Does repetitive motion cause damage? How exactly do you heal a shoulder injury? And is there a sport that is more taxing on the body than others? Join us on this latest episode of Head to Total as we welcome back Dr. Peter Lasater to talk more about Sports Medicine and different types of orthopedic injuries he sees based on the sport or training the patient is engaged in. We continue to pull back the curtain on everything head to toe on this latest podcast episode of Head to Total with Colleen Young!
#podcast #podcaster #podcasting #healthcast #medicine #medical #orthopedics #medicine #sports #sportsmedicine #soccer #football #synergy
Refresh by Roa Music | https://soundcloud.com/roa_music1031
Music promoted by https://www.free-stock-music.com
Creative Commons Attribution 3.0 Unported License
https://creativecommons.org/licenses/by/3.0/deed.en_US
Does repetitive motion cause damage? How exactly do you heal a shoulder injury? And is there a sport that is more taxing on the body than others? Join us on this latest episode of Head to Total as we welcome back Dr. Peter Lasater to talk more about Sports Medicine and different types of orthopedic injuries he sees based on the sport or training the patient is engaged in. We continue to pull back the curtain on everything head to toe on this latest podcast episode of Head to Total with Colleen Young!
#podcast #podcaster #podcasting #healthcast #medicine #medical #orthopedics #medicine #sports #sportsmedicine #soccer #football #synergy
Refresh by Roa Music | https://soundcloud.com/roa_music1031
Music promoted by https://www.free-stock-music.com
Creative Commons Attribution 3.0 Unported License
https://creativecommons.org/licenses/by/3.0/deed.en_US
Colleen Young: Hi guys, welcome to Head To Total, our podcast that pulls back the curtain on all things medical, all the technical terms and jargon. We've got Dr. Peter Laseter today.
Dr. Peter Lasater: Hello, thanks for having me again.
Colleen Young: Yeah, thanks for coming back because I thought our first podcast, you never wanna speak to me again, so good to have you back. This is great.
Dr. Peter Lasater: Good to be here.
Colleen Young: This is great. How goes the day? What's going on with you?
Dr. Peter Lasater: Oh, it's been good. Did a hip fracture surgery this morning and have some clinic going this afternoon.
Colleen Young: I'm just glad I didn't fracture my hip this morning, so that's a good thing. So just in case the audience is [inaudible 00:43], yeah, you weren't operating on me this morning. Enough goofing around Dr. Lasater, let's get right to it. We wanted to have you back because we wanted to talk about orthopedics, sports medicine, your subspecialty here. What is that all about? What is the distinction between general orthopedics versus sports medicine?
Dr. Peter Lasater: Yeah, so I did a fellowship in orthopedic surgery sports medicine, and I guess I make that distinction because there are also sports medicine fellowships out there for non-surgeons. So if you're in family medicine, emergency medicine, internal medicine, you can do a sports medicine fellowships, which is non-operative working with sports injuries that you see in athletes of the Musculoskeletal system and things like that. And to a similar degree, that's what an orthopedic sports medicine fellowship is like, except that we treat operative conditions as well. And so a lot of the focus of sports medicine is around arthroscopic surgeries, very heavy in like the knee and the shoulder. And treating injuries that are quite common in athletes. So probably the biggest one would be ACL tears and treating ACL tears with surgery, which we do arthroscopically. Meniscus tears, not saying that all meniscus tears happen playing sports, it can happen doing other things, but if it's in a young athletic population, it typically can happen playing sports. Other ligament injuries, whether it be the MCL, LCL, PCL, or things like that.
And then there are other injury conditions of the shoulder, whether it be shoulder instability, labral tears, things like that. But then we also focus on surgically treating conditions that don't always have to happen playing sports. A lot of what we train is doing rotator cuff repair surgeries which actually you tend to see in older populations as opposed to the younger athlete type thing. But the focus is around arthroscopic surgery. And then when you're doing a sports medicine fellowship we're always plugged in and connected with teams, typically schools, professional teams as well. But being involved by covering the games, being there if an athlete is injured, going to practices, checking in on players and things like that.
Colleen Young: I remember the last time we were together and I was checking out your Instagram and all the Instagram videos are really centered around sports related. There's a scope one that, forgive me, I can't watch, but there's a distinction not only between orthopedics in general orthopedic sports medicine, but also the difference between treating an athlete. Whether it be a young athlete, college athlete, professional athlete, versus treating the weekend warrior like myself who goes out and plays Beer League softball. Not that I'm not good at it, but I'm just saying it. Can you go through your experience? It was the Minnesota Twins, right? Yeah, and their third baseman might be as good as me, but I digress. So when you are treating an athlete, what is the difference in treatment versus somebody like myself who comes and says “Eh, my knee hurts, I may have twisted it rounding second base?”
Dr. Peter Lasater: I mean, when you're dealing with a competitive athlete, the focus is getting them back into gameplay. And not that your Beer League probably isn't super intense, but an athlete going back to a college or professional level is something where your body has to be completely ready, healed and ready to go. And to do that, I'll take two scenarios, you've got one, it's a competitive college athlete who gets an ACL tear, and the other one is a weekend warrior, older patient we’ll just say in their mid forties who enjoys playing sports on the weekends here and there, but isn’t competitively playing to the level of like a college athlete. So if the older patient tears their ACL, the goal is still for them to be able to do the activities and hobbies that they like to do. So if they like to play softball on the weekends or basketball or soccer or whatnot, in order to get them back into being able to compete in those types of things, if they tend their ACL, we typically recommend surgery to fix that. But typically the level of play between recreation and college competition is quite large. Plus, the weekend warrior athlete, it's not really the end of their world if they have to miss a little bit longer time or even if they don't get back into playing as often as they want. Not saying that they can't, but it's not as big of an issue at the forefront.
Whereas with a college athlete, you're dealing with the timeframe of the season, working around timing for surgery and when they're hoping to get back and things like that. And then I'd say the rehab process is going to be a lot more intense for the athlete getting back because we're not only working on getting the patient's function back to just do daily activities and things like that, but you're trying to get them ready for competitive sport plays. So a lot of that, they will probably work longer with their physical therapists and if they have athletic trainers and things like that associated with their team, you're kind of working hand in hand with them. So it's kind of a lot more moving parts and really making sure that they're ready to go to get back into sport. Whereas with the weekend warrior, you got a little bit more room to wiggle and the timeframe isn't as big of a concern
Colleen Young: Off-the-wall question Dr. Lasater, but is there a sport that is actually more taxing on the body than any other sport?
Dr. Peter Lasater: If you're talking about certain injury patterns and things like that, there's been research, a high-risk population for ACL injuries tends to be younger females who play soccer. And that just has to do with the muscle development that those athletes get from years of playing soccer tends to counteract the support of the ACL just because their quadriceps tend to be more developed than their hamstrings. And the hamstrings are what pulled the leg back and kind of help protect the ACL. There's been a lot of research with landing patterns when soccer players jump up and then they come down and they land and things like that. And that's a big area of research where they're trying to start programs to help protect soccer players from tearing their ACLs. Kind of the focus is on female young female soccer players just because they're at that higher risk. That's not to say, you know, there's plenty of knee injuries and whatnot that happen from football and things like that. Football is a contact sport so you can see plenty of other injuries and conditions that happen with that, maybe more so than other sports just because of the nature of the contact.
Colleen Young: One of the reasons why I asked that question is because for those that are actively playing soccer, whatever level you're at, you need to check out the other podcast that you did because you went into great detail about the ACL, MCL, what's the difference? Where is it located? How does it all function? So it's very important that those who are playing that sport are really checking that out. And also checking out your Instagram because I know you have a post on that. And I think most people think that the most taxing sport would be bowling.
Dr. Peter Lasater: In all honesty, I actually did have a patient who tore their ACL bowling.
Colleen Young: No way. Oh wow. Okay, won’t I make fun of that.
Dr. Peter Lasater: I think they were pretty serious bowlers, a lot better than I could ever do. But returning to sport, their goal was to return back to bowling because they were very intense bowlers, bold three, four days a week. They were in a league and tore their ACL bowling. But that was part of the discussion, they didn't want to go on having issues bowling the rest of life and that affected our decision to proceed with surgery.
Colleen Young: I know that there's someone within your practice at Mendelson Kornblum that actually takes table tennis, I can't call it ping pong anymore, table tennis very seriously. So I'm sure your hand doctors are getting the bowlers and the table tennis players. So everybody think of football when it's the most taxing, but honestly I learned that pitchers in baseball because of the repetitiveness. Can you talk to me about what you're seeing at summer in Southeast Michigan? What do you see with respect to shoulder injuries and what's going on with the preparation of shoulder injuries?
Dr. Peter Lasater: Overhead athletes throwing pitchers especially are kind of their own animal. And the thing that kind of leads up to the injury conditions is the repetition of the pitches. Especially in younger athletes, we see shoulder conditions, also elbow conditions especially from pitchers. They can get irritation of their growth plates around their elbows from overuse and pitching and things like that. If they keep going, typically see this in higher levels, but tear their ulnar collateral ligament and then have to sometimes lead to surgery, the Tommy John surgery to reconstruct that ligament around the shoulder. Especially in pitchers, you see things we call slap tear, which just means a tear of the top portion of the labrum, right where the biceps tendon attaches there, so that can cause issues. They can get pinching of certain things within the shoulder because they're kind of always holding their arm up like this and doing that repetitively.
For a lot of these injuries, especially in younger patients, if they're causing some stress and reaction to their growth plates, you just have to have them stop throwing for several weeks. Which I think a lot of times is a very difficult thing to do. And then also, put a big emphasis on pitch counts and a lot of these athletes, especially baseball players, they play in multiple different leagues and teams. So they'll play for their school team, they play for one or two travel teams and one team might just be practicing a couple days a week, but you take in all these at once. And I've seen some patients where they're playing baseball five or six days a week and are the pitchers and they're the best pitcher on the team so they're pitching all these days of the week. And you have to keep track of how many pitches that athlete is throwing between all those teams. And really what it comes down to is the athletes and or their parents themselves have to take the initiative to do that and work with the coaches on each team. Because the coach from the high school team isn't gonna know how many pitches the athlete threw with the travel team and vice versa and things like that. So maybe from their perspective they're thinking oh, he or she is below the pitch count threshold, but the body doesn't care which team you're pitching for, so you gotta take that into account. And it can be a tough thing to tell somebody that you gotta take six weeks off of throwing to let things calm down and heal when they're the star player and are playing this much.
Colleen Young: We’re talking about a younger pitcher and there's life after baseball, there's life after softball, and that's really the consideration. That's why somebody comes to see somebody like you who knows what they're doing and then they've gotta take your advice seriously because you got the rest of your life to use your shoulders, use your elbow. We lay people, say tennis elbow, but what is the difference between tennis elbow and what you described within baseball, correct me if I'm wrong, Tommy Johns, what is the difference between those two?
Dr. Peter Lasater: Tennis elbow, the tech technical term for it is lateral epicondylitis. And just to give a little anatomy session, I guess, the lateral epicondyle is just kind of the kind of bump of bone you feel on the outside part of your elbow. And there's a bunch of muscles on from your forearm that are attached there. And then one of those muscles in particular And so I see tennis elbow probably not even as much, and they call it tennis elbow because classically it was seen in tennis players, kind of with the back hand causing stress on that, which still can happen. But a lot of times we see tennis elbow just in normal people and it kind of just comes on sometimes for no reason. Sometimes you can see it in people who have jobs where they have to do a lot of work with their arms or form motion and things like that. Sometimes it just kind of comes on for no reason. And the good thing is most of the time it eventually just kind of burns itself out and goes away, but it can take a long time for the tennis elbow to go away, which can be frustrating for patients. I mean, very rarely does it get to a point where you have to do surgery for tennis elbow and basically what the surgery is, is just going to that area on the side of the elbow and cleaning out the inflamed tissue there. So that's tennis elbow.
If we're talking about Tommy John’s, kind of what I said earlier Tommy John surgery is just the nickname that's given for reconstructing that inside ligament on the inner part of the elbow, the ulnar collateral ligament, which is put under a lot of stress especially in baseball pitchers. And they call it Tommy John's because the first person who had it done to them was a professional baseball pitcher whose name was Tommy John, and I think this was back in the 1970s around there. So he was kind of the first person that they ever tried this on because it was a thing that they were seeing in pitchers that over time you just continually put stress on that ligament. And the stress is put on it with the throwing motion. There's not a whole lot of other things that put that stress on that ligament and do it over and over again. So like I said, tennis elbow you can see in anybody and it just kind of comes on. The Tommy John is what you see in baseball pitchers. I guess you can tear that inside ligament if you have a bad elbow injury, sometimes if you have an elbow dislocation and things like that, that can lead to it. But the most common way that we see the Tommy John surgery being done is for baseball players, particularly pitchers.
Colleen Young: Here's the greatest thing, as you were first describing tennis elbow, everybody was feeling that bone on their elbow, that's number one. Number two, for those of you that follow Dr. Lasater in his first podcast, he taught us about the inside and the outside of the knee, the ACL and the MCL. Now he's given us the inside and the outside on the elbow, so let's go up a little bit more. When it comes to the shoulder, are there interior, exterior tears that happen, what's happening there?
Dr. Peter Lasater: Similar to the knee, there's a joint of the shoulder and so that joint is surrounded by what we call a capsule. And then the rotator cuff also plays a part in forming that capsule. But how I describe it to patients, it's like the joint of either the knee or the shoulder, you kind of think of it like a water balloon and so inside the joint is inside that water balloon. And if we're talking about the shoulder tears and conditions that happen inside the joint or inside the water balloon are like labral tears, so the labrum is completely within the joint of the shoulder. The biceps tendon, part of it is inside the shoulder joint and that's typically where a lot of people get some inflammation or discomfort, either where it's in the shoulder joint or in part of it just before it goes into the shoulder joint. Again, like I was saying, the slap tear is kind of a combination of the biceps tendon and the top part of the labrum where there's a tear around in there.
You can get cartilage injuries because that's the ball and socket joint part of the shoulder that's also inside the joint. When it comes to rotator cuff tears, you can have one of three scenarios for a typical rotator cuff tear. You can have a complete tear, meaning it goes through the full thickness of the tendon, meaning it goes from inside the joint through the rotator cuff tendon to outside. But sometimes you can have a partial tear, so if the tear is on the area closer to the joint, we call that a partial articular tear because it's close to the articular area of the shoulder. You can also have a tear on the top part of the rotator cuff, which doesn't communicate with that area of the joint. And we call that a bursal-sided tear because the area above the rotator cuff is the subacromial bursa. So that's why we just call it a bursal-sided tear.
Colleen Young: Every time we're together, I'm like ah, it's like nothing to say, you just know it so well. The lay person like myself is always like wait, what? And you can rattle this stuff, it's absolutely amazing. I can see why the patients are turning to you for sports medicine because to you this is like, yeah, this is an everyday thing that I see and I'm doing and I'm scoping. Here's another off-the-wall question, when it comes to those who are doing weight lifting, deadlifting, is it more stress on the knees or in the shoulders? And do you treat patients like that?
Dr. Peter Lasater: Yeah, I definitely treat weight lifting patients. I guess it depends what exercises they're doing and things like that. If you're talking like a deadlift, where is that putting the most stress? I guess you're holding the weight normally when you do a deadlift in your hands, but then all the weight is going from your hands up your arms into your shoulder and then it's transferred down your spine into your legs and the rest of your body. So you're putting that stress through, but the movement of the exercise is going through the legs because you're working your legs. I mean, are your arms working? Yeah, but you're kind of doing a static hold of the weight, you're not really moving your arms or your shoulders that much, they're just kind of staying straight. And the purpose of that exercise is to work the legs. So I guess technically if we're talking about where there is more stress going through, since the joint of the knees and the hips are moving more, probably a little bit more stress there, but not to say that it's not putting weight and force on the shoulders as well.
Colleen Young: I know that at your practice, Mendelson Kornblum Orthopedics, you've built it strategically so that when a patient comes to see Dr. Lasater about a sports medicine issue, you then can refer them to a podiatrist, Dr. Klein, or a spine surgeon should get real extreme. Dr. Rashid I know just joined your practice but what do you think is the biggest advantage to a patient who has a sports related injury coming to see Mendelson Kornblum Orthopedics as a comprehensive practice?
Dr. Peter Lasater: Great question. I think having that wide range of subspecialties within the practice, we can kind of help and complement each other. I guess a great example of this is I'm actually assisting Dr. Klein on Friday with an ankle surgery, but it's kind of a sports medicine type of thing in that it's a cartilage restoration procedure so that's stuff that we do in the knee and things like that. And as part of that procedure, we're gonna be treating a cartilage defect in a patient's ankle, but we're also gonna be taking some samples of tissue and injecting that in as well. And I'm gonna be assisting that part because we're gonna be taking that from the shin bone, which technically Dr.Klein had asked me to help with because for his practice he has to stay from the ankle down. And so I'm assisting him to help kind of with the harvest of the bone marrow and things like that to help with this procedure.
So it's nice to be able to have that camaraderie and we can kind of help each other out in cases like that, but also just having them around. You know, if you are ever treating somebody for an ankle injury and you think maybe this is better served for Dr. Klein, who does more focused work on the foot and ankle then they're right there and you can send them. Sometimes too, he'll be seeing a patient in the office who has issues with their feet and they have an issue with their knee, he'll ask me hey, can you see this patient for their knee? Sometimes we're even able to work it out the same day if they're there and time permits where I can just see them that day. Not saying that is always a guarantee that can happen, but we do do that, so it's nice to be able to have that flexibility.
Colleen Young: Dr. Lasater, I know you got a busy day ahead of you, can't thank you enough for spending some more time with us. Hope to see you again soon. I hear there's a lot of great things happening within your practice, so check out the Instagram, that's huge. That's been blowing up by her. So Mr. Celebrity, let's talk again sometime soon.
Dr. Peter Lasater: Sounds great, thanks for having me, Colleen.
Colleen Young: Thank you.