Dr. Scott Blumenthal, world-renowned spinal surgeon, joins Dr Souryal to peel back the curtain on sports medicine. The Doctors discuss how they prepare themselves to perform surgeries and get over nerves, why Tennis Elbow is really a “gripping” injury, and much to do with hip fractures.
Legendary Larry Brown, current SMU basketball coach, has had a winning and diverse career spanning high school, collegiate, and professional levels on the court and on the sidelines. At 74, he is still going strong personally and career-wise despite hip replacements and many moves.
On the sometimes uncomfortable Business of Medicine segment, Dr. Souryal explains how keeping patient billing streamlined and a smaller staff helps control costs, while the current reliance on insurance company deals and arbitrary approvals can get between the patient and doctor and divert the best treatment plan.
Dr. Craig Garrison, director of Sports Medicine at the Texas Health Resources Ben Hogan Sports Medicine Center at Fort Worth joins the show in the second hour to talk about spinal rehab and core strengthening as both a post-op and preventative measure. The take-home message is that most people can avoid surgery through rehab and therapy.
Dr. Blumenthal and Dr. Souryal shed light on listeners’ questions about hip fractures, the good and the bad of Medicare, weightlifting and elbow pain, and the probable cause and recommended treatment of meniscus tears.
When we think about bone health, our thoughts usually gravitate to one or the other end of the age spectrum. One one end, we think of kids drinking their milk and eating their Flintsone’s vitamins. On the other, we think of the elderly dealing with osteoporosis and broken hips. As it turns out, those 70 or so years in between really matter. In fact, most people reach peak bone mass in their mid-20s.
Conventional thinking went that any exercise that made your muscles stronger probably made your bones stronger. However, research from the past decade has flipped that paradigm on its head. What matters most for building bone density, doctors say, is “dynamic impact.” For instance, it has been found that swimmers (who exercise in a no-impact, no-gravity environment) have significantly lower bone density than the average healthy person. Same goes for cyclists, astronauts, and those who rely primarily on gym equipment for their workouts.
So how (aside from Flintstone’s vitamins) to build bone density? A variety of exercises involve the crucial element of dynamic impact. Generally, if the exercise involves a struggle with gravitational force of the earth, it’s probably good for bone density. Playing tennis or basketball, running, walking up stairs and jumping rope are all good solutions. If those activities don’t sound particularly fun, the National Osteoporosis Foundation also highly recommends dancing.
So sign up for that salsa class you’ve been thinking about and while you’re at it, work on incorporating more yogurt, fatty fishes, and leafy greens into your diet. You’ll be well on your way to a long life of sturdy bones.
Suffering a broken leg while playing football is an acceptable risk, but no one should risk a spongy brain or a foggy future. These days, better and lighter protective equipment allows for bigger collisions that past players would try to avoid.
Dr . Souryal asks his guest, former Dallas Cowboys legend and linebacker D.D. Lewis, “If you knew then what you know now- would you still play?” Mr. Lewis reminisces about his time in the NFL’s Golden Age – back when players wore leather helmets without facemasks and seeing stars was part of the game. They share thoughts on the longterm effects of repeated concussions in the old days and the coming court decision that may help the players affected.
Dr. Souryal starts the show talking about treating hip fractures old-style and new. Topics include cool neck rolls, burners and stingers, PRP or platelet rich plasma therapy, and what is that contraption on the back of that Alabama player? We still don’t know the answer to that one.
Current ESPN analyst and former head coach P.J. Carlesimo is a guest in the second hour and starts the discussion off with observations about how coaches, trainers, and doctors work together for a team, as a team.
Throughout the show, listeners call in to ask about a legpress injury, ideas for relieving a dislocated knee cap, recurrent paraspinal spasms, and where did that cyst go?
In their short history of the Miami Marlins, the franchise has generated quite a reputation for penny-pinching. Only twice in the past 15 years has their opening day payroll been outside of the bottom 10.
Since their inception in 1993, the cycle has mostly been the same: disappoint, suck, develop young prospects, win sneaky World Series, sell off young prospects, disappoint, suck...
While this must be excruciating for their fans (who have had to reluctantly wave goodbye to promising young stars like Kevin Brown, Josh Beckett, Derrek Lee, Hanley Ramirez, and most recently, Miguel Cabrera), one could argue that the Marlins have been playing money ball since before money ball became a thing–they pinched pennies and won championships, even if it irked their fans.
This winter, however, Owner Jeffrey Loria decided it was time for a course change. They announced earlier this week that they inked a record $325 million deal with Giancarlo Stanton.
With their controversial (see below) and very back-loaded deal the Marlins are setting themselves up to pay a future 37-year-old Stanton over $30 million per year.
The big question for us at ISM: is this a worthwhile investment, given what we know about sports medicine? I crunched some numbers to how mega-deals like Stanton’s tend to play out in terms of long-term health and contribution to the team relative to the size of their contract to help figure that out.
Contract (in millions)
Games played per year
$275/10 years (restructured)
So what can the Marlins learn from the chart above?
Well, for one, they traded away the arguably best mega-deal of the millenium in Miguel Cabrera for pennies on the dollar, who restructured his contract for the long-term when he landed in Detroit and has contributed 41.2 wins above replacement and missed only a handful of games.
The trend for power hitters has not been great. For every Miguel Cabrera or Manny Ramirez ($4.35 million/WAR), there is a Mark Teixeira ($7.76 million/WAR) or an Alfonso Soriano ($17 million/WAR).
Pitchers (given the very, very limited sample size) seem to be an even less trustworthy investment. Barry Zito was paid a whopping $42 million/WAR, but went 3-0 in the Giants 2012 World Series quest.
The bottom line: despite the wealth of knowledge sports medicine practicioners have, it is nearly impossible to predict a player’s health from week to week, much less over the course of 6, 9, or 12 years.
Mark Teixeira was a stallion when the Yankees signed him long-term in 2009, but a series of unpredictable injuries have sidelined him for over 200 games in the last three years.
If anyone can do it, Stanton seems fit to buck the trend. Let’s all hope that’s the case and Loria will once again bust out the ol’ checkbook to build a winner.
Steve Nash has again found himself on sports news circuit for all the wrong reasons. Nash, who will miss the rest of the 2014-15 basketball season with a slew of back injuries, was subject to some serious social media smearing this week after posting pictures of himself hiking and golfing.
Nash took to Facebook to explain his injury and convey his frustration with it. He wrote:
“I have a ton of miles on my back. Three buldging disks (a tear in one), stenosis of the nerve route and spondylolisthesis. I suffer from sciatica and after games I often can’t sit in the car on the drive home, which has made for some interesting rides. Most nights I’m bothered by severe cramping in both calves while I sleep, a result of the same damn nerve routes, and the list goes on somewhat comically. That’s what you deserve for playing over 1,300 NBA games.
“In honor of the Showtime Lakers and the omnipresent quote factory that is the Los Angeles sports media, here some of the best Laker injury explanations of recent history.”
Shaquille O’Neal: “It’s kind of hurting pretty bad, the pinky-winky toe.” (September 2001)
Metta World Peace: “Virtually no wear and tear and things like that, it was like, amazing. So I was excited.” (May 2013)
Andrew Bynum: “Cartilage is missing. That’s not going to regrow itself.” (December 2012)
Kobe Bryant: “I don’t think I’ve ever really played a season where I’m 100 percent, so, 78 [percent] is fine.” (September 2013)
Dwight Howard: “Looking back on it, I could have sat out the whole season until now and started playing now. But I just felt like we had such a great opportunity, and some of these guys’ window for winning is very small.” (March 2013)
Injuries can derail a season and football is by nature a collision sport. With players in constant motion and contact, injuries are a frequent hazard to professional athletes. Dr. Souryal gives his spin on Cowboy’s quarterback Tony Romo’s back injuries and the medical “revenue stream” that can lead to unpleasant experiences for some patients.
As always, safety is a hot topic on the field and off. The Doc mentions the viral It Can Wait campaign to discourage texting and driving especially among teens. Now you can text, tweet, or email “#X” to let your friends know you’re about to drive and can’t respond until you arrive.
Callers ask about various shoulder injuries, stretching to increase flexibility and prevent injuries, a chipped tibia causing pain for a young soccer player, and treatment options for a lower back stress fracture. One listener asks whether just an x-ray can indicate if a knee replacement is necessary. Dr. Souryal explains that an x-ray is just one component to consider in a diagnosis and can only tell part of the story. How the patient feels and functions are critical factors in deciding which options are best. Also- whenever patients have questions or concerns about their diagnosis or treatment, a second opinion can be reassuring or point to other options.
What’s up with Calvin Johnson’s ankle? and how about RG3? The ankle is a very forgiving joint, except when it is not. A rolled ankle can heal well and quickly, but some ankle injuries take more time to repair and ligaments may stay stretched, weakened, and prone to re-injury.
Dr. Souryal shares what it is like in the operating room and the importance of the pre-operative visit. He veers from his sports medicine specialty to give some worried parents some direction. Fortunately, injured youngsters often heal quickly and the very young can have an amazing capacity to remodel their bones in a way that adults cannot.
An ACL tear is a common sports injury and the most common age to have ACL surgery is just sixteen. Dr. Souryal explains why these days cadavers play a valuable role in ACL reconstruction for older adults, but may not be an ideal source of grafting tissue for young athletes.
Callers ask questions about recovery from knee replacements, bone bruises, and using knee braces to prevent injuries on the football field.
Introducing a new feature: The House Call- where listeners can text in questions or comments and Dr. Souryal may call you back during the show. Guests today are Dr. Scott Blumenthal, world-renowned spine surgeon and Christine Golic, advisor to USA Football and and advocate for safety in youth sports.
Dr. Souryal and Dr. Blumenthal share their thoughts on the Ebola crisis that has touched Dallas, why there is no shame in crying at a football game, and explain what a “leader” is in regional parlance. They answer callers’ questions about treating a torn meniscus, patellar tendon ruptures, exercise with lower back fusions, shoulder subluxation, and more.
Christine Golic comes on to discuss her role as a spokesperson for Heads Up, a program that spreads the word on safe and healthy practices in youth and high school sports. Heads Up is a great resource for coaches and parents for proper equipment fitting, concussion recognition and awareness, as well as heat and hydration issues.
HBO’s feature The Offseason: Kevin Durant has several inspiring, get-off-your-but-and-do-something moments. By the end of it, you come to admire Durant in many ways and loathe yourself for sitting on your butt for an hour.
The most inspiring of these moments came during Durant’s first trip to Los Angeles and meets up with Thunder partner-in-crime Russell Westbrook. Here’s what they do with their free time in L.A.
Yup. Sand dune suicides.
While most of us could hardly make it a few steps up that hill in L.A., there are several ways in which we can all benefit from running on a flat beach.
The best part about running on sand is how it changes your foot striking.
A majority of runners land with their heels first and then push off of their forefeet. However, on the beach, the forefoot strikes first. And then it sinks. When your foot lands on a soft surface, it requires many of the smaller, less-heralded muscles in the feet and legs to put in extra work keeping the body balanced.
As a result, sand running makes your calves and feet work way harder, in turning burning 1.6 times more calories than normal running.
In short, sand running is more efficient than road or trail running. If you can access a beach (or some sand dunes in the desert), give it a try.
While sand running can prevent injury by strengthening underutilized muscles, Dr. Souryal cautions that it can be more injurious to some, especially aging athletes. Running on an uneven surface can be particularly taxing for the hips, knees, and ankles– often the most vulnerable spots for older runners.