Dr. Richard Rames, Jr. sheds light on the importance of joint health in maintaining both physical and mental well-being, discussing preventative measures and advances in orthopedic treatment. He provides insights into effective strategies to reduce injury risks, emphasizing the role of exercise, weight management, and nutrition.
• Understanding common orthopedic injuries and their treatments
• Importance of joint health for overall quality of life
• Advances in hip and knee replacement technology
• Role of exercise and weight management in injury prevention
• Nutrition's impact on bone health and inflammation
• Addressing gender differences in joint issues
• Risks associated with popular exercise trends
• Strategies for self-care and injury avoidance
If you’re keen on enhancing your orthopedic health, we encourage you to follow Dr. Rames's advice and discuss with your primary care physician.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello, this is Jason Edwards.
Welcome to.
Speaker 2 (00:02):
Doc.
Speaker 1 (00:02):
Discussions.
Today I'm going to talk to DrRichard Ramis, an orthopedic
surgeon, and we're going to talkabout specific injuries that
people deal with, why they havethese injuries and what we can
do to reverse or reduce theprobability of having these
injuries.
Rich, how are you doing today?
Speaker 2 (00:19):
Doing great Jason.
Thanks for having me.
Good to see you.
Speaker 1 (00:23):
I've known your father for a while and actually
knew him before I knew you, andhe's a fellow orthopedic surgeon
as well.
How's it working with yourfather?
He is, it's great.
Speaker 2 (00:34):
Yeah, he has been here.
I was talking to Todd hereabout that.
He's been out here for a longtime.
I think he joined staff here inI want to say 92 or 93 and has
obviously been here the entiretime and has a great reputation
here at St Luke's and uh and Ihave personally been coming out
here pretty much my whole life.
I saw my pediatrician here whenI was a kid and and uh, I've
(00:57):
obviously been fond of St Luke'sfor a long, long time and so
you know, when it came time forme to decide, you know where I
was going to practice it was.
You know it's kind of a nobrainer for me.
It's been fun practicing withmy dad.
It's been fun being in theoffice with him and kind of
bouncing ideas off each otherand it's made, you know,
(01:18):
obviously the transition thatcan sometimes be hard into
practice a little bit easierbecause of that kind of comfort
level.
Speaker 1 (01:25):
And obviously, you know, having him has been around
St Luke's for a long time andhaving that great relationship
with the staff and, you know,the other physicians around the
hospital has made it easy to, asfar as you know, being
introduced to people and sothat's been great, yeah, and you
know how it works is patientsor other doctors send you
(01:47):
patients, and if they have goodoutcomes, they keep sending your
patients, and so I think whenyou first got here a few years
back, a couple of my patientsactually saw you and had great
outcomes, and so that's alwaysgood to know that we got.
You know, typically you havevery high quality doctors, but
it's always good to confirm it.
Now, your grandfather was aphysician as well in Vandalia,
(02:07):
is that right?
He was.
Yeah, I had a patient who Ithink was a patient of your
grandfathers a few years back,and so was he a family medicine
doctor.
Speaker 2 (02:14):
Yeah, he did family practice, so he was one of these
kind of small town do it allgeneral practitioners so he
delivered babies, he was in theOR, he you know he did
everything for his patients andso yeah he's.
We still have a lot of patientsthat come over from Vandalia
who still know the practice andknow and then obviously my dad
(02:34):
kind of had that little nichemarket for a long time and now
they come over and and see metoo and so it's been fun because
it's always.
I always enjoy that interactionin the office of patients that
knew, knew my grandpa and, andit's fun to take a few minutes
to talk about him.
Speaker 1 (02:52):
Yeah, yeah for sure.
And so you know you're anorthopedic surgeon.
What do you spend most of yourday doing in the OR?
Speaker 2 (03:02):
Yeah, so most of my clinical practice, especially my
elective practice, is on hipand knee arthritis, hip and knee
replacements, revisions of hipand knee replacements that, for
whatever reason, need to beredone.
That's what I did my fellowshipin.
I did an extra year of trainingdoing hip and knee and so that
(03:23):
is most of what my referrals are.
I do take a lot of trauma callat the hospital and so we treat
a lot of hip fractures and wristfractures and ankle fractures,
things like that, and so themajority of my practice is more
of on the degenerative side ofthe hip and knee arthritis side.
But yeah, I do to get a lot ofreferrals of patients who have
(03:44):
had painful total joints thathave been done previously that
for one reason or the next, needto be redone.
Speaker 1 (03:52):
And so I've always heard that if you have a hip
replacement or a kneereplacement, you have something
like 15 years or so and then itneeds to be redone.
Is that accurate or what's thedeal with that?
Speaker 2 (04:01):
Yeah, that's a good question.
Patients, we talk about that alot and that is a little bit not
of a not a misconception now,because that is how it used to
be, but we are still, I mean,not in its infancy, but hip and
knee replacement didn't become,you know, very widespread
utilized until, I don't know,the 70s or 80s.
(04:22):
And then the question was alwayswhat's the youngest person you
would do this in, because theplastic liners usually was the
limiting factor, and so theywould wear out, and so most
people would say you don't wantto do a joint replacement if
you're expected to live morethan 10 or 15 years, because you
have to have it revised.
Now, about the year 2000, 2001,2002, they developed what's
(04:46):
called highly cross-linkedpolyethylene.
So it's just a better way toengineer the plastic that we
rely on for the replacements,and we are seeing, you know,
kind of awesome results fromthis new polyethylene, and so
it's just not wearing like itused to, and so that kind of
gives us the ability to treat ayounger and younger patient
population who, for one reasonor the next, get arthritis at a
(05:07):
younger age, and whereas in thepast we would kind of say you
know, you're probably too young,you kind of just have to live
with it and try different pain.
You know treatments andmedications and injections.
Speaker 1 (05:17):
But now we're seeing younger and younger patients who
are doing very well with jointreplacements and younger
patients who are doing very wellwith joint replacements, the
when I, you know, think abouthealth overall, a lot of times
I'm thinking about length oflife and you know, as far as how
do I reduce a risk of heartattack or a stroke or things
like that.
But you know, and I thinkthere's probably a link between
(05:41):
your joint health and yourlength of life too, because if
you can't move you're like lessmobile and but to me, you know,
this kind of stuff is really ahuge quality of life issue, and
I've had patients who them ortheir spouse have had, you know,
significant knee issues or hipissues which have really just
limited their ability to kind oflive their full life, and it's
(06:05):
kind of stolen their freedomfrom them, and so to me it seems
like just a real detriment toyour quality of life.
Speaker 2 (06:11):
Yeah, absolutely, I mean it's.
It is quality of life, noquestion.
And it's also and there havebeen studies that looked into
this as far as being, you know,a productive member of the
workforce and of society,because a lot of these things
will affect, you know, laborerswhere it's they literally cannot
do their jobs because of theireither hip or knee or their
(06:31):
arthritis or the pain thatthey're in, and so being able to
restore that function and allowthese people to function
pain-free kind of gets them backinto, you know, the workforce
and back into contributing.
And I think that, yeah, it's aquality of life thing.
And then it also affectspeople's mental health.
I mean, it's just such a bigthing to be able to exercise and
be able to, you know, bewithout pain, and it affects all
(06:53):
aspects of your life, not onlykind of your physical ability to
exercise and maintain a healthylifestyle, but also kind of
your mental health of being ableto do the things that you want
to do that are kind of thesestress relievers for patients.
Speaker 1 (07:06):
For sure, and, like you said, having a job gives you
purpose in life, you feel likeyou matter, and all that is
really going to have a hugeimpact on your mental health.
Now, I'm sure there's data outthere, too that shows that you
know, at a certain age, if youhave a fracture, that it can
limit the length of your life aswell.
Speaker 2 (07:26):
Yeah, and I have that discussion with families of
patients who come in with eitherhip fractures, and that's most
of the data that we have is onthe hip fracture population.
And you know, we know that,based on the Medicare data, that
those which is obviouslypatients over the age of 65,
that about 30% of those patients, you know there's a one-year
(07:46):
mortality of about 30% and it'sa really important number.
And you know, we know that it'snot a lot of times it's not
because of the hip fractureitself, it's the stuff that
comes along with it, it's themedical, you know, comorbidities
and issues that come along withthe hip fracture.
And a lot of times it kind ofsignals kind of a loss of
independence.
And you know, a lot of timesthese patients end up.
(08:10):
You know they either, you know,need help after the hip fracture
, they need to go into kind ofmore of an assisted living or
memory care type facility.
And so you know I'm very honestwith families when this happens
is that, you know, because itcan be a signal of okay, things
(08:30):
need to change as far as youknow, lifestyle and home
situation and that sort of thing.
And unfortunately I feel like,at least in our society, it
becomes, a people aren't asproactive about it as far as
kind of getting out in front ofthese things, and it's usually
to the point where somethinglike a hip fracture or some sort
of fracture happens and then itnecessitates kind of a
different level of care.
And so it is an importantdiscussion for those patients,
(08:52):
no question.
Speaker 1 (08:53):
And when you say hip fracture, is that like the top
of the femur, like a femoralneck fracture?
Is that typically where thelesion's at?
Speaker 2 (09:02):
Yeah, exactly, so usually we'll see them and
that's kind of one of the mostcommon things we treat here at
St Luke's.
As far as our fracturepopulation is either, when I
talk to patients about it I kindof categorize them into two
different types of hip fractureseither intracapsular, which is
like your femoral neck fracture,or extracapsular, where it's
outside of the hip joint andthat kind of determines whether
(09:23):
or not you have to just replaceit or you can fix it.
And by fixing it we usually usewhat's called an intramedullary
nail and align the fracturefragments and they will reliably
heal.
But when they're inside thecapsule, that's when we talk
about just replacing them,because they generally do better
.
That way You're not relying onthe fracture healing and it
(09:43):
allows the patients to kind ofget up and moving, which is
honestly the biggest thing asfar as treating especially
geriatric population is.
You want to be able to get themout of bed, get them moving,
get them back walking, toprevent the medical
complications that can come withit, Like you know, pneumonia
and blood clots and bed soresand these sorts of things that
we worry about within thatpopulation blood clots and bed
(10:04):
sores and these sorts of thingsthat we worry about within that
population, and over the yearsto me that seems like that's
been one thing.
Speaker 1 (10:13):
That's really changed a lot is after the surgery.
The impetus to actually havethem moving, like walking either
day of surgery or day aftersurgery, and the dependence on
physical therapy seems to onlyhave kind of become more
important over the years.
Speaker 2 (10:23):
Yeah, and I think that's one of the things that
you know people ask, okay,what's changed with what you
guys are doing in the last 10 or15 years?
And most of the time it's notnecessarily the surgeries
themselves, the technicalaspects of things, sometimes
it's the implants a little bit.
But I think the biggest thingis just our you know focus on
rapid recovery protocols thingis just our uh, you know focus
(10:47):
on rapid recovery protocols andwe've kind of learned the
importance of, okay, same daytherapy, get you up and out of
bed and start to get moving.
Because we recognize howthere's a little bit of a you
know time crunch as far as, uh,people do better when they're
out of bed as quickly as you can.
And so you know, when thesefractures come in, there they
are, we do treat them kind of asan urgent, urgent thing.
(11:07):
We try to get to them asquickly as we can.
You know, and there's beenstudies that have shown if you
do these fractures within 24, 48hours, they do a whole lot
better, less medicalcomplications than waiting.
And so we stress the importanceof getting kind of early
surgery to be able to get thesepatients out of bed, and
generally they do better thatway.
Speaker 1 (11:29):
Um, the um.
So if somebody is trying tostay out of this situation where
they're having a hip fractureand they're trying to not be one
of your patients, what are,what are some general things
that people can do to reducetheir likelihood of a hip
fracture or a rotator cuff tearor something like that?
Speaker 2 (11:47):
Yeah.
So hip fracture avoidance andkind of you know, preventative
measures of what we callfragility fractures, so not just
at the hip but at shoulder,wrist, lumbar spine, compression
fractures, those sorts ofthings.
We kind of stress theimportance of number one making
sure you're following up withyour primary care physician
(12:08):
about your bone health.
So regular screenings as far asDEXA scans, your bone mineral
density, that sort of thing,getting those done and because
there are medications you can beon to help with that and it's,
you know it's something thatunfortunately there is.
You know we have a shortage ofendocrinologists that treat
these and so a lot of times itdoes, the impetus does fall on
the primary care physicians andsometimes us as orthopedists.
(12:30):
We try to do what we can as faras getting people started with
things like calcium, vitamin D,other dietary supplements that
may help with bone health.
So that's one of the mainthings.
And secondarily it's simplethings like at home, getting rid
of things that might be looseon the floor, getting people
either assistive devices, eitherwalkers or canes, or something
(12:53):
that may help with their balance.
Therapy can be a big thing asfar as maintaining your strength
in your lower extremities andcertain exercises that you can
work on for balance.
All those things are importantand there's been kind of a new
found stress in the orthopedicworld as far as bone health and
there's a program called Own theBone which is kind of driven by
(13:18):
our overarching board as far asdoing what we can to get these
people who have either you'reseeing them for a hip fracture,
to get them in with somebody toprevent future injuries with,
you know, smaller, lower energymechanisms to prevent future
injuries with, you know, smaller, lower energy mechanisms.
Speaker 1 (13:35):
So the you know.
One thing I'm a big fan of isdoing squats.
If you, you know, if you can doit with weight better.
Just it's kind of the king ofall exercises, they say.
And, but plenty of patients Iencourage to do squats just up
and out of their chair and butwith the weight and the gravity
that can cause the bones to be alot stronger and a lot more
(13:57):
dense.
Before I was a physician, I wasa researcher and the lab across
the hall from me had grantsfrom NASA because the astronauts
without gravity developosteoporosis and osteopenia,
which makes the bones weaker,and so I kind of had.
Then you eat lunch with thesepeople and you hear about it a
lot.
But weight training is that a?
(14:19):
Is that?
Speaker 2 (14:20):
a big deal, yeah, very important.
And you know, and that's and Ikind of have similar
conversations with my arthritispopulation too as far as the
importance of low impactexercising in some level of
strength training too, becauseyou know, like you said, as soon
as you stop walking, you stop,you know, going to the gym, you
(14:40):
stop exercising.
Then all of a sudden, not onlydo your you know you lose some
of that bone health, your bones,you know, lose some of their
strength to it, but also your,you know, you get muscle
weakness, you start to getdeconditioned and all these
things kind of tend to spiral.
And then you get medical issueswith being more sedentary.
And so I try to talk toeverybody about the importance
(15:03):
of low impact exercising forboth your cardiovascular health
as well as the health of yourjoints, and so we try to.
I talk to patients aboutwalking, stationary bike,
elliptical swimming, rowingmachine, and then, like you said
, some form of exercise,strength training with squats
and, and you know, quad sets anddifferent things you can do
(15:23):
with your legs as far as keepingand maintaining your strength
as you get older and so if youbuild up the muscle, it's
protective to some degree.
Speaker 1 (15:30):
Is that how it works?
Speaker 2 (15:32):
Yeah, exactly, we think that it can strengthen the
joint.
It also helps keep you flexible, keep the mobility in the
joints.
We know that as patients getarthritis, things tend to
stiffen up.
Speaker 1 (15:41):
Yeah.
Speaker 2 (15:42):
And then once things stiffen up, it's just hard to
get that back, and so it's kindof important to maintain your
joint flexibility maintain, youknow, your joint flexibility.
Speaker 1 (15:53):
Yeah, you know that's .
I mean, one of the things Ireally like about doing squats
is if you know the weights onyour back and it it pushes you
down, so you actually gainflexibility if you go deep.
Now some people will argue youknow how, should you go past
parallel or not?
But if you go past parallel youget a great stretch on the
hamstrings and usually I thinkthat's the issue with most
(16:13):
people because they sit inchairs all day and their
hamstrings begin to shorten overthe years.
And so and I've talked beforein the podcast about doing it
like a 10 or 15 minutestretching routine before I go
to bed, and I think it's justone of those things that keeps
you young yeah, and the, the ageat which you know they do the
(16:34):
average knee replacement hasgone down over the years, and
that's kind of not surprisingbecause I think just the, the
weight of the average, you know,human in our society has gone
up, and so it's, if you know,you know the weight times, the's
, it's going to cause thedeterioration of the joint
faster, yeah, and so have younoticed, you know, younger
(16:57):
people getting these surgeries.
Speaker 2 (17:00):
Yeah, no question, I think it's a.
It's a younger, it's a youngerpatient population.
I think that's kind ofmultifactorial.
I mean, not only are we seeingand there's a lot of orthopedic,
you know, literature out thereas far as projections of joint
replacements by the year 2030and beyond, and it's kind of
it's almost like a logarithmicgraph.
I mean it's going like straightup because it's a combination
(17:22):
of things.
I think obviously we have anaging population, the patients
are generally getting older, andthen it's also, like we talked
about earlier, that we've, youknow, the.
The implants are better and sowe are more apt and more ready
to help a patient earlier on intheir life because we're not as
worried about having to revisethem again down the road because
the implants are a littlebetter.
(17:43):
And so I think with that we arenot.
I don't think it's necessarily.
It's probably a combination ofthings.
I think in the past, if youwere young and had arthritis, a
lot of times they would say youknow, you're, you're just a
little too young, we can't dothis yet, Whereas now we're a
little more ready to do thatoperation.
And secondarily, obviously, youknow our society as a whole,
(18:06):
unfortunately, is getting bigger.
I mean obesity thing is a is areal um problem, and so with
that you're putting a lot moreforce and pressure on your
joints and we know that that canlead to progressive arthritis
and it can get worse quickerbecause of the obesity factor.
And so that's another thing thatI talk to patients about as far
(18:26):
as preventative measures iskeeping your weight at a
manageable level.
You know there's six pounds offorce for every one pound of
body weight that you have offacross your hip and your knee,
and so you know, when I havethis conversation with patients
that are either you know thereare some patients that just are
not good candidates for hip orknee replacement because of
their BMI, their body mass index, and you know we talked to them
(18:48):
about it and the importance ofweight loss to get him back into
a lower risk profile aroundsurgery.
Then I have some patients thatlose 10 or 15 pounds that come
back and see me and they saywell, you know what I actually
feel.
Okay, now my pain's better.
I think I'm just going to putthis off.
That's great.
Those are honestly some of thebest conversations you can have
is because you kind of helpthese patients get to a
(19:09):
healthier situation, then theyget in a routine and then that
carries forward to the otherparts of their life.
Speaker 1 (19:24):
You know I talked earlier about seeing patients
who actually it's one patient inparticular whose spouse had
significant joint disease and itreally limited his life as far
as what he could do, and so itscared me and so I started this
is a few years back but Istarted reading about, like well
, what causes the damage, and itwas.
It was mainly like trauma, youknow, due to, you know you know,
pressure on the joint and thenblood flow was the other issue
and and that's kind of the issuewith with obesity is you have
(19:48):
not only the weight but there'sprobably some thickening of the
arterioles that feed the jointand so you kind of get damage on
both sides and that.
But then you know, losingweight and eating better, you
can reverse, you know, narrowingof the arteries and certainly
reverse your, you know, yourweight, you know decrease your
weight.
Speaker 2 (20:08):
Yeah, no question.
I mean, I think it's yeah,there's probably so many factors
of it that we're still kind oflearning about too, and there's
a big push now as far as and alot of patients ask about this
as far as what can you eat orhow can you change and modify
your diet or what you're doingto help prevent, kind of, some
of the inflammatory conditionsthat we have.
(20:29):
And certainly, you know, thereis definitely something to that
and I usually will kind of referpatients to dieticians because
I, you know, I tell themhonestly, like I'm not the best
person to talk to about thatit's obviously, you know, trying
to limit what you're doing asfar as processed foods and, you
know, sugars and high fructosecorn syrup all that stuff
(20:51):
certainly can decreaseinflammation throughout the body
, but that is a part of it thatis becoming more and more kind
of commonplace and looked atmore.
So there is certainly somethingto that with joint inflammation
and what you're eating.
Speaker 1 (21:04):
Yeah, there's a book called Body on Fire that kind of
just talks about overallinflammation and certainly you
know that can play into thejoints too.
And then the last thing Iwanted to talk to you about is
it looks like there's morefemale patients than male
patients.
Does that have to do with theangle of the hip or at the knee,
or do you notice that in yourpatient population there's more
(21:27):
females than male?
I have 58% of orthopedicpatients are female.
Speaker 2 (21:30):
Yeah, that's interesting.
I think that's there's probablysomething to that.
I mean, in my practice I guessI don't.
I could look back and see whatmy percentages are, but some of
it may be that just the you know, their lower extremity
alignment.
A lot of times women are inmore of what's called valgus
with their lower extremities, sotheir hips are generally out a
(21:53):
little wider and then it kind ofcomes into almost a knock knee
type alignment at their kneesand we know that that can lead
to some abnormal mechanics inthe.
We know that that can lead tosome abnormal mechanics in the
lower extremities and that canlead to some earlier arthritis.
We certainly know in our in ouryoung population.
As far as you know, sportsrelated injuries, acl injuries,
are more common in femaleathletes and uh, and we think
(22:16):
there is something to that asfar as lower extremity alignment
may put them at a higher riskof having something like an ACL
rupture.
And now, yeah, there's evenmore training that's going on as
far as you know, how toproperly land Like if a lot of
time we'll see in volleyballplayers.
Acl injuries generally are kindof non-contact injuries and so
(22:37):
there's more and more trainingthat goes into injury prevention
.
And some of that is, you know,knowing what to strengthen as
far as the lower extremities,how to land properly so you're
not stressing the ligaments ofyour knees.
But yeah, I think there's someto that.
Speaker 1 (22:50):
Yeah, I think it's.
You know, a really importantthing to do in sports in general
is to kind of follow what theycall a linear progression, and
that is like you slowly increasethe volume of you know stress
that you're putting your bodyunder, whether you're lifting
weights or running or whatever.
It is people you know it's,it's the, it's the, it's the old
athlete who you know thinksthey still got it, who kind of
(23:12):
jumped back into it and theirbody's just not ready to handle
the load.
And I'm sure you've seen, youknow, plenty of that.
Speaker 2 (23:17):
Yeah, it's the at the old, the weekend warriors that,
uh, either you know, haven'tdone it for a while and try to
go zero to 60, and or the, youknow the middle-aged person that
thinks they can get intoCrossFit at a, uh, at a very you
know age.
That maybe won't, you know not,uh, your body's just not
accustomed to moving like thatanymore and, and yeah, we'll see
(23:38):
plenty of injuries related toCrossFit.
Or, you know, pickleball isbecoming a huge thing.
And you know people joke thatpickleball was invented by an
orthopedist because of some ofthe injuries that we see from it
now.
Speaker 1 (23:50):
I shouldn't laugh.
It's just comical to think ofpickleball cause it, but it
makes sense.
Speaker 2 (23:54):
I mean you know it's a lot of lateral movements and,
like you said, I mean it's a lotof times people will get into
it because their friends playand they want to play and they
haven't done anything like thatthose kind of quick lateral
movements in a very long timeand then they try to get into it
and either have an injury orthey'll come in and have, you
know, either arthritis or somecondition that they want to get
(24:14):
taken care of so they can getback to playing pickleball and
and and so, yeah, that isthere's now.
There's articles about it inour, you know, our journal of
our Academy of orthopedicsurgeons about pickleball
injuries and, just because theyare becoming so common, about
what's common, how can youcounsel patients about how to
avoid them and treatment options, and so?
Speaker 1 (24:37):
yeah it's.
Speaker 2 (24:38):
It's definitely becoming more and more common.
Speaker 1 (24:40):
Yeah, and, and you know, I think I'm definitely pro
pickleball.
It's a good social thing, butyou just got to ease into it and
and, and you know, maybe don'ttrust yourself fully until you,
you know, have spent some timedoing it.
Yeah, okay, now I'm going to.
I'm going to round out withthis one, maybe a little
controversial, but what are yourthoughts on CrossFit?
Do you have any thoughts on it?
(25:02):
My personal thought is it'spretty herky-jerky.
I mean, I do powerlifting,which is just squat, bench and
deadlift, and power is amisnomer because scientifically,
power is like moving a forceover time.
Everything's slow inpowerlifting.
You don't speed squat, youdon't doing cleans and clean and
(25:22):
jerk and snatches.
That's like you know.
Olympic weightlifting is power,where you do it quickly, but
powerlifting is slow.
So there's no herky jerky andso to me, I think it's a lot
safer flipping around on thesebars and stuff like this.
I think there's a lot of goodbenefits from it, but it seems
risky to me when you're olderbenefits from it, but it seems
risky to me when you're older.
Speaker 2 (25:42):
Yeah, no question, I mean I, you know, I don't, I
personally I've never, I'venever gotten into CrossFit, um,
but I agree with you watching,um, some of these people do it.
There are certain things that,as an orthopedist, you and it's
whatever you know I'm sure thereare things like this for you
too, where you, as anorthopedist, you look at it and
you cringe a little bit becauseyou're just, the body wasn't
necessarily made to do thingslike that, especially at an
(26:04):
older age.
I mean, there are certainthings, not CrossFit, but other
things that make orthopedists alittle bit cringeworthy, and
that's pediatric stuff liketrampolines, monkey bars, older
motorcycles, older motorcycles,like these kind of things we
look at and are just kind ofworried because we're almost
traumatized by what we seecoming through training.
Speaker 1 (26:22):
Yeah.
Speaker 2 (26:33):
Either you know, injuries in the pediatric
population or in adults, bigmotorcycle wrecks, things like
this that we all kind of look atand we get a little worried
about, but CrossFit's one ofthose.
Speaker 1 (26:39):
in an older population, where it's just the
body is not necessarily meant todo those things.
Yeah, certainly there are somepeople who've done this for
years, over years and their bodyis well-tuned for it.
But to run and jump out andstart, I mean to me like as an
adult, like swinging from bars,I just personally I worry about
my rotator cuff, Like I just Idon't think it's strong enough
for my weight.
It's a risky proposition For mepersonally, not worth it.
Speaker 2 (27:02):
But yeah, I'm with you on that.
I kind of I gave up, uh Istopped playing basketball too,
cause I was just worried aboutuh you know I don't love it
enough to uh risk, uh you know,an Achilles or an ACL injury or
something.
Speaker 1 (27:16):
That's a career.
I ran track in college and ifyou had an Achilles injury, that
was it.
I mean you could recover.
You could do the whole thingfor a year and seeing patients
in the office.
Speaker 2 (27:26):
And it's just, you know it is a risk benefit thing.
It's like are you going to putyour body at risk?
You know to do this, that youknow whether or not.
(27:46):
But there are people that youknow I see patients that say,
look, this is what, this is mything, I love it and if it's and
, I need to keep doing it for mymental health.
And then we kind of have adiscussion and say that you know
, that's fine, I'll try to getyou to a place where you can do
that.
But I can't, you know, promisethat at this age that this is,
you know you're going to be ableto keep doing this forever.
Speaker 1 (28:05):
Yeah, 100%.
If people understand the risksand they do their own analysis,
I mean, they know how to solvethat equation better than I do
and I'm with you.
You know some people will say,like run and I'll tell them it's
going to make your skinreaction worse.
But for most people running isreally good for your mental
health and when you're goingthrough something difficult it's
(28:26):
probably worth a little bitmore redness of skin for the
mental health benefits.
So, yeah, people understand therisks.
You know there are certainly alot of secondary benefits to
exercising.
Speaker 2 (28:34):
Oh yeah, no question.
Speaker 1 (28:36):
Well, rich, thanks for everything man I appreciate
you.
Hello, this is Jason Edwards.
Welcome to.
Speaker 2 (00:02):
Doc.
Speaker 1 (00:02):
Discussions.
Today I'm going to talk to DrRichard Ramis, an orthopedic
surgeon, and we're going to talkabout specific injuries that
people deal with, why they havethese injuries and what we can
do to reverse or reduce theprobability of having these
injuries.
Rich, how are you doing today?
Speaker 2 (00:19):
Doing great Jason.
Thanks for having me.
Good to see you.
Speaker 1 (00:23):
I've known your father for a while and actually
knew him before I knew you, andhe's a fellow orthopedic surgeon
as well.
How's it working with yourfather?
He is, it's great.
Speaker 2 (00:34):
Yeah, he has been here.
I was talking to Todd hereabout that.
He's been out here for a longtime.
I think he joined staff here inI want to say 92 or 93 and has
obviously been here the entiretime and has a great reputation
here at St Luke's and uh and Ihave personally been coming out
here pretty much my whole life.
I saw my pediatrician here whenI was a kid and and uh, I've
(00:57):
obviously been fond of St Luke'sfor a long, long time and so
you know, when it came time forme to decide, you know where I
was going to practice it was.
You know it's kind of a nobrainer for me.
It's been fun practicing withmy dad.
It's been fun being in theoffice with him and kind of
bouncing ideas off each otherand it's made, you know,
(01:18):
obviously the transition thatcan sometimes be hard into
practice a little bit easierbecause of that kind of comfort
level.
Speaker 1 (01:25):
And obviously, you know, having him has been around
St Luke's for a long time andhaving that great relationship
with the staff and, you know,the other physicians around the
hospital has made it easy to, asfar as you know, being
introduced to people and sothat's been great, yeah, and you
know how it works is patientsor other doctors send you
(01:47):
patients, and if they have goodoutcomes, they keep sending your
patients, and so I think whenyou first got here a few years
back, a couple of my patientsactually saw you and had great
outcomes, and so that's alwaysgood to know that we got.
You know, typically you havevery high quality doctors, but
it's always good to confirm it.
Now, your grandfather was aphysician as well in Vandalia,
(02:07):
is that right?
He was.
Yeah, I had a patient who Ithink was a patient of your
grandfathers a few years back,and so was he a family medicine
doctor.
Speaker 2 (02:14):
Yeah, he did family practice, so he was one of these
kind of small town do it allgeneral practitioners so he
delivered babies, he was in theOR, he you know he did
everything for his patients andso yeah he's.
We still have a lot of patientsthat come over from Vandalia
who still know the practice andknow and then obviously my dad
(02:34):
kind of had that little nichemarket for a long time and now
they come over and and see metoo and so it's been fun because
it's always.
I always enjoy that interactionin the office of patients that
knew, knew my grandpa and, andit's fun to take a few minutes
to talk about him.
Speaker 1 (02:52):
Yeah, yeah for sure.
And so you know you're anorthopedic surgeon.
What do you spend most of yourday doing in the OR?
Speaker 2 (03:02):
Yeah, so most of my clinical practice, especially my
elective practice, is on hipand knee arthritis, hip and knee
replacements, revisions of hipand knee replacements that, for
whatever reason, need to beredone.
That's what I did my fellowshipin.
I did an extra year of trainingdoing hip and knee and so that
(03:23):
is most of what my referrals are.
I do take a lot of trauma callat the hospital and so we treat
a lot of hip fractures and wristfractures and ankle fractures,
things like that, and so themajority of my practice is more
of on the degenerative side ofthe hip and knee arthritis side.
But yeah, I do to get a lot ofreferrals of patients who have
(03:44):
had painful total joints thathave been done previously that
for one reason or the next, needto be redone.
Speaker 1 (03:52):
And so I've always heard that if you have a hip
replacement or a kneereplacement, you have something
like 15 years or so and then itneeds to be redone.
Is that accurate or what's thedeal with that?
Speaker 2 (04:01):
Yeah, that's a good question.
Patients, we talk about that alot and that is a little bit not
of a not a misconception now,because that is how it used to
be, but we are still, I mean,not in its infancy, but hip and
knee replacement didn't become,you know, very widespread
utilized until, I don't know,the 70s or 80s.
(04:22):
And then the question was alwayswhat's the youngest person you
would do this in, because theplastic liners usually was the
limiting factor, and so theywould wear out, and so most
people would say you don't wantto do a joint replacement if
you're expected to live morethan 10 or 15 years, because you
have to have it revised.
Now, about the year 2000, 2001,2002, they developed what's
(04:46):
called highly cross-linkedpolyethylene.
So it's just a better way toengineer the plastic that we
rely on for the replacements,and we are seeing, you know,
kind of awesome results fromthis new polyethylene, and so
it's just not wearing like itused to, and so that kind of
gives us the ability to treat ayounger and younger patient
population who, for one reasonor the next, get arthritis at a
(05:07):
younger age, and whereas in thepast we would kind of say you
know, you're probably too young,you kind of just have to live
with it and try different pain.
You know treatments andmedications and injections.
Speaker 1 (05:17):
But now we're seeing younger and younger patients who
are doing very well with jointreplacements and younger
patients who are doing very wellwith joint replacements, the
when I, you know, think abouthealth overall, a lot of times
I'm thinking about length oflife and you know, as far as how
do I reduce a risk of heartattack or a stroke or things
like that.
But you know, and I thinkthere's probably a link between
(05:41):
your joint health and yourlength of life too, because if
you can't move you're like lessmobile and but to me, you know,
this kind of stuff is really ahuge quality of life issue, and
I've had patients who them ortheir spouse have had, you know,
significant knee issues or hipissues which have really just
limited their ability to kind oflive their full life, and it's
(06:05):
kind of stolen their freedomfrom them, and so to me it seems
like just a real detriment toyour quality of life.
Speaker 2 (06:11):
Yeah, absolutely, I mean it's.
It is quality of life, noquestion.
And it's also and there havebeen studies that looked into
this as far as being, you know,a productive member of the
workforce and of society,because a lot of these things
will affect, you know, laborerswhere it's they literally cannot
do their jobs because of theireither hip or knee or their
(06:31):
arthritis or the pain thatthey're in, and so being able to
restore that function and allowthese people to function
pain-free kind of gets them backinto, you know, the workforce
and back into contributing.
And I think that, yeah, it's aquality of life thing.
And then it also affectspeople's mental health.
I mean, it's just such a bigthing to be able to exercise and
be able to, you know, bewithout pain, and it affects all
(06:53):
aspects of your life, not onlykind of your physical ability to
exercise and maintain a healthylifestyle, but also kind of
your mental health of being ableto do the things that you want
to do that are kind of thesestress relievers for patients.
Speaker 1 (07:06):
For sure, and, like you said, having a job gives you
purpose in life, you feel likeyou matter, and all that is
really going to have a hugeimpact on your mental health.
Now, I'm sure there's data outthere, too that shows that you
know, at a certain age, if youhave a fracture, that it can
limit the length of your life aswell.
Speaker 2 (07:26):
Yeah, and I have that discussion with families of
patients who come in with eitherhip fractures, and that's most
of the data that we have is onthe hip fracture population.
And you know, we know that,based on the Medicare data, that
those which is obviouslypatients over the age of 65,
that about 30% of those patients, you know there's a one-year
(07:46):
mortality of about 30% and it'sa really important number.
And you know, we know that it'snot a lot of times it's not
because of the hip fractureitself, it's the stuff that
comes along with it, it's themedical, you know, comorbidities
and issues that come along withthe hip fracture.
And a lot of times it kind ofsignals kind of a loss of
independence.
And you know, a lot of timesthese patients end up.
(08:10):
You know they either, you know,need help after the hip fracture
, they need to go into kind ofmore of an assisted living or
memory care type facility.
And so you know I'm very honestwith families when this happens
is that, you know, because itcan be a signal of okay, things
(08:30):
need to change as far as youknow, lifestyle and home
situation and that sort of thing.
And unfortunately I feel like,at least in our society, it
becomes, a people aren't asproactive about it as far as
kind of getting out in front ofthese things, and it's usually
to the point where somethinglike a hip fracture or some sort
of fracture happens and then itnecessitates kind of a
different level of care.
And so it is an importantdiscussion for those patients,
(08:52):
no question.
Speaker 1 (08:53):
And when you say hip fracture, is that like the top
of the femur, like a femoralneck fracture?
Is that typically where thelesion's at?
Speaker 2 (09:02):
Yeah, exactly, so usually we'll see them and
that's kind of one of the mostcommon things we treat here at
St Luke's.
As far as our fracturepopulation is either, when I
talk to patients about it I kindof categorize them into two
different types of hip fractureseither intracapsular, which is
like your femoral neck fracture,or extracapsular, where it's
outside of the hip joint andthat kind of determines whether
(09:23):
or not you have to just replaceit or you can fix it.
And by fixing it we usually usewhat's called an intramedullary
nail and align the fracturefragments and they will reliably
heal.
But when they're inside thecapsule, that's when we talk
about just replacing them,because they generally do better
.
That way You're not relying onthe fracture healing and it
(09:43):
allows the patients to kind ofget up and moving, which is
honestly the biggest thing asfar as treating especially
geriatric population is.
You want to be able to get themout of bed, get them moving,
get them back walking, toprevent the medical
complications that can come withit, Like you know, pneumonia
and blood clots and bed soresand these sorts of things that
we worry about within thatpopulation blood clots and bed
(10:04):
sores and these sorts of thingsthat we worry about within that
population, and over the yearsto me that seems like that's
been one thing.
Speaker 1 (10:13):
That's really changed a lot is after the surgery.
The impetus to actually havethem moving, like walking either
day of surgery or day aftersurgery, and the dependence on
physical therapy seems to onlyhave kind of become more
important over the years.
Speaker 2 (10:23):
Yeah, and I think that's one of the things that
you know people ask, okay,what's changed with what you
guys are doing in the last 10 or15 years?
And most of the time it's notnecessarily the surgeries
themselves, the technicalaspects of things, sometimes
it's the implants a little bit.
But I think the biggest thingis just our you know focus on
rapid recovery protocols thingis just our uh, you know focus
(10:47):
on rapid recovery protocols andwe've kind of learned the
importance of, okay, same daytherapy, get you up and out of
bed and start to get moving.
Because we recognize howthere's a little bit of a you
know time crunch as far as, uh,people do better when they're
out of bed as quickly as you can.
And so you know, when thesefractures come in, there they
are, we do treat them kind of asan urgent, urgent thing.
(11:07):
We try to get to them asquickly as we can.
You know, and there's beenstudies that have shown if you
do these fractures within 24, 48hours, they do a whole lot
better, less medicalcomplications than waiting.
And so we stress the importanceof getting kind of early
surgery to be able to get thesepatients out of bed, and
generally they do better thatway.
Speaker 1 (11:29):
Um, the um.
So if somebody is trying tostay out of this situation where
they're having a hip fractureand they're trying to not be one
of your patients, what are,what are some general things
that people can do to reducetheir likelihood of a hip
fracture or a rotator cuff tearor something like that?
Speaker 2 (11:47):
Yeah.
So hip fracture avoidance andkind of you know, preventative
measures of what we callfragility fractures, so not just
at the hip but at shoulder,wrist, lumbar spine, compression
fractures, those sorts ofthings.
We kind of stress theimportance of number one making
sure you're following up withyour primary care physician
(12:08):
about your bone health.
So regular screenings as far asDEXA scans, your bone mineral
density, that sort of thing,getting those done and because
there are medications you can beon to help with that and it's,
you know it's something thatunfortunately there is.
You know we have a shortage ofendocrinologists that treat
these and so a lot of times itdoes, the impetus does fall on
the primary care physicians andsometimes us as orthopedists.
(12:30):
We try to do what we can as faras getting people started with
things like calcium, vitamin D,other dietary supplements that
may help with bone health.
So that's one of the mainthings.
And secondarily it's simplethings like at home, getting rid
of things that might be looseon the floor, getting people
either assistive devices, eitherwalkers or canes, or something
(12:53):
that may help with their balance.
Therapy can be a big thing asfar as maintaining your strength
in your lower extremities andcertain exercises that you can
work on for balance.
All those things are importantand there's been kind of a new
found stress in the orthopedicworld as far as bone health and
there's a program called Own theBone which is kind of driven by
(13:18):
our overarching board as far asdoing what we can to get these
people who have either you'reseeing them for a hip fracture,
to get them in with somebody toprevent future injuries with,
you know, smaller, lower energymechanisms to prevent future
injuries with, you know, smaller, lower energy mechanisms.
Speaker 1 (13:35):
So the you know.
One thing I'm a big fan of isdoing squats.
If you, you know, if you can doit with weight better.
Just it's kind of the king ofall exercises, they say.
And, but plenty of patients Iencourage to do squats just up
and out of their chair and butwith the weight and the gravity
that can cause the bones to be alot stronger and a lot more
(13:57):
dense.
Before I was a physician, I wasa researcher and the lab across
the hall from me had grantsfrom NASA because the astronauts
without gravity developosteoporosis and osteopenia,
which makes the bones weaker,and so I kind of had.
Then you eat lunch with thesepeople and you hear about it a
lot.
But weight training is that a?
(14:19):
Is that?
Speaker 2 (14:20):
a big deal, yeah, very important.
And you know, and that's and Ikind of have similar
conversations with my arthritispopulation too as far as the
importance of low impactexercising in some level of
strength training too, becauseyou know, like you said, as soon
as you stop walking, you stop,you know, going to the gym, you
(14:40):
stop exercising.
Then all of a sudden, not onlydo your you know you lose some
of that bone health, your bones,you know, lose some of their
strength to it, but also your,you know, you get muscle
weakness, you start to getdeconditioned and all these
things kind of tend to spiral.
And then you get medical issueswith being more sedentary.
And so I try to talk toeverybody about the importance
(15:03):
of low impact exercising forboth your cardiovascular health
as well as the health of yourjoints, and so we try to.
I talk to patients aboutwalking, stationary bike,
elliptical swimming, rowingmachine, and then, like you said
, some form of exercise,strength training with squats
and, and you know, quad sets anddifferent things you can do
(15:23):
with your legs as far as keepingand maintaining your strength
as you get older and so if youbuild up the muscle, it's
protective to some degree.
Speaker 1 (15:30):
Is that how it works?
Speaker 2 (15:32):
Yeah, exactly, we think that it can strengthen the
joint.
It also helps keep you flexible, keep the mobility in the
joints.
We know that as patients getarthritis, things tend to
stiffen up.
Speaker 1 (15:41):
Yeah.
Speaker 2 (15:42):
And then once things stiffen up, it's just hard to
get that back, and so it's kindof important to maintain your
joint flexibility maintain, youknow, your joint flexibility.
Speaker 1 (15:53):
Yeah, you know that's .
I mean, one of the things Ireally like about doing squats
is if you know the weights onyour back and it it pushes you
down, so you actually gainflexibility if you go deep.
Now some people will argue youknow how, should you go past
parallel or not?
But if you go past parallel youget a great stretch on the
hamstrings and usually I thinkthat's the issue with most
(16:13):
people because they sit inchairs all day and their
hamstrings begin to shorten overthe years.
And so and I've talked beforein the podcast about doing it
like a 10 or 15 minutestretching routine before I go
to bed, and I think it's justone of those things that keeps
you young yeah, and the, the ageat which you know they do the
(16:34):
average knee replacement hasgone down over the years, and
that's kind of not surprisingbecause I think just the, the
weight of the average, you know,human in our society has gone
up, and so it's, if you know,you know the weight times, the's
, it's going to cause thedeterioration of the joint
faster, yeah, and so have younoticed, you know, younger
(16:57):
people getting these surgeries.
Speaker 2 (17:00):
Yeah, no question, I think it's a.
It's a younger, it's a youngerpatient population.
I think that's kind ofmultifactorial.
I mean, not only are we seeingand there's a lot of orthopedic,
you know, literature out thereas far as projections of joint
replacements by the year 2030and beyond, and it's kind of
it's almost like a logarithmicgraph.
I mean it's going like straightup because it's a combination
(17:22):
of things.
I think obviously we have anaging population, the patients
are generally getting older, andthen it's also, like we talked
about earlier, that we've, youknow, the.
The implants are better and sowe are more apt and more ready
to help a patient earlier on intheir life because we're not as
worried about having to revisethem again down the road because
the implants are a littlebetter.
(17:43):
And so I think with that we arenot.
I don't think it's necessarily.
It's probably a combination ofthings.
I think in the past, if youwere young and had arthritis, a
lot of times they would say youknow, you're, you're just a
little too young, we can't dothis yet, Whereas now we're a
little more ready to do thatoperation.
And secondarily, obviously, youknow our society as a whole,
(18:06):
unfortunately, is getting bigger.
I mean obesity thing is a is areal um problem, and so with
that you're putting a lot moreforce and pressure on your
joints and we know that that canlead to progressive arthritis
and it can get worse quickerbecause of the obesity factor.
And so that's another thing thatI talk to patients about as far
(18:26):
as preventative measures iskeeping your weight at a
manageable level.
You know there's six pounds offorce for every one pound of
body weight that you have offacross your hip and your knee,
and so you know, when I havethis conversation with patients
that are either you know thereare some patients that just are
not good candidates for hip orknee replacement because of
their BMI, their body mass index, and you know we talked to them
(18:48):
about it and the importance ofweight loss to get him back into
a lower risk profile aroundsurgery.
Then I have some patients thatlose 10 or 15 pounds that come
back and see me and they saywell, you know what I actually
feel.
Okay, now my pain's better.
I think I'm just going to putthis off.
That's great.
Those are honestly some of thebest conversations you can have
is because you kind of helpthese patients get to a
(19:09):
healthier situation, then theyget in a routine and then that
carries forward to the otherparts of their life.
Speaker 1 (19:24):
You know I talked earlier about seeing patients
who actually it's one patient inparticular whose spouse had
significant joint disease and itreally limited his life as far
as what he could do, and so itscared me and so I started this
is a few years back but Istarted reading about, like well
, what causes the damage, and itwas.
It was mainly like trauma, youknow, due to, you know you know,
pressure on the joint and thenblood flow was the other issue
and and that's kind of the issuewith with obesity is you have
(19:48):
not only the weight but there'sprobably some thickening of the
arterioles that feed the jointand so you kind of get damage on
both sides and that.
But then you know, losingweight and eating better, you
can reverse, you know, narrowingof the arteries and certainly
reverse your, you know, yourweight, you know decrease your
weight.
Speaker 2 (20:08):
Yeah, no question.
I mean, I think it's yeah,there's probably so many factors
of it that we're still kind oflearning about too, and there's
a big push now as far as and alot of patients ask about this
as far as what can you eat orhow can you change and modify
your diet or what you're doingto help prevent, kind of, some
of the inflammatory conditionsthat we have.
(20:29):
And certainly, you know, thereis definitely something to that
and I usually will kind of referpatients to dieticians because
I, you know, I tell themhonestly, like I'm not the best
person to talk to about thatit's obviously, you know, trying
to limit what you're doing asfar as processed foods and, you
know, sugars and high fructosecorn syrup all that stuff
(20:51):
certainly can decreaseinflammation throughout the body
, but that is a part of it thatis becoming more and more kind
of commonplace and looked atmore.
So there is certainly somethingto that with joint inflammation
and what you're eating.
Speaker 1 (21:04):
Yeah, there's a book called Body on Fire that kind of
just talks about overallinflammation and certainly you
know that can play into thejoints too.
And then the last thing Iwanted to talk to you about is
it looks like there's morefemale patients than male
patients.
Does that have to do with theangle of the hip or at the knee,
or do you notice that in yourpatient population there's more
(21:27):
females than male?
I have 58% of orthopedicpatients are female.
Speaker 2 (21:30):
Yeah, that's interesting.
I think that's there's probablysomething to that.
I mean, in my practice I guessI don't.
I could look back and see whatmy percentages are, but some of
it may be that just the you know, their lower extremity
alignment.
A lot of times women are inmore of what's called valgus
with their lower extremities, sotheir hips are generally out a
(21:53):
little wider and then it kind ofcomes into almost a knock knee
type alignment at their kneesand we know that that can lead
to some abnormal mechanics inthe.
We know that that can lead tosome abnormal mechanics in the
lower extremities and that canlead to some earlier arthritis.
We certainly know in our in ouryoung population.
As far as you know, sportsrelated injuries, acl injuries,
are more common in femaleathletes and uh, and we think
(22:16):
there is something to that asfar as lower extremity alignment
may put them at a higher riskof having something like an ACL
rupture.
And now, yeah, there's evenmore training that's going on as
far as you know, how toproperly land Like if a lot of
time we'll see in volleyballplayers.
Acl injuries generally are kindof non-contact injuries and so
(22:37):
there's more and more trainingthat goes into injury prevention
.
And some of that is, you know,knowing what to strengthen as
far as the lower extremities,how to land properly so you're
not stressing the ligaments ofyour knees.
But yeah, I think there's someto that.
Speaker 1 (22:50):
Yeah, I think it's.
You know, a really importantthing to do in sports in general
is to kind of follow what theycall a linear progression, and
that is like you slowly increasethe volume of you know stress
that you're putting your bodyunder, whether you're lifting
weights or running or whatever.
It is people you know it's,it's the, it's the, it's the old
athlete who you know thinksthey still got it, who kind of
(23:12):
jumped back into it and theirbody's just not ready to handle
the load.
And I'm sure you've seen, youknow, plenty of that.
Speaker 2 (23:17):
Yeah, it's the at the old, the weekend warriors that,
uh, either you know, haven'tdone it for a while and try to
go zero to 60, and or the, youknow the middle-aged person that
thinks they can get intoCrossFit at a, uh, at a very you
know age.
That maybe won't, you know not,uh, your body's just not
accustomed to moving like thatanymore and, and yeah, we'll see
(23:38):
plenty of injuries related toCrossFit.
Or, you know, pickleball isbecoming a huge thing.
And you know people joke thatpickleball was invented by an
orthopedist because of some ofthe injuries that we see from it
now.
Speaker 1 (23:50):
I shouldn't laugh.
It's just comical to think ofpickleball cause it, but it
makes sense.
Speaker 2 (23:54):
I mean you know it's a lot of lateral movements and,
like you said, I mean it's a lotof times people will get into
it because their friends playand they want to play and they
haven't done anything like thatthose kind of quick lateral
movements in a very long timeand then they try to get into it
and either have an injury orthey'll come in and have, you
know, either arthritis or somecondition that they want to get
(24:14):
taken care of so they can getback to playing pickleball and
and and so, yeah, that isthere's now.
There's articles about it inour, you know, our journal of
our Academy of orthopedicsurgeons about pickleball
injuries and, just because theyare becoming so common, about
what's common, how can youcounsel patients about how to
avoid them and treatment options, and so?
Speaker 1 (24:37):
yeah it's.
Speaker 2 (24:38):
It's definitely becoming more and more common.
Speaker 1 (24:40):
Yeah, and, and you know, I think I'm definitely pro
pickleball.
It's a good social thing, butyou just got to ease into it and
and, and you know, maybe don'ttrust yourself fully until you,
you know, have spent some timedoing it.
Yeah, okay, now I'm going to.
I'm going to round out withthis one, maybe a little
controversial, but what are yourthoughts on CrossFit?
Do you have any thoughts on it?
(25:02):
My personal thought is it'spretty herky-jerky.
I mean, I do powerlifting,which is just squat, bench and
deadlift, and power is amisnomer because scientifically,
power is like moving a forceover time.
Everything's slow inpowerlifting.
You don't speed squat, youdon't doing cleans and clean and
(25:22):
jerk and snatches.
That's like you know.
Olympic weightlifting is power,where you do it quickly, but
powerlifting is slow.
So there's no herky jerky andso to me, I think it's a lot
safer flipping around on thesebars and stuff like this.
I think there's a lot of goodbenefits from it, but it seems
risky to me when you're olderbenefits from it, but it seems
risky to me when you're older.
Speaker 2 (25:42):
Yeah, no question, I mean I, you know, I don't, I
personally I've never, I'venever gotten into CrossFit, um,
but I agree with you watching,um, some of these people do it.
There are certain things that,as an orthopedist, you and it's
whatever you know I'm sure thereare things like this for you
too, where you, as anorthopedist, you look at it and
you cringe a little bit becauseyou're just, the body wasn't
necessarily made to do thingslike that, especially at an
(26:04):
older age.
I mean, there are certainthings, not CrossFit, but other
things that make orthopedists alittle bit cringeworthy, and
that's pediatric stuff liketrampolines, monkey bars, older
motorcycles, older motorcycles,like these kind of things we
look at and are just kind ofworried because we're almost
traumatized by what we seecoming through training.
Speaker 1 (26:22):
Yeah.
Speaker 2 (26:33):
Either you know, injuries in the pediatric
population or in adults, bigmotorcycle wrecks, things like
this that we all kind of look atand we get a little worried
about, but CrossFit's one ofthose.
Speaker 1 (26:39):
in an older population, where it's just the
body is not necessarily meant todo those things.
Yeah, certainly there are somepeople who've done this for
years, over years and their bodyis well-tuned for it.
But to run and jump out andstart, I mean to me like as an
adult, like swinging from bars,I just personally I worry about
my rotator cuff, Like I just Idon't think it's strong enough
for my weight.
It's a risky proposition For mepersonally, not worth it.
Speaker 2 (27:02):
But yeah, I'm with you on that.
I kind of I gave up, uh Istopped playing basketball too,
cause I was just worried aboutuh you know I don't love it
enough to uh risk, uh you know,an Achilles or an ACL injury or
something.
Speaker 1 (27:16):
That's a career.
I ran track in college and ifyou had an Achilles injury, that
was it.
I mean you could recover.
You could do the whole thingfor a year and seeing patients
in the office.
Speaker 2 (27:26):
And it's just, you know it is a risk benefit thing.
It's like are you going to putyour body at risk?
You know to do this, that youknow whether or not.
(27:46):
But there are people that youknow I see patients that say,
look, this is what, this is mything, I love it and if it's and
, I need to keep doing it for mymental health.
And then we kind of have adiscussion and say that you know
, that's fine, I'll try to getyou to a place where you can do
that.
But I can't, you know, promisethat at this age that this is,
you know you're going to be ableto keep doing this forever.
Speaker 1 (28:05):
Yeah, 100%.
If people understand the risksand they do their own analysis,
I mean, they know how to solvethat equation better than I do
and I'm with you.
You know some people will say,like run and I'll tell them it's
going to make your skinreaction worse.
But for most people running isreally good for your mental
health and when you're goingthrough something difficult it's
(28:26):
probably worth a little bitmore redness of skin for the
mental health benefits.
So, yeah, people understand therisks.
You know there are certainly alot of secondary benefits to
exercising.
Speaker 2 (28:34):
Oh yeah, no question.
Speaker 1 (28:36):
Well, rich, thanks for everything man I appreciate
you.
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