Sports Medicine at Memorial Health: Understand We See Everyone – Not Just Major Athletes

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Melanie Cole (Host):  Whether you're a weekend warrior or an athlete on a team, the professionals at Memorial Health System Sports Medicine can get you back in the game. My guest today is Dr. Tom Bartsokas. He's a sports medicine specialist with Memorial Health System. Welcome to the show, Dr. Bartsokas. Tell us a little bit about sports medicine. What's involved in that field of sports medicine?

Dr. Tom Bartsokas (Guest):  Well, thanks for having me, first of all. It's an honor to be on this show that's so widely broadcast. I see sports medicine as being two main areas. The first is the treatment of musculoskeletal injuries. So, people who get hurt in their work world, if they get hurt in recreation, or they can get hurt competing in competitive athletics, this is a place for them to go and get an initial evaluation, find out what it is and how it should be treated. In some cases, since I'm a primary care sports medicine specialist, we'll find someone who has a condition that's gonna require a surgeon's attention, so I can make that referral. Usually the surgeons recognize a referral from a primary care sports medicine doctor as someone who can expedite the process. So, that's the promise to the community at large is that come get an initial evaluation from a non-surgeon, so you're safe. You won't be operated on by me, but if you do need an operation, I'll quickly say, “Here's where you should go and get the best care.” The second main area of sports medicine is treatment of lifestyle disorders. So, people who want to lose weight and they want to do it in a healthful manner; people who recognize the need to get on an exercise program, but are struggling with "What should I do? How hard should I do it? How often should I do it?" Those kinds of questions can be answered by a sports medicine specialist who oftentimes will not only have an interest in athletes, but in people who are suppressing their inner athlete. My definition of someone who is an athlete is anyone with a beating heart, so you're welcome to my practice if you have an interest in becoming more physically active.

Melanie:  I love that. I love that definition. That's just absolutely perfect. Now, if somebody just really wants to get in shape , then what can you tell them? What's your best advice when you tell somebody, "I want you to begin an exercise program and I want you to get into this so that you don't get injured and don't need to see a surgeon"?

Dr. Bartsokas:  Right. So, the keys to a successful exercise program, first and foremost, are regularity and duration. So, we want people to first make the choice towards becoming more physically active on a regular basis. In other words, most days of the week. And then, as far as the duration, it's been clearly discovered through years of research--over the past 50--that 30 minutes a day, 5 days a week of moderately vigorous exercise . . . one of the examples I use is walking between 3 and 4 miles per hour for 30 minutes, 5 days a week for a total of 150 minutes per week is enough exercise to really stave off heart disease, to reverse some of the excess weight you may have gained, and to live a healthier life. You will benefit up to 300 minutes of walking at that rate, but beyond that, now it's going to be for other reasons other than physical. You'll get a psychological benefit as far as stress relief and improving your sleep, but we really are trying to strive for people getting at least an hour of exercise 5 days a week. I think that would be a good target, initially. There's a sports psychologist at the University of Georgia who once said, "If exercise feels like work, it's worthless." And I agree with that 100%. So, I try to encourage people to tell me what they've enjoyed physically in the past and if they haven't ever had a positive experience in exercise, then to explore different things like swimming laps, or getting involved in an arthritic exercise class in an aquatic-based environment, so that if they have some joint issues, they're not going to be stressed by gravity, initially. So, they're just going to be supported by the water and have that enjoyment of seeing movement happen on a regular basis and getting the heart rate up, but in a very comfortable, initial environment for exercisers. Then, I also encourage people to think about walking because it's something. If you can get from your bedroom to your car in the garage, you can walk for exercise purposes.

Melanie:  I completely agree with you.

Dr. Bartsokas:  Even the Surgeon General of the United States is saying, "We've got to make a push to have more communities feel walkable. In other words, have access to good trails and pavement that's smooth so people in wheelchairs can actually benefit, but also have well-lit pathways, have safe neighborhoods so that people don't feel like they're going to be in a danger zone when they're out exercising. This is a push that's not coming from me. It's coming from Washington, D.C. We're just trying to support that as much as we can.

Melanie:  So, now people do specific things:  runners, they run and cyclers, they cycle and you see this so much and then they start coming up with various overuse injuries and chronic injuries like shin splits and various strains and things. What do you tell people, Dr. Bartsokas, about cross-training and the importance of doing many different things so that they don't have injuries?

Dr. Bartsokas:  Right. Well, one of the things I'll quickly tell them, let's say, a runner who comes in and they’ve got some breakdown in their musculoskeletal system and I'll say, "You who I never see? I never see competitive triathletes as patients." It's because they're doing three different patterns of movement on a repetitive basis at fairly high volumes and they are leading very athletic lifestyles but don't need medical attention because they're training their whole athleticism, not just the ability to run. So, I really think that variety is the spice of life and it's also a healthier way of exercising. You're right. Cross-training is a key. Even runners. If you're just a dedicated runner. Let's say you've got someone who's trying to compete at the collegiate level or even internationally. Even those level of runners see a distinct advantage to doing some off-running days where they're training on maybe an elliptical machine. The elliptical is a device that you can use a pattern of movement that's likely elliptical but you can do it outside and cover territory, but they also lift some weights to make sure that they don't have form faults as they get more fatigued towards the closing moments of a race. They get off their legs sometimes and go swim just to have an aerobic workout that's less stressful on the musculoskeletal system. That's what I'm encouraging people to do as they come to these overuse injuries and they just feel like, again, it's drudgery to go out and train. If you're really doing it right, your sport, your choice of athletic expression, should feel like adult recess. It should feel like an escape from the doldrums of our responsible lives and having fun and recharging your battery and doing this thing that's just wonderful. There was a book written in the 70s called The Positive Addiction and it was referring to running and the running craze. I really think that if more people became physically active to the point where they were getting those natural morphine-like substances that are made in our brains called “endorphins” I think if more people tapped into that, I wouldn't have to talk so long about the need for exercise.

Melanie:  I agree with you. Now, Dr. Bartsokas, when you've got people like runners or cyclists that have these overuse injuries, are you an ice man? Or, are you a heat man? What do you tell people about dealing with some of these overuse injuries as a sports medicine specialist?

Dr. Bartsokas:  Yes. So, it's ice, ice, ice, ice, ice. Everything gets iced unless we're dealing with the back and then, it's kind of a toss of the coin. Some people get irritated by ice massage to the spinal areas and respond favorably to warmth, so if it's your neck or low back, experiment with what works best. But, if we're talking extremities, you want to ice with one caveat:  do not ice an area for longer than 20 minutes or you can cause some nerve damage that could possibly be irreversible.

Melanie:  That's really important information. I mean, it's such great information that people need to know about those sorts of things. And, what about stretching? Do you stretch before exercise, do you stretch after? Does that help reduce the risk of injury?

Dr. Bartsokas:  So, great question because there's some recent elegant research that's been done looking at runners who stretch before and after running versus runners who never stretched and the group that was injured most were the stretchers. Now, I'm not sitting here and promoting not stretching at all. But, it should be stretching in the proper context and the proper type of stretching. So, I think the current research thought is you want to do a warm up before you do your event, but you want to do a functional warm up. So, that means if you're getting ready to go for a long-distance run, maybe you'll walk for five minutes or a half a mile, maybe you do some skipping, or hopping, but you don't go and do hamstring stretches. You don't do back stretches. You don't go up to a step and stretch your calf muscles before the run because it sets you up for micro damage in the muscles that then could later be exacerbated by your effort of running. After you get done running and you've done your functional warm up, then you do your workout--after the run--that's when you go drop a heel off a step, put your foot up on a stair step or a stump and stretch your hamstrings, stretch your groin muscles, that's the proper time for stretching -- after you've done the exertion of the workout.

Melanie:  Dr. Bartsokas, in just the last few minutes here, give your best advice about the sports medicine program at Memorial Health System--what you really want people to know.

Dr. Bartsokas:  Well, I want people to know that we have an open-door policy here. That you don't have to be a competitive sports athlete to feel welcomed. We want people to know that the motto here is "Get them in, get a diagnosis, and get them on a treatment program expeditiously." We want people to get back to their lives, enjoying their sports, contributing to their work, or becoming more physically active if they're kind of struggling with where they're at right now. It's a place to get advice. There's no such thing as a dumb question. It’s a safe place to come and bounce ideas off the things they've read on the internet or things that they were taught in high school and they're wondering, “Is it true or not”. That's my practice style and we would love to see people.

Melanie:  Thank you so much for being with us. It's great information. You're listening to Memorial Health Radio. For more information, you can go to mhsystem.org. That's mhsystem.org. Expect more. This is Melanie Cole. Thanks so much for listening.