- From sprains and strains to tears and tendonitis, you don't have to be an athlete to suffer from musculoskeletal pain.

Tonight we talk with an orthopedist and a physical therapist to learn how to deal with these injuries.

(gentle upbeat music) (gentle upbeat music continues) Good evening, and thanks for joining us for WTVP's "Docs on Call."

I'm Mark Welp.

Our bones, joints, ligaments, tendons, muscles, and nerves all contribute to giving our body shape and movement.

Unfortunately, it doesn't take a lot for our parts to give out.

Dr.

Charles Miller works for OSF Orthopedics in non-operative orthopedics and sports medicine.

And Brandon Fritz is a physical therapist with OSF HealthCare.

Good to see you gentlemen.

Thanks for coming in.

- Thanks, good to be here.

- Thanks for having us.

- Now, I know you must be busy because half the crew was asking you before we started taping about their different ailments.

So, tell us about, (Charles and Brandon chuckle) you know, this time of year.

We're coming out of winter, where it seems like we have a lot of people falling and injuring themselves that way.

And now we're coming into spring, where maybe young people are getting ready to start sports.

Are there any certain types of year where you're busier than others?

- So, in the doctor side of things, there's always something.

There's some seasonal injuries.

Like you were saying, in the winter, there's all the slip and falls, and there are every year here in the Midwest.

But, you know, there's various things that come up all throughout the year.

But, you know, coming up in spring, you get some of the basketball injuries.

Some of the winter sports injuries are kind of coming in at the end of the season.

You know, people are playing their hearts out and get injuries related to that.

And then we've got some of the other sports like the spring sports coming up like baseball and softball and things like that.

And sometimes getting into those sports, we'll see some things start to come in the door.

- Sure, and Brandon, for PT, do you see any times of the year busier than others?

- Yeah, I mean, work demands, hobbies, and, you know, home requirements never stop, so it's year-round.

But, yeah, we're definitely seeing more basketball-related injuries right now and people prepping and gearing up for track, so maybe a few more sports-related injuries right now.

- Doctor, let's talk about orthopedics and an orthopedist and what it is that you do with the human body and what your specialties are.

- Yeah, I like to refer to myself as kind of more of like a musculoskeletal doctor.

Orthopedist is one of those things that usually has traditionally been associated with surgery, but I'm not a surgeon.

I was actually trained initially, my residency was in family medicine, and I did a fellowship in sports medicine that lent itself nicely to working side by side with orthopedic surgeons to take care of musculoskeletal injuries from the non-surgical side of things.

- So we're talking knees, arm, shoulders, wrists.

- You got it, everything.

- All those joints.

All those joints.

- All the joints but also muscles, tendons, ligaments.

- Okay.

- Concussions, even, right, sports-related stuff.

- And with that being a specialty, if someone feels like they do have one of those types of injuries, should they go to their family physician first before they come to someone like you?

- Well, that's a good question.

It kind of depends on who they can get into first.

Primary care docs in the area are pretty busy.

There's a lot to see, and there's a lot of people, and there's a little bit of a shortage in some of the primary care fields.

So it can be a little difficult to get in to see the primary care doc, as I'm sure a lot of people are aware of.

In those kinds of situations, probably the biggest factor there is what your insurance allow you to do.

Some insurances require you to have a referral to see a specialist, whether it's me, or it's an eye doctor, or it's an ear doctor or gastroenterologist.

So that'd probably be the biggest thing that plays a role in whether somebody can for sure come and see me.

But in most cases, there's not usually a problem with coming and seeing me first as long as there's no other, like, insurance barriers to that.

- Yeah, deal with that fun stuff first before you head to the doctor.

Well, another question is, when you're diagnosing someone, how are you doing it?

Are you doing X-rays, MRIs, things like that?

- We're usually starting with really just talking to people, which should come as common sense, but there are a lot of people that go into their doctors and say, "Well, you know, we just looked at X-rays, and that was it."

So I usually start by talking to a person and figuring out exactly what the story is, especially when it comes to sports-related injuries.

Gotta know what happened to really have an idea what it is we're dealing with.

So we're usually starting with talking with patients.

A lot of the time there's some imaging that comes into play.

We have X-ray available to us in the office, or sometimes people come in with X-rays or MRIs or things like that ahead of time.

In some cases after we've done some initial treatments, we'll move on to some other more advanced diagnostics like MRIs or CT scans when they're necessary.

- And you don't do surgeries yourself, but there are, of course, orthopedic surgeons.

And when you have, you know, looked at a patient and said, "Okay, I think this is what's wrong with you," tell us about the process of deciding whether, okay, maybe that person can go to physical therapy, and we can make their problem a lot better, or they do need to go to a surgeon.

- Well, so there's a lot of different types of injuries, and it really depends on the type of injury that that patient has.

There are a couple special cases where when somebody comes in the door, and let's say, for example, somebody was lifting something heavy and dropped it and felt a pop in their shoulder, they come in to see me, and I ask 'em to raise their arm up, and that's all they can do.

You know, we're gonna get X-rays to make sure there's nothing broken in there.

But in those kinds of situations, we're usually gonna pop out our ultrasound, bring it around the corner, and have a look with the ultrasound and see what the tendons in the shoulder look like.

And if there's a tendon that's completely torn, that's one of those special situations where, unfortunately, I wish I could do more for you from a non-surgical side, but if we're gonna get your shoulder working again, and you've got a rotator cuff tear, probably gonna have to have you see a surgeon at that point.

So those are couple special situations like that where we have to move right onto surgery to get things to heal as quickly and as effectively as we can.

But in most of the cases, we're having somebody come in and get the whole story, maybe get some X-rays, do a full exam of the joint or the body part in question and use those findings to figure out what's gonna be our best route.

And in most of the cases that I'm seeing, even the true orthopedic cases, we're usually able to start with non-surgical treatments, conservative treatments.

Depending on the body part, again, there's a pretty good chance that non-surgical conservative treatments can improve the situation and in some cases remedy the situation entirely, along with things like physical therapy, sometimes things like injections.

- [Mark] Cortisone shots, things like that?

- Yep, so cortisone injections is kind of the standby traditional thing that we've been doing for a long time.

We also do what are called gel injections, or hyaluronic acid injections, for things like knee arthritis and as well as some of the newer technologies, some of the newer treatments that we have like platelet-rich plasma injections, which is using your own body's blood cells to try and heal things like cartilage damage, ligament injuries, tendon injuries, things like that.

- So, Brandon, when someone comes to you, and their doctor wants them to have physical therapy, they think it could help, I'm sure it's not a one-size-fits-all type deal.

Do you look at your patient, talk to your patient, look at maybe x-rays and say, "Okay, this is what we have to do, and this is what we're gonna try"?

- Yeah, absolutely.

The benefit of where we work is we have access to all of these guys' notes and their imaging, their ultrasounds, their X-rays, their MRIs.

So we have access to see what's actually going on on the inside so then we can take that into our treatment and take it into account.

So it's really nice having these guys to talk to you and pick their brain on what they think is going on.

But yeah, once we kind of have a plan of care, then we just take the patient from there.

- I've been to folks like you for a while now, and one of the things I've learned is that you're not gonna get cured overnight.

What can people expect when they come to you?

Again, I know it's not a one-size-fits-all, but, I mean, one or two appointments probably isn't gonna do the trick, is it?

- Yeah, it really depends on what patients are coming in for.

So, physical therapy, you know, each clinic is different.

Each physical therapist at those clinics can have a different specialty.

So if you're talking about a patient maybe coming in with vertigo-type symptoms, you know, they have a high level of dizziness at home or, you know, high level of nausea that's just debilitating, sometimes it could just be a visit or two to get them back up on their feet and resolve the majority of their symptoms.

But the reality is there are some people who it's taken weeks, months, years, for their pain to develop.

So, yeah, it might be a little bit more of a hands-on approach of, "Hey, you know, we'll try to work with you as much as we can."

But really, as therapists, we try to not only treat their pain but also teach them, all right, how can we manage these symptoms, and how can we actually get you to do these exercises at home so that you don't have to come back to us all the time, you know?

- Sure.

- It's always a small joke that we tell patients, but, you know, "I hope I never see you again," is a common thing that we joke with patients.

If we can get you to the point where your pain is gone, symptoms are resolved, and you know what to do to hopefully prevent it, hopefully we never see those patients apart from maybe the grocery store.

- Sure.

You know, when I go to my orthopedic guy's office, I always see a few people you could tell they're athletes, but the majority of them just blue-collar workers, construction workers, people who work in physically demanding jobs, and they're in there for aches and pains.

Do you see a lot of folks who are working physically and just do too much?

- We see everything, the whole gamut.

So, yeah, you're right, we're gonna see some younger athletes.

We're gonna see some weekend warriors, recreational athletes, and we see some people that have had work-related injuries.

We see some people that have some chronic issues that maybe is related to their line of work or something else.

Then we see people that are retired and have some nagging joint pains and things that are more degenerative in nature.

And, you know, we're pretty well apt to handle any of those kinds of things kind of from bottom to top, ages, from, you know, the young athletes in their pre-teens, even maybe sometimes a little bit younger than that, all the way up to patients over 100.

We've had some people that have come in and get some injections and do things like physical therapy.

- Let's talk about those young athletes right now, and what are some of the things you're seeing in them?

What are some of the more common injuries?

- One of the ones that happens almost year-round is ankle sprains, and there's a really varied level of comfort, it seems to me, like in the primary care community, primary care doctor's offices, how comfortable some of those practitioners are, providers are, in treating and evaluating those kinds of things.

But we see a lot of those and are pretty well versed in how to treat those.

So we get a lot of those.

There's always the things like, you know, "I was taking the dog out, and dog saw a squirrel, and leash was wrapped around my leg.

And he took off, and my leg twisted funny and felt a pop and couldn't put weight on it," come in to see me for that, so, twisted knees, sprains, things like that in the knees.

There's everything from head to toe, though.

- Sure, and with the athletes, there's always freak accidents out there, but do you see athletes that come in that maybe they didn't stretch enough, or they didn't warm up or cool down, and that's how they're getting some of these injuries?

- That's an interesting thing that you mentioned.

So not that it really makes a huge difference once somebody has an injury, but I think there's been this emphasis, at least ever since I was younger, this emphasis in stretching.

And in gym class when I was a kid, we would all do, we call static stretching, where you sit on the floor, and you reach down towards your toes, and then you reach over this way, and you stretch this way, and you stretch that way.

Before you did any kind of activity, you always had to stretch first.

And there's been some more research been done over the last 10, 20 years that's actually showing that static stretching, especially cold muscles, could in some cases actually increase the rates of injuries like sprains and strains, pulled muscles, things like that.

And really, I think the most important thing is sort of a dynamic warm-up.

That's what I usually recommend to my athletes, is doing a dynamic warm-up, where you're doing a brisk walk or a light jog or something like that before you get into whatever the intense exercise you're gonna do.

It's weightlifting, or it's CrossFit, or it's hybrid workouts or running, whatever the case may be.

Do a little dynamic warm-up to get your muscles and tendons and your joints primed for that kind of activity and really leave some of the stretching for once everything's nice and warm and sort of loosened up already so you're not gonna give yourself an injury at the time that you were actually trying to prevent getting an injury.

- And one of the things that we've seen this past fall was a lot of cross-country runners, let's take for example, some of them didn't, you know... Usually kids are quite resilient with getting into sports and everything, but there are definitely some times when if they don't have much of a running experience or much of a training experience, you know, they did too little for too long, and then they did too much too quickly, develop injuries, tendinopathies, and everything.

So, yeah, even beyond just the warm-up and cool-down, it's also zooming out and looking at it from an overall level.

You know, what's your pitch count if you're in baseball, or how quickly are you ramping your running, your mileage up?

So even from a macro level, I think it's interesting to look at that too.

- For sure.

- And is there anything that, you know, again, the blue collar workers, construction workers, anything they can do to try and prevent some of these injuries that they're gonna have?

- That's a tough thing to say, really, on kind of like an individual level.

I think that one of the things that, one of the only universal things that I would say that I see that's a pattern is essentially a lack of conditioning in general, people that aren't maintaining strength and good mobility through regular exercise outside of work, even people that work very physically demanding jobs.

There's been a lot of research that's shown that there's benefit in 20 to 30 minutes of low-impact aerobic exercise that you do most days of the week, especially with regard to things like degenerative changes like arthritis in your knees and hips and things like that.

So I would say that, in general, that people that are very physically active at work get home tired, not really wanting to do anything else, flop down on the couch, which I totally get that.

But finding some extra time aside from that that you can do a little bit of weightlifting, nothing crazy, or do a little bit of cardio conditioning, something like that that you incorporate into your routine at least a couple of times a week I think is probably one of the best things you could do to really prevent injuries on a really broad scale.

- Is there anything genetically that some people have that would make them more prone to some of these injuries?

Like, say, you're not an athlete.

You're relatively young, but maybe you have, say, plantar fasciitis.

I mean, is there anything that genetically, again, that may just be affecting people, and it's not necessarily their own fault?

They're not exerting themselves too much.

- Sure.

There are a few things here and there.

One of the questions that I get a lot is, "I have, you know, a painful knee, and Dr.

Miller diagnoses me with arthritis in my knee.

Well, my mom had arthritis, so it must be something genetic, right?"

And the really specific answer for that is, well, technically it's probably not really genetic, but from a genetic standpoint, you are built like your mom and dad.

And probably our build and some of things like how much we weigh and how active we are is a little bit of a product of both nature and nurture and that if you're built similar to Mom and Dad, there's some similarities there.

You have similar risk factors for developing things like that.

There can be some genetic factors, but they're gonna be the sort of the odd-liers out, things like connective tissue disorders that are genetic.

You have any other examples you can think of?

- Yeah, I mean, you mentioned plantar fascitis.

So, this is maybe gonna go one step beyond the genetics, but there are things that we look for in physical therapy for plantar fascitis, for chronic ankle instability and ankle sprains, where, you know, if people have only this much ankle motion or this weak of ankle muscles, then they're kind of predisposed to some of these things as well.

So they might not, you know... And we try to catch things as early as we can because sometimes people come in years later, and they say, "Well, I should have gotten PT, you know, several years earlier."

So there are definitely some things that we can look at and try to improve based on the research that's out there, so.

- As far as equipment, so to speak, I mean, are things like shoes, can that make a big deal in terms of, you know, supporting your ankles or keeping your body the way it should be?

I mean, you know, there's really expensive shoes out there that claim to do certain things, and then there's your cheapo shoes.

What's your thoughts on that?

- Yeah, I mean, there's something as easy as an ankle brace, a knee sleeve, all the way up to, there are cleats out there, I think, for, you know, a couple hundred bucks now for football and soccer athletes that claim that they're gonna prevent an ACL tear and stuff because a lot of turf and grass-related injuries happen with, or knee-related injuries happen on turf and grass.

So, yeah, I think there's always the foundational components of injuries, right, strength, flexibility, and just in general what level of in-shape-ness is that patient at.

So I think the biggest things are looking at those bigger aspects, the strength and flexibility.

The other things can definitely help.

There are certain kind of knee braces that can help kids with growing pains in their quad tendon and patellar tendons.

But I think beyond that, we look once again from that macro level of, all right, do we have a strength asymmetry from side to side or a flexibility asymmetry?

And those are probably some of the bigger things that we look at, but there are absolutely some things.

Even for patients with knee arthritis, there are unloading braces that can take some pressure off of the inside of your knee that can definitely help prolong the God-given knee that people have and, you know, equally distribute some of that stress on their knee.

But, yeah, I think there's a lot out there and some that can be definitely helpful, but we always come back to what's the strength and flexibility look like in their limbs.

- I think going back to the shoe thing, that there are a lot of different shoes out there, and it can be really hard to figure out what's gonna be the right shoe for you.

And a lot of my patients will come in and ask me like, "What's the shoe that's going to do," fill in the blank, right?

And the problem with that is is that there's a lot of feet out there, right, and there's a lot of ankles.

And there are shoes that are made for certain functions, right?

So there's stability shoes.

There's support shoes.

There's cushion-type athletic shoes.

There's minimalist shoes where there's really no cushion.

And you know, in lots of different situations, we can be trying to correct one thing or another.

You know, some people have a little bit of, there's some weakness in their ankles.

They have a tendency for their arch to flatten out, and their ankles kind of turn in a little bit.

There's some types of shoes that can help correct for that to a certain extent, right?

And if you're just going out buying those shoes thinking that that's the end-all, be-all for all of your ankle woes, I can tell you from experience that if you don't have a problem with your ankles turning in, and you get shoes that turn your ankles out, you can end up with problems on the other side of the ankles, stressing the tendons on the other sides of the ankles.

So it's a good thing to, if you've got questions like that, come and talk to somebody like Brandon or me that could hopefully help kind of guide you in the right direction.

There's actually a couple really good shoe stores around here that can also provide you a lot of support and help you navigate some of the things like shoes in particular, which is probably one of the most complicated areas of equipment.

But it's also one of the areas that, yes, shoes are expensive, but probably one of the areas where I think that money well spent is probably gonna have the biggest bang for your buck in terms of equipment that athletes use.

I mean, even people that are just going out walking for exercise could really benefit from, not necessarily that the more expensive shoe is the better shoe, but if you're gonna get a good shoe that is really built for the type of issue that you have or the type of foot shape that you have or something like that, that, yeah, you probably have to be ready to spend a little bit of money.

But I think that getting the wrong shoe and not spending enough can actually end up with worse problems, and if you look back at it, you probably would've wished you had spent a little bit of money and gotten the right kind of shoe.

- Sure.

Let's talk about age, something we all love to talk about.

As people get older and their bodies are worn, what kind of things are you seeing?

You mentioned arthritis a lot.

I guess that's one of the big ones?

- Yeah, well, I'm gonna start by saying that age is just a number, and I am a staunch believer in that.

My wife will tell you I say that all the time 'cause we're all getting a little bit older, and some of us like to just ignore that number anyway.

But age really is just a number.

If arthritis, for example, or osteoarthritis, which is kind of what people have for ages referred to as wear-and-tear arthritis, if it was strictly just a function of your age, everybody who is 70 would have the same amount of arthritis when they get to 70 if it was just a function of your age.

There's people that are 70 that have pristine knees that are not painful at all.

There's people that are 70 that have already had surgery to get knee replacements because their arthritis was so bad.

So age really by itself is just that, it's just a number.

There's a lot of other risk factors that go into it.

Prior injuries, prior surgeries, can play a role.

Body weight plays a role.

Your level of activity, physical activity, plays a role.

There's a lot of different things.

And, you know, when I was in training, there were a couple of doctors that I worked with that kind of talked about, well, your cartilage in your joints, for example, like your knees, is kind of like the brake pads on your car that, you know, the more miles you've put on your car, the more you're gonna wear that brake pad down.

And over time, you just get down to the point where there's no pad left, and you're on metal, and it's scraping, right?

I used to tell my patients that, but lately we've realized that it's actually not like that.

The best analogy would be is if your brake pads started to get worn down, if you treated them right, and you babied 'em, and you kind of were nice to 'em a little bit, some of that brake pad material would come back and would self-repair.

So, actually, the cartilage in our joints is a dynamic structure that's a living structure.

There's living cells in your body, and there's lots of different things that can stimulate that cartilage and can actually help it regenerate or at least self-repair.

So it's not just a matter of it wears down this much over a certain period of time, right?

There's a balance in all your joints in your body as to what's breaking down and what's building up.

- One thing about physical therapy, is it always easier than having surgery?

'Cause I've heard that surgery on, you know, say, a shoulder, knee, whatever, you know, you could be laid up a long time and be in a lot of therapy for a long time.

So it's coming to someone like you an easier way to potentially solve the problem?

- Yeah, there are definitely times when it's not only a viable option, but it's a good option to try to see how long you can go before you actually need the surgery, right?

I think the positive part is that a lot of these hip replacements, shoulder replacements, knee replacements, they last a long time now.

So it's a positive end to going down that surgical route.

But man, I mean, some people don't have the luxury of being able to be off work for several weeks or a couple months.

People have, you know, home requirements and home needs that they need to tend to.

So, it's definitely a great option to try a physical therapy at first, and then if it doesn't work out, you know, that option is always there.

But, you know, if you go the surgical route first, you know, then you might be laid up for a little bit.

- [Charles] Once you cut it, you can't go back.

- [Brandon] That's right.

- That's what I a lot of times will tell my patients.

It might be worth your while to at least try physical therapy.

Maybe it helps.

Maybe it resolves it completely, depending on the case.

Maybe it doesn't.

- Yeah, real quick before we go, I understand OSF's going to be opening up a walk-in orthopedic clinic.

Tell us a little bit about that.

- Yeah, so somewhere around the end of April, we're slated to open what we're terming a walk-in clinic.

So rather than having to call and schedule an appointment several weeks out to see the orthopedic surgeon or somebody like me in non-surgical orthopedics, we'll have some availability to actually see patients on a same-day, walk-in type basis, primarily for things like sports injuries, sprains, strains.

If you stub your toe super hard, and it's black and blue, and you can't put weight on it, come in and see us, and we'll x-ray it and see if you got a fracture or something like that.

- Excellent, good to know.

Well, I wish we had more time, but we're out of time.

Thanks for everything that you've shared with us.

We really appreciate it.

- Yeah, thanks.

- Dr.

Charles Miller and Brandon Fritz, they are both with OSF HealthCare.

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