Carl Maronich (Host): Meaningful Medicine is a Novant Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

I'm Carl Maronich. And today, we're going to be speaking with orthopedic surgeon, Dr. Edward Blocker, about staying active but doing it safely. Doctor, welcome to the podcast.

Dr. Edward Blocker: Yeah. Thank you.

Host: Let's first start maybe by talking about tennis and pickleball, which are popular ways for folks to exercise on the coast. Are you seeing any common injuries with these sports?

Dr. Edward Blocker: Yeah, I do. As you said, it's a very popular sport, especially pickleball, folks moving into this area where it's a large retirement community. Everybody's moving down, becoming more active, and getting into these popular sports. And then, unfortunately, as a result, we see a fair number of injuries from it. And fortunately, most of them aren't severe, but with a few exceptions. But pickleball especially has become real popular.

Host: And are there commonalities in the injuries you're seeing, elbows, knees?

Dr. Edward Blocker: Largely upper extremity and ankle kind of divide things into two groups, the types of injuries: the fall or acute injuries and then the longer term injuries we refer to as overuse injuries. The fall injuries are a little bit more dramatic as you'd imagine. Typically, falls on outstretched hands. We call those FOOSH injuries, falls on outstretched hand. Landing on your wrist to stop your fall can result in a wrist fracture. You're running up towards the net, stopping very fast, fall forward, land with a good bit of force. Fractures, fortunately, those are probably the minority of the injuries. Most of them tend to be overuse injuries that occur over just repetitive use.

Host: Sure. Now, you're based in coastal South Carolina, Beaufort, Hilton Head, which are popular for retirees and golfers. What are some common golf injuries that you're seeing in patients?

Dr. Edward Blocker: As you'd probably expect, mostly upper extremity injuries, especially shoulder. And of course, there's golfers elbow. You can get tennis elbow playing golf. Golfers elbow, the medical term is medial epicondylitis. The medial side of the elbow is the inner side of your elbow. That's typically the muscle group that's involved with a golf swing. But the opposite side of the elbow, the lateral side, which we typically refer to as tennis elbow, you're not exempt from that playing golf. So, we see a lot of that too. These, as I mentioned earlier, I would classify them as overuse injuries. These muscle groups get used repetitively with each golf swing. It can lead to tendonitis and irritation where the tendons originate from the bones. And there's some oftentimes simple remedies for it. And then, shoulder injuries are close behind the elbows with golf. But those are the top two. Shoulder and elbows are the most used joints in that sport.

Host: Sure. And for some golfers like myself, a lot more swings than the average golfer. So, more chance for injury. And to try to prevent injury, I have to guess warming up, stretching would probably be advised.

Dr. Edward Blocker: It is. And I recognize it's boring, and it's hard to make yourself do. But it's not one of those things we just say do it. It really does make a big difference. Stretching, unfortunately as we get older, tendons and ligaments become a little bit less resilient, less elastic. So if you have a fall or a twist or somehow stress these ligaments... When we're children and adolescents and even 20s and 30s, those ligaments are more likely to stretch. They're more elastic. And as we get older, they lose their elasticity. They're more likely to tear. And so, stretching helps return that elasticity. Stretching does a lot of things. There's things you take for granted, like proprioception. When you have your arm out in space, you don't have to look to see where your hand is to know where it is, and that's a function of nerves that run through the ligaments and soft tissues of our joints.

So when you stretch, you're actually helping that feedback loop between your brain and your extremities before you go into play and moving faster. Your brain's sort of talking to your muscles. Sometimes your brain gets ahead of the muscles these days. So, stretching kind of gets your nervous system in sync with your muscles and your motors, your muscle groups, and also stretches the ligament so that if you do take a tumble, you're more likely to stretch it than to tear it.

Host: Yeah. And I suppose there's a better way to stretch or some ways are better than others for stretching. Would you recommend that golfers kind of get some stretching advice? Or what's the best way for athletes to find out the best ways to stretch?

Dr. Edward Blocker: Slow and easy. I mean trainers and physical therapists are experts in that, and they can show you 15 different ways to do it. But the biggest thing is if that's going to be a rate-limiting step to somebody, just doing it. If you're running, getting ready to go on the pickleball court, stretching your hamstrings, you can walk up to a tree or the hood of your car. We've all seen runners doing that beforehand. That'll stretch out your gastroc or your calf muscles. And, you know, of course, stretching your arms and shoulders and elbows. Basically, you're just moving arms and subsequently ligaments and all the directions that they go to put the ligaments that support them under a little bit of tension.

Of course, YouTube's a good friend too. You can YouTube stretching, stretching exercises before pickleball, it'll tell you 10 different things you can do. But the biggest thing is make it simple. It doesn't have to take too long. If it's too long and too complicated, you won't do it. So, just a short but concise and well-focused stretching exercise regimen before you go out on the court or on the golf course would be time well spent.

Host: Yeah. Great, great advice. There certainly are sudden injuries like fractures and things that happen. And then, as you mentioned, kind of overuse injuries, things that happen over time. Why is it so important not to delay orthopedic care from these repetitive motion injuries?

Dr. Edward Blocker: Well, they can sort of self-perpetuate. So, you know, I wouldn't want to convey that every little ache or pain, you've got to go in for, but the ones that seem to be hanging around and not getting better, or maybe if it's interfering with what you're doing, if you're going out and if the side of your elbow hurts when you play pickleball, and it doesn't get better after a few days and you go back on the court and it seems to hurt a little bit worse, and then a little bit worse the next time, then those things can sort of, you know, amplify and get worse. And the early on in the course of these repetitive use injuries, it's oftentimes very simple to get it stopped on the treatment algorithm of options from least to most, surgery being at the most obviously invasive, complex end; and then, simply rest at the easier end. As something lasts longer, you're more likely to have to march up the treatment level of complexity towards surgery. So, the sooner you can get things turned around and headed in the right direction, the better. And early on usually simply involves, you know, adding stretching or maybe an anti-inflammatory.

Host: Yeah. As you kind of mentioned it, people should have a kind of sense of their body to know when it's kind of an ache or pain they can work through. And when something feels a lot different and they know, now it's time to get some help.

Dr. Edward Blocker: Exactly. I tell patients all the time, listen to your body. It'll tell you when to seek advice. You know, sometimes we're grown up with the adage of no pain, no gain. But at this point, it's not giving in, if it's a consistent pain that's there, especially if it's limiting your activities or, you know, a certain swing that it happens every time and you notice you're losing power because of it, it is probably asking for help.

Host: As you mentioned a minute ago, there's a range of treatments that might be needed from this physical therapy to surgery. Maybe you could talk a little bit about the steps of that and, when it comes to surgery, the kind of things that one might expect if they go down the surgical route.

Dr. Edward Blocker: Yeah. So, the beginning treatments of most of these things begins with some stretching. Just picking tennis elbow as an example, and this is applicable to most of the other maladies, tennis elbow is inflammation of the ligaments on the outer side of your elbow, and simply stretching those muscle group in the beginning … so that they're not so tight from the origin of the muscle off of the bone. It helps, again, return elasticity, maybe addition of an anti-inflammatory, an oral anti-inflammatory like Advil or Aleve. Of course, as long as there's no other medical reasons not to take those.

Step above that is oftentimes a cortisone injection. That's also an anti-inflammatory, but it's a steroid anti-inflammatory. And it goes, you know, right to the source as opposed to a medicine that goes everywhere systemically. Physical therapy sometimes, I'll oftentimes give patients exercises to do in the office, instruct them in the office, and what they can do at home. Oftentimes adding in anti-inflammatory. See them back if it's still hurting. A good percentage of those patients don't need that follow-up appointment, because it's better and they've returned to play, but they have the appointment if it's not better. Plan B is oftentimes that cortisone shot I mentioned, or sometimes formal physical therapy. I'll send people to therapy for two reasons. One, to learn the right exercises; two, to make sure you do them. So, I would probably have to have an appointment with a therapist to make sure I do it.

If you have a lot of discipline and you know the right exercises, you can do it on your own at home. But that kind of third level might be actually going to formal physical therapy, and there's always additional stretches they can show you. And then, if they're failing all of that, which fortunately we're getting into much smaller percentage of patients now, you know, end up at this surgical level. And surgery is very reliable way to cure all these maladies. We're in a good place with this. And there's a lot of arthroscopic techniques now and more minimally invasive procedures we can do. It's still a long rehab. The recovery after surgery is always longer than people want it to be. The human body, it's still healing at the same rate. It always has. We've come up with better procedures, but the healing time is still slower. So, average, six, eight, sometimes 12 weeks, of recuperation after these surgeries. So, that's another reason to deal with it early rather than later.

Host: Yeah. The technology that you've probably seen over your career has developed. And you're probably able to do things now that maybe you weren't when you started. Has that had a big impact on this kind of work?

Dr. Edward Blocker: Yeah, it has, especially in the world of joints. I never thought I would be talking to patients about robots, but here we are, and even AI. We use AI daily in the office. AI is getting integrated into our robotic surgeries. So yeah, there's things that, you know, my grandfather was an orthopedist, I don't think he saw this coming. But it's a remarkable time we're in right now.

Host: Amazing stuff. Kind of to that point, but are there still misconceptions or maybe common questions that you get from patients?

Dr. Edward Blocker: Yeah. Probably one of those that I hear the most may not be totally applicable to, sports injuries and such, but a lot of times people feel like they should have a joint replacement, for instance, now, because they might need it later. But the indication for a joint replacement, a hip or a knee or these days even ankles and shoulders is pain. So, I tell people all the time, you know, your joint will tell you if it's time for something like that. And This is applicable to a lot of things in orthopedics. So if it's not to that level, you know, we're all going to be older later, but surgery now for symptoms that don't warrant it, I don't think it’s a good idea. You may never reach those symptom levels. We're all going to be older, but it'd be kind of like our car tires are going to have more mileage on them later too, but you wouldn't change them at 15,000 miles. So, I think that's probably one of the biggest things I hear that's, you know, a misconception that people have.

Host: Well, Doctor, as we prepare to close, maybe you could talk a little bit about what got you into orthopedics and sports medicine. I know you mentioned your grandfather was an orthopedic surgeon, but what drew you to the specialty besides the family connection?

Dr. Edward Blocker: Yeah. I've always liked using my hands since I was a young kid. One of my grandfathers was an orthopedist. The other was a carpenter. I worked with him and had a farm. In farms, you fix things all the time plus he built houses. So, I worked with him at a very early age and really enjoyed using my hands. Things that were broken that that we would fix, it was very gratifying. My other grandfather was an orthopedist. And when I realized that that's kind of a glorified carpentry, and you actually have the added satisfaction of helping people feel better, I figured out at seven years old, that's what I wanted to do.

Host: I suppose the carpenters may be using robots too to do their work these days.

Dr. Edward Blocker: They are CNC machines. There are a lot of similarities. And in some cases, I think some of the carpentry procedures might be harder than what we do. But it's all hand-eye. And best thing I like about orthopedics is it's not just hands on, but it's a lot of common sense.

Host: Yeah. Very good. Well, I'm sure podcast hosts will be done by robot someday soon, but I'm glad today was not and I was able to have this conversation with you. Dr. Edward Blocker, orthopedic surgeon. A lot of great advice. We appreciate it.

Dr. Edward Blocker: Sure. Enjoyed it. Thanks. Good talking to you.

Host: Good talking to you as well. And if you enjoyed this podcast, please share it on your social channels and explore our entire podcast library for other topics of interest.

To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org. I'm Carl Maronich. This is Meaningful Medicine. Thanks for listening.