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