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Melanie Cole (Host): Henry Mayo Newhall Hospital and Keck Medicine of USC are collaborating to bring expanded specialty care to the Santa Clarita Valley, including orthopedic services. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Joining me to tell us about this is Dr. Joseph Liu. He's an Orthopedic Surgeon with USC Orthopedic Surgery, a part of Keck Medicine of USC, and he's on the medical staff at Henry Mayo Newhall Hospital. Dr. Liu, thank you so much for being with us today. I'd like you to start by telling us a little bit about yourself and how you came to Keck Medicine of USC and Henry Mayo Newhall.

Joseph Liu, MD (Guest): Great Melanie. Thanks so much for having me on the podcast today. I'm Dr. Joseph Liu. I'm a team physician for USC athletics and a previous assistant team physician for the NBA Chicago Bulls and MLBs Chicago White Sox. My expertise is in arthroscopic surgery, knee ligament injuries, cartilage restoration, and repair, shoulder instability, rotator cuff repair, shoulder arthritis, hip impingement, hip labral tear. And I also perform total shoulder replacements. I joined the Keck Medicine of USC initially, back in September of 2021, joining the faculty of the Orthopedic Surgery department. And I actually grew up in Orange County. So I'm excited to come back home after a long period of training in New York, as well as Chicago. And as a part of the Keck Medicine of USC and Henry Mayo initiative, I joined the Henry Mayo staff, as a part of this initiative as well.

Host: Well thank you for sharing that and really cool by the way. Cause I'm in Chicago and White Socks and the Bulls and that's awesome. So now I'd like you to tell us a little bit about this collaboration. How did the Henry Mayo Newhall Hospital and Keck Medicine of USC collaboration to bring those expanded specialty care to the Santa Clarita Valley, including orthopedic services? How did that come about and what services are you talking about?

Dr. Liu: So I think that this initiative came about as the leadership at Henry Mayo and Keck Medicine collaborated about what services were necessary for the community. And I think the key is to bring the specialty services of Keck Medicine, and expand them into the Santa Clarita Valley.

Part of it, I think the initiative started with some of our other surgical services, including colorectal service surgery. And I think found that you know, the Santa Clarita Valley also required additional specialty orthopedic services, including sports medicine, spine surgery, as well as trauma that could benefit the greater Santa Clarita Valley as well.

And so I think part of it is just you know, a real big congratulations and the kudos to our leadership in Keck Medicine, as well as Henry Mayo Newhall to be able to kind of form this collaborative initiative.

Host: Well, it would be great. It's great for the community. So tell us about some of the most common sports injuries that you treat. You mentioned a bunch when you were telling us about yourself, but when you're seeing these kinds of sports injuries, whether they be youth athletics or collegiate, or even pro, or the weekend warriors, the golfers and the runners, what are the most common things you see?

Dr. Liu: So I think that you know, they kind of divide by joint that I see. So starting with the most common knee injuries, the most common ones I see are anterior cruciate ligament, or ACL tears, as well as meniscus tears. And the ACL is one of the key ligaments that provides rotational stability within the knee and injuries to the ACL are particularly common in our student athlete population in sports that involve significant cutting and pivoting.

And these include things like soccer, basketball, football, lacrosse, the kind of the list goes on. This is a particularly common non-contact injury, meaning that you don't necessarily have to be involved in an injury, a collision injury on the field. Often these are done when patient and a student athlete just plants and kind of turn, and then they hear a pop and they have swelling. And, you know, in particular, these are really challenging injuries because they take about a year to come back from.

Host: And they're common in girls. Yes.

Dr. Liu: In particular, they're actually a little bit more common in girls than boys. There's a couple of reasons for that. One of the reasons is that girls just their biomechanics, they tend to land in a little bit more dynamic valgus. And what I mean by that is the knee tends to point inward more when they're flexing their knee going into dynamic squat position. And so that action of going kind of inward within kinda turning allows that kind of rotational force that is involved in the ACL injury. The other reason for that is there are some hormonal reasons. So because they're a little bit more estrogen heavy, they are, the ACL is a little bit more susceptible to tearing and, they're a little bit more ligamentously lax as well.

Also maybe hormonal reasons and maybe genetic reasons, but, I think there's a slightly higher incidence of ACL tears in girls, as opposed to boys overall, although in the past, because until it kind of title nine came around, boys had actually had more ACL tears just because the volume of boys participating in these kind of cutting and pivoting sports is a little bit higher in the past or historically.

Host: That's a good point. And if you'd continue and I didn't mean to interrupt you with that, but I think it's important for listeners to know kind of those risks as you were telling them. And what else do you treat?

Dr. Liu: Yeah. So the other really common type of a knee injury that I treat is called are meniscus tears. And the meniscus are kind of two C-shaped shock absorbers between the thigh bone and the shin bone within the knee itself. And over time they can get worn out kind of like treads on a tire. They're commonly seen in the athletic population.

In particular in conjunction with ACL tears because they do provide some secondary rotational stability, but also in our older athletes because of the repetitive nature of wear and tear of many years of being active. And so, these meniscus tears tend to cause, symptoms like clicking, catching and locking, particularly when patients are squatting deep or, you know, kind of deep flexion as well as a deep flexion and rotation.

And so those are things that are really common injuries that often can be treated without surgery, but sometimes do ultimately need, have some need for surgery as well. Outside the knee, the most common shoulder injuries that I treat are rotator cuff and shoulder instability. And I think there is a, those are probably two different patient populations.

Rotator cuff tears are a little bit more common older populations, and that's because the rotator cuff, which are small muscles around the shoulder that really help with shoulder stability are a little bit more susceptible to wear and tear at again with a lot of additional overhead movement and lifting overhead, which comes with lots of years of being active overhead.

Shoulder instability is a little bit more common in our younger population. And that's probably again with some of our collision sports, like basketball and football, where athletes are putting their arms in the position of of risk, which is kind of above their head and out to the side and their shoulder can dislocate.

And the earlier the age at which they dislocate, they're more susceptible to repetitive shoulder instability in the future. So it's student athletes that get these injuries younger are, are more likely to have more instability events in the future and probably more likely to need surgery as well.

Host: What a great list that was. Thank you, Dr. Liu. So when we're talking about these injuries and you've given us a lot of information here, let's talk a little bit of prevention, because that would seem to be a great place to start is prevention. And you mentioned some of the lateral sports and the movements, when you're talking to your athletes or your golfers or your runners or anybody else about things that they can do to keep themselves strong and hopefully prevent athletic injuries and sports injuries in the first place; what's some of the best advice you give them?

Dr. Liu: So I think there is a tendency to just want to jump into any activity or sport as students we get there. And I think that's probably the two most common times that we're going to have an injury is right away when the muscles are cold and not warmed up or secondarily, towards the end of an activity when the muscles are tired and fatigued.

And so for the former, the most important thing is to, you know, do an appropriate warm of a spending that 10 to 15 minutes before engaging in an activity and doing an activity or doing exercises that are sports specific, taking your muscles through the entire range of motion, doing body weight exercises that are going to be sub-maximal effort. And getting your muscles engaged and ready to do more explosive movements. And so I think that appropriate warmup and not just jumping right into an activity is really, really critical. On the flip side, in terms of fatigue. I think recognizing that when muscles are tired, you can't necessarily perform at the, level that you want to, and because of that, your body may react instinctively. So therefore recognizing when you're too fatigued and stopping yourself earlier, pulling yourself out before you're about to injure yourself, I think is really critical. I think the latter is a little bit more challenging because you know, a lot of those times it's hard to recognize that with the adrenaline.

But I think that's why appropriate scale up in terms of how much activity people are doing. Particularly with weekend warriors is really critical because those are the ones that people may not recognize how tired they are or how quickly they get tired. Especially if they haven't done an activity for a long period of time.

Host: And I think we're also seeing a lot of this chronic overuse, right? Especially in our youth who are trying to sports specifically practice or train in one sport. When I, my son is a gymnast and I really made him go into other things, during the couple of years that he was in gymnastics, because I didn't want him solely focusing on one thing.

And so I know that that's a big deal, but now for those of us parents who have kids that are in sports, Dr. Liu, tell us about first-line treatments for these common injuries before someone sees an orthopedic surgeon or an orthopod, a sports medicine specialist like yourself. What are some things we can do at home if our kids are overdoing it, if we're overdoing it, tell us about RICE. Has that changed? Do we add movement now? Tell us about some of those things.

Dr. Liu: Absolutely. Let's start with RICE because I still do think that is a very, very good first-line treatment for families. You know, cause it definitely is going to help and it will probably decrease the amount of swelling and inflammation that's generated with any injury. And so RICE stands for rest, ice, compression and elevation, and all of those things are still applicable for an acute injury because within the first 48 to 72 hours is when most of the swelling and the inflammation that occurs. And so if you can decrease the amount of swelling and inflammation that occurs, it's going to decrease the amount of time that potentially a student athlete or an athlete or a weekend warrior is out of their activity or, you know, or having more pain or swelling.

And I think the main thing to add for a joint, though, is that if we can maintain range of motion, that would be really critical as well because the body wants to kind of freeze the joint in response to any trauma, because that's the way they feel like it's the best way to heal. But a stiff joint or a frozen joint is actually more painful and more debilitating than a joint that potentially is looser.

And so what we always find, we find is the most challenging thing is that, you know, someone will be seen in our emergency department and they'll put place them into some sort of immobilization, like a knee immobilizer and then often it, and unfortunately, sometimes it does take a couple of weeks for them to see an orthopedic surgeon.

And by that time, if they've been in a knee immobilizer for that amount of time, that means they've lost a significant amount of range of motion. And then now they have to return to recover from that range of motion which can take a little bit more time or significantly more time as well. So that may take additional time away from their daily life or their, the sports that they're trying to get back to.

So I do think that if they have the ability to do gentle range of motion, and it's not painful or it's a little stiff or it's a little bit of soreness with the range of motion. I think it's appropriate to add a little range of motion to it and not fully immobilized the joint for weeks on end. Or if someone insists that they need to be immobilized, then they need to see someone sooner because immobilization for several weeks is actually detrimental to healing.

Host: So as we get ready to wrap up this very informative podcast today, Dr. Liu, I'd like you to summarize the field that you're in, when you feel that someone should seek medical attention and come to see you and what you want them to know about all over cross training, benefits of low impact activity, yoga, water aerobics, walking, weight training, functional, all of it, kind of tie it all up for us into a nice, neat picture for an overall picture of body wellness and injury prevention.

Dr. Liu: First and foremost, one should seek additional medical attention or more care, I think for the lower extremity, swelling and limping are kind of key signs that injury is more severe than anticipated. And I tend to say that if it's just a simple strain or sprain, then you should be getting better over the next day or two. And I think if, when it's lingering more than three to five days, going on a week or so, there's definitely more additional injury and, that should seek kind of higher level of care.

I think in the upper extremities, trouble lifting their arm overhead and night pain are definitely red flags that should bring patients or people to see additional medical attention as well. And that suggested that there is additional soft tissue injuries inside the joint that that needs to be addressed potentially with additional imaging or additional workup.

I think that, from an injury prevention perspective, I think that, preparation is key and warming up appropriately and recognizing fatigue is key. So, anytime someone's wanting to start a new activity or trying to get back to sport, I think, having appropriate planning, meaning that, you know, if you're going to plan for two hours activity, hopefully that two hours also includes the appropriate warm-up as well as cool downtime.

And if you're going to start a new activity, making sure you scale up appropriately, start with a lot easier exercises or a lot easier competition, and then working up your way appropriately. And so if you have a goal or target in mind, that just needs to be reliable. So if you haven't been running for a long period of time, then, your goal, shouldn't be to try to run a marathon within the next couple of months.

It should be kind of a target that's a little bit more realistic, and also less prone to injury as well. And then in terms of overall sports health. I do think that cross training is incredibly important. I think that, you know, a good lesson for athletes overall is that cross training helps, distribute the stress across all the muscles in the body.

I think a lot of us, when we're trying to be a little bit too sports specific and do one activity all the time it puts the injury and stress and wear on the same muscles and joints over and over and over. And that's the most likely time when you know, the body or the people or athletes may not feel fatigued, but their body's feeling the wear and tear.

And that's when it's really hard to predict when injuries are going to happen. In fact, if you cross train and you start to work out other muscles, you actually may be more effective in the sport or activity you're doing because those other muscles are synergistic and make you more explosive, more athletic.

And so I think that's just a really good key for, for parents as well as students and as well as athletes trying to go forward is it's, I think the cross training is actually beneficial and actually does not take away from the sport that they're trying to excel in.

Host: What great information. You're an excellent guest, Dr. Liu, Thank you so much for joining us and to schedule an appointment with a Henry Mayo Keck Medicine of USC Orthopedic Specialist, please call 661-600-1740 or you can visit Keckmedicine.org/henrymayo. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole.