Coffee Date

Well, hello! It has been entirely too long since I have jumped on here. My website was my first creative outlet for sportsdrmorgan and I miss it! There is something said for letting my mind wander and sharing in a larger way than good ‘ole instagram.  Alas, you have asked some questions recently and I thought tackling them on this forum would be a great way to ease back in to writing on the regular. 

Let’s have a little coffee date, shall we? 

How’s motherhood? (The most frequently asked…) 

In a nutshell, it is all of the things people say. It’s a blend of all encompassing love and this intrinsic force deep inside that you didn’t know you had. It’s exhausting and beautiful. The days are truly long and go by too fast. We live far from family and haven’t had any outside help which has made this mama a little strung out at times. But I am eternally grateful I get to be with her everyday and to watch her learning and grow.  We are really learning and growing together really. And the responsibility of nurturing another human is not lost on me, especially in the world today. She is such a tiny wonder. I can’t wait to see who she becomes.

Did you finish your closet clean out?

Ugh. Yes, and no. I tried on everything single piece of clothing I own and tossed out a ton of stuff- 4 giant bags full. You will see it in an upcoming Reel I have yet to edit (did I mention motherhood is also very time consuming)?  Still, every time I walk into my closet I feel at a loss. I tossed another pile out just yesterday. The shift from clinical medicine during a pandemic with the added new mother component and geez… Stella is still trying to get her groove back.

What spring trends are you loving?

On that same note… spring is here! Well, at least in Phoenix it is. And I am dying for a sundress and some color. Bright, floral, pastel or bold, you name it as long as it’s happy. I think for the same reasons above I am really pushing for fun style this year. Classics will never die… but I want to amp it up in a unique way. I feel like getting dressed everyday should be a celebration right now! Anyone else? 

What’s next for SportsDrMorgan? 

Well, team, this is a loaded question. For those of you reading for the first time, I quit clinical medicine about a year and a half ago. Quit meaning… a pandemic relocation mediated an extended maternity leave that has led to more questions than answers. When I walked away from a prestigious academic medicine career I was really happy and also confused. When you are on one path your whole life switching to another can be a little bit (okay a lot a bit) frightening. That said, sportsdrmorgan has exciting things in store. Stay tuned on Instagram to see an awesome opportunity I have upcoming. I am still full of content ideas and as always I will continue to strive to share my knowledge in a fun accessible way, while mixing in a lot of who I am; clothes, mothering, doctoring and hopefully one day soon some travel. I always say I might be a great doctor but I am better at people. And I want to reach as many of you as I can. As always, if you have anything I can help with send it my way. 

Anyway…. Nap time is over and I gotta run. Let’s make this coffee date a regular thing, shall we? 

– Dr M

All you need to know: Cortisone.

In orthopedic offices cortisone shots are offered to patients every day. What exactly is a cortisone shot and who needs it? What are the risks and benefits? 

Let’s start at the beginning.  Cortisone is the name used to describe a group of steroid medications we inject into the body. In orthopedics a cortisone shot is given into your knee, shoulder, finger etc… basically any joint space or area. Other names you may hear are methylprednisolone (Depo-Medrol), Triamcinolone (Kenalog) and betamethasone (Celestone). 

I describe these injections to my patients as strong anti-inflammatory medications that are injected into (as one example) your knee.  They work similar to anti-inflammatory medicines you take by mouth (like Advil or ibuprofen) by decreasing inflammation.  However, the mechanism of how it works is different. Also, since we are directly injecting them into the area sometimes they are more effective. 

What does the cortisone actually do? I want to make this super clear- a cortisone injection does one thing only- decrease pain. Cortisone does not fix the injury, repair the joint it is injected into, grow back cartilage or any other magic. Just pain relief. 

How is the shot usually given? Most often cortisone is mixed with a standard numbing medication and injected using a syringe and needle. The numbing medication helps short-term with the pain (just like going to the dentist and getting numb before they pull a tooth) and it also helps distribute the cortisone evenly. My standard recipe is 40 mg of Kenalog and 4 mL of 1% lidocaine in the knee.  Another doctor’s recipes may differ based on their preferences and experience. 

When are cortisone shots needed? That is a difficult question without knowing the specifics of your injury or problem.  That said, the most common thing injected with cortisone are the things that cause us pain. Makes sense, right?  But also keep in mind all things that cause pain do not get a cortisone shot.  One very common use for cortisone is in the treatment of osteoarthritis. Osteoarthritis is the degenerative breakdown of cartilage (a whole topic we will discuss another day) but simply put it is wear and tear on a joint surface.   When someone has pain from osteoarthritis cortisone is often the first go-to for relief. Cortisone also can help with pain associated with meniscal tears, labral tears, bursitis, and several other conditions. Be mindful that there are certain areas of the body, such as tendons, ligaments or soft tissues spaces that either should not have cortisone injected at all or it is at best questionable to do so. 

Who needs one? That is a great discussion for you to have with your doctor!  I would ask the following: What are the goals of the injection? How can I optimize the pain relief to make it better long term?  What are the risks, side effects or alternatives? Remember although very well tolerated any medication we give isn’t a free pass and has risks and side effects. You need to know these ahead of time.  

Here are some of the ways I answer the above. First, how to optimize the pain relief?  I optimize the pain relief after giving a cortisone shot by focusing on the overall function of the body.  If you have a shoulder problem, I want your shoulder to be functioning as close to a normal shoulder as possible.  This is often hard to do! Your shoulder moves differently when you have pain.  Without guidance it is nearly impossible to fix.  Also, with a shoulder problem you are limited in your ability to use that arm normally which can affect other body parts.  This is called compensation.  It can include how you hold your arm, the alignment of your neck or back, and even how you move the other arm. We need to break this cycle for your pain to go away for good!  Cortisone can help with the pain but if the movement pattern is not improved it isn’t a long-term solution. Why? Your body has gotten accustomed to moving the injured way.  If you get cortisone and are having less pain, this is a great time to try to optimize the shoulder movement to keep the pain away. I often recommend physical therapy for this.  Also please note- physical therapy can be fantastic even without a cortisone shot. 

Next, what are the risks? Every medication has risk. I always remind patients every needle stick has a risk of bleeding and infection. The skin is your safety barrier and sticking a hole in it means breaking that barrier.  When sticking a needle into the skin there are structures below the surface.  Depending on where the needle is headed (more for certain injections than others) we need to be aware of blood vessels to avoid bleeding.  These are both very small risks but depending on the person getting the injection.  Another important risk I always discuss applies to patients with diabetes.  We know cortisone injections can transiently increase blood sugar for about two weeks after the injection.  If you are a well-controlled diabetic you can likely still have the injection, but your physician should have you monitor your sugars closely and report any issues. Unfortunately, if your sugars are out of control before the injection it may not be safe to proceed.

How long does the pain relief last?  That is highly variable.  I tell my patients the medication effect lasts a few months. That is how long the medication itself is altering the insides of joint.  However, if you do more (refer back to the above about PT and shoulder pain), then it may last much longer.   Another possible and important ‘risk’ to be clear on is sometimes cortisone does not provide any pain relief at all. 

What if I need to get several cortisone injections to maintain pain relief? This again is variable but could be a concern.  Let’s revisit the knee example for osteoarthritis.  You as my patient have had one the injection every few years and otherwise have done well!  You are able maintain your exercise program, stay at a healthy weight and are maintaining cardiovascular fitness… to me, this is great! Those benefits clearly outweigh the occasional injection.  However, if you notice that you are having repeat injections and the time between them is getting shorter to maintain pain control this may not be the best solution any longer.  There is some data that suggests repeated cortisone injections may advance breakdown of the tissue faster than normal.  So, we must proceed with caution.  

Overall injections of cortisone are safe and well-tolerated in many and can be extremely helpful in alleviating pain. If you have questions about cortisone or whether you are a candidate for one it may be time for an educated discussion with your orthopedic physician.

My Starting 5 – April 2021

I was supposed to have this published on the fifth of the month, but instead of working over the weekend we took some much needed time off! A mini babymoon night was just what the doctor ordered. It was great to be able to just relax and spend a few moments away to ourselves after such a hectic year. Just wish it was a longer trip!

I am back on my game plan and writing in real time so that I can get you my Starting 5 for the month of April.  As a reminder, the Starting 5 is my list of the top of items or tips/tricks that I am loving and would share with you over the water cooler at work or over wine with my BFFs. There was a great response to last month’s list… (Here!) hoping you find some gems in this one as well. 

Without further ado… the April Starting 5. 

Hypervolt

Hpyerice Hypervolt in gray and black shown zoomed in
Hypervolt with Bluetooth Percussion
  • 2 words: Game Changer. I have experience with these devices as a team doctor and know they can be great. I was trying to come up with a fun Christmas gift for my husband this year and came across an advertisement. I thought he might love it as he gets a little stiff from his workouts mixed with long days standing over the operating room table. So yes, this was actually a gift I bought for him knowing full well I might use it too… #marriage Come to find out, it is a total game changer for me in this pregnancy! I have been using it daily on my hips, low back, glutes etc. My SI joints have been a hot mess since the second trimester and this little nugget has been worth every penny. Note that I did get it on sale for the holiday… so keep an eye out for a deal but knowing how much we both use it I would absolutely pay full price. 

Be Well By Kelly Protein Powder

Be Well By Kelly Protein Powder
  • If you follow me on Instagram (which I hope you do! @sportsdrmorgan) it is no secret I love Kelly Leveque and her nutrition concepts. When she launched her brand of protein powder I needed to test it out. Prior to this, I have used several whey and plant-based powders. Some I still love (Tone it up Peanut Butter is delicious!) but wanted something less processed to use during pregnancy. Enter BWBK Protein. It is extracted in a chemical free manner, is made from grass-fed beef and contains collagen. I choose the vanilla flavor and have been loving it in my morning smoothie. Also, hot tip- you can mix a small amount in almost anything to up the protein. Another current go to: mix a half scoop in all natural PB and spread on an apple as a balanced snack. 

Hatch Belly Oil

Hatch Belly Oil
  • Staying with the pregnancy theme I splurged on the luxurious Hatch Belly Oil. I have been slathering on all the balms and oils and creams I can find to aid in the stretch as my belly grows. Nothing truly prevents stretch marks according to the science, but it sure doesn’t hurt to keep the skin hydrated. The Hatch Belly Oil is pricey, but it lives up to the hype! The smell is soft and pleasant and it dries super fast. I also love applying it because it feels like a little dose of luxury. And in the times of COVID, while pregnant, staying home all the time… there is something to be said for feeling a little luxury in my post-shower routine. 

Getting Dressed

  • Speaking of little luxuries… getting dressed while pregnant isn’t one of them. Nor is getting dressed during a pandemic! Anyone else switched to a 100% sweats and yoga pant wardrobe? Then one day I got dressed. Nothing fancy, just something that made me feel good to wear. I also put on my engagement ring and a splash of makeup. I don’t usually wear my ring when I am home since the majority of the day I find myself doing chores like laundry or washing dishes. That day I noticed immediately I felt better. Putting a small amount of effort can make a huge improvement in your mental wellbeing. Hopefully this is something I can remember to do postpartum as well!  Funny story one day I did ‘full makeup’ for a photo I was taking and when I walked into the bathroom I caught my own reflection in the mirror and literally jumped. I scared myself because I didn’t recognize my own reflection. Haha. Definitely time to step up my day-to-day game for no one except me and my own mental wellbeing. 

Outlet Shopping

  • It is no secret I love a bargain. I needed new bedding for our a new California King size bed. (bed linked here  … I love it!) But I also didn’t want to spend a fortune on the linens. Bedding is important for sleep yes, but my 28lb Frenchie sheds on it. I also needed a few furniture items for our nursey but didn’t want to break the bank.  Baby stuff adds up and is expensive! I will do another post on what we bought for the babe, spoiler alert, you don’t need as much as the registry folks want you to think you do. 
  • After ogling a few of the duvets online from Restoration Hardware I serendipitously found an RH outlet nearby. I did the same for Pottery Barn when hunting for a glider and crib. Here’s the tip. Look for an outlet version of these stores. They sometimes carry ‘scratch and dent’ products, but they also sometimes have perfect returns that cannot be resold. 
  • While in the RH Outlet I stumbled across a pair of Cal king sheets that matched my aesthetic, but no duvets.  I didn’t go to buy sheets. Ugh. I decided to pull them out of the packaging to be sure I didn’t also ‘need’ to buy sheets even though we had just bought two sets… and low and behold it was a DUVET! I was ecstatic. I continued my hunt by searching for shams… but couldn’t find 2 that matched and were the appropriate size. That is until I again opened a package that had been mislabeled. No way, right!  The sales lady was laughing with me by the time I finished. She said the product comes in on large pallets and they cannot look through each in detail. So, if you do venture to find a bargain don’t be afraid to ask to look inside the packaging!
  • While on my Pottery Barn Outlet shopping trip I had another great experience. I had started my search for nursery furniture online, but to my dismay every glider that I did not find hideous was backordered or special order and wouldn’t arrive until months after our due date. Did you know some of these chairs take like 10-20 weeks to produce, let alone ship? The gestation on the chair is as long as on the actual baby. A friend told me to try the PB Outlet as I could take the pieces home the day I purchased. I found the perfect glider in a neutral gray fabric… and while there saw a crib that would work too. We had initially intended on the cheapest crib possible and had considered one from Ikea. But those looked flimsy in person and I was concerned about function.  I also did a deep dive into crib and nursery safety one afternoon (working from home = lots of deep dives into the internet baby space) and I found out about Greengold Certification and the chemical free nature of the products from PB. This was a win win. We got our glider and crib, and I grabbed a stuffed lamb toy to add to the mix. All in all, we saved money and were able to get them set up in the nursery in plenty of time. 

Ski Season.

The cold winter air on your face, fresh powder under your feet, stillness of the wilderness… Whether you tackle the slope on skis or a snowboard nothing quite compares to the feeling of that first run of the day. But as with all sports, injuries can ruin what started as the perfect alpine morning.  Read on to learn about the most common issues snow seekers face and what can be done to stay as safe as possible. 

Common Injuries

For winter sports enthusiasts of the skiing type, the most prevalent injury is in the knee.  With the feet and ankles locked in a hard sided ski boot, the force is directed to the knees means when you fall on the slope.  This force can cause a variety of knee issues, one of the most feared is the ACL Tear (which I wrote about in depth here… LINK), but you can also injure other areas including ligaments such as the MCL or LCL, the menisci, or even the bones (femur/tibia) as they join at the knee.  

For snowboarders, knee injuries can also occur. However, given the orientation of the board on the slope and the single-sled positioning (feet both fixed to the same board), the most common area injured is the wrist. When a snowboarder starts to fall, they instinctively reach for the ground causing injuries ranging from minor sprains to fractures of the wrist bones. 

For all alpine lovers, injuries to the shoulder can also occur.  During a fall you can easily land on your shoulder or outstretched arm causing injuries to the tendons, muscles, or ligamentous structures in and around the shoulder. Shoulders can stretch out of place (subluxate), dislocate, or break with this mechanism. 

Other areas of the body are also prone to injury from a fall on the slope including the hips, spine, and chest wall. 

The most traumatic snow sport related injuries are those to the head or neck. For experienced and novice skiers alike, barreling down a slippery slope can be hazardous. Conditions that make this worse are crowded areas and other obstacles like trees or rocks.  Hitting another person or a tree can have devastating consequences as can your head on the hard packed snow.  Injuries can range in severity from concussion  to bleeding or fractures to severe traumatic brain or spinal cord injuries.

How to stay safe

Staying safe on the slopes makes for a much better day then ending a run with an injury.  

My recommendations: 

1- know your limits and the trail maps

2- train before you ski

3- save the alcohol for the après

4- wear a helmet, always

1. Know your limits

Staying safe on the slopes requires a level of understanding of what you are getting yourself into as well as a knowledge your ability. If you are a beginner or novice, look at the trail map ahead of time and stick with the runs appropriate for your skill level. You are not competing for a spot on the Olympic team… Even if you are more advanced, remember to avoid putting yourself in a position where you feel out of control.  The number one reason I see patients in the office with an injury is getting themselves into an uncomfortable position.  If you end up in this scenario, it is best to stop and ask for help. Ski patrol is always available to keep you safe.  They would much rather help you down the slope than find you injured. 

Another great tip is to take a lesson. No matter how advanced of a skier you are, lessons can be extremely helpful! During my last ski trip, I took a lesson, and it was worth every penny. The instructor was a true gem, helping me (more novice) and my husband (more intermediate) at the same time by challenging each one of our levels safely.  He was so great that when he ran into us the next day while skiing with his daughter, he skied with us for a bit for follow up tips.  These instructors live for skiing, know the terrain, and know how to teach you to be better. Everyone can learn!

2. Train before you go

If you were going to run a half marathon you wouldn’t just show up race day and expect to finish without problems.  Same goes for snow sports. Even if you are in great physical shape at baseline, some activity specific training can be beneficial.  Skiing and snowboarding are physically demanding sports. You need strong legs, great control of your upper and lower body, and stamina to survive the day.  I can’t count the number of patients who describe their injury as something like, “I was tired, out of control and crashed but can’t remember what actually happened.” Don’t be that person. 

3. Save the Après

Ah yes, the time-honored tradition of that first amazing post-ski après beverage at the lodge. It may be my favorite part of the ski day.  However, studies have shown that alcohol increases the risk of injury for both skiers and snowboarders. (As does any illicit/mind-altering substance use). Save the après festivities for after you are done skiing for the day. 

4. Wear a helmet, always

This one cannot be stressed enough. Head injury can be a devastating outcome of a crash on the slopes. No matter how well you ski, a fall can still happen. It is sort of like driving, even if you drive perfectly, someone else can hit you or cause you to crash. So, we were seatbelts, right? Wear a helmet every time you ski or snowboard. Protect your skull and brain and decrease your risk of tragic outcomes. 

If an injury occurs

Ski patrol is always available for injured skiers. They are all over the mountain and at the base, and most resorts employ trained medical staff. Some even have physicians available. Every ski town I have been to has a local urgent care as well with a team that is used to seeing slope related injuries. If you need follow up after a day on the slopes for a bone, muscle or joint problem seek out your local sports medicine orthopedist. It is always helpful to bring any images (Xray’s, MRI’s, etc…) that were taken on the slopes or after.

And of course, enjoy the snow!

Orthopaedic Injuries of Pregnancy

It is no secret that pregnancy comes with a host of changes for your body. These changes allow you to accommodate making a new life but also can put you at risk for musculoskeletal issues along the way.  This is often because of some combination of loosening of ligaments due to hormones, changes in the center of gravity due to your new “bump”, added weight in general, and increases in overall body stress.

Most common Issues I see in practice:

#1 Injuries from a Fall:

As a specialist, I usually see a patient when they hurt something that needs further investigation.  Injuries happen to even the healthiest of pregnant patients.  One of the most common I see is an ankle sprain (see my full post here on all things ankle sprains) Pregnant patients often feel unbalanced.  A movement as simple as stepping off a curb awkwardly can lead to an ankle injury. The great news is the treatment for ankle sprains during pregnancy is very similar to the average patient, and most do very well without long term issues. 

Another common injury from a fall is a broken kneecap (patella).  Again, these tend to happen because of being a little off balance.  With a slip or fall, you can land directly on the knee causing the patella to break. This is painful! The injury is not usually subtle and makes it difficult to stand or walk.  X-rays will show us the problem, and sometimes the problem needs to have surgery to fix, but often you can get better with a period of resting your leg in a straight position. Though keeping your leg fully straight for weeks is not easy while pregnant… something I appreciate even more now that I am pregnant! But my patients have made it through, and you will too! 

Other broken bones can also happen during pregnancy from falls. The second most common fracture in my practice is a broken wrist. When you start to fall you naturally reach for the ground to brace yourself. Unfortunately with this motion, you can land on your outstretched hand break a bone in your wrist called the distal radius. Again, sometimes these need to be fixed with surgery. The ones that do not are treated in a cast for several weeks. Being in a wrist cast while pregnant also seems absolutely no fun, but it is achievable and safe.  Keep in mind these things can happen in pregnancy (just like outside of it), and orthopedic doctors are trained to do what is best to make sure your bones heal well, and your pregnancy stays safe. It is key to let your OB know if you have had a fall or are seeking care with another doctor. This allows us to all work together to be sure we are optimally treating you and keeping everything as pregnancy safe as possible.

#2 Aches and Pains

Ah yes, the joys of pregnancy…  Sometimes if feels like everything hurts whether you move or sit still! Joint pains, achy muscles, and stiffness all over are very common.  Muscle imbalance mixed with a growing belly often leads to a very common complaint, back pain.  It is estimated that 50-80% of patients experience back pain during pregnancy (2). Other super common areas of pain are the hips/pelvic girdle, knee, and neck. Most of this can again be attributed to the normal changes that occur during pregnancy, and keeping active throughout is the absolute best way to keep these issues at bay.  

#3 Wrist and Hand issues

Again attributed to the changes of pregnancy, wrist and hand pain is also very common. One specific condition that plagues pregnant patients is carpal tunnel syndrome.  This condition usually experienced as hand numbness and tingling in the thumb, index and middle fingers and has been estimated to occur in up to 62% of women who are pregnant (1). Great news, this most often resolves on its own after delivery. Until then, stretches and braces for the wrist usually help relieve the symptoms. 

How to stay safe:

First and foremost, listen to your body! The changes of pregnancy alter so much about your function and physiology. You should avoid risky activities where falling could occur, be careful on wet ground and ice, and always be extra vigilant of where you are walking. Stepping off a curb requires attention as does hurrying across a street or walking on a dirt road/path. Be careful! 

Another great tool is a daily body “check in” to see how you are feeling. Is your back tighter today? How do those hips feel? If you can catch an ache or pain early before it becomes severe, you can likely fix it faster. Add in stretches or targeted exercises for your problem areas, and keep moving throughout pregnancy.  Another tip is to remember to take a break if you are sitting for a prolonged period. This helps keep your body from becoming stiff.  It is important to avoid heavy lifting, and be sure you are using proper techniques to lift with your legs (not your back) to stave off further back pains and injuries.  Avoid reaching far away from your body as much as possible to keep your center of gravity stable.  Sadly, since your balance is a little off, retiring your high heels short term is the safest thing to do. 

As always on this website I preach an overall healthy, active lifestyle. In pregnancy this doesn’t change! If anything, it means more focus on these techniques to keep you fit as everything changes. Daily stretching, strengthening, and cardiovascular exercise help keep your body healthy and strong all pregnancy long. This helps you avoid injuries, keeps a better mind-body connection to avoid falls, and keeps aches and pains away.

Finally, what to do if you have pain or get hurt:

First, think about the severity (how bad is it?). If on your daily body check you noticed some general soreness and aches and pains, start with easy-to-do changes at home. Sit in a more proper position while working, remember to take standing breaks, and be sure you are getting proper exercise and stretching.  Always keep in mind your daily routine and that you may need to change something if your body is aggravated by these activities. Also, as always, talk to your OB! Bring up these concerns at appointments or even before if you feel they are significant.  Many small aches and pains are common and not a big deal, but you should always discuss with your doctor to be sure something further doesn’t need to be evaluated. Also know that even for general aches and pains, sometimes braces or other supports can be used to ease the discomfort.  Sometimes your doctor may recommend a pregnancy-safe medication such as Tylenol or even refer you to physical therapy to aid in your recovery.

If you have a larger amount of pain related muscle or joints or if you have had a sudden injury, an urgent/emergency evaluation is the way to go. You should also absolutely reach out to your OB as they can work with your orthopedic team to be sure you are optimally treated as a whole by coordinating specific recommendations based on pregnancy. If you need an X-ray, don’t panic. You can use a shield, and the doctor will do everything possible to keep you safe by only taking x-rays that are necessary to treat you properly. Trust your doctor, and ask questions along the way. I never feel bad when a pregnant patient asks about the necessity of a test or treatment. 

Sources:

1. https://pubmed.ncbi.nlm.nih.gov/19753825/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306025/

3. https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/back-pain-during-pregnancy.html

The ACL Tear.

As we approach the end of football season, there is one injury that we have heard of several times throughout the year (and past years as well). The ACL tear.  Most sports fans have seen this listed on the injury report and heard the announcers talk about concerns for this when a player goes down on the field, but what is it? Why is it a big deal, how does it happen, and what is typically done about it?  

First, knowing a little anatomy of the knee is important. The ACL – or anterior cruciate ligament – is an important structure inside your knee joint.  We have 4 ligaments in and around that area, named for where they are located. Anterior (front) and posterior (back) cruciate ligaments, and medial (inside) and lateral (outside) collateral ligaments.  Today we focus on the ACL because it is usually the most ‘tragic’ when injured in sports. By tragic, I mean the one that is the most worrisome for an athlete because of the long treatment and recovery process that often alters one’s career short and long term. 

The ACL connects the bottom bone in the knee (tibia) to the top bone of the knee (femur) from front to back.  It plays a key role in stabilizing the knee. In medicine we would say it “resists anterior translation of the tibia on the femur.”  Stick with me here… this means in regular language that it stops the bottom bone of the knee from sliding forward in relation to the top bone during normal movement, aka inside the knee joint where it bends.  This bending is what allows us normal knee motion needed for walking, running, jumping, playing.  But we need something to help keep the bones attached to one another or else the knee may feel unstable (jelly-like) when we put stress on it.  [Think of the knee as a door hinge where the ACL is the pin that connects the two pieces of the “hinge”; without this the door can swing open and closed gently, but if it’s pushed too hard the hinge may not line up properly and may become damaged].  Not an ideal situation if one is interested in getting back to doing higher impact activities like playing football. 

If the ACL is torn the knee becomes unstable because the bottom bone can shift away from the top bone.  The cool thing the human body is that there are often redundant systems.  For the most part (although not always for every person) normal walking and low-impact day-to-day life can still be achieved without the ACL because the other ligaments and muscles around the knee can pick up the slack to provide stability.  This means even without an ACL, for daily life activities, many people move about fine.  The problem is with any sudden or shifty movements, such as cutting in sports or in high-impact jobs like law-enforcement or firefighting where folks are required to do movements that aren’t straight forward or backwards. These types of movements are more complex and require more stabilization, so without an ACL the knee can feel unstable and even give out.  For football and other sport athletes, one also would not get the control or explosive power she or he needs to play.   

An ACL tear most likely occurs when the leg is forced in a way that stretches the ligament too far.  Remember, the ACL blocks forward movement of the bottom part of the knee.  Consider a  a football player whose foot is planted to the ground when his knee gets pushed backwards, pushing the top bone away from the bottom bone. Pop!  The ACL is overstretched and gives way.  This is just one example, and there are of course other ways this happens.  Sometimes it involves a collision with another player (as described above) and sometimes it involves getting the leg in an awkward position when a person is running or jumping with the knee buckling inwards/backwards due to the force of the jump or a bad landing.  In this case, it is simply the lack of control and force of the jump landing or cut that causes the tear.  We tend to think of these “non-contact” tears occurring most frequently in young female athletes (maybe a teenage basketball player) that hasn’t developed full hip/knee control. 

The tearing of an ACL is an abrupt injury and not usually subtle.  Sometimes people hear a pop (but not always), feel a pop, have sudden onset of significant pain, and usually fall to the ground.  Most of the time the injured can’t walk easily (if at all) and don’t usually keep playing the game after.  The knee swells up from the inside due to the trauma (effusion).  I usually ask patients if it swelled up like a water balloon as an analogy.  A former mentor of mine taught me when I was learning about knee injuries that a young person running or cutting during sports with a sudden burst of pain with a pop in the knee and large swelling is an ACL injury until you prove otherwise.  This still rings true for my patients today.  #mentor

To diagnose the ACL tear we first talk about what happened when the injury occurred in great detail.  Then, we do an office examination of the knee, as well as the hips and lower legs.   Looking at the other nearby joints is important! Just because it seems that it might be an ACL tear it doesn’t always mean that is our answer.  We complete a few special maneuvers that help clue us in to what possible problem could be happening inside your knee. These maneuvers are helpful to distinguish other injuries that present in the office like an ACL tear.  This exam also helps us determine what next steps to take or if there is concern for other associated injuries (ACL tears often occur with other injures such as MCL tears, meniscus problems, and bone or cartilage injuries).

So you tore your ACL, what now?  Since it is such a crucial ligament for knee stability, most highly active people or athletes should discuss surgery to repair or reconstruct the ligament in the knee.  It does not grow back. It does not scar into place or heal. That said, it is important to note that older patients or people who are less involved in side-to-side/cutting sports or activities may not need surgery.  Be sure you have a discussion with your doctor about what the benefits of surgery are for you, the associated risks of the procedure, as well as the expected long term outcomes.  We practice medicine using the guide of high quality research, and if the studies show that you may do just as well without surgery, that may be the best way to treat your specific injury. Most important is to have these discussions with an orthopedic sports trained surgeon.  They will discuss options, the optimal timing to have surgery if it is thought to be best for you, and also very importantly your rehabilitation and expectations for recovery.  

Whether one has surgery or is treated without operation, he or she will need extensive physical therapy/rehab.  It takes many months for one to get back on the field!  One has to be patient.  For professional athletes that have dedicated athletic trainers and rehab specialists, these are season ending injuries. Often with great rehab, they can return in 6 months (at the earliest) though it can take 1 or more years to reach the prior level of sport.  But these are gifted individuals with many many resources.  For the average injury, it will be at least 1 year before one may feel 100%. And keep in mind, once a person has had an injury, and then had surgery, it is quite possible the knee will never feel 100%.  [Stay tuned for my article discussing preventing injuries like ACL tears.]

Stay healthy-

I miss sports…

April 30. 

The fiancé and I took a long run tonight around our neighborhood.  I have been trying to get into the swing of exercise during the pandemic. But if you read my last post (linked here!) it hasn’t always been easy.  So, when offered a leisurely paced (aka Morgan’s pace, not his pace) tonight after dinner, I took him up on the offer.  When we were about 1.5 miles out, we happened upon the local high school sports fields.  Immediately I felt the need to reach out my hand towards the gate.  There was a pit in the bottom of my stomach.  Seeing that football field I was struck with so many emotions.  I really miss sports. 

My job sometimes isn’t easy, and it often weighs on me.  As an emotive person the weight of everyone’s pains and injuries can build up. The expectations of seeing volumes of patients, doing paperwork, and managing a staff can weigh on my sensitive being.   And when you have games to cover on countless weekends and evenings it can start to feel like a chore.  But that day I felt such a strong longing to stand on the sidelines on a fall Saturday covering a football game.  I could feel the cool breeze in the air, hear the fans cheering in the stadium, and see our team playing on the field.  I long for the day we are able to play sports again.  But this longing is mixed with the fear I have for the safety of our athletes. COVID-19 has changed everything, including my perspective.   

May 3.

My fiancé and I have jumped on the bandwagon and are watching The Last Dance on ESPN (ESPN Story linked here).  The story for those that don’t know is about the Chicago Bulls in the era of the great Michael Jordan.  And you know what, I’ll say it again, I really miss sports. While watching I couldn’t help but think about why I feel so strongly about it.  I am not just a fan.  There is something more to the desire I feel.  

You’ve have heard the saying, “if you can’t be an athlete be an athletic supporter?” Well I think we as team docs are the ULTIMATE athlete supporter.  Let’s be honest again, I am not larger than life. I will never be.  But these athletes are.  And when they stand in victory we stand on the sidelines or in the very far background.  The feeling that we helped, even in a just small amount, contribute something towards whatever it was that allowed them to get there… WOW. Even if we didn’t directly contribute anything aside from being there in case, even when we are just there to watch it from behind the scenes while it is all happening…. Same feeling. Still Wow. 

The energy of being around sports is irreplaceable.  I don’t have a championship ring, but I know what it is like to watch that end being achieved. Maybe that is in part why we do our jobs;  it isn’t for the ring itself in our case but to be a part of something greater than ourselves, to help the best of the best achieve her or his best, to help those larger than life characters to be the gladiators of today. 

Team doctors are always there.  Winning seasons or losing ones. Pandemic or not.  There is no real credit and most of us don’t care. All we want to be there to help the best achieve greatness. We want the gladiators of our time to shine. We want those who are larger than life to make magic.   

Bottom line, I am honored to go behind the scenes and play my very small role in the greater world of sports.  It is absolutely my honor to have stood in every tunnel in which I have been placed. It is my honor to walk into a locker room and help an athlete in need.  

I often joke that it is like going behind the curtain of the Wizard of Oz at times. You know what is back there now, and some of the spectacle of it all changes.  But what an honor it is to know the greatest of the greats. 

Dang, I miss it. 

40 days.

April 20. 

Monday. I think its Monday. Yes, I checked, definitely Monday.  Forty days since the NBA announced they were postponing the season. We have been in “social distancing” since March 19th.  Life has happened since then in some ways: I have gotten engaged, moved, started telemedicine.  Amidst it all we as a society still are trying to plan a future.  I see it for me as we are forging ahead planning our wedding (not for the faint of heart doing a pandemic I might add).  We dream of our perfect honeymoon and hope we can go somewhere amazing. But as it looks now, that may not be in the cards with the regulations on foreign travel in the short-term. 

But life has also stopped. Hard stop. In some ways life hasn’t happened at all.  No sports to cover.  No concerts to attend or dinners out to be had.  People’s most joyous life events usually celebrated on a grand scale like birthdays and baby showers have turned in to drive by affairs. Vacations have been postponed.  And let me be honest with you, it has not been easy.  It seems petty to complain about not having a Friday cocktail out on the town, but we’re missing out on celebrating life’s milestones in the way we’re used to. We are social creatures. And when you take away the social part, even the most introverted souls are rippled.  

So now, we are all suddenly given this block of time without socialization or events to attend.  A full block of protected time spent at home.  Yet, somehow, I am personally struggling to know exactly what to do with it. And you know what, I have decided that is okay.  

There is so much pressure around us to do something productive at all times, especially during this social quarantine.  Social media is full of daily workouts, everyone is baking banana bread or reading novels or cleaning their closets or doing 73 step skin care routines nightly.  And sure, I have upped my home cooking (mostly out of necessity), but honestly some mornings I am simply proud that I have gotten out of bed.  There have been no home projects completed.  My closet is still a mess, and my at home workout routine has not been as strong or structured as my workout routine was pre-COVID-19.  I have been reading about how part of your brain- whether you realize it or not – is focused on this whole pandemic. Part of your brain is literally in panic mode wondering about your safety and survival, even if you aren’t consciously thinking about it. When I read that, my internal feelings made sense for the first time.  Sure, I want to be running every day and planning this wedding and dreaming of my fall sports seasons, but the future is so nebulous right now and my brain is at least in part in fear of the world around me.  It makes it nearly impossible to plan ahead, to dream, to have any sort of existence outside of waiting. 

And the waiting is hard. We don’t know how long this will last. Luckily for us, California has done an excellent job at social distancing so far, and our number of cases has been what most would call fair.  Under the leadership of our governor we are appearing to use science and testing and planning all appropriately.  But, no one knows when we will return to “normal.” And what is the definition of normal going to be?  For someone like myself that tends towards the worrier type, I am in a constant state of heightened fear. And even in the moments of joy and comfort I am in the background playing the movie reel of “what if it’s not okay.”

I admit this because I want you, or anyone who might read this, to know that it its okay.  It is okay not to know. It is okay to be worried and fearful and not feel like learning French or refinishing your wood floors is high priority right now even if you’ve always wanted to.  Just because you have the time, doesn’t mean now is the time.  Sometimes we just need to let ourselves survive anyway we can. Give yourself grace today. We all need it.