Dr. TO 860

Sports medicine 101 discussion High Ankle Sprian discussion.

Episode Transcript

(00:00):
It's tip off time for Doctor tO. Sorrel and Inside Sports Medicine on
ninety seven to one The Freak.Doctor Sorriel one of the nation's leading orthopedic
exertions and former head team physician forthe Dallas Mavericks, bringing his unique sports
insights and stories from inside the game. With special guests from the world of
professional, college and high school sportsand sports medicine, The Doctor breaks it

(00:21):
all down. Buckle up your chinstrap and tighten your laces for the most
informative ninety minutes in sports medicine.It's kickoff time for Inside Sports Medicine with
Doctor t O. Sorryal on ninetyseven to one The Freak. Good set,

(01:00):
Good Saturday morning, everyone, andwelcome to Inside Sports Medicine. I'm
your host, Doctor to Sorry.I live in the studio on this episode
eight six zero. Now we arenew to ninety seven to one The Freak,
but we're not new to the radioworld. Inside Sports Medicine has been

(01:26):
on in the Dallas Fort Worth marketfor twenty two years. This is our
twenty third season and that's why wehave eight hundred and sixty live episodes under
our belt. This is your sportsMedicine Current Events show where the topics are
ripped right off of the sports desk. Over the next couple of well,

(01:46):
no not a couple of hours.Over the next ninety minutes, you're gonna
be informed, entertained, and hopefullylearn something new. This is a call
in show, and we'll give outthe number several times so you'll have the
opportunity to all in with some sportsmedicine kind of questions we have. We

(02:07):
literally pack a lot of information ina relatively short time. I want to
make sure that everyone understands that we'renot radio people. I'm not a radio
personality. I'm an orthopedic surgeon.But I've been doing this for a while,
so I've learned just a few tricks. Reset the show. Make sure

(02:30):
that some of your new listeners knowwho you're what they're listening to. There's
a credibility factor here, and Ithink it was mentioned in the opening that
I took care of the Mavericks fora good part of three decades. I
have a championship ring to show forit, which I'm extremely proud of.

(02:55):
I should have had two. Twothousand and six, I really thought,
well, I don't want to gothere yet from time to time and on
a relatively regular basis, my friendsare going to join. Today it's doctor

(03:15):
Scott Blumenthal. Morning, Scott,Hey, good morning. He brought me
out of retirement. Well, theybrought me out of retirement. We haven't
been on the air for about ayear, which is kind of cool because
you get your Saturdays back. ButI really like this. I like doing
this. I still have a lotto say and I'm happy that you're here

(03:37):
to help me say it. Well. I appreciate the big Rays too.
He doubled my salary. That's howgenerous. Doctor syel Is doubled my salary
for being on the show. Iappreciate that. Yeah, two times zero
is still so. Scott and Ihave known each other for a long time.
He is a spine specialist. Heis a Texas back Institute up in

(04:01):
Plano. But we go back tothe week before internship at UT Southwestern,
way back a long time ago.We both did our orthopedic surgery residency at
UT Southwestern. It's a five yearresidency program and after you complete your training

(04:23):
in orthopedics. I went on thesports medicine path. He went on the
spinal surgery path. But we continuedto be best of friends. And when
I was with the Mavericks, hewas my spine consultant, and he's actually
my spine consultant for pretty much everyall my patients. Scott's a heck of

(04:45):
a lot more famous than me.He often travels the globe teaching spine procedures,
in particular the relatively new procedure ofinstead of fusing your spine, putting
in a disc replacement, kind oflike a new replacement except for your bag.

(05:06):
And he's one of the innovators.What twenty years ago you started this?
Or fifteen years ago? When didyou do this? It is in
March, in March upcoming, itwill be twenty four years wow. Yeah,
So we've been doing this procedure.We did it first in the US.
Technology was developed mostly in Europe,and we brought it here. We

(05:32):
went did all the FDA trials andyou know, which is a whole nother
show explaining like do you really wantto be as a patient in a trial
We're going to try something that's notquite FDA approved yet on you. But
we do it, and it's donein drugs and devices and things like that.
But you have to I mean howelse are you going to approve it

(05:54):
is something? It is the onlyway, It's the only way to do
it. And now that I havetraveled the world, I used to be
very critical of the rigors of FDAtrials. We have the best system in
the world. If you if youget something here, the chance of it
being faulty is not zero, butit's low. If you get something at

(06:15):
certain in certain other parts of theworld, it's not as rigorously tested.
And you know, for example,we have a fair number of patients that
will say, hey, I went, should I go to Europe and get
this new thing that you can't gethere? Well, the answer is it's
not here because it hasn't been rigorouslytested, and a lot of the times

(06:36):
those new things don't work as well. And much like some people, well
you don't know the pitfalls yet,right, And if you're in a part
of the world where it's not sorigorous to get for example, drugs approved,
you know, a lot of peoplego and get experimental drugs for cancer

(06:56):
or something that you can't get inthe US. But the reality is,
again it's not really been tested andanecdotally, if it works for you,
wonderful, but it's got to workmost of the time over for thousands of
people. So statistically, yes,you know it has to pass this trial.
But if you're a lucky one thatgets a one in one hundred response

(07:17):
to something you can't get in theUS, I would never tell you not
to do it, but just youknow, buyer beware. So suffice said
to say, Scott's a lot morefamous than I am. He's been a
frequent guest on the show that he'snot actually not even a guest anymore.
And probably in the next couple ofweeks, we're going to bring back doctor

(07:39):
Ballard and maybe doctor Mayor. DoctorMayer, who was with me at Texas
Sports Medicine for five years, wascalled up to the big leagues. He
was called up to be the Saintsdoctor and he is the New Orleans Saints
head team physician. He's in NewOrleans, of course, but he's been

(08:00):
on the show many many times,and so we will bring him back,
probably by phone, in the nexttwo or three weeks. What is a
correct pronunciation, I mean you Mayor, I don't know, oh the city
New Orleans. Yeah, I justbecause I've heard it pronounced many different ways.
Now it depends where you're from.I guess you know Karen, my
wife is from New Orleans. Soso how does Karen say it? I

(08:22):
don't know, because I mean they'redifferent. It's kind of like, oh,
I'm blanking see and this is andthis is why. So on New
Orleans new I've heard New Orleans,New Orleans. I've heard New Orleans.
Oh yeah, so I don't knowwhat's what's correct? Cincinnati, Cincinnata,
you know that kind of stuff,like, what do people did you just

(08:43):
say Cincinnata? What do people neverheard that before? What are people from
New Orleans? I don't know NewOrleans. Maybe somebody. I'll call Karen
during the break and ask her.Okay, uh, the phone number is
two one four seven eight seven nineteenseventy one. On the other side of
the Ronaldo is filling in this morning, and we are grateful to have him.

(09:05):
Or I made fun of this lastweek. If you're calling from Fort
Worth, it's eight one seven seveneight seven nineteen seventy one. I don't
know why that matters in this daywhere we don't have long distance anymore,
but two one four seven eight sevennineteen seventy one, and we will be

(09:26):
able to get you on and answeryour questions, probably in the next segment.
So I realize that since we've cometo ninety seven one the Freak,
there are a slew of new peoplethat have never heard Inside Sports Medicine before.
And I get it, and it'sit's my task to introduce you to

(09:52):
the show without taking for granted thefact that you've never ever heard it before.
We do our best. Again Isay, we're doctors. We're not.
We're not radio people. We doour best to keep medicine kind of
on a thirty thousand foot view,the big picture kind of thing, rather

(10:18):
than you know, getting down intothe details of is it titanium or is
it alloy or But from time totime, if you listen to us long
enough, yeah, we'll get downinto the weeds. But is it also,
don't expect a diagnosis calling Oh yeah, yeah, because part of medicine

(10:41):
is like laying eyes and hands onpeople and just telling us your story.
We can come up with the topfive things that people with those symptoms have,
but it doesn't substitute for a visitwith a weather your doctor care professional
doctor, not a provider. Yeah, we're not providers. Inside joke I'm

(11:01):
going to elaborate later. Yeah.Yeah, that's actually a very good point,
Scott, thanks for bringing that up. So we we're we're here to
kind of educate this. This isa teaching show and I and I and
I love doing this and I hopeit comes across that way. Uh.
In the intro, I said,hopefully you're going to learn something new.
I will be disappointed if every episodeyou don't learn something new, and so

(11:24):
that said, hell, you mightlearn several new things on on the show.
But but laying down the front ofthe groundwork, Scott and I have
been doing this for a long timetogether, and we're going to answer your
questions. And the phones are alreadykind of lighting up. So this is

(11:45):
this is great. And also it'sworth mentioning that you and I, over
this decades of time have built largepractices that if that's our day job,
we see patients and we have practicesthat although doctor sooy On are very specialized,

(12:07):
we have people that can take careof every orthopedic, sports medicine or
spinal problem at our day jobs.Yeah all right, So either this segment
or next segment, we're going todo our sports medicine one. Oh,
one, which is kind of abasic teaching thing, and I decided to

(12:28):
pick today. I'm going to talkabout a high ankle spring lots of reasons.
Number one, very few people understandit, even orthopedists, some of
them don't really understand it. Andit is mind boggling to me. And
the reason I thought about mentioning itis Trevor Lawrence was out with a quote

(12:50):
unquote high ankle sprain. But whenyou watch the video, sure didn't look
like it looked like just a gardenvariety sprain to me. But it reminded
me that this may be a goodthing to use for sports medicine. One
oh one, Now that we areon ninety seven to one, the freak.
Uh hey, Ronaldo, can Igo to the phones real quick?

(13:15):
All right? I want to goto line too. I want to go
to Henry from from Wiley. Goodmorning Henry or on the air. What's
up? Good morning, doc?Doctors? Yes, how are you?
I am very well. Are youthe Henry that I know? Yes?

(13:35):
He couldn't say my name, ohhe did. Good morning, Genova,
welcome, my good morning, goodmorning, good morning. And we are
we are forever connected. We areforever connected. I mean, it's a
really bizarre thing. You want totell the story, No, you're better
I tell the stories to me.Yeah. So Genova is a longtime listener

(13:56):
to Inside Sports Medicine. He's followedus from the days we were on ESPN
to the days that we were ona ticket. Now he's here on ninety
seven to one in a freak andand we've met a few times. Gerovol
has a very interesting and complicated medicalhistory. He's actually a heart transplant survivor

(14:18):
and this most recent procedure that hehad, My young daughter was his antesthesiologist.
And you know, she goes intothe room and she's pre opting him
for surgery and he notices the nametag and so Sorrel are you related to

(14:39):
doctors? She goes, Yes,that's my dad, And next thing,
you know, I'm going to visithim. And I mean it was just
random. I mean how I don'tknow how many cases they do at UT
Southwestern on a given day, andit just so happened that it was my
my young doctor Sorial taking care ofamazing. Yeah, it's amazing, amazing.

(15:05):
So I'm hoping that you're doing well. I am doing well. I
am doing well. So what kindof question can you possibly have for inside
sports medicine? Well, I havetwo. For one, you know,
my oldest is getting ready for uhto possibly try to come work for the

(15:26):
same person that doctor Mayer works for. Oh wow, yeah, it's that
time he played his last football gameand he had a high ankle spring with
a chip bone. And I wasactually calling about. Two was neuropathy,
because you know, after our surgeries, a lot of times we suffer from
neuropathy. Well, I'm a muchmore I'm much better at high ankle springs

(15:50):
than i am about neuropathy. Sowe'll talk about that. But I do
want people to know, and Ishould have mentioned it earlier. Uh,
Genovl's got two boys that play Divisionone football, And are you telling me
that one of them is going forthe end NFL draft? He is.
He's a senior there, one ofthe few brothers who started on this line

(16:12):
together. Do you want me youwant me to make a phone call to
doctor Mayer and make sure he passesthis physical Yes, we do need to
make sure he is physical. They'rethe youngest was the right tackle and the
oldest was the starting the left tacklesin the NCAA history. It's only a

(16:34):
few brothers that have ever done that. When he says brothers, he means
blood brothers literally. Yes, yeah, so that's pretty cool. So look,
we have to go on break herein the next twenty seconds. And
this is really a good call becauseit does set up my discussion about high
ankle springs in general. So ifyou don't mind holding for a little bit

(16:56):
after this quick little break, we'regonna now, you know, Doc,
come on now, you know,I'll hold for you. I'm grateful And
Ronaldo let Doug know that he's goingto be next after Genovl. This is
Inside Sports Medicine on ninety seven toone the Freak. Don't forget to listen
to us on iHeartRadio app and thepodcast is going to be on there,

(17:18):
hopefully in the next week or sotoo. Sorry, I Scott Bloomenthal coming
right back. Welcome back, Welcomeback to Inside Sports Medicine TiO. Sorry,

(17:53):
I'll here live in the studio.Scott Blumenthal sitting on the other side
of the table. Ronaldo is runningthe board and answering the phones. Welcome
to the show and thank you forjoining us on this beautiful Saturday morning.
In North Texas. With the iHeartRadioapp, you can listen anywhere on the

(18:15):
planet. Just find ninety seven wonthe Freak and listen live. That is
a really, really cool feature thatthat I found very attractive for a show
like this. There was a while, I don't know, maybe ten years

(18:36):
ago where we were syndicated. Wewere in we were in Miami, San
Francisco, Chicago, New York,but it wasn't live in those cities.
So we we earned some fans inthose markets, but they couldn't interact the

(18:59):
way that the locals did because itwasn't live in their cities. Well,
with this app, you can listenlive on the East coast. Obviously it's
an hour later on the West coacha little bit more difficult, but we
had listeners in Honolulu on a regularbasis. Now, I don't know what
time they have to wake up tolisten to the show, but they did.

(19:23):
That's pretty cool. But the iHeartRadioapp, make sure you download it,
make sure you go to your favoriteradio stations and pick ninety seven one
the Freak, and with that,make sure you listen to us every Saturday
morning at sevenot thirty. All right, let's get Henry back on the phone.
Actually Henry's last name, Genovol's firstname. So let's get Genobol back

(19:44):
on the phone. Are you back, yes, sir? All right.
So for we're gonna we're gonna blendtwo segments together. Number one, we're
gonna take your call, which wehave, and number two on the sports
medicine one oh one side, wewere going to talk about high ankle sprains
today. So you're telling me thatone of your D one football playing boys

(20:07):
had a high ankle sprain? Howdid that happen? The running back was
running fast enough, so did somebodyfall on him? No, the running
back was supposed to be running,he got the play was supposed to go
up the middle. The running backfailed, and my son was supposed to

(20:30):
cut in with behind the running backand throw an additional block to a linebacker.
And the running back fail and hestepped on the back of his foot.
There you go. You see thatthat was the key piece of information
that I was waiting to hear.And so now now I'm going to go

(20:51):
to the sports medicine one on onesection. We've all rolled our ankles.
In fact, we did a studyin the NBA when I was there,
and the number one injury in theNBA is a sprained ankle and you're duking
it out under the basket. You're, you know, trying to get position.
You land on another player's foot andyour foot rolls in. That's a

(21:14):
garden variety ankle sprain. We've allhad it. You step on a crack
on the sidewalk, you step ona rock, and if you're really uncoordinated
like me, you step on aneggcorn and you roll your ankle. That
is a different animal than a highankle sprain. A high ankle sprain is
not when your foot rolls in.It's when your foot rotates out, and

(21:41):
in those situations it's almost always acontact injury. In football, what you
just described was textbook. The runningback stepped on the back of his heel,
forcing the foot to rotate outwards.And the major difference is it's a
whole set of different ligaments that getdamaged when you're all your ankle. The

(22:04):
ligaments on the outside get damaged,and those are flimsy. Anyway, on
the high ankle sprain side, whenit rotates out, you damage the deltoid
ligament. It's called the deltoid becauseit's triangular shaped. That's a really thick,
big giant ligament. And if therunning back is a pretty big guy,
or if the linebacker falls on theback of your ankle, when you

(22:27):
tear that big giant ligament, ittakes a long time to heal. That's
why high ankle sprains have this negativeconnotation. Ooh, that must be really
bad. Yeah, because it takesa long time to heal. In addition,
In addition, and I think thisis where it got the term high

(22:48):
ankle sprain. In addition, thetwo bones of the lower leg, the
tibia and fibula, and it's nottibula, it's the tibia and the fibula.
They are held together by a coupleof ligaments down just a little bit
above the ankle. And if yourfoot rotates far enough out this is kind

(23:11):
of gruesome on a Saturday morning.But if your foot rotates far enough out,
you tear the ligaments that hold thetibia and fibula together. And because
they're situated about an inch above theankle joint, that's the name high ankle
spring. Well, those take along time to heal, and it does
render your ankle unstable. The tuaTua had a procedure to hold the two

(23:37):
bones together and was able to comeback in a couple of weeks. I
think the linebacker that for Georgia thatjust won the not linebacker, the tight
end, he's going to be thetop tight end picked in the draft.
Bowers, I think, yeah,he had a high ankle sprain that required
a surgical procedure to correct. Thoseligaments are actually hold them together. So

(24:02):
a high ankle sprains a whole differentanimal. It's not just and this was
a connotation many years ago where wein the sports medicine world thought that high
ankle sprain is just a bad regularsprain. No, no, no,
it's not just a bad irregular Youcan get a bad regular sprain. I've

(24:23):
seen it, James Jackson. Butthis is just a whole different injury.
But in general, it's a worseinjury. It's longer recovery, Yes,
for your general ankle sprain inside outside, Yes, yes, and yes.
And the reason it's a worse injury, and you weren't listening because you were
on your phone. I already saidit, it's because you tear a bigger

(24:45):
ligament, so instead of tearing theflimsy ligaments on the lateral side, the
outside. You tear the deltoid ligament, which is much much bigger and thicker
on the medial side, the bigtoe side, and that's why it takes
longer. Oh, let's go,let's go even deeper. Yeah, the
multiple ligaments, the anti tib fib. Also, I've already said that I

(25:06):
get off your phone when we're onthe air. I was trying to promote
us see social media. Okay,well we just increased our listenership by one,
so sports medicine one oh one,Yeah, we uh high. Ankle
sprain is a different animal. Andlet's go back to the Trevor Lawrence thing.

(25:27):
It's going to be a sidebar here. They replayed the video from five
different angles angles. Ha, sorryit's early. They replayed the video from
five different angles. And I neverreally saw that his foot rotated out.
Well I looked at that too,and there was one angle and it's exactly

(25:49):
the same mechanism. Because you treateda family member of mine. I did.
And it wasn't the tackle going down, but then and he's already down,
he pushed back and it twisted theankle out out the wrong way.
So that's what I didn't see.Yeah, it was the recoil taking him

(26:11):
down with the flip kind of caughtunder him. So often, those of
us sitting at home watching the gameshave a huge advantage that the medical staff
at the actual event don't have.I had this discussion with doctor Andrews and
also had the discussion with Meyer aboutthis. When you're on the sideline of

(26:34):
a football game, and I don'tcare what level, pee wee, high
school, whatever, you don't havethe video replay handy, you don't have
it in front of you. Youdon't see that split second where the quarterback
was clearly concussed. The camera seesit, and but by the time you

(26:57):
run out to the field or bythe time the player comes back to the
sideline, a lot of those symptomshave resolved, and you don't really know.
Now. Having said that, andwe could ask Mayor this question.
Sure you know that when the quarterbackscome off and defense is on, they're
looking at iPads and looking at defenseand formations. Can would a team physician

(27:22):
like Conductor Mayor say, hey,give me the iPad, I want to
play back the injury. While he'ssitting in the tent with the athlete,
I don't know. It's a greatquestion. I don't know. One of
the things that I did early inmy career. And and by the way,
they didn't have TVs in the lockerrooms back in the early days,
but now they've got TVs in thelocker rooms and the Mavericks when they have

(27:45):
a game, there's a studio.There's a full TV studio at American Airlines
Center that has every camera angled imaginable. And it just so happens that the
studio was right next to the lockerroom. So I'm a way to the
locker room to evaluate one of ourplayers who were visiting. One of the
first stop that I made was inthe studio to look at the injury from

(28:08):
various different angles, so that Iknew what I was examining when I walked
in there. But for other situations, you don't have that. You don't
have that. There was a ohgosh, the quarterback for Florida State,
the backup quarterback for Florida State,not this last week, but the week
before, clearly concussed, clearly concussed. His eyeballs rolled back and the video

(28:33):
was very very clear. But bythe time the medical staff came to him
he was getting up and he walkedto this. He came back in the
game. He came back in thegame, fourth quarter of that game,
and then he had to sit outthe championship and I was scratching my head.
Did no one know that this youngman had a concussion at the time?

(28:56):
They did, obviously didn't. Yeah, because he didn't you didn't pass
the tests to get into the game. The next week, did they do
the test on the sideliner? Ithink somebody saw the video and noted that
he was concussed and that's why hesat out. Now, Yeah, we
can talk about the Florida State thinglater. So Genovl, you're connected to

(29:22):
Florida State too, You just don'tknow it. My niece went there.
But how am I connected to FloridaState? My kids? My oldest boy,
his teammate and roommate is number sixtythree. It starting right tackle for
Florida State. Oh wow, Look, I hope that I helped you understand

(29:44):
high unkle sprain. It does takea long time, and yeah, I
sit tape it and wait for thedamn thing to heal. All right,
you guys, all right, let'sgo to Doug. Good morning, Doug.
How are you. Hey, guys, welcome to sunny Cozamel, Mexico.
I'm calling in. You were talkingabout listening all over the globe and

(30:07):
here I am in Cozumel talking toyou guys. I am a blown away.
I thought that that was a typo. When I looked at the board,
I thought that was we Doug close. We are retired and we live
our winners down here in the sunshine. How so yeah, so anyway,
you know, like I said,I'm retired, so I'm older sixty three

(30:30):
and uh, you know, uh, I just wanted to reach out about
hip replacements. I've had one intwenty twenty two and one in twenty twenty
three. And before you say anything, you know, I just want to
maybe maybe running marathons is not goodfor guys over two hundred pounds and also
in your fifties. Maybe drinking alcoholis not so good because of avascular necrosis.

(30:56):
But what I'm trying to get ahold on at this point, and
you know, I no longer drink, but I'm just curious, how can
I maximize the life of these hipsthat I've been blessed with. You know,
They've given me these and I wantto make them. You know,
I'm kind of young to have thatdone right, So I'm trying to make

(31:17):
sure they last till the end ofmy life. And so I'm trying to
get any kind of information that youcan provide on how this is going to
play out for me going forward,if you can give me any insight.
And also, on a different note, I'm kind of interested in what Dirk
Novinski's life looks like going forward,because I know that he had a lot

(31:38):
of ankle and foot problems towards theend of his career. Is he going
to be able to live a normallife towards the end of his seven foot
you know life? Well, I'mgoing to answer that one. First.
The ankle is one of the mostforgiving joints in the body. I mean,
it can take quite a bit oftrauma, quite a bit of arthritis,
and you still function with very minimalpain. So I'm hoping for Dirk's

(32:04):
sake that he he has an uneventfulfuture when it comes to as ankles.
Now, let's go back to thehip thing, and so you you wouldn't
think that a sports medicine doc wouldknow a lot about replacements, but I
have to I absolutely have to.I actually studied joint replacements a long time

(32:29):
ago, and for a split secondI thought that I might want to do
that, but I didn't, andit was its changing the joint and putting
in something metal and plastic is revolutionary. And new replacements have been around for
a while. Hip replacements have beenaround for a while. I'm going to

(32:52):
give you a little historical perspective.Back in the days before we had new
replacements, the alternative for a severelyare three knee was a fusion. Basically,
fuse that joint in one position sothat it doesn't move and if it
doesn't move, it doesn't hurt.That is barbaric. It is barbara You

(33:13):
can't get in and out of thecar, you've got a permanent limp.
You lay down and sleep at night. You can't move your leg, your
knee. It was barbaric. Soit was revolutionary to have an ear replacement
that preserved motion. Well, ifyou have the need for a replacement,

(33:34):
and I want to go back towhy Sportstock would know about this, Well,
because a lot of my athletes haveextraordinarily traumatic careers, especially in football,
and by the time they're thirty fiveor forty they are arthritic and might
be in need of an ear replacement. So I have to know what the

(33:55):
alternatives are. And I also haveto know what happens in stage when you
end up having a or hip replacement, So how do you preserve it?
Watch your weight, so if you'recarrying extra twenty pounds, see if you
can lose that and reduce your impact. Those are the key features of trying

(34:16):
to preserve a new replacement or ahip replacement. I have patients who get
a near replacement so that they cango back to playing tennis. Bo Jackson
had a hip replacement when he wasreally young because he did have a vascular
necrosis like you said, and hetried to come back and play baseball.

(34:37):
Well, guess what, it lastedtwo years and he had to have a
revision. So you can't do that. If you're going to have a hip
or near replacement, watch your weight, stay fit, and don't beat it
up by running or playing a lotof team. You can do anything recreational,
you just can't go to extremes.Stationary bike it's my go to right

(35:00):
now. I love the stationary bike. I love stationary bike. We've talked
about this before, but when doctorStory and I trained, we weren't taught
to advise patients on activity modification,lifestyle change as you know, go from
decade to decade, and we've kindof learned through trial and error now and

(35:21):
then we teach our students that whenyou sit in council a patient after they
have a replacement of a joint ortrying to avoid a replacement of a joint,
you know, part of your treatmentis to modify your activities, non
impact stuff like you said, likestationary bike perfect, great, great cardio

(35:42):
workout, Doug, I couldn't bemore flattered than for you to have called,
and especially calling from Cozmel. Thankyou, thank you, enjoy your
winter. We got to go onbreak up. I guess he already left
us. All right, this isInside Sports Medicine too, Sorel ninety seven
to one, the freak coming rightback, Welcome back, Welcome back to

(36:22):
Inside Sports Medicine too. Sorry,I'll hear live in the studio. Scott
Bloomin's all there. Ronaldo way overthere. So we had a call from
COZAML Mexico. Very cool, butnow we have the real heavyweights. Can
we go to line one real quick? Good morning, Ben, you are

(36:45):
an inside sports medicine. What yougot hey? Doctor? Sorrywe I just
wanted to say what an honor itis to have you on the airwaves at
ninety seven to one The Free andI love you. I'm a huge of
yours. I'm an admirer, butI'm also a person who's lucky to consider
you a friend. But Texas sportsmedicine has meant the world to me and

(37:08):
my family. Whether it's you,doctor Levy, doctor Ballard, doctor mayor
you guys have helped me with rolledankles, You've helped me with knee surgery,
and it was you know, Ialso being you know, of course
I'm from the Ben and Skin Show, and being you know, being able
to work with the Mavericks for somany years, I know the high regard

(37:30):
with which you are respected, andso it's pretty cool to be able to
say, oh, yeah, thesame people that help Dirk stay healthy.
I can go see those doctors andthat just speaks volumes about you and your
practice and your team. And I'mjust it's it's a true honor to turn
on the radio and be able tohear you on ninety seven to one The
Freak. So I just wanted tosay welcome. Well, first of all,

(37:52):
thank you very much. I'm veryflattered by your kind words. Ben
Rogers from Ben and Skin Show.I have known you since before you were
famed us, but but now you'reyou're big time buddy, big time.
Thank you for Thank you for welcomingus. Look I I told I told

(38:14):
Zach the other day. We've beenon the air for a long time,
and yes we're not radio people,We're just doctors who happened to do this
on the side. You all herehave made us feel so welcome. This
is a this is a different experiencethan what I've had the previous twenty two

(38:34):
years, and I couldn't be happier. I'm looking forward to I'm looking forward
to growing this. I'm looking forwardto introducing a whole bunch of people to
you know, the stuff that wetalk about. Well, I wanted to
also tell you this. It's ait's a it's a funny juxtaposition being that
you know, we goof off,we talk sports, but we goop off

(38:55):
a lot. And here you are. You've got a great sense of humor,
but you're one of the greatest surgeonsin the world. And so now
you're in our studio, and Iwanted to tell you that the shows have
been pranking each other this week withlittle sound devices that are hidden throughout the
studio. So I wanted to letyou know we think the Morning show is
pranking our show and the other shows, and so you're getting caught in some

(39:19):
friendly fire there. I'm afraid.Well, it's funny you should say that,
because I was going to ask youoff the air. There are some
weird sounds in the studio and I'vealready gotten up two or three times to
look and see where they're coming from. What is going on here? I
mean, I think there's a sickcat in the corner. There are no

(39:40):
smells anyway, Yeah, a smellprank. Now, having said that,
it is bothering to you a tonmore than it's bothering me. I can
turn this stuff off. It doesn'tbother me. But every time it happens,
he gets very agitated. It's botheringme because I don't know where it's
coming from. Yes, So lastyear, right around this time, one

(40:00):
of our team members prank to therest of the staff. They hit a
little tiny cricket device. Oh youcan't, you can't see it, and
every once in a while you hearcricket and you're like, is there a
cricket in yere? And so thisyear they chose to ramp it up a
little bit. And there's some flatulencehappening. Oh, we've heard it there.
Yeah, And there's a cat andthere's all sorts of crazy sounds happening.

(40:22):
But some happen every two minutes,some happen every twenty minutes, and
we've all been scouring the studio tryingto find where they are. But the
prankster is beating us on this one. So do people on the air hear
this, No, sir, totorture the people in the studio. It's
working. It is working. It'sonly working with one half of us,

(40:46):
it is working. I started thinkingyesterday. I was like, you know,
tomorrow, we're going to have someof the greatest surgeons on the planet
in the studio. Maybe we shouldfind these things, but we just never
could find them. So I apologizethat you're getting caught up in the warfare
between hosts on different shows. Youknow what, you've just given me an

(41:07):
idea, if and when we everfigure out where these sound effects are coming
from, we might kind of prankother doctors in the o R. Can
you imagine a sick cat in theror a cricket. I'm going to sneak
one into your house so that youcan't sleep at night. Ben, this

(41:28):
is crazy stuff. Thank you somuch for allowing us to be part of
this. And listen. I'm goingto tell everybody listening, I wouldn't be
here if it wasn't for you gettingme plugged in with the right people.
Thank you. Hey, you're welcome. And I just wanted to put a
bow on this by saying, youknow, I love pickup basketball. I'm
a weekend warrior. I'm not verygood, but it's the only exercise I

(41:52):
like. And there was a pointwhere and I'm fifty three now, and
there was a point about I don'tknow, seven years ago, maybe five
years ago, where I thought Iwas done because my knee hurts so bad.
And I went in and saw youguys, and you know, I
had no cartilage left or no brakepad left. It was just a mess.
And you know, now five sevenyears later, I don't ever think

(42:14):
of my knee. I don't wearknee brais, I don't ever think about
it. It's the most successful medicalyou know, thing that I ever had
done in my entire life. It'slike, you guys gave me a whole
new knee, and I'm truly gratefulfor you guys. I love hearing that.
I absolutely love hearing that. That'swhy we do what we do.
Thanks Ben, have a great Saturday. See you guys. Alrighty orthopedics best

(42:37):
feel out there. What we don'tsave lives, we save lifestyles. Yeah,
and you know it's sometimes we savelives too, but mostly lifestyles.
So I I don't know this isgonna sound corny on a Saturday. I
love what I do. I loveand I know you love what you do.
And and we talked about it earlier, how barbaric it was to fuse

(43:02):
the knee, and how far we'vecome by. You know, we're not
going to make you a peg leganymore. We're now going And by the
way, and this sounds even worse, So it was either so for someone
who had a severely arthritic knee orhad a terrible, terrible knee infection,
it's either either you fuse the jointor you cut the leg off. That's

(43:30):
what was done. And then allof a sudden you fast forward and it
wasn't. I mean, we've beendoing new replacements for forty fifty years now.
Hey, listen, instead of cuttingthe leg off, instead of doing
this blah blah blah, let's putin a metal and plastic version of the
knee and it worked. Yeah,this is lifestyle surgery. I can't imagine

(43:53):
what they were thinking way back then, and I don't know what they're going
to be thinking ten years, twentyyears from now. Yeah, when theoretically
there'll be biologic ways to repair arthritis, not middling plastic ways. Look,
so you know that we do stemcell work, and I've been very involved
with stem cell work for the lastfifteen years. In fact, the first

(44:14):
stem cell meeting I ever went to, I went to with you in New
York City. Remember that a coupleof decades ago. It was a couple
of decades ago. But that's howlong we've been looking at this. I
personally believe that the future of medicine, all types of medicine, whether it's
cancer treatment or arthritis or whatever,it's gonna be biologic. Yeah, it's

(44:35):
gonna it's gonna be basically, doctorswill be computer programmers, programming cells manipulate
the exactly to do stuff. Yeah, we'll manipulate your stem cells too.
Look, we can already grow anew meniscus in the lab. Now it's
not practical, but what can itgrow a new kidney? I think they
can. I remember reading that.I'm sure. Yeah, so so we
can do that. It's just notat the level where it's you know,

(44:59):
applicable to everyday people. But eventuallythat will probably be the answer. So
I do some some stem cell worknow, and I often tell my patients
I'm my criteria are very rigorous.I'm very picky as to who's a candidate,

(45:22):
who's not a candidate, And itseems to it seems to have significant
benefit in some people. I didone of my first stem cell procedures on
her knee on a pro basketball playerthat was really severely arthritic, and his
career was in jeopardy. And itwas twelve years ago, and to this

(45:44):
day he still sends me texts thankyou. Now, I look and I
say, how did this work?Or why did it work? Or how
there's a lot of unanswered questions.One of the sponsors on the show is
you know, several sponsors on theshow, some of regenerative medicine clinics.
Look, I think there's definitely aspace for that, but you're not.

(46:05):
Everybody's a candidate. Not everybody's acandidate. I want to go on a
break, but when we come back, Scott, I want you to comment
on you know how in your spineworld we used to fuse the spine on
a regular basis, and we stilldo and a lot of people still fuse

(46:27):
the spine. But the disc replacementis pretty much going to do the same
thing that the new replacement did.Quick a little break and then we're going
to come back and see what Scottthinks about that. Inside Sports Medicine iHeartRadio
app. You can listen to usanywhere on the planet, including Kozamel.
The podcasts are going to be ontheir relatively recently. Uh recently, No,

(46:51):
relatively soon. I definitely need togo on break. Welcome back to

(47:21):
Inside Sports Medicine too. Sorry,I'll here live in the studio, Live
in the studio, Scott Blumenthald sittingon my left, Ronaldo running the board
and answering the phones on the otherside of the glass. Uh, we
might be able to take one lastcall two one, four seven, nineteen
seventy one. This segment of InsideSports Medicine is brought to you by Jaguar

(47:45):
Land Rover Dallas before the break andthis is this is this is right up
your alley, Scott. Before thebreak and before Ben Rogers called, we
were talking about how barbaric orthopedics usedto be back in the olden days,

(48:06):
and how we used to fuse ajoint that was damaged. I've never done
a hip fusion, but earlier inmy residency training, I did a knee
fusion. And imagine, imagine ifyou will, your knees fused in one
position, doesn't move, stuck therefor the rest of your life. And

(48:27):
how do you get in the frontseat of the car. How do you
know? I don't know, Idon't know. But that's what we did.
And then somebody said, whoa wait, instead of fusing the joint,
why don't we just it sounds barbaricon Saturday morning. Still, let's cut
the joint out, replace it withmetal and plastic that looks like a knee
and go from there fast forward.Near replacements are now a million people a

(48:53):
year get a joint replacement. Amillion people a year. We're still fusing
backs from what I hear, butrevolutionary work that you were involved in of
replacing the fusion with a disc tellme more. All right, that was

(49:15):
pretty perfect, It wasn't I that? Well, that was a perfect lead
in. Yeah, and uh,you know you you better get a caller
in here to rescue because I'm gonnakeep talking until you tell me to stop.
And well, along that, alongthat. Before we I even answer
your question, I need to shoutout the music choices today. So I

(49:37):
thought they were excellent, excellent musicchoices. And I do have a question,
quick one for you. Sure where'syour coffee? You always used to
bring coffee. I walked out withoutit. It's it's a disaster. I'm
desperate. I'm having withdrawals. Well, I'm sorry walked out without it.
I'm sorry I finished mine. Iwould have I would have shared, but
I wouldn't have like the stuff youused to poison your coffee, like sugar

(50:00):
and milk. And so I keepit. I keep I keep a log
of every show I've ever done.So I've six eight hundred and sixty pages,
single pages of each show that I'veever done. And there was one
show that I called the No coffeeshow, and I thought it was a
I was just out of sink becauseI didn't have coffee that morning. And

(50:22):
well, had I not said it, it would have been seamless. This
was a seamless This was not anon well coffee show. Thank you,
thanks, you were great. Butthe no Coffee show was a disaster because
I know I'm terrible when I don'thave my morning coffee. So I would
anyway go ahead. I would thinkit was the no Coffee Show, a
solo show. It was, Yeah, you can't do that, you can't

(50:43):
do that. Yeah, the timingis off. Yeah. So you want
to talk about fusion. I wantto talk about yeah, yeah, yeah,
and replacing arthritic choints. So thelead in that you said is exactly
the lead in that we do whenwe travel over the world and give these
lectures on disc replacement, and wedo it in the neck, cervical spine,

(51:06):
the lumbar low back, and thereare certain and you said that fusions
are still done, very very common, and they still are. But what
we do is we treat diagnoses.So you treat arthritis to the kneear hip
when it's bad enough, and youdo all the stuff to try to,

(51:27):
you know, prolong the life ofthe joint. Then you replace it same
thing with the spine, with somesmall caveats because many times in the neck
and cervical spine you also can pincha nerve and you have to treat that.
The spine is a lot more complicatedthan a knee. But having said

(51:47):
that, for the diagnosis of discdegeneration, which if you go to the
doctor, he'll say you have degenerativedisc disease, which it's not a disease,
it's arthritis of a joint. It'stime I took patient. I love
this. My favorite question, wellwhy did I get this? Or you

(52:07):
know, all runs in my family, which I used to kind of like
put that to the side. Whydid I get this? It's time and
gravity. It's just it's just that's, you know, tread on the tire.
We're outliving our joints. Now therun in the family thing I used
to pooh pooh, But now there'sreally good research showing a huge genetic component
to not whether you get it ornot, but to how quickly you'll get

(52:29):
it, how badly you'll get it. So there is a genetic component.
But if you live long enough you'regonna wear out your hip, your knee,
your neck, your back, You'regonna get arthritis or degeneration in those
joints. Little sidebar, and thisis has Now I'm derailing you, little
side sidebar. You know the voterin my entire career to a cl injuries.

(52:52):
There's a genetic component to that too. Yeah, there is a genetic
component. So yeah, they wouldn'thave prize me at all that there's a
genetic component to the lower back wearand tear. Yeah. So here,
Now here's the controversial thing that I'mgoing to say is that for certain diagnoses.
If you have scoliosis, everybody knowswhat scoliosis is, curve. If

(53:17):
you are in a car accident andbreak your back or neck, fusion is
still very commonly used, and it'svery very appropriate. If you have degeneration
in your neck and back and thefirst choice your surgeon says is fusion,

(53:37):
always ask well, what about replacingmy bad disc or discs or what are
my alternatives? What are the alternatives? Because we are heading towards very rapidly
that disc replacement for a say inthe neck, a degenerated or herniated disc

(53:59):
is the ego to treatment and fusionwill go away for that diagnosis. To
make them for very extenuating circumstances,what I know, it's the exact opposite.
If you go to a spine surgeonwith a herniae disc in your neck,
you're gonna get a fusion recommendation ninetyplus percent of the time, and

(54:21):
that's just wrong, particularly in amajor metropolitan area. Then what do you
replace the disc with? So again, with with some caveats, the most
common materials are exactly what we weretalking about for the hip and knee.
It's a surgical metal, usually atitanium or cobal chrome alloy, and a

(54:42):
surgical plastic called high molecular weight polyesthlyinyes. So it's like in their hip replacement,
basically replacing a disc with a syntheticversion of the disc now in the
neck, and that's that's what wedo in the lumbar. But let me
stop you before you go there,because if I don't bring this up now,
I'm gonna forget it. Was itlast year or two years ago?
Ronaldo? Are you a hockey personby any stretch? No? Not really?

(55:05):
No? All right, well,there was a hockey player who had
a neck issue. Michael, thereyou go, there, you go share
that story, because he was,this is exactly what you're talking about.
So this is how we have evolved. Sports medicine, sports medicine, we
have evolved. So he was playingI Blieve Buffalo, say I want to

(55:28):
flow maybe, and he had hernedisk in his neck and he wanted an
artificial disc, but his team wantedwanted a fusion, and his team said,
no, you have to have afusion and he said, I don't
want that. Very well researched guy, and they ended up trading him to

(55:49):
Colorado Vegas. Vegas, they endup trading him to a team that said,
yeah, you can have an artificialdisc and as long as you're cleared
to play again, you can play, which it was. And since that
time, too or three other NHLplayers have had artificial discs. We've yet,
as far as I know, todo one in an NFL player,
But it's going to happen because letme tell you why, let me tell

(56:10):
our listeners why we were yet todo that. No one knows what it's
like to have a collision sport andhave a synthetic spine. We had a
whole symposium went to Seattle. Itwas broadcast in podcast format or YouTube all
over the world with about eight orten experts and had a day long discussion

(56:32):
just on this and created our ownlittle treatment algorithm. And so the answer
is it's gonna happen. It's interesting, and you're the best person answer this.
It will not be a team doctoror the team's spine consultant who will
do it. It'll be someone whogoes to get an opinion from someone else,
which is what Michael's clearly has done. I think he had a surgery

(56:55):
done in Denver by not a bysome specialized in independent but not tied to
a team. We see consults likethat because right now I'm not tied to
a team anymore, but get independentconsults all the time, as does some
of my other partners. So wetreat a lot of professional athletes and and

(57:17):
and we've got more not necessarily freedom, but we can lay out the options
more for the player, patient family. It's et cetera. This is a
topic for another show because you bringup the team physician thing, when when
you are the exclusive consultant for theteam has a different set of limitations than

(57:45):
if you are a second opinion correct, you know, and so it would
be Yeah, that's a whole thatthat'd be. That'll be a great episode.
By the way, great eis wecan get Mayor because with New Orleans,
you know, when we were doingsecond opinions for NFL players, which
I do all the time, that'sdifferent than if you're the doctor for that

(58:07):
team. It's precisely, I mean, that's that's a that's a that's digging
deep under into the weeds. Soyou replace him. So I want to
go to Tony's call before we haveto run out, So you've you've got
a few more minutes. Yeah,So the one caveat in the in the
neck and a cervical spine. There'sa new disc out that's not metal and
plastic. It's made out of adifferent type of plastic and a ceramic a

(58:32):
silicon. Oh yeah, yeah,so zirconium actually so, and that disc
is pretty cool because you can youcan see behind it on MRI scan,
whereas metal discs they create a scatter. So from a diagnostic standpoint, neck
down the road, it's got someadvantages. And we're using this this new

(58:53):
material disc a lot now and I'mreally really happy with So in the first
segment of the show, I wastelling people that inside Sports Medicine, we're
going to try to take the thirtythousand foot view and just kind of give
you big picture stuff, but fromtime to time we get into the weeds.
We're in the weeds right now,we're talking about cerium, and so

(59:15):
thirty thousand foot view is if you'rebeing treated for dist degeneration or discarnation in
your neck and back, don't justjump to fusion. Fusions are becoming less
and less, disk replacements becoming moreand more. That's the thirty thousand That's
the one thing to remember. Ilove this, and let's go to Tony
from Weatherford. Tony, good morning, you're on Inside Sports Medicine. What's

(59:37):
up? Good morning. So I'vehad issues. I turned fifty four about
three and a half weeks ago,Happy birthday. Thank you. I'm not
active during the week. I tendto be a basically a Challe's potato just
because I'm just physically tired and drained. Do officiating all weekend long. I

(59:59):
do sports baseball, football, basketball, so I'm constantly running. But I've
noticed that years ago in high school, I sprained my left ankle bad enough
to where they said I would havebeen better off if I'd just broken it.
That left knee has been scoped becauseof the torn meniscus and repaired left

(01:00:21):
hip was dislocated when I was youngplaying football. Wow, but my left
side is destroyed basically. But myright knee has been really bothering me.
It feels like it needs to popjust inside the left side and the joint,
and I just got to kind ofwork through it and it'll end up
popping, kind of like a licking, lickingmen or something that's kind of hung

(01:00:43):
up, and it'll pop and thenit'll be better. Probably cartilage. I'm
just gonna say this right now.It's probably cartlage. If you had a
meniscus on the other knee, Iwouldn't be surprised if you have a meniscus
on this one. But go ahead, go ahead, Okay. So anyway,
that's the deal on my knee,and my low back tends to bother
me a lot. I mean,it gets tight. I have biadic issues.

(01:01:05):
I try to stretch, and everynow and then if I do the
right stretch and twist, it'll pop. Give me a lot of instantaneous relief.
I'm just wondering is this something thatis just going to progressively get worse
in time or will stretching. Itry to get in the hot tub and
run the jets on them, youknow, pretty often irregular it seems to
help a little bit. But isthis something that I should really go and

(01:01:29):
get checked out and treated or isit something that just will get better with
stretching and just kind of great questions, great question, Scott. So the
good question is is it going toget better or worse with time? Was
that the question? Yeah? Kindof The answer is yes, no.
And maybe the one thing we know, and I tell my patients this,
is that their X phrase slash MRIswill absolutely get worse with time. We

(01:01:53):
know that because that's just again timeand gravity. But symptoms can can they
can wane. So there is noanswer to should I have this operation now
because I know I'm going to needit in the future. That's a terrible
reason the day. Yeah, Idon't know for that one either. So
the answer is we don't know aboutthe future. Because if you do stretch

(01:02:15):
and exercise, and you know,keep as close to your optimum body weight
as possible, it can just getbetter with time and it's not that your
X rays are getting better, it'sjust your symptoms are and that's what we
treat it with symptoms. Now,the only caveat and I've used I've overused
that word, so caveat is aforbidden word in the next show. The

(01:02:37):
only thing I would warn you aboutis that if the sciatic part, the
nerve part, ever, persists,doesn't go away, then yeah, I'd
get it looked at. If it'sjust fifty year old, you know,
ex athlete guide back pain that youcan get better with stretching and hot tubs
and things like that, that's that'spretty normal. Yeah, And I'm going

(01:02:58):
to add a little bit to that, Tony, because as wear and tear,
it sounds like you've been hard onyour body given all the injuries that
you've described. Wear and tear isa progressive disorder, and what Scott said
is one hundred percent true. Whateveris going on in your need tends to
get worse over time. However,the symptoms may not necessarily, so there

(01:03:21):
are things that you can do toslow down the progression of wear and tear.
You know, monitor your weight,reduce your impact, et cetera,
et cetera, et cetera. Thoseare common sense things to do. What
I was thinking back to our oldshow, the last show on the old
network. I don't remember yesterday.What are you talking about? Don't fall

(01:03:43):
for those balance of nature commercials?Where did that come from? Because that's
how we ended the last show,is I got you some balance in nature
because those commercials drive me crazy becauseit's just it's junk science. And this
is why Scott earned the title thederailer. He just derailed the tire constant.
You don't think that that people havequestions about what they see on commercials.

(01:04:04):
It's like, oh, well,yeah I do, But I don't
know what that has to do withTony's question. I made up a question
for him. Oh hey, Isaw on TV this balance of Nature stuff,
So Tony there there. Yes,it's progressive disorder. We're going to
try to do what we can toslow down the deterioration. And now I
got a question about that going offwith what you said a second ago.

(01:04:27):
But you just go ahead, No, go ahead, go ahead and ask
you because we only have one minuteleft. Okay, So you were talking
about, you know, lessening theimpact. I usually keee some kind of
phone tracker or step tracker on myphone or watch or whatever on while I'm
doing this stuff, and on theweekend, I average between twenty and thirty
miles a weekend. Oh good.And a lot of that, especially in

(01:04:51):
football, is running up and downthe sidelines and in basketball up and down
the court. Ye. So there'sdefinitely a lot of impact there. So
I really started thinking about just backingoff on that. Yes. Yes,
And I'm going to throw this outthere because you said something earlier. You
said that during the week you're acouch potato because you're tired. The body

(01:05:12):
doesn't respond well to episodic impact.It would be much better for your body
that if you had some kind ofactivity on a Monday, Wednesday, Friday,
and then the big activity on theweekend. Then to do nothing on
Monday through Friday and then thirty mileson a weekend. It's much better for
your body if you try to dosomething during the week as well. It

(01:05:34):
didn't have to be intense, itdidn't have to be long. But something
will help. It looks like theguy with a stationary bike. Yeah,
just do something, yeah something,Just just move it. Get the joints
limber, don't sit on a couch. Thanks Tony, I appreciate it.
Keep listening, all right, Thankyou guys. All right, Episode eight
hundred and sixty is complete. Don'tforget. You can see Scott Blumenthal at

(01:06:01):
the Center for Disc Replacement up inPlano, and you can come see us
at Texas Sports Medicine. We areour day job is as physicians, and
our weekend job is to help educatethe public. So hopefully this episode was
entertaining and informative. Don't forget tolisten to us next week. If you

(01:06:26):
can't listen to us on your regularcar radio, you can listen to iHeartRadio
app Hopefully we're going to have ourpodcasts on the available as well in the
next week or twos. In caseyou missed any part of this, until
next week on behalf of all ofus here on Inside Sports Medicine and ninety
seven won the Freak. Tell yourfriends