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Melanie Cole: Sports-related injuries can be highly debilitating and very painful, but learning more about the field of sports medicine can help you to overcome and prevent those injuries before they happen? My guest today is Dr. Ashish Rawal. He's an orthopedic surgeon at Stoughton Hospital. Tell us what sports medicine is. What is this field all about?

Dr. Ashish M. Rawal: That’s an interesting question and I would say that sports medicine really is more of a philosophy of how we take care of patients. The most important thing is many people think and feel that sports medicine only involves taking care of competitive athletes. The truth is it really takes care of people for all different backgrounds, and the main thing is that for all of us, we have something important in our lives that we do that we consider our sport. Although I take care of a lot of athletes whether it be high school or college or professional athletes, I take care of everyday people that do activities that make them happy whether it be a sport, whether it be gardening, whether it be playing with their grandchildren and just playing out in the yard. All those things are important to everybody and my job is to make sure that injuries don’t slow them down and they can get back to doing what they want to do.

Melanie: What's the difference between a sports medicine physician and an orthopedic surgeon?

Dr. Rawal: In terms of training, an orthopedic surgeon does their full residency training, and to be really called a sports medicine orthopedic surgeon, it involves an additional fellowship training in orthopedic sports medicine, which is usually when you have additional training. It does also involve extra certification as well. Besides being board certified in orthopedics, I'm additionally board certified in orthopedic sports medicine. It does require extra training as well as extra board certification to really call yourself a true orthopedic sports medicine surgeon.

Melanie: What are some of the most common injuries that you see? They hear that word ‘rotator cuff,’ obviously, people have back issues or they pull a hamstring or knee issues, ACL in girls and soccer players. What do you see most often?

Dr. Rawal: I’d say the most common two body parts that I see are shoulder and knee injuries. The type of injury varies with age with our younger patients and athletes. I do see a lot of patients with ACL injuries, which stands for anterior cruciate ligament. It’s one of the main stabilizing ligaments in the knee, and for many athletes, they can tear that which can slow down their career and I can help people back into the game with that. With shoulder issues, the more common things we see for younger patients is issues where they can dislocate their shoulder and that can become a chronic problem and that’s something we can help take care of. As patients get older, we see patients with rotator cuff injuries and that’s something that can be quite debilitating. However, it’s something that we can definitely help patients with, and many times, we can begin and successfully treat patients without ever having to think about surgery. When it is appropriate, then we make that recommendation as well.

Melanie: As you mentioned, as people get older, they're more subject to those rotator cuff injuries, even from golfing or playing tennis. You said that they don’t necessarily necessitate surgery, so what can you do for somebody with a rotator cuff injury as they're so common? Does physical therapy help? What do you like them to do if they’ve got that pain?

Dr. Rawal: The most important thing first is to do the things that we consider RICE, resting it, icing it, in the shoulder, it's not necessarily elevating it, but things like anti-inflammatory, so Advil, Aleve, as long as your health is okay and you can tolerate those. Obviously, if it’s something that’s not getting better on its own, then that’s something that after an evaluation, maybe the right answer is to begin with physical therapy, maybe an injection or maybe give it more time. We also have diagnostic tools like an MRI to really assess and see if the rotator cuff is truly torn. Believe it or not, there are many people out there who have no pain in their shoulder that might have a rotator cuff tear and just because they have a tear doesn't mean that it’s something that requires surgery to fix. The important thing is to figure out not only if they have it but is it truly what's giving them pain and discomfort because we want to treat what the real problem is and not something that’s not causing trouble.

Melanie: Does a rotator cuff tear even if it’s a little one? Does that fix itself or not really?

Dr. Rawal: They tend not to heal and they will always stay there, but in some patients, they can become asymptomatic overtime that their pain may go away, but when their pain doesn't go away and they have that tear, that’s when a conversation about fixing that with orthoscopic surgery would be discussed.

Melanie: There are so many topics that we could discuss as far as sports injuries, but injuries and then there's prevention of injuries, which is really a burgeoning field of injury prevention. Tell us how you can work with athletes and non-athletes to hopefully prevent those injuries before they happen.

Dr. Rawal: That is a big growing field and that is something that is near and dear to my heart because I take care of so many young athletes. As much as I love taking care of them, it would be better for all of us if they never got injured to begin with. There are great training programs out there that can help identify potentially at-risk patients. We know that’s been very effective for young people in terms of prevention of tearing their ACL and you can get potentially a 50%-75% reduction in risk by instituting programs like this at schools. I found that those have been helpful and potentially if we have two kids on the team that may tear their ACL in one year, if we can make that number one or zero, to me that’s a huge win. I think that’s a great thing for all our young kids as they get older. We really would prefer not to see them get hurt rather than come and see me.

Melanie: What about the increase in chronic overuse because they're sports specific training? There are kids that are really just concentrated on one sport. What do you tell them about cross-training, taking a season off, even pitching arms, doing something so that they don't get those chronic overuse injuries?

Dr. Rawal: That’s a fantastic point and that is something that has become a growing problem due to sports specific specialization. When I was a kid, I played three different sports in a year and really got a break from each one, not only physically but mentally. That really prevented those injuries and that day and age is somewhat gone where we have athletes, in order to really stay focused and be the best possible at that sport, they have to go year-round. My job is always to be an advocate for that young athlete and say although we want you to be the best that you can, we have to avoid having a breakdown of your joints and muscles and ligaments and tendons. That involves identifying these at-risk student-athletes and also having very frank conversations with coaches and parents and discuss what's the best way to keep them competitive but also mentally and physically prevent them from breaking down? It's important for me to be an advocate and sometimes that requires me stepping in and telling a coach that we need to give a student-athlete a break in order to prevent long-term issues.

Melanie: How does sports medicine combine with physical therapy and occupational therapy, athletic training? It seems like everything is coming together, even chiropractic is in the mix now. How do you see all these different fields working together to make this big umbrella of sports medicine?

Dr. Rawal: That is something that has always been very important in my training and in my career as an orthopedic surgeon specializing in sports medicine. I've always had a very good relationship with physical therapists, occupational therapists, athletic trainers because they're the ones who really work with these athletes day in and day out and get to see what's causing them to have trouble, how they're getting better and they can really help me out and obviously I can help them out. I think we’re all members of one big family that can work together and we all have our purposes and expertise that can really help someone either stay out of trouble or once they have an injury help them get back to their full function.

Melanie: How can you help the community? You mentioned reaching out to coaches and maybe educating parents and athletes on everything from prevention of these injuries to concussion identification. Speak about how you can really get out in the community and help them and wrap it up with your best advice about sports medicine, preventing injuries and really understanding what your body can do so that you can be the best at whatever it is you choose to do.

Dr. Rawal: Education is the cornerstone of that and I think that's something that I've always project myself on helping the community in terms of education locally, giving talks on education for concussion management, management for heat exhaustion and those types of injuries that can occur from that, and injury prevention as well. Being a good partner with the community local schools and athletic clubs is very important. Another important facet for me is I belong to an organization called Stop Sports Injuries and they have a lot of wonderful resources for parents, athletes, educators, and coaches to really learn more about the problems that our athletes face to prevent that. I think that when that education piece is there, we can really do a lot and we've seen that in the world of concussion, I think by and far the big reason why it was a problem in the past is because we really didn’t understand what was going on. Once that education piece is there, that can really be a game changer in how we take care of people and prevent these problems from happening.

Melanie: Great information. Thank you so much for being with us today and for your work in the community and educating parents and coaches and athletes on the ways to prevent these sports medicine injuries. Thanks so much for being with us here listening to Stoughton Hospital Health Talk. For more information, you can go to stoughtonhospital.com. That’s stoughtonhospital.com. I'm Melanie Cole. Thanks so much for tuning in.