February 12, 2025 • 26 mins
Discover the inspiring journey of Dr. Devon Myers, whose path from collegiate baseball player at Truman State University to a leading sports medicine specialist offers valuable insights into the world of athletic health and recovery. Dr. Myers shares his experiences and lessons learned from growing up in Fenton, playing college baseball, and his transformative role as a patient care tech at MOBAP. We explore his educational adventures from Kirksville to Columbus, Ohio, and back to WashU for his fellowship. Tune in to hear Dr. Myers' perspectives on managing the physical and mental hurdles faced by athletes during recovery, and learn how empathy and understanding play vital roles in effective medical care.
Get ready to explore the complex world of ligament injuries with Dr. Myers as we tackle common challenges like ACL, PCL, and MCL tears, and the infamous Tommy John surgery. Discover the pressures young athletes face due to early sports specialization and year-round play, and why diverse athletic experiences can be crucial for healthy development. Finally, gain insights into injury prevention strategies through progressive overload, and understand how balancing muscle, ligament, and tendon health can mitigate risks. Dr. Myers' passion for sports medicine is palpable as he shares practical advice and compelling stories from his work with athletes striving to return to their peak performance.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Doc Discussions.
I'm Jason Edwards and this isthe world's best medical podcast
, in my opinion.
I'm here today with Dr DevinMyers, and this is a little bit
different than our prior podcastbecause this is actually the
first time I'm meeting him.
Devin, welcome to the podcast,Thank you.
And so I like to start off withkind of figuring out like who
you are and where you're from.
(00:20):
So where do you come from?
Speaker 2 (00:21):
So I actually grew up in Fenton, so I'm a local boy.
Speaker 1 (00:23):
Very good.
Speaker 2 (00:24):
Went to Rockwood Summit High School Did my
undergrad, so I played baseballthere that's kind of my thing
and then went to Truman up inKirksville.
Speaker 1 (00:32):
Did you play baseball at Truman?
Speaker 2 (00:33):
Played baseball there .
That's great yeah, did myundergrad there and exercise
science and then went to took ayear off actually before I kind
of decided I wanted to get intomedicine a little late in the
game at Truman and then actuallyworked at MOBAP for a year as a
patient care tech.
Speaker 1 (00:47):
That's good.
That's a great experience.
I think doing things like that,and being an athlete too, helps
you become a better doctor.
Speaker 2 (00:54):
Yeah, the experience at MOBAP was definitely.
It was a good appreciation forwhat nurses and sort of support
staff do.
So it's a tough job.
But after that I went to medschool, actually back to
Kirksville, to KCOM up there,and then did my residency in
Columbus Ohio.
So I was up there for fiveyears.
Very cool city yeah very muchlike St Louis, kind of clicky in
(01:16):
terms of the areas and goodsports town, so we enjoyed it
there and then I ended up backat WashU for my sports med
fellowship.
So it was good to be home lastyear and kind of transitioning
into practice this year.
Speaker 1 (01:27):
Yeah, very good, and um and so, uh and uh, truman's
uh, it's uh, is it one double Aor division two, d two, d two
and so but I mean that's that'spretty impressive to play NCAA
sports Very, you know it's kindof every uh kid out there.
You know it's kind of every uhkid out there.
You know they're going to get ascholar and it's you know what,
the one percent, two percent,it's not a lot of people who end
(01:48):
up doing for sure it was.
Speaker 2 (01:49):
Uh, it was a choice I made to go there versus
somewhere bigger, because Iwanted to play and have that
sort of you know that collegiateexperience be more involved
rather than kind of be in thebackground, so it worked out
well for me for sure.
Speaker 1 (02:01):
Yeah, it's a lot's a lot about fit too, oh yeah.
And and you know the the, Ithink there's some advantages to
being in Kirksville in general,it's there's not a ton of
distractions.
Speaker 2 (02:10):
That's true.
There's more or less nothing todo.
Speaker 1 (02:13):
And so I mean I'm sure you can get into trouble
there, but as as young kids do.
But you're medical school andalso your craft.
So did you get injured ever asa baseball player?
Speaker 2 (02:26):
Nothing that needed surgery, actually, but, yeah,
plenty of injuries along the way.
I was a catcher, so lots oflittle knee things, you know,
injections here and there forthe shoulder and whatnot.
Speaker 1 (02:36):
Did you ever get injured to the extent that you
had to sit out?
Speaker 2 (02:41):
Yeah, for a couple summers I had actually a low
back issue that needed aninjection and um, so I ended up
kind of burning a summer while Iwas in college, but nothing
during the actual collegiateexperience.
Speaker 1 (02:53):
And that's.
You know, it's an when you're,when you put your whole, I mean
at that level.
You put a lot of your life intoit, I know, and it's incredibly
depressing to put all this workin and then all of a sudden you
can't play, and I'm sure thatwas your experience.
Speaker 2 (03:07):
Yeah, I think that's a big component of what we do.
You know, in orthopedics,especially in sports medicine,
like you know, you have theseathletes who are like training
their whole lives for thesebig-time events, or if it's a
pro athlete like this is theirlivelihood, right.
So when they get hurt it's, youknow, it's not just a physical
problem, it's a mental,psychological thing too, and so
there's a big component ofplaying, you know, not only
(03:28):
doctor, but you know sort oftherapist too.
And, um, you know, if it's,especially if it's a big injury,
somebody tears their ACL andthey're, you know, everybody
knows what that means nowadays.
So they know they're done for ayear more or less, and so
that's pretty defeating.
Speaker 1 (03:43):
And, yeah, you think of I can't remember what year it
was, it was probably 08 orsomething like that or 09, tom
Brady, first game of the seasongets tackled by the Chiefs
player.
I think he tore his ACL rightand it's like you think well,
he's Tom Brady, you know he'sgot everything.
Well, that had to be anincredibly depressing year for
somebody like that and I thinkit lends some credibility if
(04:05):
you've been there, you know, asa doctor to say, hey, you know,
I don't know exactly what you'regoing through, but I've been
there and I can kind of we canget through this Like I've been
down this road before.
Speaker 2 (04:16):
Yeah, 100 percent.
But also the experience ofhaving worked with other you
know high-level athletes in thepast I think also lend some
credibility, because then youkind of know what their thought
process should be and kind ofwho to connect them with to give
them the best outcome but alsothe best sort of you know path
forward while they're recovering.
Speaker 1 (04:38):
You know, it's pretty rare as a college athlete, and
certainly a professional athlete, to go through your career and
not deal with injuries.
It's kind of part of the deal.
Oh yeah, I mean you do havepeople like Michael Jordan who
just like didn't have a ton ofinjuries, at least that you knew
about.
But I mean you know there's,and then there's there's these
(04:59):
kind of legendary injuries theJoe Theismann, 85, broken leg.
Kevin Ware, 2013.
Speaker 2 (05:08):
That was brutal, brutal, oh God.
Speaker 1 (05:10):
One of the worst ever involved a hockey player from
St Louis in 1989, Clint.
Speaker 2 (05:16):
Malarchuk yeah, yeah, get sliced in the neck.
Speaker 1 (05:18):
Yeah, and by the grace of God, one of the
trainers was right there.
Are you familiar with?
Speaker 2 (05:25):
this.
Speaker 1 (05:25):
Yeah, he stuck his finger up the neck and he was a
Vietnam combat medic as well asa trainer, and put his knee on
his collarbone.
Speaker 2 (05:33):
Yeah, it was wild.
Speaker 1 (05:34):
And it's like you know.
So we all have these visions.
What are some of the badinjuries that you've seen?
You know, in the midst of play.
Speaker 2 (05:44):
That's a good question.
Speaker 1 (05:45):
Or actually, I mean you probably did you go, like
during your training did you goto sporting events?
Speaker 2 (05:50):
Oh yeah, Okay, yeah, especially last year during my
fellowship at WashU.
We cover a lot of differentevents.
Speaker 1 (05:56):
You probably saw more actually like as an athlete
than in that year.
Speaker 2 (06:00):
I've had a couple of folks with spinal cord type of
injuries, neck injuries, neckinjuries those are always scary.
More football than anythingelse is obviously what kind of
lends itself to that.
I'm trying to think of whatelse I kind of saw last year.
Speaker 1 (06:17):
There's a lot of non-dramatic injuries.
Nothing like super vicious.
Speaker 2 (06:20):
Those are the things you have nightmares about.
Thank goodness, right they gettheir neck sliced or something.
But yeah, that's part of thethings you have nightmares about
.
Thank goodness they get theirneck sliced or something, but um
, but yeah, there's it's.
That's part of the interestingpart, I guess.
Speaker 1 (06:28):
I mean, it's interesting in kind of a weird
gruesome way but yeah, it's, youknow, it's like it's just you
know advocate for it, buteverybody finds it fascinating
you know there's somethingunpredictable about it.
Speaker 2 (06:38):
right To kind of be it's not like, especially in
orthopedics, like if you'redoing you know hip replacements
or knee replacements, like youknow there's nothing wrong with
that, that, but that's you knowkind of what you do, right.
So that's one thing and that'swhat you do and you're you kind
of know what to expect, what'scoming next.
But if you're covering a game,or even you know, in our field
where we're doing a lot ofdifferent stuff, it's not just
kind keeps it more interesting.
(07:02):
There's just a lot more at play,right so you got to know how to
manage head injuries.
You got to know how to manageneck injuries, so I'm not a
spine guy, but I know how tospine board and moments, um, you
know you need a cool head, yeah, for sure.
(07:26):
If something's and and you knowthe issue is, a lot of times
there's parents that getinvolved and they're down on the
field, they're crying oryelling or whatever, and so it
definitely makes it a little bit, uh, it's a stressful moment
for sure.
Speaker 1 (07:39):
And I'm sure you know , through your training and
through mentors and stuff likethat, and probably even just
through your own personalexperiences, you kind of learn
how to take control of thesituation.
For sure To get people to calmdown.
Speaker 2 (07:49):
Yeah, yeah, definitely part of the training.
So yeah.
I had some really good mentorsat WashU.
Speaker 1 (07:58):
The.
There's injuries that are likeoveruse injuries too, like
stress, fractures and thingslike that.
Do you deal with that kind ofstuff?
Speaker 2 (08:05):
as well.
Yeah, to a certain extent, um,kind of depends on on what it is
.
Obviously, yeah, um, you knowsome of those folks.
You know we're, we'reoftentimes the first contact
point for a lot of those people.
So, like you know the um crosscountry runner who ends up with,
you know a tibial stressfracture or you know a femoral
stress fracture, stuff like thatyeah, it's more commonly lower
extremity, obviously, sinceyou're, you know, more
(08:28):
repetitively bearing weightthrough those areas.
It can happen in the feet, fifthmetatarsal, other places as
well.
So you know we are often thefirst point of contact because
you know they havemusculoskeletal pain.
Yeah, identifying them can bechallenging, though Sometimes
you, you know you get x-rays andthey can be fairly normal and
you have to have enoughsuspicion to get an MRI.
And that's where I think beinga good doctor comes in, cause
(08:50):
you know you're kind of lookingat the patient as a whole, right
, like if it's a young female,maybe they're have some sort of
the female athlete try going onor somebody who's postmenopausal
and you know it's oftentimesmore in females that we see it
or someone who's you know evenguys, who are like training for
ultra marathons, or crazy stufflike that.
Speaker 1 (09:07):
I've had five stress fractures, and so I ran cross
country at Mizzou.
Speaker 2 (09:11):
Okay.
Speaker 1 (09:12):
And four of them were in my tibia and one in my femur
and it's you know, after awhile you're like well, it's
right between the joint and likeyou know, right on the bone and
you kind of have a pretty goodidea.
But it did take them a little.
They did like a now this wasover 20 years ago, so they did
like a nuclear medicine bonescan, yeah, like a true bone
scan, yeah, and you can still dothose.
Speaker 2 (09:30):
So MRI will show it a little bit quicker, a lot of
times.
Speaker 1 (09:33):
Is that right yeah?
Speaker 2 (09:34):
You know they're more sensitive now.
But yeah, then you got to lookat, you know, from a
rheumatologic standpoint or likenot even that, but like
somebody who can give themvitamin D or calcium or high
doses of those things, thingslike that Because it could be
for that.
Speaker 1 (09:53):
We don't want to talk about stress fractures the
whole time, but for thatspecific injury it could be like
an issue with the person,correct?
Speaker 2 (10:01):
For me it was a volume issue.
Speaker 1 (10:02):
I was like running like over 100 miles a week, and
so that'll kind of do it.
Speaker 2 (10:06):
I don't think I've run 100 miles in the last six
months.
Speaker 1 (10:08):
Well, I promise you've ran more than me in the
last six months, but yeah.
So trying to figure out likewhat the underlying cause is,
whether it's internal orexternal locus of control.
Speaker 2 (10:19):
Exactly.
Speaker 1 (10:21):
And then and the do you deal with ligament injuries
at all?
Speaker 2 (10:27):
Yeah, that's one of my primary sort of focuses.
Speaker 1 (10:29):
Is that?
Right as a sports guy, so um sowhat kind of what kind of
things is it with that?
It's like ACL yeah.
Speaker 2 (10:37):
You know, ligament wise, acl is obviously a big one
Everybody thinks about.
But um, you know, in the kneethere's ACL, pcl, mcl, obviously
the lateral collateral as well.
You know, there's ligamentseverywhere else too, in the
ankle.
Speaker 1 (10:53):
What about the elbow?
Speaker 2 (10:54):
Not so much the Tommy John, tommy John ligament, the
UCL, yeah, you know some kind ofcomplex lateral elbow
instability with usually moreassociated fractures, yeah.
And then you know the tendonsare kind of the other half of
our equation, so, like theAchilles repairs and that's a
that's a tough one to come back.
Yeah, oh, it sucks.
Yeah, and the rotator cufftears those sorts of things.
(11:16):
Yeah, not so much from a sportsperspective.
Those are usually moredegenerative or traumatic and
older folks, but it's also sortof falls under the same ballpark
as something a sports guy doesin terms of ligaments and
tendons being one of our mainkind of focuses.
Speaker 1 (11:29):
And so, and there's, you know everybody, the Tommy
John.
It's a real popular subjectmatter because some pitchers you
know have gotten the surgeryand came back and been great.
Speaker 2 (11:42):
Yeah.
Speaker 1 (11:43):
And some people even argue like it's like better to
get the surgery.
Speaker 2 (11:47):
Like you've heard this right, yeah, yeah yeah,
it's definitely a sort of a wisetale.
Yeah, there are some people whohave had the surgery and they
throw harder.
But you know, why is that?
I mean, it could be that youknow their ligaments have been
stretched out for years from thesort of overuse of throwing and
you get a fresh new ligament inthere that heals nicely.
You get a good surgery and nowyou have a tighter ligament
(12:09):
there and so, um, you throwharder.
It could be the months andmonths of rehab where you're
focused specifically on yourcore and your chain and your
shoulder and all that otherstuff that you weren't doing
before when you were justconsistently throwing a baseball
.
So it's hard to pinpointexactly why that is.
I would tell you that that'snot the majority of people.
The majority of people do getback to play, but there are
(12:30):
there.
There is definitely apercentage of folks who don't I
don't have a number in front ofme but a percentage of folks who
don't ever get back to the samelevel they were at.
Yeah, and it's probably higherthan most people would expect.
Speaker 1 (12:40):
What are people having the surgery at a younger
age than they did previously?
Speaker 2 (12:44):
That is true for sure .
Speaker 1 (12:45):
Why do you think that is?
Speaker 2 (12:47):
I think a lot of it has to do with the year-round
sports craze and the sports kindof specialization.
It seems to be cooling off alittle bit.
When I was going throughplaying in high school and
college, it was like everybodywas saying you've got to pick a
sport, you've got to pick asport, you've got to play all
year round.
And so I pretty much I mean forwhen I was like 10 or 11 on, I
(13:08):
pretty much played baseball allyear round.
Yeah, and looking back on it,that was a horrible decision.
I probably would have had funplaying football or hockey or
any other sport, right and um.
But that was you kind ofdevelop one set of muscles, one
(13:28):
set of movement patterns,whereas you're not, you know,
doing other sports.
Maybe you're not throwing aball, maybe you're doing more
running or kicking or you knowwhatever that is and you kind of
strengthen muscles that you'renot otherwise using.
Speaker 1 (13:40):
So I'm going to get in hot water here.
That's a part of it.
I'm going to get in hot wateron this one because almost most
of the people I talk to aboutthis tell me I'm wrong.
But I'm going to stick with myposition.
The pushing kids.
Now we're getting off track,but that's OK.
Pushing kids in a sport toohard, I think too early, is a
(14:04):
bad idea.
And I'll hear people say well,you don't know, jason, this is
St Louis.
If they're not, you know, atnine years old doing this,
they'll never make the varsityteam.
And like, obviously I was aDivision I athlete and I've
actually talked to, you know,other college athletes about
(14:27):
this and they, they, they agreewith me yeah, they say yeah, and
I I could kind of tell the wayyou're framing it and and so in
a high skill sport like golf orbaseball, you probably need to
start earlier to develop thatskill.
Golf or baseball, you probablyneed to start earlier to develop
that skill.
Um, and things um like likefootball, which certainly has
(14:48):
some skill to it but it's likeless of a skill Um.
You know, I've seen people umplay their first year of college
or of high school football as asenior and be all state I mean
you and so I think it's moreimportant to have kind of a to
be a good athlete, to train butto do many things.
And I think it's more importantto have kind of a to be a good
athlete, to train but to do manythings, and I think that's
better for you psychologically.
Speaker 2 (15:10):
Oh, a hundred percent .
Speaker 1 (15:11):
And a hundred percent selling out, you know, in
fourth grade for one sport whereyou're not going pro like it's
not happening.
Speaker 2 (15:18):
It's not a good idea.
I mean like I said, I kind ofdid that and I regret it now
yeah.
Like at the time it seemed likethe best choice.
But I mean, from an injurystandpoint luckily I never had
anything terrible happen butyeah, I think it would have been
better for my overalldevelopment physically, yeah.
And I just think that from apsychological standpoint
(15:40):
nowadays, like even when I wasplaying, like there was two good
travel teams in St Louis andthat's what it was yeah, If you
didn't play on one of them, youplayed on you know some other
sort of like semi-competitivetravel team, but you maybe
travel for a couple of weeks, acouple of weekends per summer,
kind of.
Speaker 1 (15:53):
Thing.
Speaker 2 (15:53):
It was pretty relaxed right.
Speaker 1 (15:55):
It's not.
That's not how it is anymore.
Speaker 2 (15:56):
Right, it's like there's like 10 different travel
teams.
They all have like eight.
You through 18, you you'reshelling out thousands of
dollars a month.
You know to these organizationsand there's nothing wrong with
them I mean, their intentionsare good, I think you know, to
help kids learn but it gets tobe this like behemoth that they
can't control.
Speaker 1 (16:13):
And it kind of takes over the whole family and and
and like to the people.
If you're doing that out there,I don't know what's right.
I'm just saying but I, but Ihave spent a lot of time in
sports and most of the people Iknow who have been collegiate
sports and I mean I've trainedwith Olympians um, you know,
high level guys, um, most ofthem as adults are not super pro
(16:36):
that.
Speaker 2 (16:36):
Yeah, and I don't think there's anything wrong
with you know, if you're outthere trying to, you know, help
your kid, do what they want todo and they enjoy it.
Speaker 1 (16:43):
And if the kid loves it, yeah, then that's great.
I mean a hundred percent.
Speaker 2 (16:47):
And and you know you got to do what you enjoy doing,
right, but um, I mean, I cantell you like when I got to my
last couple of years of college,I was pretty burnt out and I
kind of I feel bad about thatnow, cause I wish I could go
back and play, yeah, but, and itwas.
You know you look back and like, man, that was that should have
been the time of my life, but Iwas kind of ready to be done.
Speaker 1 (17:05):
So so I mean you know you play baseball, which is
kind of a glory sport.
Track is not a glory sport.
I mean you know there's notlike.
You know everybody's like, oh,you're on the track.
No, it doesn't happen.
Yeah, would know who they are,who are on the basketball team
and the football team, who were.
And I mean you know you get,you know arena full of people
(17:28):
cheering their name.
Everybody on campus knows themthat I remember them were the
same exact thing.
You know, junior year.
They're like I don't like thisanymore.
This has turned into somethingthat like it's not fun, it's all
work and I'm not saying likepoor me, but it's being a
college athlete.
It's a tough one.
Speaker 2 (17:44):
Yeah, it's a grind, you know you're trying to do
school and that's, you know,hard enough for most people, and
then you're doing and againit's not like a feel bad for me
kind of thing, but it's it'sdefinitely like a lot of people
don't realize how, howchallenging it is, Even at the
(18:13):
D2 level.
Speaker 1 (18:14):
Cause they're um.
When I was there, they had thisslogan.
It was like we chose D2.
Like, like there's levels to it, but there can be some great.
Speaker 2 (18:23):
Oh yeah, individual athletes and teams.
Some great baseball players inthe conference I was in that
ended up playing pro and so, alljoking aside, did you ever see
the Appalachian State versusMichigan?
Speaker 1 (18:34):
When Michigan was ranked number one, Appalachian
State was like either the D2 or1AA national champion of
football.
Speaker 2 (18:40):
They played each other the first game of the
season, the Appalachian statebeat them, the number one team
in the country.
Speaker 1 (18:44):
So yeah, they're good .
Yeah, the yeah, but yeah.
So I mean you know you can getsome good athletes at all levels
for sure.
Um and so, um.
So do you see?
Um?
Speaker 2 (19:05):
no-transcript are getting a little older, um,
typically you know 50s to 80kind of kind of range, um, but
up to whatever um, but then themostly you know the true sports
injuries are going to be inyounger folks who are doing
those kinds of activities.
So the ACL tears, the you knowtrue like meniscus tears, um,
(19:27):
shoulder dislocations, ac, jointsprains, those kinds of things
are going to be usually in in intrue athletes that are younger.
Yeah, I say true athletes.
That's probably not fair but um, even your weekend warriors or
people who are out kind of doingyou know stuff on the weekend,
so um, even like meniscus tearsthough, for example, like we see
meniscus tears in the 20 yearold football player, but we also
(19:48):
see meniscus tears in, you know, people in their fifties and
sixties who have been grindingon their knee for a while and
maybe have a twisting pivotinginjury and now they have a
meniscus tear.
So how you treat them in somesometimes a little bit different
, but um, you know, those arekind of.
Those are one of the ones whereI kind of clump into.
Like everyone can get it, butthere are injuries typically
more in younger folks, like theshoulder dislocations and AC
(20:08):
joint sprains and things likethat that are more traumatic.
Yeah, and I see some fracturesand stuff too that are kind of
of all ages.
But yeah, it's a mixed bucketfor sure.
Speaker 1 (20:17):
All right.
So everybody knows like thenewest, hottest craze is
pickleball and you know, youknow and I've heard from
actually, dr Ramis was talkingto me about it saying you know,
this is a new area where there'sa ton of injuries, but it can
(20:41):
get to a point where it's likeoutside of the realm of normal.
Can you talk to me about justkind of differentiating, like
when people need to see youversus normal aches and pains,
and then pickleball specifically?
Speaker 2 (20:49):
Yeah, so the pickleball craze is definitely
real.
We see all kinds of pickleballinjuries nowadays and it varies
from, like your, your tenniselbow, which we see oftentimes
in any kind of racket sport,versus, like you know, trips and
falls, where we get handfractures and wrist fractures
and gosh, even like hipfractures, which is not, not
(21:09):
ideal for someone who's outplaying pickleball.
But you know, even then to kneeinjuries where you have
exacerbation of knee arthritisor meniscus tears, things of
that sort.
So the variety of the spectrumis huge.
Just because of the way thatyou're playing, you're involving
a lot of different things.
Um, in terms of you know when tocome see somebody, um, I think
(21:33):
anytime, you know, anytimeyou're, you're noticing uh,
increased pain without, uh,significant swelling, without,
you know, swelling inside thejoint or in the soft tissues
where you can still weight bear.
Um, where things are managedwith ice and anti-inflammatories
, then that's kind of the placeto start.
So, um, you know using the iceconsistently for a couple of
days, taking, you know,reasonable doses of
anti-inflammatories, obviouslywithin, you know, the normal
(21:53):
standards, um, six to 800milligrams every, you know,
three times a day.
That's that kind of thing.
Um, I see a lot of people whoare like oh, I took ibuprofen,
but they took like 400milligrams once a day, which is
not going to really do much.
Speaker 1 (22:04):
So yeah, I do the three.
I do 600, three pills threetimes a day for three days.
Usually it takes care of me,yes exactly.
Speaker 2 (22:16):
So I'm two 30.
So I mean, if you do yeah,exactly, if you do a little run
of that and noticing things likeswelling, you felt a pop in
your knee or your shoulder orsomething along those lines, you
can't move your joint, you haveum inability to weight bear,
those are all reasons to comesee somebody much sooner,
obviously.
But, um, you know, it's one ofthose things that's kind of
intuitive to some degree.
Speaker 1 (22:34):
Yeah, yeah, yeah, thankfully, yeah, and and for
sure.
There's going to be some achesand pains as you adapt.
I mean that comes with it.
But I, you know, I always tellmy patients with cancer that you
know, if you're having pain formore than two weeks and it
seems like it's only gettingworse, you know, that's the time
For sure, yeah, and persistenceis definitely a sign.
Speaker 2 (22:50):
So, and in people who are playing pickleball like,
like you said, a lot of peopleare picking it up now who
haven't been super active, andthat's great.
We want you to be active and soultimately it's a good thing.
But you have to understand,like when you're out there
running back and forth, makingquick, pivoting, cutting
movements using a repetitiveracket swing, that you haven't
done in maybe 10 or 20 years,that it's probably going to be
(23:13):
sore and that can turn intotendonitis, it can turn into
exacerbation of preexistingarthritis or, you know, maybe
you had a meniscus tear alreadythat was asymptomatic, that
you've now aggravated.
So those are kind of the trickythings where maybe you had a
little bit of knee pain and youhave arthritis and it just
wasn't flared up and now youhave full blown arthritis and
(23:33):
some people are confused aboutthat.
Speaker 1 (23:35):
Do you um, um, do you lift weights?
So the you know you're familiarwith the concept of progressive
overload, right Like, over time, you slowly increase the volume
or the weight or both Of course.
And you know I've talked aboutthis before on the podcast but,
like your muscles will probablyadapt faster than anything, and
(23:57):
the older you are, the slowerthey adapt.
Your bone density can improvesignificantly with weight
training and just activity ingeneral, but the ligaments and
tendons, although they can getstronger, do so much slower, and
so if you increase yourphysical activity and your
muscles are adapting rapidly,those ligaments and tendons are
(24:18):
not.
Speaker 2 (24:19):
They can adapt but it's slow and they kind of adapt
, not so much in the way thatmuscles do in terms of
strengthening or hypertrophying,but they kind of change their
structure their orientation.
They reorganize the collagenright Exactly to kind of modify
the way you're treating it.
Essentially, the issue is thatthe muscles hypertrophy quicker
and they tend to kind of tightenup as you're using them more.
(24:39):
And so if you get morestiffness and tightness through
the muscles.
you're pulling on thoseligamentous, you know, tendinous
insertions more and that's whenyou start to develop tendonitis
.
So Achilles, you know tennis,elbow, shoulder, those are the
things that you know, and thenyou got to work with physical
therapy and things like that toreally stretch the muscles out
so that the tendons can have alittle bit of relief.
Speaker 1 (24:59):
And so the best way to kind of mitigate your risk of
injury would be to kind ofslowly increase your volume over
time.
If you're lifting for sure,taking the deload week where you
kind of go down every five orsix weeks, yeah, of course it's
kind of a good idea.
Speaker 2 (25:14):
Similar process.
Speaker 1 (25:15):
Yeah.
Speaker 2 (25:15):
Where you get out and you play, you know, do some
practice, then go, you know, tothe next day when you maybe play
one game of pickleball and thenyou go play two days, two games
of pickleball the following day.
So rather than like going outand playing for three hours
straight, you know where you'rejust cutting and pivoting and
diving, swinging.
I mean, you're going to pay forthat.
Speaker 1 (25:34):
So I'm going to pay for that.
So, yeah, exactly.
Well, it seems like a reallycool, um cool practice that
you've created here, and I thinkyou know, being an athlete, I'm
sure you love working withathletes and then you know,
seeing them down the road dowell too is very gratifying.
Yeah Well, devin, I want you toknow.
We're very happy to have youhere, and thanks for coming on
(25:54):
the podcast today.
Speaker 2 (25:55):
I appreciate it.
Yeah, thanks for your time, youbet.
Welcome to Doc Discussions.
I'm Jason Edwards and this isthe world's best medical podcast
, in my opinion.
I'm here today with Dr DevinMyers, and this is a little bit
different than our prior podcastbecause this is actually the
first time I'm meeting him.
Devin, welcome to the podcast,Thank you.
And so I like to start off withkind of figuring out like who
you are and where you're from.
(00:20):
So where do you come from?
Speaker 2 (00:21):
So I actually grew up in Fenton, so I'm a local boy.
Speaker 1 (00:23):
Very good.
Speaker 2 (00:24):
Went to Rockwood Summit High School Did my
undergrad, so I played baseballthere that's kind of my thing
and then went to Truman up inKirksville.
Speaker 1 (00:32):
Did you play baseball at Truman?
Speaker 2 (00:33):
Played baseball there .
That's great yeah, did myundergrad there and exercise
science and then went to took ayear off actually before I kind
of decided I wanted to get intomedicine a little late in the
game at Truman and then actuallyworked at MOBAP for a year as a
patient care tech.
Speaker 1 (00:47):
That's good.
That's a great experience.
I think doing things like that,and being an athlete too, helps
you become a better doctor.
Speaker 2 (00:54):
Yeah, the experience at MOBAP was definitely.
It was a good appreciation forwhat nurses and sort of support
staff do.
So it's a tough job.
But after that I went to medschool, actually back to
Kirksville, to KCOM up there,and then did my residency in
Columbus Ohio.
So I was up there for fiveyears.
Very cool city yeah very muchlike St Louis, kind of clicky in
(01:16):
terms of the areas and goodsports town, so we enjoyed it
there and then I ended up backat WashU for my sports med
fellowship.
So it was good to be home lastyear and kind of transitioning
into practice this year.
Speaker 1 (01:27):
Yeah, very good, and um and so, uh and uh, truman's
uh, it's uh, is it one double Aor division two, d two, d two
and so but I mean that's that'spretty impressive to play NCAA
sports Very, you know it's kindof every uh kid out there.
You know it's kind of every uhkid out there.
You know they're going to get ascholar and it's you know what,
the one percent, two percent,it's not a lot of people who end
(01:48):
up doing for sure it was.
Speaker 2 (01:49):
Uh, it was a choice I made to go there versus
somewhere bigger, because Iwanted to play and have that
sort of you know that collegiateexperience be more involved
rather than kind of be in thebackground, so it worked out
well for me for sure.
Speaker 1 (02:01):
Yeah, it's a lot's a lot about fit too, oh yeah.
And and you know the the, Ithink there's some advantages to
being in Kirksville in general,it's there's not a ton of
distractions.
Speaker 2 (02:10):
That's true.
There's more or less nothing todo.
Speaker 1 (02:13):
And so I mean I'm sure you can get into trouble
there, but as as young kids do.
But you're medical school andalso your craft.
So did you get injured ever asa baseball player?
Speaker 2 (02:26):
Nothing that needed surgery, actually, but, yeah,
plenty of injuries along the way.
I was a catcher, so lots oflittle knee things, you know,
injections here and there forthe shoulder and whatnot.
Speaker 1 (02:36):
Did you ever get injured to the extent that you
had to sit out?
Speaker 2 (02:41):
Yeah, for a couple summers I had actually a low
back issue that needed aninjection and um, so I ended up
kind of burning a summer while Iwas in college, but nothing
during the actual collegiateexperience.
Speaker 1 (02:53):
And that's.
You know, it's an when you're,when you put your whole, I mean
at that level.
You put a lot of your life intoit, I know, and it's incredibly
depressing to put all this workin and then all of a sudden you
can't play, and I'm sure thatwas your experience.
Speaker 2 (03:07):
Yeah, I think that's a big component of what we do.
You know, in orthopedics,especially in sports medicine,
like you know, you have theseathletes who are like training
their whole lives for thesebig-time events, or if it's a
pro athlete like this is theirlivelihood, right.
So when they get hurt it's, youknow, it's not just a physical
problem, it's a mental,psychological thing too, and so
there's a big component ofplaying, you know, not only
(03:28):
doctor, but you know sort oftherapist too.
And, um, you know, if it's,especially if it's a big injury,
somebody tears their ACL andthey're, you know, everybody
knows what that means nowadays.
So they know they're done for ayear more or less, and so
that's pretty defeating.
Speaker 1 (03:43):
And, yeah, you think of I can't remember what year it
was, it was probably 08 orsomething like that or 09, tom
Brady, first game of the seasongets tackled by the Chiefs
player.
I think he tore his ACL rightand it's like you think well,
he's Tom Brady, you know he'sgot everything.
Well, that had to be anincredibly depressing year for
somebody like that and I thinkit lends some credibility if
(04:05):
you've been there, you know, asa doctor to say, hey, you know,
I don't know exactly what you'regoing through, but I've been
there and I can kind of we canget through this Like I've been
down this road before.
Speaker 2 (04:16):
Yeah, 100 percent.
But also the experience ofhaving worked with other you
know high-level athletes in thepast I think also lend some
credibility, because then youkind of know what their thought
process should be and kind ofwho to connect them with to give
them the best outcome but alsothe best sort of you know path
forward while they're recovering.
Speaker 1 (04:38):
You know, it's pretty rare as a college athlete, and
certainly a professional athlete, to go through your career and
not deal with injuries.
It's kind of part of the deal.
Oh yeah, I mean you do havepeople like Michael Jordan who
just like didn't have a ton ofinjuries, at least that you knew
about.
But I mean you know there's,and then there's there's these
(04:59):
kind of legendary injuries theJoe Theismann, 85, broken leg.
Kevin Ware, 2013.
Speaker 2 (05:08):
That was brutal, brutal, oh God.
Speaker 1 (05:10):
One of the worst ever involved a hockey player from
St Louis in 1989, Clint.
Speaker 2 (05:16):
Malarchuk yeah, yeah, get sliced in the neck.
Speaker 1 (05:18):
Yeah, and by the grace of God, one of the
trainers was right there.
Are you familiar with?
Speaker 2 (05:25):
this.
Speaker 1 (05:25):
Yeah, he stuck his finger up the neck and he was a
Vietnam combat medic as well asa trainer, and put his knee on
his collarbone.
Speaker 2 (05:33):
Yeah, it was wild.
Speaker 1 (05:34):
And it's like you know.
So we all have these visions.
What are some of the badinjuries that you've seen?
You know, in the midst of play.
Speaker 2 (05:44):
That's a good question.
Speaker 1 (05:45):
Or actually, I mean you probably did you go, like
during your training did you goto sporting events?
Speaker 2 (05:50):
Oh yeah, Okay, yeah, especially last year during my
fellowship at WashU.
We cover a lot of differentevents.
Speaker 1 (05:56):
You probably saw more actually like as an athlete
than in that year.
Speaker 2 (06:00):
I've had a couple of folks with spinal cord type of
injuries, neck injuries, neckinjuries those are always scary.
More football than anythingelse is obviously what kind of
lends itself to that.
I'm trying to think of whatelse I kind of saw last year.
Speaker 1 (06:17):
There's a lot of non-dramatic injuries.
Nothing like super vicious.
Speaker 2 (06:20):
Those are the things you have nightmares about.
Thank goodness, right they gettheir neck sliced or something.
But yeah, that's part of thethings you have nightmares about
.
Thank goodness they get theirneck sliced or something, but um
, but yeah, there's it's.
That's part of the interestingpart, I guess.
Speaker 1 (06:28):
I mean, it's interesting in kind of a weird
gruesome way but yeah, it's, youknow, it's like it's just you
know advocate for it, buteverybody finds it fascinating
you know there's somethingunpredictable about it.
Speaker 2 (06:38):
right To kind of be it's not like, especially in
orthopedics, like if you'redoing you know hip replacements
or knee replacements, like youknow there's nothing wrong with
that, that, but that's you knowkind of what you do, right.
So that's one thing and that'swhat you do and you're you kind
of know what to expect, what'scoming next.
But if you're covering a game,or even you know, in our field
where we're doing a lot ofdifferent stuff, it's not just
kind keeps it more interesting.
(07:02):
There's just a lot more at play,right so you got to know how to
manage head injuries.
You got to know how to manageneck injuries, so I'm not a
spine guy, but I know how tospine board and moments, um, you
know you need a cool head, yeah, for sure.
(07:26):
If something's and and you knowthe issue is, a lot of times
there's parents that getinvolved and they're down on the
field, they're crying oryelling or whatever, and so it
definitely makes it a little bit, uh, it's a stressful moment
for sure.
Speaker 1 (07:39):
And I'm sure you know , through your training and
through mentors and stuff likethat, and probably even just
through your own personalexperiences, you kind of learn
how to take control of thesituation.
For sure To get people to calmdown.
Speaker 2 (07:49):
Yeah, yeah, definitely part of the training.
So yeah.
I had some really good mentorsat WashU.
Speaker 1 (07:58):
The.
There's injuries that are likeoveruse injuries too, like
stress, fractures and thingslike that.
Do you deal with that kind ofstuff?
Speaker 2 (08:05):
as well.
Yeah, to a certain extent, um,kind of depends on on what it is
.
Obviously, yeah, um, you knowsome of those folks.
You know we're, we'reoftentimes the first contact
point for a lot of those people.
So, like you know the um crosscountry runner who ends up with,
you know a tibial stressfracture or you know a femoral
stress fracture, stuff like thatyeah, it's more commonly lower
extremity, obviously, sinceyou're, you know, more
(08:28):
repetitively bearing weightthrough those areas.
It can happen in the feet, fifthmetatarsal, other places as
well.
So you know we are often thefirst point of contact because
you know they havemusculoskeletal pain.
Yeah, identifying them can bechallenging, though Sometimes
you, you know you get x-rays andthey can be fairly normal and
you have to have enoughsuspicion to get an MRI.
And that's where I think beinga good doctor comes in, cause
(08:50):
you know you're kind of lookingat the patient as a whole, right
, like if it's a young female,maybe they're have some sort of
the female athlete try going onor somebody who's postmenopausal
and you know it's oftentimesmore in females that we see it
or someone who's you know evenguys, who are like training for
ultra marathons, or crazy stufflike that.
Speaker 1 (09:07):
I've had five stress fractures, and so I ran cross
country at Mizzou.
Speaker 2 (09:11):
Okay.
Speaker 1 (09:12):
And four of them were in my tibia and one in my femur
and it's you know, after awhile you're like well, it's
right between the joint and likeyou know, right on the bone and
you kind of have a pretty goodidea.
But it did take them a little.
They did like a now this wasover 20 years ago, so they did
like a nuclear medicine bonescan, yeah, like a true bone
scan, yeah, and you can still dothose.
Speaker 2 (09:30):
So MRI will show it a little bit quicker, a lot of
times.
Speaker 1 (09:33):
Is that right yeah?
Speaker 2 (09:34):
You know they're more sensitive now.
But yeah, then you got to lookat, you know, from a
rheumatologic standpoint or likenot even that, but like
somebody who can give themvitamin D or calcium or high
doses of those things, thingslike that Because it could be
for that.
Speaker 1 (09:53):
We don't want to talk about stress fractures the
whole time, but for thatspecific injury it could be like
an issue with the person,correct?
Speaker 2 (10:01):
For me it was a volume issue.
Speaker 1 (10:02):
I was like running like over 100 miles a week, and
so that'll kind of do it.
Speaker 2 (10:06):
I don't think I've run 100 miles in the last six
months.
Speaker 1 (10:08):
Well, I promise you've ran more than me in the
last six months, but yeah.
So trying to figure out likewhat the underlying cause is,
whether it's internal orexternal locus of control.
Speaker 2 (10:19):
Exactly.
Speaker 1 (10:21):
And then and the do you deal with ligament injuries
at all?
Speaker 2 (10:27):
Yeah, that's one of my primary sort of focuses.
Speaker 1 (10:29):
Is that?
Right as a sports guy, so um sowhat kind of what kind of
things is it with that?
It's like ACL yeah.
Speaker 2 (10:37):
You know, ligament wise, acl is obviously a big one
Everybody thinks about.
But um, you know, in the kneethere's ACL, pcl, mcl, obviously
the lateral collateral as well.
You know, there's ligamentseverywhere else too, in the
ankle.
Speaker 1 (10:53):
What about the elbow?
Speaker 2 (10:54):
Not so much the Tommy John, tommy John ligament, the
UCL, yeah, you know some kind ofcomplex lateral elbow
instability with usually moreassociated fractures, yeah.
And then you know the tendonsare kind of the other half of
our equation, so, like theAchilles repairs and that's a
that's a tough one to come back.
Yeah, oh, it sucks.
Yeah, and the rotator cufftears those sorts of things.
(11:16):
Yeah, not so much from a sportsperspective.
Those are usually moredegenerative or traumatic and
older folks, but it's also sortof falls under the same ballpark
as something a sports guy doesin terms of ligaments and
tendons being one of our mainkind of focuses.
Speaker 1 (11:29):
And so, and there's, you know everybody, the Tommy
John.
It's a real popular subjectmatter because some pitchers you
know have gotten the surgeryand came back and been great.
Speaker 2 (11:42):
Yeah.
Speaker 1 (11:43):
And some people even argue like it's like better to
get the surgery.
Speaker 2 (11:47):
Like you've heard this right, yeah, yeah yeah,
it's definitely a sort of a wisetale.
Yeah, there are some people whohave had the surgery and they
throw harder.
But you know, why is that?
I mean, it could be that youknow their ligaments have been
stretched out for years from thesort of overuse of throwing and
you get a fresh new ligament inthere that heals nicely.
You get a good surgery and nowyou have a tighter ligament
(12:09):
there and so, um, you throwharder.
It could be the months andmonths of rehab where you're
focused specifically on yourcore and your chain and your
shoulder and all that otherstuff that you weren't doing
before when you were justconsistently throwing a baseball
.
So it's hard to pinpointexactly why that is.
I would tell you that that'snot the majority of people.
The majority of people do getback to play, but there are
(12:30):
there.
There is definitely apercentage of folks who don't I
don't have a number in front ofme but a percentage of folks who
don't ever get back to the samelevel they were at.
Yeah, and it's probably higherthan most people would expect.
Speaker 1 (12:40):
What are people having the surgery at a younger
age than they did previously?
Speaker 2 (12:44):
That is true for sure .
Speaker 1 (12:45):
Why do you think that is?
Speaker 2 (12:47):
I think a lot of it has to do with the year-round
sports craze and the sports kindof specialization.
It seems to be cooling off alittle bit.
When I was going throughplaying in high school and
college, it was like everybodywas saying you've got to pick a
sport, you've got to pick asport, you've got to play all
year round.
And so I pretty much I mean forwhen I was like 10 or 11 on, I
(13:08):
pretty much played baseball allyear round.
Yeah, and looking back on it,that was a horrible decision.
I probably would have had funplaying football or hockey or
any other sport, right and um.
But that was you kind ofdevelop one set of muscles, one
(13:28):
set of movement patterns,whereas you're not, you know,
doing other sports.
Maybe you're not throwing aball, maybe you're doing more
running or kicking or you knowwhatever that is and you kind of
strengthen muscles that you'renot otherwise using.
Speaker 1 (13:40):
So I'm going to get in hot water here.
That's a part of it.
I'm going to get in hot wateron this one because almost most
of the people I talk to aboutthis tell me I'm wrong.
But I'm going to stick with myposition.
The pushing kids.
Now we're getting off track,but that's OK.
Pushing kids in a sport toohard, I think too early, is a
(14:04):
bad idea.
And I'll hear people say well,you don't know, jason, this is
St Louis.
If they're not, you know, atnine years old doing this,
they'll never make the varsityteam.
And like, obviously I was aDivision I athlete and I've
actually talked to, you know,other college athletes about
(14:27):
this and they, they, they agreewith me yeah, they say yeah, and
I I could kind of tell the wayyou're framing it and and so in
a high skill sport like golf orbaseball, you probably need to
start earlier to develop thatskill.
Golf or baseball, you probablyneed to start earlier to develop
that skill.
Um, and things um like likefootball, which certainly has
(14:48):
some skill to it but it's likeless of a skill Um.
You know, I've seen people umplay their first year of college
or of high school football as asenior and be all state I mean
you and so I think it's moreimportant to have kind of a to
be a good athlete, to train butto do many things.
And I think it's more importantto have kind of a to be a good
athlete, to train but to do manythings, and I think that's
better for you psychologically.
Speaker 2 (15:10):
Oh, a hundred percent .
Speaker 1 (15:11):
And a hundred percent selling out, you know, in
fourth grade for one sport whereyou're not going pro like it's
not happening.
Speaker 2 (15:18):
It's not a good idea.
I mean like I said, I kind ofdid that and I regret it now
yeah.
Like at the time it seemed likethe best choice.
But I mean, from an injurystandpoint luckily I never had
anything terrible happen butyeah, I think it would have been
better for my overalldevelopment physically, yeah.
And I just think that from apsychological standpoint
(15:40):
nowadays, like even when I wasplaying, like there was two good
travel teams in St Louis andthat's what it was yeah, If you
didn't play on one of them, youplayed on you know some other
sort of like semi-competitivetravel team, but you maybe
travel for a couple of weeks, acouple of weekends per summer,
kind of.
Speaker 1 (15:53):
Thing.
Speaker 2 (15:53):
It was pretty relaxed right.
Speaker 1 (15:55):
It's not.
That's not how it is anymore.
Speaker 2 (15:56):
Right, it's like there's like 10 different travel
teams.
They all have like eight.
You through 18, you you'reshelling out thousands of
dollars a month.
You know to these organizationsand there's nothing wrong with
them I mean, their intentionsare good, I think you know, to
help kids learn but it gets tobe this like behemoth that they
can't control.
Speaker 1 (16:13):
And it kind of takes over the whole family and and
and like to the people.
If you're doing that out there,I don't know what's right.
I'm just saying but I, but Ihave spent a lot of time in
sports and most of the people Iknow who have been collegiate
sports and I mean I've trainedwith Olympians um, you know,
high level guys, um, most ofthem as adults are not super pro
(16:36):
that.
Speaker 2 (16:36):
Yeah, and I don't think there's anything wrong
with you know, if you're outthere trying to, you know, help
your kid, do what they want todo and they enjoy it.
Speaker 1 (16:43):
And if the kid loves it, yeah, then that's great.
I mean a hundred percent.
Speaker 2 (16:47):
And and you know you got to do what you enjoy doing,
right, but um, I mean, I cantell you like when I got to my
last couple of years of college,I was pretty burnt out and I
kind of I feel bad about thatnow, cause I wish I could go
back and play, yeah, but, and itwas.
You know you look back and like, man, that was that should have
been the time of my life, but Iwas kind of ready to be done.
Speaker 1 (17:05):
So so I mean you know you play baseball, which is
kind of a glory sport.
Track is not a glory sport.
I mean you know there's notlike.
You know everybody's like, oh,you're on the track.
No, it doesn't happen.
Yeah, would know who they are,who are on the basketball team
and the football team, who were.
And I mean you know you get,you know arena full of people
(17:28):
cheering their name.
Everybody on campus knows themthat I remember them were the
same exact thing.
You know, junior year.
They're like I don't like thisanymore.
This has turned into somethingthat like it's not fun, it's all
work and I'm not saying likepoor me, but it's being a
college athlete.
It's a tough one.
Speaker 2 (17:44):
Yeah, it's a grind, you know you're trying to do
school and that's, you know,hard enough for most people, and
then you're doing and againit's not like a feel bad for me
kind of thing, but it's it'sdefinitely like a lot of people
don't realize how, howchallenging it is, Even at the
(18:13):
D2 level.
Speaker 1 (18:14):
Cause they're um.
When I was there, they had thisslogan.
It was like we chose D2.
Like, like there's levels to it, but there can be some great.
Speaker 2 (18:23):
Oh yeah, individual athletes and teams.
Some great baseball players inthe conference I was in that
ended up playing pro and so, alljoking aside, did you ever see
the Appalachian State versusMichigan?
Speaker 1 (18:34):
When Michigan was ranked number one, Appalachian
State was like either the D2 or1AA national champion of
football.
Speaker 2 (18:40):
They played each other the first game of the
season, the Appalachian statebeat them, the number one team
in the country.
Speaker 1 (18:44):
So yeah, they're good .
Yeah, the yeah, but yeah.
So I mean you know you can getsome good athletes at all levels
for sure.
Um and so, um.
So do you see?
Um?
Speaker 2 (19:05):
no-transcript are getting a little older, um,
typically you know 50s to 80kind of kind of range, um, but
up to whatever um, but then themostly you know the true sports
injuries are going to be inyounger folks who are doing
those kinds of activities.
So the ACL tears, the you knowtrue like meniscus tears, um,
(19:27):
shoulder dislocations, ac, jointsprains, those kinds of things
are going to be usually in in intrue athletes that are younger.
Yeah, I say true athletes.
That's probably not fair but um, even your weekend warriors or
people who are out kind of doingyou know stuff on the weekend,
so um, even like meniscus tearsthough, for example, like we see
meniscus tears in the 20 yearold football player, but we also
(19:48):
see meniscus tears in, you know, people in their fifties and
sixties who have been grindingon their knee for a while and
maybe have a twisting pivotinginjury and now they have a
meniscus tear.
So how you treat them in somesometimes a little bit different
, but um, you know, those arekind of.
Those are one of the ones whereI kind of clump into.
Like everyone can get it, butthere are injuries typically
more in younger folks, like theshoulder dislocations and AC
(20:08):
joint sprains and things likethat that are more traumatic.
Yeah, and I see some fracturesand stuff too that are kind of
of all ages.
But yeah, it's a mixed bucketfor sure.
Speaker 1 (20:17):
All right.
So everybody knows like thenewest, hottest craze is
pickleball and you know, youknow and I've heard from
actually, dr Ramis was talkingto me about it saying you know,
this is a new area where there'sa ton of injuries, but it can
(20:41):
get to a point where it's likeoutside of the realm of normal.
Can you talk to me about justkind of differentiating, like
when people need to see youversus normal aches and pains,
and then pickleball specifically?
Speaker 2 (20:49):
Yeah, so the pickleball craze is definitely
real.
We see all kinds of pickleballinjuries nowadays and it varies
from, like your, your tenniselbow, which we see oftentimes
in any kind of racket sport,versus, like you know, trips and
falls, where we get handfractures and wrist fractures
and gosh, even like hipfractures, which is not, not
(21:09):
ideal for someone who's outplaying pickleball.
But you know, even then to kneeinjuries where you have
exacerbation of knee arthritisor meniscus tears, things of
that sort.
So the variety of the spectrumis huge.
Just because of the way thatyou're playing, you're involving
a lot of different things.
Um, in terms of you know when tocome see somebody, um, I think
(21:33):
anytime, you know, anytimeyou're, you're noticing uh,
increased pain without, uh,significant swelling, without,
you know, swelling inside thejoint or in the soft tissues
where you can still weight bear.
Um, where things are managedwith ice and anti-inflammatories
, then that's kind of the placeto start.
So, um, you know using the iceconsistently for a couple of
days, taking, you know,reasonable doses of
anti-inflammatories, obviouslywithin, you know, the normal
(21:53):
standards, um, six to 800milligrams every, you know,
three times a day.
That's that kind of thing.
Um, I see a lot of people whoare like oh, I took ibuprofen,
but they took like 400milligrams once a day, which is
not going to really do much.
Speaker 1 (22:04):
So yeah, I do the three.
I do 600, three pills threetimes a day for three days.
Usually it takes care of me,yes exactly.
Speaker 2 (22:16):
So I'm two 30.
So I mean, if you do yeah,exactly, if you do a little run
of that and noticing things likeswelling, you felt a pop in
your knee or your shoulder orsomething along those lines, you
can't move your joint, you haveum inability to weight bear,
those are all reasons to comesee somebody much sooner,
obviously.
But, um, you know, it's one ofthose things that's kind of
intuitive to some degree.
Speaker 1 (22:34):
Yeah, yeah, yeah, thankfully, yeah, and and for
sure.
There's going to be some achesand pains as you adapt.
I mean that comes with it.
But I, you know, I always tellmy patients with cancer that you
know, if you're having pain formore than two weeks and it
seems like it's only gettingworse, you know, that's the time
For sure, yeah, and persistenceis definitely a sign.
Speaker 2 (22:50):
So, and in people who are playing pickleball like,
like you said, a lot of peopleare picking it up now who
haven't been super active, andthat's great.
We want you to be active and soultimately it's a good thing.
But you have to understand,like when you're out there
running back and forth, makingquick, pivoting, cutting
movements using a repetitiveracket swing, that you haven't
done in maybe 10 or 20 years,that it's probably going to be
(23:13):
sore and that can turn intotendonitis, it can turn into
exacerbation of preexistingarthritis or, you know, maybe
you had a meniscus tear alreadythat was asymptomatic, that
you've now aggravated.
So those are kind of the trickythings where maybe you had a
little bit of knee pain and youhave arthritis and it just
wasn't flared up and now youhave full blown arthritis and
(23:33):
some people are confused aboutthat.
Speaker 1 (23:35):
Do you um, um, do you lift weights?
So the you know you're familiarwith the concept of progressive
overload, right Like, over time, you slowly increase the volume
or the weight or both Of course.
And you know I've talked aboutthis before on the podcast but,
like your muscles will probablyadapt faster than anything, and
(23:57):
the older you are, the slowerthey adapt.
Your bone density can improvesignificantly with weight
training and just activity ingeneral, but the ligaments and
tendons, although they can getstronger, do so much slower, and
so if you increase yourphysical activity and your
muscles are adapting rapidly,those ligaments and tendons are
(24:18):
not.
Speaker 2 (24:19):
They can adapt but it's slow and they kind of adapt
, not so much in the way thatmuscles do in terms of
strengthening or hypertrophying,but they kind of change their
structure their orientation.
They reorganize the collagenright Exactly to kind of modify
the way you're treating it.
Essentially, the issue is thatthe muscles hypertrophy quicker
and they tend to kind of tightenup as you're using them more.
(24:39):
And so if you get morestiffness and tightness through
the muscles.
you're pulling on thoseligamentous, you know, tendinous
insertions more and that's whenyou start to develop tendonitis
.
So Achilles, you know tennis,elbow, shoulder, those are the
things that you know, and thenyou got to work with physical
therapy and things like that toreally stretch the muscles out
so that the tendons can have alittle bit of relief.
Speaker 1 (24:59):
And so the best way to kind of mitigate your risk of
injury would be to kind ofslowly increase your volume over
time.
If you're lifting for sure,taking the deload week where you
kind of go down every five orsix weeks, yeah, of course it's
kind of a good idea.
Speaker 2 (25:14):
Similar process.
Speaker 1 (25:15):
Yeah.
Speaker 2 (25:15):
Where you get out and you play, you know, do some
practice, then go, you know, tothe next day when you maybe play
one game of pickleball and thenyou go play two days, two games
of pickleball the following day.
So rather than like going outand playing for three hours
straight, you know where you'rejust cutting and pivoting and
diving, swinging.
I mean, you're going to pay forthat.
Speaker 1 (25:34):
So I'm going to pay for that.
So, yeah, exactly.
Well, it seems like a reallycool, um cool practice that
you've created here, and I thinkyou know, being an athlete, I'm
sure you love working withathletes and then you know,
seeing them down the road dowell too is very gratifying.
Yeah Well, devin, I want you toknow.
We're very happy to have youhere, and thanks for coming on
(25:54):
the podcast today.
Speaker 2 (25:55):
I appreciate it.
Yeah, thanks for your time, youbet.
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