what seems to be an injurious hit, players’ and coaches’ immediate concern is the next play. For them, timeouts are too valuable to waste on a maybe-maybe-not concussion.

By giving an independent trainer the power to stop play, a coach’s interest in keeping a drive’s momentum going no longer supersedes his interest in player safety.

If this rule was already in effect, we likely would not have seen a woozy Julian Edelman finishing out the drive for the Patriots after getting rocked by Kam Chancellor in the Super Bowl.

NO PEEL-BACK BLOCKS OUTSIDE OF THE BOX

In 2013, NFL owners agreed to outlaw the peel-back block within the tackle box. This meant that an offensive lineman or back could not let a defender by him, only to take his legs out from under him. This rule was inspired by Matt Slauson’s season-ending hit on Brian Cushing in 2012. This new addendum does not seem to have been inspired by a particular injury, but could prevent heat-seeking receiver/blockers in the mold of Hines Ward from chopping down an unsuspecting defensive back.

Should we care?

Probably not. Blocking receivers like Ward usually hit high when they sneak up on d-backs. However, with high hits being increasingly penalized, one could see why a receiver would look to take a defender’s legs out from under him. It’s a smart preventative measure, but don’t expect to see it called very frequently in the coming season.

BACKS CAN’T CHOP ENGAGED DEFENSIVE PLAYER OUTSIDE THE TACKLE BOX

In another measure to protect vulnerable defensive backs and linebackers, running backs may no longer take out the legs of a defender already engaged with an offensive blocker.

Should we care?

Yeah. While this mouthful of a rule will also rarely be called, it eliminates the possibility of a defensive player sustaining a completely unnecessary season ending ACL tear.

NO HITTING DEFENSELESS RECEIVERS AFTER AN INTERCEPTION

Prowling safeties may no longer hit a receiver post-interception under the guise of a pass defender.

Should we care?

Eh. Receivers are already quite well protected, and this situation seems pretty rare as well.

NO PUSHING TEAMMATES DURING PUNTS OR FIELD GOALS

Say goodbye to rugby scrums at the line of scrimmage during field goals. Hard to see the major safety implications for this one.

Should we care?

Yes. This rule will be tough to enforce, as there is a fine line between pushing your teammate and charging at the opponent. The rule will be fodder for many a call-in radio show if it is ends up reversing a game winning field goal or turning a punt into a first down.

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3/21/15 Episode 528: Clap with your Carpals, Tap with your Tarsals

Remember that! Dr. Souryal and his talented crew start with a discussion of who likes who for the Big Dance. You can clap and tap along to the college fight songs played between segments. Dr. Scott Blumenthal, world-class spinal surgeon, is once again welcomed as guest.

Our first caller wants to know why his strained abdominal muscle from power lifting keeps coming back after two years, another weight-lifter asks if the cortisone shot he had for his bursitis/bone spurs/tendonitis in his shoulder is a quick fix or permanent solution, and a returning caller asks what the reason for an elbow tendon surgery could be. Later, several questions concern conditions in teen athletes, including a pop in the knee, resistance in the hips, and a pulled hamstring.

Sports Medicine 101 covers fractures of the fifth metatarsal, which is the long bone on the outside of the foot that connects to the little toe. When it breaks, you can’t predict which fractures are going to heal fine, which may require a screw, and which just won’t heal with a screw or bone graft, either.

Health insurance companies don’t make it easy to understand what coverage patients are getting and what financial obligation they will have, especially out-of-network or with hefty deductibles. In the Business of Sports Medicine segment, both the Doc and Dr. Scott have stories to share about canceling recent surgeries due to misunderstandings about coverage. Between appeals and fine print, a lot of time and resources are wasted, which leads some very good doctors and surgeons to no longer take insurance at all.

Arkansas, Alaska, or Hong Kong? Wherever you are- you can text us! ESPN 64636

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Power naps for the win

Professional athletes’ relentless quest for a competitive advantage is once again pushing science towards new frontiers.

We have long known that getting a bad night’s sleep can throw us off for days to come. For athletes and laypeople alike, sleep deprivation leaves us feeling unfocused, impatient, and physically weak.

It took a while for someone to hypothesize: if lack of sleep is so detrimental, then extra sleep should be beneficial.

Cheri Mah, a Stanford sleep researcher, was the first one to seriously examine the benefits of optimal sleep or “sleep extension.” Her subjects happened to be athletes. The results were staggering, by sleeping slightly more than enough, athletes became faster and more accurate. Their reaction times improved as they became less prone to mid-game exhaustion.

Collegiate and professional basketball players are known for putting emphasis on sleep, often napping 2-3 hours during the afternoon of a game day. However, Mah says that this sort of luxurious napping can actually have detrimental effects, leaving the player feeling groggy. Mah suggests that a 20-30 minute power nap is much more beneficial, providing the restorative benefits to the mind and body without the grogginess that deep REM sleep induces.

For more, read Mah’s interview with fellow sleep advocate Arianna Huffington,  and check out this awesome infographic based on Mah’s research:

 

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03/14/15 – Episode 527: Rule #1- Listen to the Patient

Listen to this podcast if you want to know why Texas Rangers starting pitcher Yu Darvish is out for the season and faces a long recovery after undergoing surgery on his arm. Today’s Sports Medicine 101 segment is all about Tommy John surgery, or UCL reconstruction, which was named after and first performed on former LA Dodgers pitcher Tommy John in 1974. Tommy John’s operation didn’t go perfectly, yet miraculously, he was able to resume his fantastic pitching career. Then Dr. Craig Garrison, director of Sports Medicine at the Texas Health Ben Hogan Center, walks us through the yearlong rehabilitation process for UCL reconstruction.

Time flies as Dr. Souryal gets to as many questions as he can in just two hours. Many queries on this episode tie in to a theme: go get the right diagnosis before trying procedures or surgery. The first question of the day comes in by text about right lower back pain that won’t go away, then a caller asks about where to go for his probable “winging scapula” and subsequently, the Doc’s Newfie gets a dog groomer!

The next caller still has pain after many knee procedures and is at a loss for his next step, while similarly, a concerned husband describes his wife’s frozen shoulder and continued lower arm pain after several treatments without a clear diagnosis. Other callers include a weightlifter with an AC joint injury, a 55 year old with pain in both shoulders that may be neurological, and a 38 year old man with knee pain who is advised to ask about other options before rushing into surgery. At the end of the show, a future kinesiologist and former baseball player has some shoulder pain, but only on occasion. What to do? You guessed it: go get a diagnosis!

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