Dr. TO 865

Today we talked about Ja Morants season ending surgery injury he had to get and we are just as confused as fans of the NBA. Also go into a deep converstion about ACL injuries.

Episode Transcript

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

(00:20):
it all down. Buckle up yourchin strap and tighten your laces for the
most informative ninety minutes in sports medicine. It's kickoff time for Inside Sports Medicine
with Doctor t Syale on ninety sevento one The Freak. Good Saturday morning.

(01:03):
Everyone, Good Saturday morning, andwelcome to Inside Sports Medicine. I'm
your host, Doctor TiO. Sorry, I'll live in the studio. This
is your sports Medicine current events show, where the topics are ripped right off
of the sports desk. Over thenext ninety minutes, you will be informed,

(01:29):
entertained, and hopefully learn something new. You will have the opportunity to
call in or text in questions andcomments live in the studio. Today.
Scott's here, Brad's here, Hunter'shere. Garrett's on the other side of
the glass, running the board andanswering the phones. We have a bunch

(01:49):
to get to. Good morning everybody, Good morning Dot, but you can
talk good morning, all right.So this is episode eight hundred and sixty
five for those of you keeping track. I can't remember exactly. I think

(02:12):
this maybe episode six on ninety sevento one in the Freak where we say
what we want. But we've beendoing this a long time. This is
our twenty third season. Yeah.So when I said that you will be
informed, entertained, and hopefully learnedsomething new, I meant it. The

(02:32):
topics ripped right off of the sportsdecks this morning. We're going to talk
about John Morant and the fact thathe's out all year because of a shoulder
injury. A lot of people don'treally understand what is going on. We
don't understand what is going on,but it is an excellent launching point for

(02:53):
a discussion on the sports medicine oneoh one segment which is probably going to
take almost the entire second hour.We're going to talk about ACL injuries.
We're going to talk about where weare today. We have done this in
a while in the past, we'vedevoted entire shows to that subject. There

(03:17):
have been libraries written about ACL injuries, anti acruciate ligament injuries. You can't
watch a college football game, NFLgame without hearing those initials ACL. So
I figured it's probably time to revisitthat. And we have a whole new

(03:38):
audience here on ninety seven to onein a freak, so really a good
thing for us to revisit. Weused to and I think at some point
we're going to do it again.We used to have a camera in the

(03:58):
studio and the most lively entertaining discussionswere during the breaks when when we're not
in front of fifty thousand people.Uh So, I kind of wish we
had the camera because in our preproduction meeting before we started, it was
very interesting. Yeah, well we'reon the freak where you can say what

(04:23):
you want to say. So Iguess riz that's what I want to say
was complete context. It was wellbecause that's that's what we were talking about.
Yeah, that's what we were talkingabout. And oh and sus yes,
sus okay. So the Ja Morantthing is sus oh definitely, sus

(04:47):
Okay, let's give let's give thelisteners of context. So we we were
talking before the show started about termsthat the I guess what we would call
the younger generation bringing home that genz? What is what is the past?
That past that millennials? What isit now? People born in the

(05:10):
twenty first century? My kids iPadkids, iPad iPad kids. I mean,
yeah, that's what they're called nowadays. Really whoa, yeah, you've
got a restaurant. Every kid's gotan iPad. I went to one last
night and the kid was walking outwith this big iPad and headphones and was
like, you don't need that ata restaurant. So he like he was
ten or eleven years old. SoI travel with an iPad because I like

(05:34):
to watch movies and read. That'swhat I download books. I don't carry
books anymore. And uh, formy birthday, I got a grandpa iPad
oversize. I'm so embarrassed, butit's much better. Like actually I had
a mini pad. Now I havelike the full size iPad. I'm like,

(05:56):
well, but I can see itbetter. Well. So the younger
generation, they they have a lingothat they use with certain things. And
you know, my kids range fromeight to fourteen and so I'm learning some
of this stuff. And uh yeah, we were talking about RIZ. So
Doc, we talked to you whatRIZ is? You use it completely out
of context, but you know we'llno no no, no, no,

(06:18):
no no no no, did youjust we're just thrown out. I'm just
throwing words that I just heard.I watched I remember one of these that
streaming series, I think a yearago, and it took place in California,
young Asian kids, not kids,but like twenties and stuff, And

(06:39):
every other time these guys were talking, they probably said word one hundred times
per episode, and it just gotold. I'll tell somebody that the other
day. Can I do humble Bride? Is that still a thing? Humble
Bride? Yeah? Sure, I'mjust curious what this is gonna be about.
We go ahead. It was aboutthe word word. First time I
ever heard it. Okay, Iwas having a conversation with Kobe Bryant and

(07:01):
he said word and turned the guynext to me and said, what does
that mean? What? We werehaving a regular conversation and he says word.
What word is like confirmatory? It'sjust it confirms, like yeah,
right, like man, that's good. It got way over used in twenty
twenty three. I mean it's stillaround. I mean this was ten years

(07:25):
it's still around, but it's gottenway overused. Yeah, someone said something
to me. It's basically I saidword like I agree, that's good.
I'm i'm I'm in agreement with that. Would you say that's that? I
use that right? Okay, okay, So, but riz is completely out
of context. Sus Is was usedin context because you said, this whole

(07:45):
Jamaran thing is sus sus No capis suspect no cap Okay, what is
that funny story about? Go aheadtell them not kidding, I mean real
really no cap no lie, nolie, no lie word, no word.
So, yes, this whole Jamerantthing is us. Here's what's interesting
is that you and I dot wewere in clinic at the same time,

(08:09):
so watching television breaking news Ja Moranout for the thing, out for the
season with shoulder surgery from a tornlabor yeah, and you at each other
like what yeah, why exactly?So we'll we'll we'll break that down.
Other people may not understand, butlike for us, that's questionable because we're

(08:31):
like, he can't finish the season. It happens all the time, So
so let's talk about that. SoBrad used the word subluxation. That just
basically means the joints slipped in andout, did not come all the way
out. If a joint comes allthe way out, you dislocated. So
football players dislocate their fingers. Peopledislocate their shoulder. You know, I'm

(08:56):
not a Dwayne Wade fan, butwhen he dislocated his shoulder and he was
wheeled out in hyah, you know, crying, Uh, Doc had to
look. I'll never forgive him andLebron for what they did to Dirk.
But that's a different story anyway.So dislocation is when the joint comes completely

(09:20):
out and most of the time youneed help putting it back in again.
Whether it's a finger or shoulder ora kneecap, subluxation is just as slips
in and out, Okay, thathappens in the shoulder often often, I
can't imagine that there is not ina football game, whether it's high school,

(09:45):
college or pro where that doesn't happen. At least once somebody subluxes their
shoulder on a regular it's an unstablejoint. It's a The problem with the
shoulder is it's it's an unstable joint. So as a result, if if
you're reaching out to make an armtackle and somebody hit you from behind,
your shoulders going to slip in andout. So I suspect something similar happened

(10:07):
to John Morant, which again happenson basketball on a regular basis. You're
going up for a layup, somebodyyou know goes under you. It happens
all the time. And what surprisedus is that it was surgical and it
was season ending. Why was thisnot we have and then finish out the

(10:28):
season and we do it at theend of the year. So we've talked
to this is a good case becausewe've talked about, you know, how
does sports medicine influence, you know, your life as a viewer or as
a fan whenever you watch sports,and in this case, you know,
for us on the professional side,we see patients like this all the time.

(10:50):
We're thinking, our goal is totry to keep players on the court.
Yep, right, We're we're whatyou have mentioned as safety officers,
were chief safety officers, chief safetyofficers, and so when you look at
John Morant's injury, is what isa typical is Again, we don't know
the whole story. But what isatypical is that on a shoulder subluxation,

(11:13):
that's typically maybe a few weeks out, some rehab plus minus injection to get
you through the season and then postseason. If there's an injury to the labor,
which is the tissue that sits betweenthe ball in the socket and helps
with stabilizing the shoulder, then youcan repair it then. But on a
on a subluxation and not a completedislocation to now you know have season ending

(11:39):
surgery. It's you know, it'sa typical, I don't know the full
story, but it's very sus sus. So then you couple that with the
contract history, Well, now you'regoing a different direction. Now you're going
to the particular situation that jaw isright right the But that's what I'm saying

(12:05):
when you look situationally at what's happened. So like, I don't know the
whole story. Again, I'm gonnakeep saying I don't know the whole story.
But it didn't he just come back. He just came back. Yeah,
a couple of weeks ago, right, Yeah, he was on a
twenty five game suspension to start theseason, right came back one Player of
the week or trending their third tolast in the Western Conference. Don't you

(12:26):
think you'd want to keep that going? Well? In light of how his
season ended last season, with youknow, you know, everything that was
happening off the court, the controversy, the controversies, his his his name
not being seen in the greatest lightin the public. I would think he

(12:48):
would he would want to play anddo everything he can to really try to,
you know, you know, havehis name be seen in a better
lin. I don't want to sayclear his name, but but but to
be seen in a better light.So I don't I don't know. It's
it's interesting. But then you know, we talked about the contract. Yeah,
well, so what makes the NBAmore different than NFL, for example,

(13:13):
is the guaranteed contract. You haveguaranteed contracts in the NFL, but
it's only the top players. Youknow, the top players get the you
know, fifty million guaranteed and signingbonuses, et cetera. But but the
other fifty three guys on the team, fifty two guys on the team,
they have to earn it. Theyit's not guaranteed. So if you're hurt,
you're you don't get paid. Whatis it? What is this saying?

(13:39):
And Hunter, you may know this. You can't make the club from
the tub. It's I think somethinglike that, you can't make the club
from the tub or something like that. You're injured anyway. So the guaranteed
contract in the NBA means that youget paid whether you're on the court or
not, and that that may influencesome folks to maybe take a medical option

(14:09):
that they wouldn't have right taken.Yeah, if it was contract exactly.
Yeah. So, and he justsigned this max season, his first year,
a one hundred and ninety seven millionguaranteed contract. That's a lot of
toy plastic guns. Yeah. Plus, the Grizzlies aren't playing for anything this

(14:31):
year. You got Steven Adams who'sout, Marcus Smart who's day to day.
Usually he hasn't had the healthiest seasonwith the Grizzlies this year. The
Grizzlies in general are just a strugglingteam this year. So I understand doing
the surgery now, Yeah, yeah, I will agree. It was just
out of the blue. Oh jawsout for the season with ending season surgery.

(14:52):
Hey, when so we were talkingabout d Wade, You're talking about
whenever he dislocated his shoulder. Iremember that. Did he come back the
season? It was in playoffs?I think I think it was. I
think it might have may have beena playoff game. Look, it's and
I don't want to get into thatbecause this is way over medical. Okay,
So we're sports medicine docs. Wedeal with sports medicine at every level,

(15:15):
whether you're recreational, whether you're ahigh school kid, a college kid,
on an Olympian. You know,doctor Manner and Manning sees a lot
of Olympians or pros. We seea lot of pros. We don't really
get into the I can't think ofthe word that I want to use.
We don't get into the culture.The Yeah. So at the end of

(15:41):
the day, we're chief safety officersis which is what Brad just mentioned.
But it is our task to allowour patient, our athlete to showcase their
talents. I mean, that's reallywhat it's about. The The the easiest
answer in sports medicine is no,yeah, you better not play. That's

(16:03):
the easiest answer. The most difficultanswer is to allow someone to play in
crucial times. In crucial times,I get it that Memphis may be tanking.
I get it. But on ona John Morant situation, if if

(16:25):
you're trying to showcase your brand,is it really smart to be suspended,
come back for a couple of weeks, and then be out again. Look,
none of my business, absolutely noneof my business. But on this
station we say what we want.Yeah, is it? I mean,
for the value of his brand?Okay, so let's let's play this out

(16:51):
if and again, I'll continue tosay this that I don't know the full
none of us know this. Butlet's talk about a typical situation. Yeah,
sub lux shoulder. I'm seeing JohnMoran in the training room. We've
got imaging. He's got a tornlabrum and you know, and his exam
is what I would expect, hisshoulders hurting a little bit, but you

(17:12):
know, but so write it out, get right pain. If my recommendation
would be, hey, listen,we can get you back. Yeah.
So then the question is was thewas the decision made despite what the sports
medicine physician said that says, hell, okay, yes, I'm taking that
into account, but because of whateverother reasons, I'm going to just go

(17:34):
ahead and have the surgery this year. Yeah. So like we're never really
going to know the whole story.Yeah, quick little break, We're going
to come right back. Two onefour seven eight seven, nineteen seventy one
is the phone number, which isalso the text number. Two one four
seven eight seven, nineteen seventy one. This is Inside Sports Medicine too.
Sorry, I'll coming right back.It comes as it's alliss, Welcome back.

(18:27):
Very appropriate song choice given the factthat the sun is coming up out
our window. Welcome back to InsideSports Medicine. TiO Sorrey, All in
the gang here, Scott Brad HunterGarrett two one four seven eight seven nineteen
seventy one. You can text,or you can call in. We're going

(18:48):
to take your medical questions here ina little bit. So I already said
earlier, and I don't know ifyou guys care, but eight episode eight
sixty five, way way way backin episode six hundred range we talked about
sports medicine secrets, and I'm notgoing to go into it because that was

(19:14):
a whole episode all by itself.You know, don't believe what you read
because that was put together by apublic relations person. When it comes to
injuries, that was one of thesports Medicine secrets. One of the sports
medicine secrets that took me a longtime to figure out, and it may

(19:37):
be applicable in this Ja Morant situation, is that sometimes the athlete doesn't want
to play. Sometimes the athlete justdoesn't want to play. He's got one
hundred and ninety seven million, he'sgot his own life, he's got his
friends, he's got whatever whatever.And by the way, that's not just

(19:59):
at the pro level. Mm hmmm. We've talked about, you know,
seeing young high school kids in ouroffice on a regular basis, and my
knee hurts. So you do everytest in the book and you can't find
anything, and it turns out thatlittle Johnny or little Tammy is not getting

(20:23):
along with the coach or is beingbullied perhaps or whatever, and they just
don't want to play. And thenthe knee problem or their knee complaint is
just kind of a way out thatthat took me years to figure out,
because I would be frustrated. Imean, I can't find anything wrong.

(20:44):
I mean I've done an MRI.Did I did? Was it a poor
quality MRI? Did I miss something? And then you realize when you when
you tell a little Tammy or littleJohnny. That are those the two names
I used before, because I thinkI used the baby. I don't know.
When you tell them, hey,you know, I think you're just
gonna have to sit out, theyget a smile on her face. Well
look, and I've seen this atthe pro level. Sometimes the athlete just

(21:10):
doesn't want to play. So we'regonna talk work comp real quick. Sometimes
a worker doesn't want to go backto work. Yeah, yeah, talk
yeah, I mean and Scott inyour spine world, Uh, and you've
got to see this sometimes they justCology is huge. In fact, when

(21:33):
we do these lumba artificial discs forwhich you're done for low back pain,
they're all screened by a psychologist,a pain psychologist to look at stuff like,
you know, history of abuse oryou know, job dissatisfaction, mirrial
dissatisfaction, all the kind of thingsthat can contribute to either getting better or

(22:00):
better. Does that influence your decision? Well, we've got a because that's
a sensitive we've got a red light, yellow light, green light. If
we get a red light from ourpsychologist, and it's a surgery for subjective
symptoms only, we don't do it. Wow, because because you know,
they're not going to exactly That's whatI was going to ask. So why

(22:21):
do you not do it? Isbecause there odds of a good outcome are
not as good as if they werepsychologically healthy. Listen, this is delicately
that good. No, no,no, this now. I could talk
about this all day long. Iwant to get back to what you're talking
about in regards to jam Morant withthis. But well, no, no,

(22:41):
no, I'm done with that.I just do them as an example.
But sometimes the athlete doesn't want toplay. Yeah, they don't want
to play, But the psychology ofthe patient upon entering your clinic has influence
on whether they get better or not. Oh yeah, I mean you know,
they could have the right diagnosis.All the imaging says that the indication

(23:08):
shows that I need to do thisprocedure or this surgery and any even if
you do it right and you doeverything based on the book, if psychologically
they aren't prepared to be better,they probably won't get better. And on
the other end, it works theother way, and we'll use use tarics

(23:30):
example instead of mine the copper bracesas a colture to my example, which
is balance of nature. I wasabout to say, no, that's you
psychological. Oh absolutely, it's notthe copper and it's and it's not the
ground up vegetables and fruits. It'sthe it's the intervention. It's it's I'm

(23:52):
doing something that they say is goingto work. On those commercials that it's
quote unquote FDA cleared, which meansnothing. By the way, to viewers,
FDA cleared means nothing. It's notfd They don't say FDA approved.
Then it's just a marketing term.It is not anything that that is even
looked at. But that's really goodto know because I didn't know that.

(24:14):
You just watch these commercials, thisis FDA clear. There's there's one that
that shakes your shakes your ankles andbe good for you. Oh no,
no, no no. And that'sat the bottom FDA cleared. It means
nothing. Doesn't look at those things. And and on the commercial says helps
your circulation, helps you, movement, helps any nerve problems. Helps this
helps that. You know. Afew weeks ago, I was going to
talk about this because it caught myattention. I watched the adult it's moving

(24:38):
the feet on its own, andit's like, yeah, and wait,
it's motorized. Yes, it's notlike you're pedaling. Yeah, you're not
pedaling. No, it's moving yourfeet for you. And let me let
me as as a consumer for thoseof you that are listening that are likely
medical consumers, you know now withwith very elaborate websites and marketing and you

(25:03):
know, all these interactive things thata lot of medical practices have. I
hope I'm not. I'm sure I'mgoing to insult somebody if if the only
thing you find on a website fora drug, a device, or any
medical thing like a doctor's office istest patient testimonials run the other way.
Yeah, and I'm not saying becausewe do patient testimonials, but they're on

(25:26):
the back of our web page andthe front of it is educational material data
all that stuff. Testimonials are nice, but if that's your only way of
marketing testimonists should contribute to that's theonly marketing you have, then that's then

(25:47):
it's because you don't have anything elseto hang your hat on. And and
the the ads this product changed mylife, right, what was your life
like before? Well? I loveit because there, you know, they're
they're showing the person's feet getting pedaledwhile they're sitting there and it's some nd
shape person, you know, withtheir feet getting pedaled, and they're like,

(26:07):
yeah, this is great. I'mlike, and by the way,
they must make a lot of moneybecause that ad runs all the time.
And I'm and in the beginning,in the beginning, when I first saw
it, I thought, okay,so, yeah, so you know what
a eighty year old lady, thatmay be a good thing to do.
Just sit there and pedal and pedaland actually get your muscles firing and and

(26:30):
maybe break a little bit of asweat. Yeah. But then a few
more observations and I saw an electricalcord. Yes, and I thought,
wait a second, she's not peddling. It's just moving. It's just moving.
Yeah, it's it's just Grandma,I bought you a jiggler and your
feet and you can upgrade for thefive mile an hour version, which allows

(26:55):
Yes, you got to listen tothe word for real, you know,
you upgrade up for the the fivemiles per hour version. Wow. Yeah.
Do you think I'm ever gonna getsued by balance of nature? No,
I think they're gonna. I thinkthey're gonna ask you to be a
part of their testimonials testimonial campaign.No everybody has the price. There you

(27:18):
go, Scott Leverage that said,because well I evolved, I evolved in
my thinking. Yeah, yeah,look again, Yeah, I did try
this FDA cleared thing, so thisf D and I do want to revisit
that because I found it fascinating andI did not know that that was a

(27:38):
thing. All that means is thatthe FDA did not look at it right,
that the FDA actually says this productis okay. Well, what is
cleared me means nothing. FDA approvedmeans the f D a study company had
to study it, submit it tothe FDA, and the FDA had to
find it safe and affective. That'sFDA approved, safe and effective. Anything

(28:03):
else means it's market It's a marketingtool. So the FDA doesn't clear anything
it approves, So it's not so. I guess when they say cleared,
they just hadn't been removed off theshelf from the FDA. I guess I'm
trying to think of that. Yes, it means, it means nothing.
It's just a confusing marketing term.FDA approved is what the FDA does,

(28:26):
and I've done FDA studied. SoFDA doesn't clear anything they approve and that's
a very rigorous process. So backto this whole idea of patient doesn't want
to get better, right, Yeah, So one of the reasons why I
went into sports medicine is because typicallythe patient has a motivation to get better.

(28:53):
Yes, as we sit here practicingphysicians, we have had to rotate
in other fields of medicine where sometimesit feels like I don't know if the
person sitting in front of me actuallywants to participate in themselves actually getting better.
The reason why I went into sportsmedicine, I'm like, Okay,

(29:15):
these people have a motivation. Iplayed sports, they want to get better,
So I agree with you, Doc. Is confusing when I'm sitting in
front of a patient, I'm assumingyou want to get back to whatever it
is, work, pickleball, walking, And when everything says objectively you're fine,

(29:37):
but they're they're still hurting, It'slike, what, I don't understand
what's happening. Look, I'm notit's not common. I'm not common in
our world, and our world isnot common at all, but it's happened
enough that I think it's a thing. Yeah, it's a thing that sometimes
the athlete doesn't want to play forwhatever reason different for whatever reason, they're

(30:02):
not getting along with a teammate,or they don't think they look good in
the uniform, or I don't Idon't know. No, no, no,
no, no, that's great stuff. Yeah, but these are all
these are all upper level, youknow, a lot of trial and error
learning. Speaking of upper level,a lot of trial and air learning.

(30:22):
Sports medicine one oh one. Todaywe're going to talk about ACL injuries,
and only because well, first ofall, I've devoted my entire career to
this, thirty five years of studyingacls. But there was a story on
the local news. I think itwas last Thursday, Thursday, that study

(30:45):
came out that said that ACL injuriesare eight times more common than female athletes.
That's old news. We've known thatfor thirty years. I wrote about
that nineteen ninety one. And sothey interviewed a sports doc and the whole

(31:07):
story was maybe forty five seconds.You know, the whole story was very
short, and I didn't see hisname. I didn't catch his name.
It wasn't written on the TV.And he, you know, he kind
of stated the regular facts, youknow, that there are a lot of
reasons why this is more common inwomen, you know, hormonal and whatever,
whatever. And at the very end, the question was asked, well,

(31:33):
what can they do? And hesaid, and I'm not sure if
he said this or the reporter saidthis, but there are exercises that you
can do to strengthen your ligaments.And I thought I was gonna throw something
at the TV. No, thereare no exercises out there to strengthen your

(31:56):
ligament. Yea, yeah, sodon't you think we would have known that
by now? So let me letme clarify for the listeners. Thank you.
Muscles can be strengthened. Absolutely.You can strengthen a muscle. You
can go in the gym, youcan put some reps in, you can
put some weight on the bar,and your muscles can be strengthened. You
can stretch, you can you canstretch your tendons. Stretch your tendons.

(32:17):
Absolutely, but it's gonna be realhard. And I don't know if we've
figured out at this point in medicinehow to how to strengthen a ligament,
which is the tissue that connects boneto bee. Hunter and I have talked
about how to strengthen the ligament,put in an internal brace. We've talked
about that, but there are noexercises for that. No, not to
strengthen a ligament. You can't strengthenan A C L. So I'm just

(32:43):
assuming that people know what a ligamentis. So let lets let's let's do
sports medicine one on one on thislast second before we last few seconds before
we have to go. Bones arepretty easy, two hundred and seven.
Bones. It's a it's the skeletonthat is in the owner of most science
classrooms. Cartilage, it's gristle,it's padding. Cartilage is the white cap

(33:10):
on the end of the bone whenyou eat a drumstick or a chicken leg.
And when that cartilage wears out andthe bone is exposed, that process
is arthritis. You know you hearold people talk about bone on bone.
Well, that's because the cartlage isgone. Ah, doctor says, I
don't have any more cartlage in myknee. Yep, that's cartilage. Ligaments

(33:30):
are the structures that hold the bonestogether. So you've got ligaments around your
finger joints, You've got ligaments onyour shoulder, you've got ligaments in your
knee. You've got ligaments in yourankle. Ligaments are the structures that stabilize
the joint. When you sprain anankle, you're damaging the ligaments. And

(33:51):
so the reason why Inside Supports Medicineis on the air after twenty three years
was because of a story that cameout about EMMITTT. Smith. EMMITTT.
Smith sustained a third degree ankle sprain. In our world, that means you
tore all the ligaments, right,okay, And the newspaper article said EMITTT

(34:16):
Smith sustained a third degree ankle sprainbut fortunately no, fortunately no ligament damage.
And I thought, what where didthe reporter get that? Because a
third degree means ligament damage. Andthat's when I realized that, you know,
maybe there's a place for a showlike this where we kind of explain

(34:37):
this stuff to him. So whenyou sprain your finger, when you sprain
your knee, when you sprain anything, you damage the ligament. It's a
matter of degree. Did you stretchit, did you rip it in two?
And muscles and tendons are what movesthe joints. So the prototype tendon
is the Achilles tendon. It itis the ridge between the muscle, the

(35:00):
calf firing, and the joint moving. Brad has some good experience with achilles.
I'm a professional achilles terror. Yeah, professional terror and healer and healer
and healer both. You've done reallywell. All right, quick little break
and more on this subject. Howdo we treat planner fasci itis? Man,

(35:22):
that is a tough one. Well, if we have time, I'm
gonna answer that question. Yeah.Two, one, four, seven,
eight seven, nineteen seventy one,call in, text in your questions.
More to come on Inside Sports Medicine. Welcome back, Welcome back to Inside

(35:51):
Sports Medicine, TiO. Sorry,I'll hear live in the studio. The
Beatles are just the generational group.I mean every generation they'll span, every
generation doesn't matter. You know.I wasn't a Beatles fan until late in
adulthood. Yeah, and then Irealized how far ahead of their time they

(36:14):
really were. Yeah. Yeah,you know, you listen to some of
these songs and they're truly timeless.And the fact that they were what seventy
years ago, it's the mind boggling. I am told by Garrett that our
podcasts are now loaded. Would youtell everybody how to access them? Of
course. So if you have theiHeartMedia app, which is free on any

(36:37):
app store, you go to Androidor iPhone, you can look up inside
sports Medicine podcasts and you will belooking for a inside sports Medicine picture that
is blue, white and red.So otherwise red, white and blue.
Yes, okay, it's early inthe morning. I had one cup of

(36:58):
calls. Yes, and you goon there. There is five episodes to
listen to. After today's episode,I think there's five one, two,
yeah, yeah, five, episodesix. After today's episode, we will
have another one posted. There'll beepisode eight sixty four and all six episodes
will be there and you can listenanytime you won. It's free, enjoy

(37:22):
it, listen to wherever. Ifyou're at the gym, out for a
walk, a stroll, at thegrocery store, shopping, wherever, you
can listen to them. So onceyou edit them and take out the ads,
how long is it in our sixhours seven minutes? So not that
bad, No, not at all. It's a if you're listening to like
a sports podcast, usually typically aroundthe same So how do we have a

(37:46):
way to access or tabulate how manylisteners we get on how many downloads on
the podcasts. I guess that's asubject for us internally. Then yeah,
I would have to look into thatall right too. I'm guessing, uh,
all right, so I want togo back to the ACL thing.

(38:13):
There would not be a field ofsports medicine if the ACL was not so
prominent and prevalent. Folks have beentearing. Humans have been tearing their acls
since the beginning of time. Whenthe caveman was running away from the dinosaur

(38:37):
and planted to change direction, thecaveman probably blew out his ACL, and
he probably got back on his feetand eventually was able to run away from
mammoths. But anytime the caveman neededto plant and change direction, problem,

(39:00):
that was a problem because the ACLdoes not heal. The ACL. The
anti acruciate ligament is suspended in theknee between the femur and the tibia,
kind of like a guitar string,like a rubber band, and it does
not stretch. Well, I guesstechnically it stretches a few millimeters and then
ruptures, but it's not elastic.Okay, it's not elastic, and you

(39:22):
can't strengthen it. So once youtear your ACL, once you plant and
your knee and that you hear thatsickening pop. Two of us in this
room have heard that there it doesn'theal. So even though the acute phase
subsides, the swelling goes down,the motion returns, the knee is always
going to be rendered unstable. Andso for the cave man, he probably

(39:45):
couldn't cut left to get away fromthe mammoth. You could run straight,
you could cut right, but youcan't cut left because otherwise your knee is
going to give out. So inthe seventies, with the the advent of
arthroscopic surgery, we were now ableto look at the ACL, and we're
looking at where where it originates andwhere it inserts, and what it really

(40:08):
looks like when it's torn. AndBill Clancy out of the University of Wisconsin,
Scott has met him several times,came up with a way to substitute
for the ACL using a piece ofyour kneecap tendon. Believe it or not,
that is still the same procedure we'redoing now. It's been what twenty

(40:31):
can't do the math that fest it'sbeen fifty years. That's the same procedure
we're doing now. So once youtear your ACL. What we do is
we substitute for it, and wetake a piece of your kneecap. That's
the gold standard. Sometimes we takea hamstring and double it over three or
four times. Sometimes we take acadaver, a dead person's patell or tendon,
and then the end of the daywe're just giving you a new ACL.

(40:55):
The biology of this injury is ithas to heal, it has to
become incorporated into your knee structure.That takes time. How much time we
don't exactly know because we've never putone in and a human and then gone
back in and taken it out.I will tell you the Scandinavians of biopsied

(41:20):
acls and looked at the biopsy undera microscope. But you realize that when
you take a bite to the ACL, you're weakening it. So I can't
imagine that man tough to get byyour ethics committee at a Yeah, it
would be tough to get by yourethics committee at the hospital. But we've
done those studies on dogs, rabbits, monkeys where we've gone in and taken

(41:40):
the ACL out and looked at itunder a microscope and guess what in the
animal studies. It can take upto a year for it to be fully
incorporated into a monkey knee or adog knee, so in humans it probably
takes about a year to do that. Now it has suff efficient strength so

(42:00):
that you can come back eight nineten months later, not fully healed,
but eight nine ten months later.It boggles my mind that there are orthopedists
out there that don't understand this veryimportant piece of the puzzle, the biology.

(42:22):
I just heard the story the otherday that a young football player,
high school kid, retore his ACLsix months after the initial surgery because he
was released to go back to play. Yeah, six months is quick.
Six months is quick, real quick. There was a trend, you know,
there's an advantage to having gray hair. There was a trend back in

(42:43):
the nineties where, oh gosh,I'm blanking on his name. It was
an accelerated rehab program where you cancome back in four to six months after
an ACL okay, which means thatthe swelling's gone, in motion is back,
and your strength is there. Andthat I was a shellborne guy named
Shelbourne, a big name in theworld of orthopedics. So he was proposing

(43:07):
this accelerated rehab program. And youngboys and girls were trying to come back
at four to six months out.The recurrence rate was through the roof.
It has since been abandoned. Somebodyforgot the biology. Even though you got
your motion back, even though yougot your strength back, even though your

(43:28):
muscles look fantastic, the new ACLis not healed yet. Yeah, so
coming back at four months is arisk. It's a rolling the dice.
Yeah, you may get away withit, you know, we talked about
this with Aaron Rodgers. We talkedabout him the biology of an achilles repair.
You can't change the biology of therepair if you come back early.

(43:52):
Yeah, you may be able toget away with it. Yeah, but
you're taking a risk. Physiology,biologies just takes time. It just takes
time. So look, why arewe talking about this because they're still in
twenty twenty four. There's still somebad stuff out there. There's some bad
advice, there's some bad surgical technique, there's some bad stuff out there.

(44:15):
And yeah, I have the platformand I can talk about it and I
can say, you know what,this is the science and this is what
we do. There's another aspect ofthis, and that is the follow up
and the rehab. I tell allmy patients, my ACL patients, the

(44:37):
rehab is as important, if notmore important, than what I did.
Definitely, So me putting in anew ACL in there is that's just half
the battle. You got to getthe motion back and it's got to be
proper. So Hunter doesn't like thisbecause he's with me and clinic. I
see my ACL patients once a weekfor a month, and that's highly unusual

(45:00):
nowadays. Most of the time they'llget an appointment that will see you in
a month, and when they comeback, they're being seen by them or
the PA or whatever. Close followup is vital. It's vital because if
you don't get those last couple ofdegrees, you're gonna limp forever and ever
and ever. And so I doit. I haven't come in. You

(45:23):
don't get paid for that. It'sall part of the global fee. So
I do it for free. Again. Hunter makes fun of me for that.
But you know, and I knowthat acls are a long way from
what Scott does. But I wantto ask you about the rehab after a
disc replacement. You don't do youreally need the close supervision after you replace

(45:45):
a disc? Mean, it's kindof a yes and no thing. It's
not a weekly deal because you know, you've gone over the protocols with your
physical therapists and nursing them a coupletimes a week for probably about the first
six weeks or so, check acouple of X rays along along the route,
you know, a couple two weeksand six weeks, and then obviously

(46:07):
kind of forever after that. Butthat initial rehab period is more intense,
with more with the physical therapists,and if they see any red flags,
they'll they'll come get us and we'llwalk over there. The other problem is
we see so many patients from outof town oh yeah, that we have
to kind of give them instructions togive to their local physical therapists on how

(46:30):
to rehab an artificial disc. Sokind of had to make it more cookie
cutter. Well, but and II don't mean to insult you or or
offend you in any way possible,but in your line of work, the
surgical technique is paramount, no question, okay, And so so in the

(46:52):
ACL, in my world, it'sfifty to fifty. I need to do
a good job and then rehab needsto do a good job. In your
disc replacement. Would you say it'seighty twenty technique that's a tough one.
In the cervical spine, probably yes. In the lumbar spine, I think
it's it's more sixty forty fifty tofifty because rehab it's real important in the

(47:15):
lumbar less so in the cervical spine, and it's just because of the forces
that go through that. And it'salso done for you know, again this
is getting into weeds a little bit, but for slightly different diagnoses in the
neck and the little back, differentproblems. So back back to the ACL.
So the diagnosis is pretty straightforward.Now that we've got MRIs and and

(47:37):
we have videotape. It's funny we'vebeen talking about this in the office on
a NFL telecast. You can tell, oh, he towards a cl y
know, you can just see it. Yep, the knee just buckled a
little bit. You can just seeit. So now we've got video,
we've got MRIs. You know again, when Clancy first did this, they

(48:01):
didn't have any of that. Itwas an examination of a really swollen knee
that was full of blood and youjust, oh, we used to do
what they used to do diagnostic evalveswhere basically we're gonna look in the o
R and if it's torn, wewant your permission to fix it. Yeah.

(48:22):
Now nowadays, obviously everything is donein advance, and so the diagnosis
is not that difficult anymore. Althougha few weeks ago I told the story
about the young man that was misdiagnosedas a ptellar dislocation, never got an
MRI, but anyway, But so, for the most part, diagnosis of
base al injury is pretty straightforward.The surgical treatment is pretty straightforward. The

(48:49):
rehab is to me, I justhave to emphasize it, and I also
have to emphasize the biology. Itjust takes a while. And we had
a we had a patient the otherday, young lady, very good soccer
player, very good soccer player,and from from day one she said I

(49:10):
was her second opinion, or maybeI was a third opinion. She went
to see one doctor and said thathe'll have her back in six months.
And she came to me and shegoes, well, doctor so and so
says he'll have you back in sixmonths. I said, yeah, you
probably can be coming back in sixmonths, but it's risky. And I
also said even after eight months,even after you wait, it's still risky.

(49:31):
You know, it still might teara second time. And I said,
I'm not going to compromise on that. And every single visit we have
the same discussion, Yeah, canI come back? It hadn't been eight
months yet, Can I come back? It hasn't been in and and the
thing is, she really did agood job with the rehab. You know,
there's no swelling, there's no bruising, she's got full motion, she

(49:53):
does not hurt, so so sheit looks normal. So one of the
things I tell my patients, andit's probably true for you when it comes
to a c LS, is you'regonna feel better before you are better.
Absolutely, you're gonna think you're better, but you can you can't steal that.
You're gonna you're gonna you can playtrademark. I said, you're gonna

(50:13):
feel better before you are better.Yeah. I mean, because particularly in
our world, they want the majorityof our patients want to get back.
Yeah, and when they start feelingbetter, they're like, I think I
can go, and you probably feellike you can go, but you can't
go. So I explained to mypatients what we see on imaging delays behind

(50:35):
oh yeah, yeah, yeah,so you're always gonna feel better than how
you do, whether you really arebetter. And one last point, because
I gotta take this break. Ican't tell when the a c L is
fully healed. Well, you can'tpop going the MRI. I can't tell
it's biology. It's it's biologic.And so we're not gonna buyop see it.
We'll leave that to the Scandinavians whenI examine it if feel stable.

(51:00):
So I don't really have anything otherthan a calendar to tell people that,
hey, I think your ACL mightit be healed in six months? And
some people sure, do you wantto take the risk? I don't wan.
Yeah, all right, quick littlebreak. Lots and lots of text
questions. We're going to do ourbest to get to those. Also,

(51:22):
you know, I forgot to dothis. Many of you are listening on
the app. I'd be very interestedto know how far away from Dallas Fort
Worth some of our listeners are.So if you want to text us two
one, four, seven, eightseven, nineteen seventy one and just put

(51:42):
in a geographic, I'm listening fromblank inside Sports Medicine TiO. Sorry Scott
Brad Hunter, Garrett, all ofus coming right back. So movie ye
yeah, yeah, yeah yeah,welcome back, Welcome back to Inside Sports

(52:15):
Medicine TiO. Sorry, I'll herelive in the studio, Big games to
play Beatles, all right, So, lots of texts, lots of texts
two one, four, seven,eight seven, nineteen seventy one. You

(52:36):
can call in as well. Brad, you want to feel that meniscus PRP
question since you do a lot ofthat. Yeah, so it says torn
medium miniscus. How long after injectingPRP do you know if it was successful?
And then I had a question saying, well, depends on what kind
of tear it is of the mediaminiscus. You can have in a cute

(52:58):
tear like you run uncut boom tearyour meniscus, or you can have a
degenitive tear, meaning that it's justkind of wear and tear over time.
Uh, difference between like having aslash of the tire or your traad kind
of wearing down. You know.So don't you tell people what PRP is?
Yeah? So PRP stances for plateletrich plasma. Uh. Basically what

(53:19):
we do is we bring in theclinic, we draw your blood, we
spin it down, we take thethe concentrated platelets and growth factors that are
that are in your blood to tryto help serve as an anti inflammatory pain
reliever and sometimes depending on where weput it, regenerative mechanism. So,
uh, to answer the question,they actually I asked the question what type

(53:40):
of tear it is that maybe theyhurt me. I don't know, but
it says it's a chronic medial meniscusdegenitive tear with degenitive joint disease worse and
medial than lateral. So really,this is not just this question. This
is an arthritic knee. Yeah,this is an arthritis question. So yeah,
to just educate real quick, degenitivejoint disease means, like you were

(54:05):
talking about earlier arthritis, the cartilageis wearing down in the knee. Subsequently,
you get a degenitive meniscus in thesame setting. So what you're really
dealing with is arthritis, not necessarilythe medial meniscus tear media or lateral meniscus
tear. So PRP can help inthat setting. There's been a study that
shows that it helps, that PRPhelps more than what has been used for

(54:27):
ages, which is the jail injectionsuronic acid and steroid. So yes,
it can work. How long Itell my patients anywhere from about four to
six weeks. You'd be able totell a difference. It doesn't work fast
like steroid injections, but it doeswork longer. And it doesn't work in
everybody. No, but we've gotmore data to show that it's working.

(54:51):
There's got to be a certain concentrationof playlist. Right there, you go,
there's a question about plant of fashion. Did you want to talk about
that? Well, so plant fasciitis, which is fasciatis a lot of
that's not a word we use veryoften now, No, No, yeah,

(55:12):
so planet fascia iis relatively common problem. You know, morning pain,
first few steps, it feels likeyou're walking on razor blades. It's a
difficult problem for all of us totreat. And what's the best way to
treat it. I don't know.And that's why it's so difficult. You
have to kind of throw the kitchensink at it. So they're stretching,

(55:32):
there's icing, there's shoes, there'sorthotics. You just have to throw the
kitchen sink at it. And sometimeswe do cortizone shots, although they're extraordinarily
painful. Sometimes we do PRP,and I've had really good luck with PRP
for planet fasciatis. But I'll tellyou what. Patients don't like it when
you're sticking a needle in the bottomof their foot. It's real. There's

(55:57):
just not a really good take thisand you'll be better answer. Uh,
But you just have to throw thekitchen sink at and you have to be
patient. The problem with planeti fasciitisis that it's not a dangerous problem.
No, it's a nuisance. Butit hurts like hell. It does hurt
like hell. Yeah. And Ihad a patient the other day. He
said he's had he's been battling plantarfasciatis for a long time and he was

(56:22):
on a run or something and somethingpopped in the bottom of his foot and
it was killing him. And hecame in and I said, you just
treated yourself. Yeah, yeah,the planto fascion rupture was. You just
solved your problem. The surgery isjust to release the ligament. Yeah,
you know real quick about that.Pr P and the meniscus tier. PRP

(56:44):
doesn't fix a meniscus, Oh no, right, because I think that was
part of the question is does itIt doesn't fix the meniscus, and we
know that, but it does serveas a great anti inflammatory and and and
pain reliever for it. And inhis circumstance, that's what he's looking for
because ourritus is more of a painrelieving yeah issue, not can you cure
arthritis. So for planofasciatas, Itell my patients, listen, you probably

(57:10):
haven't stretched enough. If they toldme they were stretching five times a day,
I'd probably say you're still not stretchingenough. If they said seven,
I'll probably say stretching nine. Stretch, Stretch, Stretch the heck out of
that thing. Try to you know. I tell people, buy like a
little to crossball and just step onthat thing right at the point where it
hurts. And you're probably not doingit right unless it hurts, just to

(57:30):
try to get some kind of bloodsupplies to that thing, but it lingers.
Unfortunately. I have plantofracciatis a fewyears ago, and the optimal time
to stretch is when it hurts themost. Yeah. Yeah, So if
you wake up in those first twosteps are bothering you, stretch, Yeah,
stretch. Scott, do you havea planner fasciatis version in the spine.

(57:52):
No, but I've had plantar fasciatisand yeah, are you're right?
You have to be patient. It'sit's gonna get better. You take your
anti inflammatories stretch. I wouldn't dothe injection. Yeah, I know.
I'm just saying I wouldn't. I'mnot saying others shouldn't. Yeah, I'm
too much of a whimp. Samehere. I've had same here. I've

(58:15):
had it before, and I wouldn'tget PRP at my own heel. I
mean, I do it, andI've done it before. Yeah. Usually
I'm telling patients, look, that'llbe the last thing. I'd probably go
for an amputation rather than injection heel. Yeah, yeah, yeah, So
sometimes we have to do those uncomfortablethings. Ah. We'll probably circle back

(58:37):
to this ACL thing at some pointin the future because this is this is
a problem that is not going away. One of the exciting aspects that I'm
doing a Texas sports Medicine with ACLS. We're trying to figure out a way.
I told you earlier that I've devotedmy entire career to this and and

(59:00):
I've had ACL injuries and I've hadACL surgery. And what we're trying to
figure out is why is this soprevalent? Why is it eight times more
common in women? Why? Whyis why do we have five hundred thousand
acls a year and seems like thevast majority of them are on Sundays when

(59:22):
you watch TV. And what isit that we can do to try to
change that. There's been I toldyou earlier, libraries written on ACL injuries
libraries, but very little has beenwritten on the why and the prevention.

(59:42):
There are lots and lots of theoriesas to why. Oh it's the kind
of shoes you wear. Oh no, it's the AstroTurf. Oh no,
it's that time of month. Andthere are lots of different But what what
has actually what has actually been proven? The only one of the possible ideologies
that has been proven is actually apaper that I wrote, the folks who

(01:00:07):
have a narrow notch have a higherrisk of ACL injuries. And narrow notch
is something you see on the Xrays. It's where the ACL lives.
By the way, that study hasbeen published in every language on the planet
twenty six thousand times. And yeah, so that's again humble brag. But

(01:00:30):
the point is ACL injuries end upbeing a physics equation. Yeah, it's
a physics equation. I remember Hunter, which is I'm glad you're in a
room here today. When we weretalking to your parents about fixing your ACL,
the one thing that I said isyou're big, you're fast. I

(01:00:52):
cannot put a substitute that is goingto overcome the physics equation. I just
can't. There's not one available.And it is a physics equation. You're
you're running full speed and this thisis we've talked about this in the NFL
before. Bigger, faster, stronger. Yeah, okay, the guys are
bigger, the guys are faster,the guys are stronger, but the ACL

(01:01:15):
is not any bigger now than itwas when you were seventeen, or stronger
or stronger. So bigger, faster, stronger. You are going what is
it, a four to three fortyand you're changing direction on a kickoff.
It ain't gonna hold up. Yeah, you know, the vast majority don't
hold up. And so we haveto figure out a way to address the

(01:01:38):
physics equation. And I don't knowexactly how to make the ACL stronger but
we're working on We're working on augmentingit with an internal brace. Now,
mind you, it does take.It is a surgical procedure. And you
know, so far I've only donefour, but I've put in an internal

(01:01:59):
brace and all my ACL reconstructions nowfor the past six or seven years,
and Hunter's going to be looking themup to see what the recurrence rate is,
to see if we you know,if if augmenting the graft, which
is already bigger than your original ACL, if that actually lessens or decreases the
likelihood of a retear. So far, knock on wood, I think it

(01:02:22):
is. So the next logical stepis, okay, well, if it's
augmenting the new graft and making itstronger, can it be used on the
native ACL, which we know isalready too little to begin with. I
don't know. Time will tell,but this is uh, this is the
kind of exciting work that we're doing. If you were to this is off

(01:02:45):
the wall, redesign the knee.Yep, how would you redesign a human
knee? I'd make a bigger aCL. It's that simple, just a
bigger ACL. Look, and thisis not this is not rocket science.
And then the idea of preventative surgerewidening the notch and making a bigger ACL
makes sense. That's that's it.I mean, it's this. This is

(01:03:07):
not that complicated. It's just notthat complicated. It's a physics equation.
Your shoes are sticking to the turf. You're asking the knee to make a
ninety degree cut while you're running attwenty miles an hour, and the structure
that is asked to hold it togethergives theoretically, it gives. If you
could also find a genetic marker.Oh, we're looking at that Scott's artificial

(01:03:30):
intelligence. It's we already know that, then you could make the case that
it would be cost effective to justlike you know, go into the dental
hygienists have your teeth cleaned twice ayear. Oh guess what, you know
you need to have implants put inyour ACL and have your notch widened if

(01:03:51):
you're going to be an athlete.And then we get a FDA cleared approved,
Yeah, that will require it requiredthat require approval not to Well,
so here's so, first of all, I know you and I have had
this discussion before because we have theseincredibly boring discussions when we drink scotch.

(01:04:12):
But if it's a physics equation andit's happening, three quarters of three fourths
of all ACL injuries are non contact. Now, if it's contact, it's
a whole different animal. You know, if you're playing football and a three
hundred and fifty pounds lineman falls onyour knee. I don't care what your
genetics look like, but there's clearly, and I've actually investigated this at ut

(01:04:38):
Southwestern and at Stanford, there's clearlya genetic marker. The genetic marker is
not necessarily one gene. I mean, it could be a thousand genes.
But this seems to run in families. I keep using you as an example,
over and over and over again.Your brother's torn both acls, your
mom's torn both acls, You've tornin ACL. There's got to be a

(01:05:01):
genetic marker. There just has tobe, And these stories are out there.
What is the gene four? Well, there's some people that have big
hands, some people have little hands, some people have big nos, some
people have little nose. Some peoplehave a big ACL and they're protected,
and some people don't have a bigACL and they're not protected. We're trying
to figure out what the genetic markeris. The first step? Am I

(01:05:25):
boring people? I think I maybee boring people. Oh. The first
step is to get these families whereit seems prevalent and find out what their
gene code is. And then geta whole bunch of normal people and find
out what their gene code is,and then have some analysts look on the
microscope and see if they can finda marker. Another way to to evaluate

(01:05:49):
it doesn't there's nothing definitive would bea prospective evaluation of identical genetically identical twins.
They've done it, Oh, inScandinavia, absolutely, and and I'm
sure they found through the roof becausein the through the roof, in the
spine they found similar rates of disdegeneration things like that that there is obviously

(01:06:11):
genetic component. What the gene is, no one really knows. So the
Scandinavians have been looking at ACL injuriesand they have medical records on every body
in Sweden, and they went backto nineteen eleven. They've got I don't
know, hundreds of thousands of datapoints for acls, and they've done identical
twins going back to nineteen eleven.And it is overwhelmingly genetic. Now which

(01:06:40):
gene it is, we don't know. Yeah, that's a toughie. That
is a toughie. It is atoughie because, look, I don't know,
maybe one hundred years from now,we can manipulate the genes. So
instead of instead of putting in aninternal brace on little Johnny, we figure
out how to manipulate the gene sothat you don't have diabetes anymore. Then
well, wow, that was amazing. This is very nerdy, but then

(01:07:02):
you a nerdy but for all youthen you've got con genetically engineered one of
There was an old Star Trek episodethat was revived in the movie series on
genetically manipulated humans like superhumans. Ithink they kind of do that now,

(01:07:24):
Yeah, what that sounds us?That fourth I don't think I miss what
you're thinking, miss Princess Bride reference. I love that. By the way,
doctor says, keep blowing up theknee running five k's Does a brace
help with this type of problem surgery? Should I just give up heavy running?

(01:07:47):
I don't think you blow out aknee running. So my guess is
their knee might be swelling because ofrunning, and that's usually going to be
something closer to arthritis. I don'tthink it brace helps this. Which did
he say? I can't read itfrom this far. Did he said blow
out or blow up? I mean, because if he's talking about swelling,
that usually means debris keep blowing upthe knee. With blowing up, I
don't know what that means. Idon't know, but uh, an internal

(01:08:09):
brace probably won't help with that,but you probably should get an X ray
and get it seen to see whatthe actual diagnosis is. Someone that's listening
from Chicago, Yay, that's thefarthest way. Then it doesn't. It
doesn't beat kazim l. We've gotsomebody listening from the mean streets of Highland
Village apparently. Yeah, those arenot mean streets. I think it was.
I think he was being facetious.Ummm. Someone said that losing weight

(01:08:34):
helped their planeto fasci itis. Ithink losing weight would probably help more than
just planet fascia itis, probably helpa whole lot of stuff. Yeah,
So seventeen twenty two wants me topost a link to the narrownach acl paper
interesting readings. It'd be boring foryou. Yeah, I'm so sorry.
No, no, no, no, no. Listen. If you nerd
out like we do, just googleit narrow notch acl soryal. It'll come

(01:08:57):
up in twenty six thousand different languages. You can choose what language. And
it's so funny because if so firsttime I ever saw my paper published in
Chinese, it's it's Chinese letters andthen sorry, all is in English,
and I thought, well, Iwonder what they said about me? Anyway,
all right, episode eight sixty five. Hopefully you learn something today.

(01:09:24):
Hopefully you are entertained. We gota I'm sorry. We can't answer all
of the questions. We're gonna tryto answer them. Back in the older
days, we used to say youcan email us, Brad, do we
have a Do we have an email? We can say, is it on
the website? Ask doc? Iwant if it's on a website. On

(01:09:45):
the website, we still have anask doc. You can go to website.
Yeah, go to inside your TXsportsman dot com. There's an ask
doc and you can kind of emailus that runner. Listen if you if
you want to run and you're havinga problem still running, just see a
sports medicine doct. You can comesee us. I do want to take
this time to thank our sponsors Jaguar, Landrover Dallas, part of the now

(01:10:10):
automotive family, Backendorf Jewelers since nineteenforty eight. Texas Sports Medicine, Performance
and Recovery Center, the Center forDisc Replacement. Yes, where doctor Bloomenthal
disc lives replacement. Yeah, lastweek there was a little bit of a
slip up there last week on behalfof all of us here on Inside Sports

(01:10:31):
Medicine. Don't forget to go toiHeartMedia app and download the podcast if you
missed any part of this, oryou can come see us. Come see
us at Texas Sports Medicine. Untilnext time, tell your friends and the