Transcript: Sports Injuries | Apr 06, 2000

Maureen Taylor sits in a studio with yellow walls and a small TV set in the background, which reads “More to life.”

Maureen is in her late thirties, with wavy blond hair in a bob. She’s wearing a blue zip-up blazer over a black turtleneck sweater.

She says HI, I'M MAUREEN TAYLOR.
ARE YOUR CLOSETS FULL OF
KNEE PADS, SHIN GUARDS,
HELMETS AND WRIST
PROTECTORS?
OR DO YOU HAVE
CRUTCHES, TENSOR BANDS,
AND KNEE BRACES
IN THERE?
SPORTS AND GAMES CAN BE FUN,
UNTIL SOMEONE GETS HURT.
TODAY ON
MORE TO LIFE
WE'LL LOOK AT
YOUR SPORTS INJURIES.

(music plays)
The opening sequence shows a wooden table with a small lit candle as several words fly by: Nutrition, medicine, prevention, treatment, health.
Fast clips show different sets of hands performing activities on the table such as pulling petals from a daisy, drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.
In animation, the title appears inside the shape of a house: “More to life.”

Then, Maureen reappears in the studio.

She says AND WELCOME TO
MORE TO LIFE.
WARMER WEATHER IS
HERE AND, WITH IT,
THE GAMES OF SPRING
AND SUMMER BEGIN.
BUT BEFORE YOU GO
OUT TO TAKE THAT JOG,
OR THROW A FEW BASKETS,
ARE YOU PROPERLY EQUIPPED
AND PROPERLY WARMED UP?
DON'T LET AN INJURY PUT
YOU ON THE SIDELINES.
Dr. DAVID LOWE IS A SPORTS
MEDICINE SPECIALIST,
WHO WORKS OUT OF RYERSON
POLYTECHNIC UNIVERSITY,
AND THE UNIVERSITY OF
TORONTO SPORTS INJURY CLINIC.

David is in his late thirties, clean-shaven, with very short curly black hair. He’s wearing glasses and a pale blue shirt.

Maureen continues IF YOU HAVE ANY QUESTIONS
ABOUT BROKEN OR BRUISED BONES,
OR ANY CHRONIC INJURIES,
GIVE US A CALL.

A caption appears on screen showing two phone numbers.

Maureen continues IN TORONTO DIAL 416-484-2727.
CALL LONG DISTANCE TO 1-888-411-1234.
AND YOU CAN EMAIL YOUR
QUESTION FOR Dr. LOWE TO
moretolife@tvo.org
AND Dr. LOWE, WELCOME
TO THE PROGRAM.

David says THANK YOU VERY MUCH.

Maureen says HOCKEY INJURIES
ARE GRABBING ALL
OF THE HEADLINES
THESE DAYS.
WHY DO THERE SEEM TO BE
SO MANY IN THAT SPORT?

The caption changes to "Dr. David Lowe. Sports Medicine."

David says WELL, IT'S A DIFFICULT
QUESTION TO ANSWER FULLY.
I THINK CERTAINLY,
THE PRESS IN CANADA,
AND OUR OBSESSION WITH
HOCKEY AS THE NATION,
CERTAINLY BRINGS THOSE
INJURIES MORE TO LIGHT.
RECENTLY, PROBLEMS WITH
CONCUSSIONS HAVE PROBABLY
BEEN THE BIGGEST THING.
AND THERE ARE A NUMBER OF
FACTORS RELATED TO THAT.
I THINK IF YOU LOOK
BACK 50 YEARS AGO,
THE SIZE OF HOCKEY PLAYERS
WAS QUITE A BIT SMALLER.
THE SPEED OF THE GAME
WAS QUITE A BIT SLOWER,
AND THE SIZE OF THE RINK
WAS THE SAME AS IT IS NOW.
SO YOU ADD QUITE A BIT
MORE WEIGHT TO PLAYERS,
QUITE A BIT MORE SPEED,
DIFFERENCES IN THE BOARDS,
AND THE GLASS
AROUND THE RINK,
AND I THINK IT LEADS TO
MUCH HIGHER INTENSITY
COLLISIONS, WHICH ARE
LEADING TO MORE INJURIES.

Maureen says NOW, I THINK WE ALL KNOW
THAT A CONCUSSION IS A BUMP
ON THE HEAD, BUT WHAT IS
THE PHYSIOLOGICAL THING
THAT IS GOING ON THERE?

David says WELL, BASICALLY, A
BRAIN IS A VERY, VERY
INTRICATE ORGAN
IN OUR BODY,
AND THERE ARE A
LOT OF CONNECTIONS,
NEURAL CONNECTIONS.
WHEN YOU SUFFER A
CONCUSSION, BASICALLY,
THOSE CONNECTIONS
ARE BEING JUMBLED.
AND THEY CAN HAPPEN
JUST FROM FORCES,
ROTATIONAL FORCES, OR THE
DIRECT CONTACT FORCES
CAUSING SOME JUMBLING, OR
THERE CAN BE STRUCTURAL
DAMAGE FROM A MORE
SIGNIFICANT BLOW.
ONE OF THE DIFFICULTIES WITH
CONCUSSIONS IS SOMETIMES
PEOPLE AREN'T REALLY
DIAGNOSING THEM.
THEY'RE JUST SAYING,
I GOT MY HEAD HIT,
AND IF THEY'RE
NOT KNOCKED OUT,
THEY'RE NOT THINKING
THEY HAVE A CONCUSSION.

Maureen says WHAT ARE THE SYMPTOMS,
OR THE SIGNS
THAT YOU SHOULD LOOK FOR?

David says THAT'S A BIG THING.
MOST CONCUSSIONS ARE THE
LOWER GRADE CONCUSSIONS
WHERE YOU DON'T ACTUALLY
LOSE CONSCIOUSNESS.
SO THE MOST COMMON SYMPTOMS
SOMEONE WOULD HAVE WOULD BE
BEING A LITTLE BIT
CONFUSED, SLIGHTLY DAZED,
MAYBE HAVING
SOME DIZZINESS.
SEEING THE
PROVERBIAL STARS.
THOSE ARE ALL KIND OF
SYMPTOMS OF THE MORE
COMMON FORM OF
CONCUSSION.
THEN, OBVIOUSLY, AS
YOU GET MORE SERIOUS,
THEN THERE MAY BE LOSS OF
CONSCIOUSNESS, AMNESIA,
THOSE KIND OF MORE
SERIOUS SYMPTOMS.

Maureen says AND WHEN SHOULD YOU SEEK A
DOCTOR'S OPINION ON THIS?

David says WELL, I MEAN, I
THINK, CERTAINLY,
THE FIRST TIME ANYBODY'S
HAD A CONCUSSION,
IT'S PROBABLY WORTHWHILE
TO TALK TO SOMEONE.
ANYBODY WHO HAS MORE THAN
JUST A FEW MINUTES
OF CONFUSION OR DIZZINESS,
AND SYMPTOMS THAT PERSIST
FOR SEVERAL HOURS,
CERTAINLY, THEY SHOULD
BE SEEING A PHYSICIAN
RELATIVELY SOON.
AND ANYONE WITH ANY OF THE
MORE SIGNIFICANT ONES.
IF YOU ACTUALLY LOSE
CONSCIOUSNESS FOR
ANY PERIOD OF TIME,
THEN YES, CERTAINLY,
SEEING A PHYSICIAN
WOULD MAKE SENSE.

Maureen says HOW MANY CONCUSSIONS
SHOULD YOU ALLOW YOURSELF,
OR YOUR CHILD, BEFORE
YOU PREVENT THEM
FROM PLAYING THAT
SPORT ANYMORE?

David says THAT'S REALLY THE THING
THAT'S IN THE NEWS
MOST FREQUENTLY NOW.
AND THAT'S A TOUGH
ONE TO ANSWER.
SOME PEOPLE, ONE
CONCUSSION MAY BE ENOUGH,
DEPENDING ON THE SEVERITY
AND THE UNDERLYING
PHYSIOLOGY IN
THAT PERSON.
MOST OF THE GUIDELINES
THAT WE HAVE LOOK AT THE
TYPE OF CONCUSSION YOU HAD,
THE FREQUENCY OF THOSE
CONCUSSIONS, AND HOW CLOSE
TOGETHER THEY ARE TO DECIDE
WHETHER OR NOT YOU SHOULD
CONTINUE WITH YOUR SPORT,
OR HOW MUCH TIME YOU SHOULD
HAVE OFF BEFORE GOING BACK.
I THINK THAT'S OFTEN THE
PROBLEM FOR PEOPLE IS
THEY DON'T TAKE THE RIGHT
AMOUNT OF TIME IN BETWEEN
HAVING AN INJURY AND GOING
BACK TO PARTICIPATING.

Maureen says THE OTHER THING WE'VE
BEEN READING ABOUT,
THE CANADIAN MEDICAL
ASSOCIATION JOURNAL
PUBLISHED A REPORT ON HOCKEY
INJURIES THAT INCLUDED
243 SPINAL INJURIES IN
THE PAST 30 YEARS.
HOW DO THOSE HAPPEN?

David says PROBABLY THE MOST COMMON
MECHANISM FOR THAT
IS SOMEBODY GOING
INTO THE BOARDS,
BEING EITHER HIT FROM
BEHIND, OR STUMBLING
INTO THE BOARDS AND
HITTING INTO THE BOARDS
WITH THE TOP OF THEIR
HEAD, OR THE NECK,
AND THEIR NECK BEING
COMPRESSED RESULTING
IN SIGNIFICANT INJURIES.
THOSE ARE, OBVIOUSLY,
QUITE TRAUMATIC
AND TRAGIC WHEN
THEY HAPPEN.

Maureen says AND A SPINAL INJURY CAN
BE ANYTHING, I SUPPOSE,
FROM PARALYSIS IN SOME
CASES TO, I DON'T KNOW,
I BROKE MY BACK ON A HORSE
ONCE WHEN I WAS YOUNGER.
I DON'T HAVE ANY PROBLEMS
AS A RESULT OF THAT.

David says YEAH, THAT'S RIGHT.
OF THOSE 243 INJURIES,
NOT ALL OF THEM RESULTED
IN PARALYSIS OR
LONG-TERM PROBLEMS,
BUT ANYBODY WHO HAS EVER
BEEN AT ANY KIND OF
SPORTING EVENT AND SEEN ONE
OF THOSE THINGS HAPPEN,
WATCHING SOMEBODY
LYING ON THE ICE,
OR ANY KIND OF
PLAYING FIELD,
IT'S QUITE A TRAUMATIC EVENT
FOR EVERYBODY INVOLVED.

Maureen says OKAY.
LET'S LEAVE HOCKEY
FOR A SECOND.
A LOT OF PEOPLE WILL BE
JOINING A SOFTBALL LEAGUE
FOR THIS SUMMER, GETTING
OUT TO PLAY SOME TENNIS.
WHAT'S YOUR SORT OF
GENERAL ADVICE TO PEOPLE
WHO ARE GOING TO START
GETTING ACTIVE AGAIN?

David says ONE OF THE THINGS, I GUESS,
THAT'S THE BIGGEST ISSUES
FOR PEOPLE IS
START SLOWLY.
I THINK THAT'S ONE OF THE
PROBLEMS WE SEE A LOT
OF WEEKEND WARRIORS,
WE LIKE TO, I GUESS,
DESCRIBE PEOPLE AS, WHO
MAYBE MOST OF THEIR WEEK
ARE SITTING AT THEIR DESK,
DOING THEIR DESK-TYPE WORK,
AND THEN ON THE WEEKEND,
DECIDE ALL OF A SUDDEN,
THEY'RE GOING TO GO
OUT AND PLAY AS HARD
AS THEY'VE EVER PLAYED.
AND YOU REALLY HAVE TO WORK
INTO THOSE KIND OF THINGS
GRADUALLY, OR THE RISK
OF INJURY GOES UP.

Maureen says WE HEAR A LOT
ABOUT WARMING UP.
IS THAT TO PREVENT
MUSCLE INJURY?

David says CERTAINLY, THAT'S
A BIG PART OF IT.
WARMING UP HELPS TO GET
OUR MUSCLES MOVING
MORE PROPERLY, GETTING
BLOOD FLOWING TO THEM,
SO THEY'RE MORE EXTENSIBLE
FOR THE MOST PART,
SO YOU'RE GOING TO AVOID
THE KIND OF STRETCHING
INJURIES WHERE YOU'RE
GOING TO TEAR A MUSCLE.
IT ALSO GETS YOUR JOINTS
READY FOR THE KIND
OF MOTIONS THEY'RE GOING
TO HAVE TO GO THROUGH
IN WHATEVER KIND OF ACTIVITY
YOU'RE GOING TO DO.
SO WARM-UP IS IMPORTANT.
NOW, IT'S MUCH MORE
IMPORTANT FOR PEOPLE WHO
HAVE AN UNDERLYING PROBLEM.
THERE'S A RECENT STUDY OUT
OF AUSTRALIA THAT ACTUALLY
SHOWED THEY COULDN'T FIND
ANY BENEFIT TO STRETCHING.
AND THAT'S SOMETHING WE'VE
TALKED ABOUT FREQUENTLY,
DOWN AT THE U OF T, CAN
YOU SHOW ME ANY PROOF
THAT STRETCHING HELPS.
I THINK THEY DID
SHOW, THOUGH,
THAT STRETCHING FOR PEOPLE
WHO HAVE AN UNDERLYING
PROBLEM, OR IF YOU'RE
LIVING A MORE SEDENTARY
KIND OF LIFESTYLE IS
PROBABLY A GOOD IDEA.

Maureen says AND STRETCHING AFTER,
THOUGH, HAD BENEFITS,
DIDN'T IT?

David says THAT'S RIGHT.
AND CERTAINLY, YOU KNOW,
PEOPLE WHO STRETCH WITHOUT
DOING ANY KIND OF ACTIVITY
TO GET THE BLOOD FLOWING,
THE STRETCHING
IS NOT AS GOOD.
SO THAT WE USUALLY SUGGEST
PEOPLE DO SOME KIND OF PHYSICAL
ACTIVITY FIRST, WHETHER
IT'S JOGGING AROUND
FOR FIVE MINUTES, RIDING
A BIKE OR SOMETHING,
TO GET THE BLOOD FLOWING
A LITTLE BIT BEFORE
YOU DO YOUR STRETCHING,
STRETCHING TENDS TO BE
MUCH MORE
EFFECTIVE THEN.

Maureen says OKAY.
WE'RE TALKING WITH Dr. DAVID
LOWE THIS AFTERNOON.
HE IS A SPORTS
INJURY SPECIALIST.
IF YOU HAVE QUESTIONS
ABOUT EXERCISE AND SPORTS,
AND THINGS THAT HURT
WHENEVER YOU DO THEM,
THEN GIVE US A CALL...

The caption changes to "416-848-2727. 1-888-411-1234."

Maureen continues AND OUR EMAIL ADDRESS IS...

The caption changes to "moretolife@tvo.org"

Maureen continues AND LET'S SEE, “DOCTOR, CAN
YOU TELL US ANYTHING ABOUT
THORACIC OUTLET SYNDROME?
I'VE JUST BEEN
DIAGNOSED WITH THIS,
AND CAN YOU TELL ME WHAT
WOULD CAUSE SEVERE SHOULDER
PAIN, OR COULD AN INJURY
TO MY SHOULDER BE THE
MORE LIKELY CAUSE OF
ALL THE PAIN?
I'M NOW IN PHYSIO, AND I
CAN BARELY STAND THE PAIN
AFTER EACH SESSION.”

David says OKAY, WELL, TO START WITH,
THE FIRST DIAGNOSIS
OF THORACIC OUTLET
SYNDROME DESCRIBES,
THERE'S AN AREA IN YOUR
UPPER BODY WHERE THE NERVES
AND BLOOD VESSELS THAT GO
DOWN TO SUPPLY YOUR ARM
EXIT FROM YOUR NECK AND GO
DOWN TO PROVIDE BLOOD FLOW,
AND THE NERVE CONNECTIONS
TO MUSCLE SENSATION.
THERE ARE A NUMBER OF
FACTORS THAT CAN LEAD
TO INCREASED PRESSURE
IN THAT AREA,
WHICH CAN RESULT IN
SYMPTOMS SUCH AS PAIN,
THAT CAN RESULT IN
NUMBNESS, TINGLING,
WEAKNESS IN EXTREMITY.
AND THE FACTORS THAT CAN
BE RELATED TO THAT
ARE MUSCLE TIGHTNESS.
THERE CAN BE PROBLEMS
IN YOUR NECK.
THERE CAN BE PROBLEMS
WITH AN EXTRA RIB.
SO THESE KIND OF THINGS ALL
HAVE TO BE LOOKED AT
QUITE CLOSELY.
USUALLY, THOSE KIND OF
THINGS ARE WORKED OUT
THROUGH THE PHYSIOTHERAPY.
WITH THE OTHER PART
OF YOUR QUESTION,
THE SHOULDER PAIN COULD BE
RELATED TO THE THORACIC
OUTLET PROBLEM, ALTHOUGH
IT COULD BE RELATED TO
ANOTHER TYPE OF INJURY.
AND WITHOUT EXAMINING YOU,
OR HEARING MORE OF YOUR
HISTORY, IT WOULD BE HARD
TO TELL YOU WHICH OF THOSE
TWO ISSUES IS RELATED TO
YOUR SHOULDER PROBLEM.

Maureen says SHOULD THE SHOULDER
HURT AFTER YOU'VE
BEEN THROUGH PHYSIO?

David says MOST TIMES, WHEN YOU
ARE FIRST STARTING
PHYSIOTHERAPY, THERE MAY BE
SOME THINGS THAT CAUSE
A LITTLE BIT OF
DISCOMFORT.
THAT'S USUALLY NOT A PROBLEM
AS LONG AS THE PAIN
IS NOT PERSISTING
FOR A LONG DURATION.
IF THE PAIN IS LASTING MORE
THAN AN HOUR OR SO AFTER
YOU'VE HAD A TREATMENT, THEN
YOU NEED TO DISCUSS IT WITH
YOUR PHYSIOTHERAPIST AND GO
OVER THE ROUTINE YOU'RE
DOING, AND PERHAPS
THEY NEED TO MODIFY
THE PROGRAM YOU'RE ON.

Maureen says OKAY.
GOOD LUCK.
THANKS FOR THE EMAIL.
THERESA IS ON THE
LINE IN SUDBURY.
HI, THERESA.

Theresa says HI.
I'M A DANCER, AND I HAVE AN
ANKLE INJURY THAT'S BEEN
PERSISTING NOW FOR, I
THINK, TWO OR THREE MONTHS.
AND IT'S ON MY INNER LEG,
JUST ABOVE MY ANKLE BONE
WHERE IT HURTS.
AND I GO TO A CHIROPRACTOR,
AND HE DOESN'T SEEM
TO HAVE ANY IDEA WHAT
IS WRONG WITH IT.
AND IT'S HURTING WHEN I
WALK, AND WHEN I DANCE.
SO I WAS JUST WONDERING IF
MAYBE YOU COULD HELP ME
WITH WHAT
SORT OF
INJURY IT MIGHT BE.

David says CERTAINLY.
CAN YOU JUST DESCRIBE AGAIN
THE AREA WHERE YOU'RE
FEELING THE PAIN, AND
DID IT COME ON ACUTELY,
ALL OF A SUDDEN, OR DID
IT COME ON GRADUALLY?

Theresa says OKAY, WHAT HAPPENS IF
I'M JUST WALKING, LIKE,
FIVE MINUTES IT WON'T HURT,
AND IT WILL COME ON REALLY
STRONG SO I HAVE TO
LIMP, AND I WEAR BRACES.
IT'S ON THE INNER
SIDE OF MY LEG,
JUST ABOVE MY
ANKLE BONE.

David says OKAY.
WELL CERTAINLY WE DEAL
WITH A LOT OF DANCERS,
AND ANKLE AND LOWER LEG
PROBLEMS ARE PRETTY COMMON
IN THE DANCE AREA.
THERE ARE A COUPLE
OF THINGS THAT ARE
POTENTIAL PROBLEMS HERE.
AND ONE OF THE MORE
COMMON ONES WITH DANCERS,
THERE ARE TWO TENDONS THAT
PASS BEHIND THE INSIDE PART
OF YOUR ANKLE, AND WHICH GO
UP THE INSIDE PART OF YOUR SHIN.
THEY'RE CALLED, ONE OF THEM
IS FLEXOR HALLUCIS LONGUS,
IT'S A MUSCLE THAT
PULLS ON YOUR BIG TOE.
AND WITH DANCING, DOING
A LOT OF POINT WORK,
THERE CAN BE SOME
IRRITATION WITH THAT TENDON.
THE OTHER ONE IS CALLED
TIBIALIS POSTERIOR,
AND IT'S INVOLVED IN
MORE RAISING OF THE TOE,
AS WELL, AND RAISING
OF THE ENTIRE FOOT.
SO THOSE ARE TWO MUSCLES
OR TENDONS THAT COULD BE
IRRITATED, AND BE
PART OF THE PROBLEM.
THE OTHER MORE SIGNIFICANT
PROBLEM, THOUGH,
THAT I THINK YOU NEED
TO HAVE CHECKED OUT,
IS IT COULD POSSIBLY
BE SOMETHING CALLED
A STRESS FRACTURE.
STRESS FRACTURES ARE
COMMON IN PEOPLE
WHO DO REPETITIVE
ACTIVITIES.
COMMON IN DANCERS, AND
PARTICULARLY DANCERS
WHO ARE DANCING SEVERAL
HOURS A DAY.
SO I THINK THAT'S
SOMETHING YOU REALLY NEED
TO HAVE INVESTIGATED A
LITTLE MORE CLEARLY.
AND WHETHER THAT
INVOLVES HAVING X-RAYS,
OR SOMETHING
CALLED A BONE SCAN,
WHICH ARE TYPICALLY THINGS
CHIROPRACTORS CAN'T ORDER,
SO YOU MAY NEED TO
SEE A MEDICAL DOCTOR
OR PHYSIOTHERAPIST TO GET
A BETTER IDEA ON THAT.

Maureen says WHEN YOU SAY
STRESS FRACTURE,
IS SOMETHING
ACTUALLY BROKEN?

David says YEAH.
A STRESS FRACTURE, I GUESS
THE WAY I WOULD DESCRIBE IT IS,
IF YOU TOOK A PIECE OF
METAL, AND KEEP BENDING IT,
AND YOU KNOW HOW EVENTUALLY
YOU DON'T GET A BREAK ALL
THE WAY THROUGH, BUT
YOU START SEEING SOME
STRUCTURAL CHANGES AND
SOME WEAKNESS IN IT.
SO IT'S NOT LIKE ALL OF A
SUDDEN YOU DID SOMETHING,
AND, YOU KNOW, WHEN YOU
BREAK YOUR ARM AND YOU'VE
FALLEN OFF A TREE
OR SOMETHING,
AND IT BREAKS IN HALF,
YOU KNOW RIGHT AWAY.
WITH A STRESS FRACTURE,
IT'S USUALLY THE RESULT
OF MORE GRADUAL,
REPETITIVE ACTIVITIES.
AND THERE IS A TIME PERIOD
WHERE BONE NEEDS TO RECOVER.
AND THERE IS
JUST NOT ENOUGH.
THERE'S TOO MUCH BREAKDOWN,
AND NOT ENOUGH BUILD-UP,
AND YOU DEVELOP A FRACTURE,
WHICH EVENTUALLY COULD
GO ON TO BECOME A
COMPLETE FRACTURE.

Maureen says SO MIGHT SHE HAVE TO LAY
OFF THE DANCING FOR A
WHILE IN ORDER FOR
THIS TO HEAL?

David says CERTAINLY.
IF THE DIAGNOSIS IS
A STRESS FRACTURE,
THE TREATMENT IS REST.
AND THAT'S ONE OF THE MORE
DIFFICULT THINGS WE HAVE
IN SPORTS MEDICINE, IS
TELLING ACTIVE PEOPLE THAT
THEY NEED TO CHANGE
WHAT THEY'RE DOING.

Maureen says OKAY.
GOOD LUCK,
THERESA, THANKS.

She turns to a computer screen and reads
ANTHONY WOULD LIKE TO KNOW
ABOUT KNEE RECONSTRUCTIONS.
“THIS IS AN ANTERIOR CRUCIATE
LIGAMENT RECONSTRUCTION.
I HAD THIS PERFORMED ABOUT
TEN YEARS AGO, AND NOW,
I'M HAVING RECURRING
PROBLEMS WITH THE KNEE.
DOES THIS TYPE OF SURGERY
HAVE A LIFE SPAN ON IT?”
WARRANTY RUN OUT?

David says YES.
WE DON'T TYPICALLY, SURGEONS
DON'T GIVE WARRANTIES,
NECESSARILY, ON THEIR
SURGERY, BUT ANTHONY,
IT'S TOUGH TO KNOW
SPECIFICALLY WHAT SURGERY
YOU HAD TEN YEARS AGO.
THINGS HAVE
CHANGED SOMEWHAT.
THE SURGERY NOWADAYS,
WHAT THEY'RE DOING,
MOST PEOPLE ARE USING
ARTHROSCOPIC TECHNIQUES
SO THERE IS MUCH LESS
TISSUE DAMAGE INVOLVED,
AND THERE ARE REALLY
TWO OPTIONS MOST
OF THE SURGEONS
ARE USING.
ONE IS THEY USE A PORTION OF
THE TENDON THAT GOES
FROM YOUR KNEECAP DOWN
TO YOUR LOWER SHIN,
OR THEY USE ONE OF YOUR
HAMSTRING TENDONS TO
BASICALLY REFIGURE THE
ANTERIOR CRUCIATE LIGAMENT.
THERE AREN'T A WHOLE LOT
OF STUDIES THAT GIVE US A
TIMEFRAME ON THAT, AND
WHETHER YOURS SHOULD WEAR OUT.
CERTAINLY, IF YOU'RE HAVING
TROUBLE WITH YOUR KNEE,
THOUGH, AND YOU'VE HAD
THAT KIND OF SURGERY,
THE OTHER THINGS THAT GO
ALONG WITH IT IS THE AMOUNT
OF TRAUMA THAT'S INVOLVED
IN THE ORIGINAL INJURY
CAN CERTAINLY LEAD TO AN
INCREASE RISK OF ARTHRITIS,
AND THERE COULD BE DAMAGE
TO OTHER STRUCTURES
WITHIN THE KNEE.
SO I THINK IF YOU HAVE
HAVING TROUBLE THAT
LONG AFTER HAVING AN
INITIAL SURGERY,
THEN IT REALLY NEEDS TO BE
LOOKED IN TO SEE WHETHER
YOU HAVE SOME ARTHRITIS
THAT'S DEVELOPED,
OR WHETHER THE ACTUAL
SURGERY HAS RUN
ITS COURSE.

Maureen says OKAY.
THANKS, ANTHONY.
TANYA IS IN OAKVILLE.
HI, TANYA.

Tanya says HI, HOW ARE YOU?

Maureen says GOOD, THANKS.

Tanya says GOOD.
I DO A LOT OF RUNNING.
I'VE BEEN RUNNING FOR
ABOUT TEN YEARS NOW.
AND ABOUT TWO YEARS AGO, I
WAS DIAGNOSED WITH A STRESS
FRACTURE IN MY PELVIS,
AND ABOUT A YEAR AGO,
I HAD ONE IN MY FOOT.
WHEN I HAD THE
ONE IN MY PELVIS,
I STOPPED RUNNING FOR A
LITTLE WHILE AFTER BECAUSE
I COULD BARELY EVEN WALK.
IT WENT AWAY, AND I GRADUALLY
STARTED RUNNING
AGAIN.
AND I'M DOING QUITE
A BIT OF RUNNING NOW,
AND I FEEL IT AGAIN.
I'M JUST WONDERING,
WILL THIS EVER GO AWAY?
I MEAN, I'VE HAD
EVERYTHING I'VE DONE.
I'VE HAD THE BONE DENSITY,
I'M TAKING CALCIUM
SUPPLEMENTS, AND I'VE
TRIED TO EAT, YOU KNOW,
MORE PROTEIN, BUT IS THERE
ANYTHING ELSE I CAN DO?

David says FIRST OF ALL, WAS YOUR
BONE DENSITY NORMAL?

Tanya says IT WAS JUST A
LITTLE LOW.

David says OKAY.
SEEMS LIKE A BIT
OF AN ODD QUESTION,
ARE YOUR PERIODS NORMAL?

Tanya says YEAH.

David says OKAY, BECAUSE THERE IS
A LOT OF RESEARCH INTO
A PARTICULAR PROBLEM WITH
FEMALES WHO ARE QUITE
ACTIVE DEVELOPING A LOT
OF STRESS FRACTURES AND
ACTUALLY HAVING A
LOWER BONE DENSITY,
WHICH MAY BE RELATED TO
SOME HORMONAL CHANGES AS
A RESULT OF NOT ENOUGH FOOD
INTAKE FOR THE AMOUNT
OF ACTIVITY YOU'RE DOING.
GIVEN THE FACT YOUR BONE
DENSITY IS NOT SIGNIFICANTLY
ABNORMAL, AND YOU'RE
DOING OTHER THINGS,
THE KIND OF ISSUES THAT
NEED TO BE LOOKED AT
ARE PROBABLY
BIOMECHANICAL ISSUES,
TO SEE WHETHER THERE IS
SOME PROBLEM WITH YOUR GAIT
PATTERN THAT'S RESULTING
IN INCREASED STRESSES
IS CERTAIN AREAS, IN EITHER
YOUR FOOT, OR YOUR PELVIS,
THEN ALSO LOOKING AT THE
MUSCLES AROUND THOSE AREAS
TO SEE WHETHER THEY'RE
STRONG ENOUGH TO DEAL
WITH THE KIND OF LOADS
THAT YOU'RE PUTTING ON.
SOME PEOPLE JUST AREN'T, YOU
KNOW, INTENDED, I GUESS,
TO RUN AS MUCH AS
YOU'RE RUNNING.
AND THEY MAY BE AN OPTION,
BUT USUALLY WE CAN FIND
AN ANSWER THAT GETS
YOU GOING WITH DOING
THE THINGS THAT
YOU WANT TO DO.

Maureen says SO SHE SHOULD TRY TO SEE
A SPECIALIST OF SOME KIND?

David says I THINK SO YEAH.
IT SOUNDS LIKE SHE'S HAD,
YOU KNOW, VERY GOOD CARE,
AND THEY'VE DONE THE TESTS
THAT WE WOULD NORMALLY DO.
I GUESS THE OTHER THINGS I
WOULD PROBABLY WANT TO LOOK
AT IS THE HORMONE LEVELS AND
RE-LOOK AT THE BONE DENSITY.
IF IT WAS SLIGHTLY REDUCED,
THEN THERE MAY BE
A REASON FOR THAT.
AND THAT MAY NEED TO BE
MORE THOROUGHLY ADDRESSED.

Maureen says OKAY, SPEAKING OF
FEMALE ATHLETES,
THERE WAS A YALE STUDY THAT
SHOWED FEMALE ATHLETES
ARE MORE PRONE TO
KNEE INJURIES.
TELL US WHY THAT IS.

David says I GUESS THAT GOES BACK
TO OUR PREVIOUS CALLER,
WHO WAS A MALE, THOUGH,
TALKING ABOUT THE
ANTERIOR CRUCIATE
LIGAMENT.
CERTAINLY OVER THE
LAST SEVERAL YEARS,
WE'VE SEEN A MUCH HIGHER
FREQUENCY IN PARTICULAR SPORTS
OF FEMALE ATHLETES
SUFFERING INJURIES TO THIS
ANTERIOR CRUCIATE LIGAMENT.
THERE HAVE BEEN A NUMBER
OF THEORIES PROPOSED ABOUT THAT.
SOME OF THEM RANGE FROM
THINGS LIKE THE WAY WOMEN
ARE PLAYING SPORTS NOW IS
MUCH MORE LIKE THE WAY
MEN PLAY SPORTS.
IF YOU LOOK LIKE A WOMEN'S
BASKETBALL GAME 10 OR
15 YEARS AGO, THE
STYLE OF PLAY WAS
QUITE DIFFERENT THAN
WHAT YOU SEE NOW.
IT'S MUCH MORE
ATHLETIC, MUCH MORE -
I GUESS ATHLETIC
IS NOT A GOOD WORD.

Maureen says AGGRESSIVE.

David says AGGRESSIVE, YEAH.
AND SOME OF THE ISSUES THEY
LOOK AT ARE IS THE FEMALE
BODY SET UP DIFFERENTLY,
AND THERE MAY BE SOME
IMBALANCES IN THE STRENGTH
BETWEEN THE HAMSTRING
MUSCLES AND THE
QUADRICEPS MUSCLES.
THERE HAVE BEEN PEOPLE
THAT HAVE LOOKED AT
THE HORMONAL ISSUES
AROUND IT.
WE KNOW THAT IN PREGNANCY,
CERTAIN HORMONES ARE NEEDED
TO STRETCH LIGAMENTS IN
THE PELVIS SO YOU
CAN DELIVER A BABY.
SO THE SAME THING MAY
HAPPEN IN THE KNEE,
THAT AS YOUR HORMONE
LEVEL CHANGES,
LIGAMENTS MAY ACTUALLY
BECOME LESS EFFECTIVE,
SO THAT'S ANOTHER
POSSIBILITY.
THE THIRD THING THAT
PEOPLE HAVE LOOKED AT IS
DO BOYS AND GIRLS PLAY
DIFFERENTLY AS CHILDREN,
AND LEARN DIFFERENT
KINDS OF THINGS,
THEIR MUSCLES LEARN
DIFFERENT THINGS?
AND THEN WHEN YOU GET INTO
THESE THINGS AS I GUESS,
AN OLDER TEENAGER, AND YOU
START DOING THESE MORE
AGGRESSIVE THINGS, IF YOU
DON'T HAVE THAT BASE,
COULD THAT BE A FACTOR FOR
WHY YOU'RE SEEING MORE
KNEE INJURIES IN WOMEN?
AND THAT'S CERTAINLY
SOMETHING WE SEE AT THE
UNIVERSITY LEVEL
QUITE FREQUENTLY.

Maureen says OKAY.
ALINA IS IN MISSISSAUGA.
HI, ALINA.

Alina says HI, MAUREEN.
HI, Dr. LOWE.
YOU'VE BEEN HELPING
ME ANSWER SOME
OF THE QUESTIONS I WAS
TRYING TO ASK YOU.
I WAS JUST INTERESTED ON THE
EFFECT SPORTS HAVE ON
THE GROWING PHYSIOLOGY
OF A CHILD,
AND SPECIFICALLY IT WAS
ABOUT MY SIX-YEAR-OLD
DAUGHTER WITH
KNEE INJURIES.
AND SHE HAS PLAYED BACK
CATCHER FROM T BALL
TO HARDBALL, AND NOW
SHE'S IN HOCKEY,
AND HAVING A LOT
OF KNEE PROBLEMS.
AND SHE'S BEEN DIAGNOSED
ONCE WITH FLOATING
KNEECAPS, BUT HER
MUSCULATURE IS STRONG,
AND THEN AS WELL THE
CHIROPRACTOR HAS SAID
THE HIP IS ABOUT A HALF
INCH OFF, OR SOMETHING,
SO THE BIOMECHANICS MIGHT
BE WRONG THERE, TOO.
SO I GUESS, PARTLY, YOU HAVE
ANSWERED A LITTLE BIT
OF IT, BUT IT'S A WOMEN,
BUT AS WELL AS CHILDREN,
AS THEY'RE GROWING UP,
WHAT EFFECT CAN SOME OF
THESE SPORTS DO ON THEM
AS THEY'RE GROWING
IN THE LIGAMENTS AND
THINGS LIKE THAT?

David says THAT'S AN
IMPORTANT QUESTION.
I THINK WE'RE SEEING YOUNGER
PEOPLE GET INVOLVED
IN MORE RIGOROUS ACTIVITIES
FROM AN EARLIER AGE,
AND PARTICIPATE IN
QUITE HIGH LEVELS.
WE JUST RECENTLY SAW WE HAVE
A 13-YEAR-OLD WHO IS OUR
NATIONAL CHAMPION IN DIVING,
AND SPORTS LIKE GYMNASTICS
WHERE YOU'RE KIND OF OVER
THE HILL WHEN YOU REACH 17.
SO THOSE SPORTS PUT A
LOT OF STRESS ON JOINTS.
WITH SPECIFIC REGARD
TO YOUR DAUGHTER,
BASEBALL CATCHERS AT
ANY LEVEL, YOU KNOW,
THE POSITION THEY HAVE
TO BE IN PUTS A LOT
OF STRESS ON
THEIR KNEES.
SO IT'S NOT UNUSUAL TO
HEAR YOU SAY YOUR DAUGHTER
HAS SOME KNEE PROBLEMS.
AS FAR AS THE PHYSIOLOGY
THAT'S INVOLVED, CERTAINLY,
YOUNG GIRLS WHO ARE QUITE
ACTIVE TEND TO HAVE LOWER
BODY FAT LEVELS, TEND TO
HAVE DELAYED PERIODS,
SO THEIR BONE GROWTH
IS DELAYED, AS WELL.
AND THAT CAN LEAD TO
PROBLEMS, YOU KNOW,
IN THEIR FUTURE
LIVES, AGAIN,
AROUND THE OSTEOPOROSIS
ISSUE AND THINGS LIKE THAT.
TYPICALLY NOT SEEN IN SPORTS
LIKE BASEBALL AND HOCKEY,
MUCH MORE IN THE SPORTS
LIKE FIGURE SKATING,
GYMNASTICS AND DANCE.
BUT I THINK YOU'VE TALKED
ABOUT SOME OF THE PROBLEMS
WITH YOUR DAUGHTER, AND
SOME OF THE THINGS
THAT HAVE BEEN LOOKED AT.
AND THEY SOUND QUITE
REASONABLE TO ME,
THAT THEY'RE DOING THE
RIGHT KIND OF THINGS WITH HER.

Maureen says WHEN A PERSON COMES
INTO YOUR CLINIC,
AND LET'S SAY
THEY'RE UNDER 50,
COMPLAINING OF KNEE PAIN,
HAVEN'T HAD A
SPECIFIC INJURY, WHAT
DO YOU LOOK AT?
BECAUSE IT'S MY
UNDERSTANDING,
SOMETIMES YOU
LOOK AT THE BACK.

David says YEAH.
BASICALLY, ANY JOINT,
I GUESS THE OLD SONG,
THE KNEE BONE IS
CONNECTED TO THE HIPBONE.

Maureen says IT'S ALL CONNECTED.

David says AND THAT CERTAINLY
HOLDS TRUE,
THAT WHENEVER WE ARE
LOOKING AT A JOINT,
WE NEED TO LOOK AT THE
JOINTS ABOVE AND BELOW IT
TO SEE WHETHER THEY
CAN BE INVOLVED
IN WHAT'S HAPPENING.
WITH REGARDS TO BACK
PROBLEMS LEADING TO
PROBLEMS ELSEWHERE,
CERTAINLY, THE FACT
THAT OUR NERVE SUPPLY
COMES FROM THE BACK,
THAT CONTROLS THE MUSCLES,
AND OTHER FACTORS
INVOLVED WITH THE
MOVEMENT OF JOINTS,
THAT BACK INJURIES CAN
CERTAINLY LEAD TO PROBLEMS
WITH THE KNEE, AND
QUITE FREQUENTLY,
HIP PROBLEMS LEAD
TO KNEE PROBLEMS,
AS OUR LAST
CALLER SUGGESTED.

Maureen says OKAY, INTERESTING.
THANKS, ALINA.
A QUESTION FROM
ALEXANDRA.

She turns to her computer screen and reads
“AFTER YEARS OF
PLAYING TENNIS,
I'VE DEVELOPED WHAT I
GUESS IS COMMONLY
REFERRED TO AS
MORTON'S NEUROMA.
THE PAIN COMES AND GOES,
ALTHOUGH IT'S GENERALLY
WORSENING AS
TIME GOES ON.
APART FROM PAIN RELIEVERS
AND THE OCCASIONAL
ANTI-INFLAMMATORY, IS
THERE ANYTHING I CAN DO
TO LESSEN THE
DISCOMFORT?”
SO WHAT IS
MORTON'S NEUROMA?

David says YEAH, MORTON'S NEUROMA IS
A CONDITION WHERE THERE
ARE NERVE FIBRES THAT
TRAVEL BETWEEN YOUR TOES,
AND SUPPLY SENSATION
TO THE AREA.
WHAT HAPPENS FOR A
NUMBER OF REASONS,
DIFFERENT REASONS IN
DIFFERENT PEOPLE,
IS YOU DEVELOP SOME SCAR
TISSUE AROUND THE NERVE,
AND IT BECOMES QUITE
UNCOMFORTABLE AND PAINFUL.
SOME OF THE THINGS YOU
HAVE DONE ARE HELPFUL.
OTHER THINGS THAT CAN
SOMETIMES ALLEVIATE
THE PROBLEM ARE, OF
COURSE, PHYSIOTHERAPY
OR ATHLETIC THERAPY.
SOMETIMES GETTING AN
ORTHOTIC DEVICE WHICH
RELIEVES SOME OF THE
PRESSURE ON THE AREA,
MAY BE USEFUL TO YOU.
AND THE OTHER THING WE DO
RELATIVELY FREQUENTLY
IN THIS INSTANCE FOR PEOPLE
WHO HAVE HAD PERSISTENT
PROBLEMS IS ACTUALLY A
CORTISONE INJECTION INTO
THE AREA, AND PEOPLE
FIND THAT THAT TENDS
TO BE QUITE EFFECTIVE IN
RELIEVING THE PROBLEM.

Maureen says ARE THERE ANY SIDE EFFECTS
TO HAVING CORTISONE INJECTIONS?

David says YEAH, THERE ARE SIDE
EFFECTS WITH ANY - I
GUESS, PRETTY ANYTHING
I COULD DO TO SOMEBODY,
THERE ARE POTENTIAL
SIDE EFFECTS.
BUT CORTISONE, PARTICULARLY,
AND THE WHOLE ACT OF GIVING
AN INJECTION, THE MAIN SIDE
EFFECT OF ANY INJECTION
WOULD BE THE RISK
OF INFECTION.
THE RISK OF BLEEDING
WOULD BE THE OTHER THING.
BUT WE RARELY SEE THOSE IN
THESE KIND OF INJECTIONS.
WITH THE CORTISONE ITSELF,
THE CORTISONE THAT
WE INJECT IS BASICALLY A
SYNTHETIC VERSION OF
CORTISONE THAT OUR
OWN BODY'S PRODUCES,
AND IT'S A POWERFUL
ANTI-INFLAMMATORY AGENT.
BUT IF WE PUT IT
DIRECTLY UNDER THE SKIN,
IT CAN CHANGE THE
COLOUR OF THE SKIN,
THE THICKNESS OF THE SKIN,
INTO CERTAIN TISSUES,
IT CAN WEAKEN
THOSE TISSUES.
IF IT GETS ABSORBED A LOT
INTO THE BLOODSTREAM,
THERE ARE MORE
SERIOUS SIDE EFFECTS.
BUT THE AMOUNT THAT WE USE,
AND LOCATION WE PUT IT IN,
PARTICULARLY IN SOMETHING
LIKE A MORTON'S NEUROMA,
THE SIDE EFFECTS OF THE
CORTISONE ITSELF
ARE QUITE LIMITED.

David says OKAY.
BACK TO THE PHONES.
ART IS IN OTTAWA.
HELLO, ART.

Art says OH, HI.

Maureen says HI.

Art says THIS IS ANOTHER THING TO
DO WITH TENNIS, IN A WAY.
I HAVE TENNIS ELBOW
ACTUALLY IN BOTH ELBOWS.
ONE IS FROM 20 YEARS AGO
WHEN I OVERDID SERVING
PRACTICE AND GENERATED
A TENNIS ELBOW
IN THE RIGHT ELBOW.
BUT A YEAR AGO OR SO, I
WAS DOING EXERCISES
WITH MY FINGERS, TO
DO WITH ARTHRITIS,
AND DEVELOPED ANOTHER TENNIS
ELBOW IN THE LEFT ARM.
AND IN BOTH CASES,
THEY'RE STILL THERE.
THE MOST RECENT
ONE IS MORE SEVERE.
AND I TRIED THE
EXERCISES, LAP
STRAPS
AND THOSE
SORTS OF THINGS,
AND I DON'T SEEM TO BE
MAKING ANY PROGRESS.
I'M WONDERING IF THERE IS
ANYTHING THAT CAN BE SUGGESTED.

David says WELL, YES, CERTAINLY, THAT
SOUNDS LIKE A DIFFICULT
PROBLEM YOU HAVE WITH
SOMETHING FOR 20 YEARS.
IT WOULD BE AGGRAVATING
FOR MOST PEOPLE,
AND THEN WHEN YOU GET
IT ON THE OTHER SIDE,
WOULD ADD TO SOMEBODY'S
FRUSTRATION.
SOUNDS LIKE YOU'VE DONE
MOST OF THE COMMON ROUTINE
THINGS WE DO WITH PEOPLE
WITH TENNIS ELBOW.
HOWEVER, GOING BACK TO
SOMETHING MAUREEN STATED
EARLIER, IS WHEN WE SEE
STUFF HAPPENING ON BOTH
SIDES, WE FREQUENTLY LOOK
TO SOMETHING ABOVE
THAT AREA AS BEING
POTENTIALLY THE CAUSE.
AND LOOKING AT YOUR NECK IS
SOMETHING THAT YOU MAY
NEED TO HAVE SOMEBODY DO.
BECAUSE WE START TO WORRY
WHEN SOMEBODY IS GETTING
THE SAME PROBLEM ON
DIFFERENT SIDES,
THAT THERE MAY BE A MORE
CENTRAL DIFFICULTY.
SO HAVING SOMEBODY HAVE
A GOOD ASSESSMENT OF
YOUR NECK WOULD
BE WORTHWHILE.
IF YOUR NECK IS CLEARED,
THEN YOU NEED TO LOOK
AT WHAT ARE THE OTHER
POTENTIAL THERAPIES,
AND GOING BACK TO
THE PREVIOUS CALLER,
CORTISONE INJECTIONS, IF
YOU'VE TRIED THE THERAPY
AND THE BRACES AND THINGS
LIKE THAT, IS ONE OPTION.
THERE ARE SOME NEW THERAPIES
THAT PEOPLE ARE PROPOSING
ARE QUITE EFFECTIVE IN
THINGS LIKE TENNIS ELBOW.
AND IT'S A HIGH FREQUENCY
ULTRASOUND TREATMENT.
AND I'M NOT SURE WHETHER
IT'S AVAILABLE IN OTTAWA.
I KNOW THERE ARE THREE
CLINICS IN TORONTO
THAT ARE OFFERING
THIS SERVICE.
I HAVEN'T SEEN A
WHOLE LOT OF RESEARCH,
BUT ANECDOTALLY, I'VE HAD
PATIENTS WHO HAVE HAD
THE TREATMENT AND HAVE
FELT A LOT BETTER,
SO THEY AVOID SURGERY.
SURGERY IS THE FINAL OPTION
IN THAT TYPE OF PROBLEM.

Maureen says JUST FURTHER TO THE
ULTRASOUND, MARY, BY EMAIL,
IS 45 AND DEVELOPED TENNIS
ELBOW LAST NOVEMBER.
SHE'S DOING
WEIGHT TRAINING.
AND SHE WENT FOR ULTRASOUND
TREATMENT LAST JANUARY,
FIVE TIMES A WEEK FOR A
TOTAL OF 14 SESSIONS.

She reads from the computer screen
“ALTHOUGH I DON'T HAVE
CONSTANT PAIN ANYMORE,
I STILL FEEL IT, AND
I'M AFRAID TO GO BACK
TO THE STRENGTH
TRAINING.
SO PRESENTLY, I'M
NOT DOING ANYTHING.”
DO YOU THINK SHE SHOULD
TRY THE ULTRASOUND AGAIN?

David says BASICALLY, THE ULTRASOUND
I WAS TALKING ABOUT
IS SLIGHTLY DIFFERENT
THAN THE ULTRASOUND -
THE ULTRASOUND IN MOST
PHYSIO CLINICS IS A LOWER
FREQUENCY, AND THIS IS A
NEW TYPE OF ULTRASOUND,
SIMILAR TO WHAT THEY'VE
USED, I GUESS, FOR YEARS,
TO BREAK UP KIDNEY STONES,
GALLBLADDER STONES.

Maureen says WHERE DO YOU
HAVE THAT DONE?

David says NO, ACTUALLY - FOR
THE KIDNEY STONES AND
GALLBLADDER IT'S DONE
IN A HOSPITAL, YES,
FOR YOUR ELBOW OR YOUR
FOOT OR SOMETHING,
IT'S DONE IN SOME
PRIVATE CLINIC,
SO IT'S OUTSIDE OF
THE PUBLIC SYSTEM.
THIS IS A FREQUENT
THING WE SEE,
AND A THING WE
TRY TO AVOID,
IS HAVING PEOPLE GIVE
UP THEIR ACTIVITY
AS A RESULT OF AN INJURY.
SO I THINK CERTAINLY, IF
YOU'VE NOT RECOVERED,
IT REALLY MAKES SENSE
FOR YOU TO GO BACK
AND TALK TO SOMEBODY.
SEE IF THERE'S ANYTHING
THAT'S BEEN MISSED.
OUR LAST CALLER TALKED
ABOUT WEARING A BRACE,
AND THAT MAY BE SOMETHING
THAT YOU'VE NOT TRIED
THAT MAY HELP YOU GET
BACK TO LIFTING WEIGHTS,
AND NOT HAVE THE SAME
PROBLEM YOU'RE EXPERIENCING.
BUT WE REALLY LIKE TO PUSH
PEOPLE NOT TO GIVE UP.

Maureen says JUST BACK TO ART'S
QUESTION FOR A SECOND.
IF HE HAS HIS NECK CHECKED
OUT, WHAT DO WE MEAN BY,
ARE YOU TALKING
MANIPULATION OF THE NECK,
OR ARE YOU TALKING SOME
EXERCISES IN POSTURE
AND THINGS LIKE THAT?

David says BASICALLY, WHEN
I SAY CHECKED OUT,
I MEAN HAVE IT EXAMINED
TO SEE WHETHER THERE
IS A POTENTIAL PROBLEM IN
THE NECK THAT COULD BE
RESULTING IN PRESSURE ON
CERTAIN NERVE ROOTS
AS THEY'RE LEAVING THE
NECK, WHICH THEN LEAD
TO MORE SUSCEPTIBILITY
TO TENNIS ELBOW.
I CAN'T TELL YOU WHAT
TYPE OF THERAPY
WOULD BE APPROPRIATE.
IT DEPENDS ON WHAT
THE NECK PROBLEM IS.
AND CERTAINLY, MANIPULATION
IS USED, IN SOME INSTANCES,
NOT AS COMMONLY IN
THE MEDICAL AREA,
AS IN CHIROPRACTIC,
BUT, YOU KNOW,
FOR CERTAIN PROBLEMS,
MANIPULATION
MIGHT BE APPROPRIATE.
BUT IN MOST CASES, IT'S MORE
OF A HANDS-ON TREATMENT,
EXERCISES, AND THINGS
LIKE THAT, ARE USUALLY -

Maureen says I HAD TO LEARN TO
BRING IN MY CHIN IN
SOMETIMES LIKE THIS.

She pulls her chin back, and then says
OKAY, THANKS, ART,
AND GOOD LUCK.
MARGERY IS NEXT.
HI, MARGERY.

Margery says HI, THERE.

Maureen says HI.
GO AHEAD.
YOUR QUESTION
FOR Dr. LOWE.

Margery says YES, I WAS CROSS COUNTRY
SKIING SIX WEEKS AGO,
AND I FELL OVER ON
MY LEFT HAND SIDE,
AND I INJURED MY
UPPER ARM.
AND I HAD AN X-RAY THAT
SHOWED NO FRACTURE.
AND I'VE HAD AN ARTHROGRAM,
AND THAT WAS NEGATIVE.
BUT I'M STILL HAVING A LOT
OF DISCOMFORT IN THE UPPER
SHOULDER THAT SORT OF
RADIATES DOWN TO MY ELBOW,
AND THEN EVEN SOMETIMES I
SORT OF HAVE A SENSATION
IN THE PALM OF MY HAND.
I'M WONDERING IF SIX WEEKS,
IS THAT UNUSUAL FOR THIS
LENGTH OF TIME FOR IT TO
BE STILL BOTHERING ME?

David says NOT NECESSARILY.
I'D JUST LIKE TO ASK YOU
A COUPLE OF QUESTIONS.
HOW IS THE MOVEMENT
IN YOUR ARM NOW?
ARE YOU ABLE TO
MOVE IT FULLY?

Margery says I'M ABLE TO MOVE IT FORWARD
AND DO A LOT OF THINGS.
WHERE I HAVE A LOT OF
TROUBLE IS MOVING IT FROM
RIGHT IN FRONT
OF ME, TO LEFT.
LIKE, TAKING A PARKING
TICKET OUT OF ONE OF THOSE
LITTLE BOXES.

David says YUP.

Margery says AND THEN AT FIRST PUTTING
THE BLINKER ON MY CAR
WAS VERY PAINFUL.
NOW, THAT'S BETTER.
I DON'T SEEM TO HAVE ANY
POWER PUSHING MY ARM OUT,
OUTWARDS, MY LEFT ARM.

David says OKAY.
AND ANY TROUBLE AT NIGHT?

Margery says NO.
SOMETIMES I TAKE A DOUBLE
TYLENOL TO HELP ME SLEEP.

David says OKAY.
SOUNDS LIKE YOU'VE HAD SOME
GOOD INVESTIGATIONS DONE
TO RULE OUT A
BONY PROGRAM.
THE ARTHROGRAM IS DONE TO
LOOK AT A ROTATOR CUFF
TEAR, MOST LIKELY.
AND IT'S A GOOD TEST.
IT'S NOT THE BEST, BUT
IT'S AS GOOD AS WE GET
IN MOST PLACES IN ONTARIO.
I'M NOT CLEAR WHETHER YOU'VE
HAD ANY PHYSIOTHERAPY
OR NOT, BUT IF NOT,
THAT WOULD MAKE SENSE.
AT SIX WEEKS, IF IT'S
NOT GETTING BETTER,
I WOULD CERTAINLY PUSH
YOU TO TRY AND GET SOME
TREATMENT TO
MOVE THIS ALONG.
IT CERTAINLY SOUNDS LIKE
MORE OF A MUSCULAR PROBLEM.
AND THAT'S SOMETHING HAVING
SOME TREATMENT ON USUALLY
HELPS PEOPLE IMPROVE
THEIR FUNCTION.
AND FOR YOU, IT SOUNDS LIKE
JUST REGULAR ACTIVITIES
OF DAILY LIVING ARE
BECOMING TROUBLESOME,
AND THAT CAN BE
QUITE UNCOMFORTABLE.

Maureen says OKAY.
CHECK OUT
PHYSIOTHERAPY FOR THAT.
SPRAINED ANKLES HAPPEN.
AND I'VE OFTEN WONDERED,
WHAT DO WE MEAN BY SPRAINED?
WHAT DOES THAT IMPLY?

David says SPRAIN USUALLY
APPLIES TO LIGAMENTS.
SO LIGAMENTS ARE
STRUCTURES THAT JOIN
TWO BONES TOGETHER
ACROSS A JOINT.
AND WHEN WE TALK
ABOUT A SPRAIN,
WE MEAN THAT THAT LIGAMENT
HAS EITHER BEEN STRETCHED
OR TORN, AND IT'S JUST A
QUESTION OF THE DEGREE.
SO WE USUALLY
RATE THINGS.
MOST THINGS WE RATE,
DOCTORS LIKE TO BE SIMPLE,
IS GRADE, ONE,
TWO, THREE.
WE DON'T LIKE TO HAVE TOO
MANY VARIABLES INVOLVED.
SO A SPRAIN CAN BE
DIFFERENT IN ITS SEVERITY,
BUT IN MOST CASES,
AT THE VERY LEAST,
IT'S BEEN STRETCHED.
AND THEN, AS IT GETS
WORSE, PARTLY BE TORN,
AND THEN
COMPLETELY TORN.

Maureen says AND IT WILL HEAL?

David says IF THEY'VE COMPLETELY
TORN, MOST LIGAMENTS
ARE UNDER SOME TENSION SO
THAT THEY CAN'T REATTACH.
IT'S ALMOST LIKE IF YOU HAD
A RUBBER BAND THAT YOU
ARE STRETCHING, AND IT
GETS CUT IN THE MIDDLE,
THOSE ENDS PULL APART,
AND THERE IS NO WAY
FOR THEM TO REJOIN.
IN MOST CASES, THOUGH,
WITH ANKLE SPRAINS,
EVEN IF YOU'VE
TORN THE TISSUE,
YOUR FUNCTION CAN
GET BACK TO NORMAL,
AS LONG AS YOU RETRAIN
OTHER STRUCTURES AND OTHER
MUSCLES AROUND YOUR
ANKLE TO WORK PROPERLY.
THERE WERE SEVERAL STUDIES,
PRIMARILY OUT OF EUROPE,
YOU KNOW, WITH SOCCER
PLAYERS WHO HAVE INJURED
THEIR ANKLES
QUITE SEVERELY,
AND OTHERS WHO HAVEN'T DONE
THE SAME STRUCTURAL DAMAGE,
BUT THE FUNCTION OF THOSE
PEOPLE IS MORE RELATED
TO WHETHER THEY RETRAIN
THE MUSCLES AND
THE BALANCE STRUCTURES
AROUND THEIR ANKLE.

Maureen says OKAY.
WE'RE TALKING ABOUT SPORTS
MEDICINE THIS AFTERNOON
WITH Dr. DAVID LOWE.
HE IS A SPORTS MEDICINE
SPECIALIST WHO WORKS OUT
OF THE UNIVERSITY OF TORONTO
SPORTS INJURY CLINIC,
AS WELL AS RYERSON
POLYTECHNIC UNIVERSITY.
IF YOU HAVE A QUESTION FOR
Dr. LOWE, GIVE US A CALL...

The caption changes to "416-848-2727. 1-888-411-1234."

Maureen continues EMAIL YOUR QUESTION TO...

The caption changes to "moretolife@tvo.org"

Maureen continues AND WE'LL GO TO
TRISHA IN LONDON.
HELLO, TRISHA.

Trisha says HELLO.

Maureen says HI.

Trisha says I HAVE A QUESTION.
I JUST RECENTLY STARTED
PLAYING RACQUETBALL
ABOUT FOUR MONTHS AGO.
AND MY CALVES JUST ACHE
ABOUT 20 MINUTES INTO
THE GAME, AND THEN
AFTERWARDS.
AND I WAS WONDERING,
I DO STRETCH BEFORE,
AND I TRY TO STRETCH AFTER.
I'M JUST WONDERING WHAT
THAT COULD BE CAUSED FROM.
MY ANKLES HURT TOO, BUT
I UNDERSTAND THAT'S FROM
JERKING BACK AND FORTH WHEN
YOU DO PLAY RACQUETBALL.

David says YEAH, CERTAINLY RACQUETBALL
AND SQUASH ARE TWO SPORTS
WHERE THERE IS A LOT OF
STRESS PUT ON THE CALF
REGION AND THE ACHILLES
REGION BECAUSE IT'S
A SMALLER SPACE, THERE'S
LOTS OF GOING BACK AND FORTH
AND SIDE TO SIDE.
AND WE FREQUENTLY SEE
INJURIES INVOLVING
THE CALF OR THE
ACHILLES TENDON AREA.
THIS IS A NEW
ACTIVITY FOR YOU.
HAVE YOU BEEN QUITE ACTIVE
WITH OTHER THINGS BEFORE THIS?

Trisha says UM, YES.
I DO JOG.
BUT I'M SPORADIC.
I JOG FOR SIX MONTHS, THEN
TAKE ABOUT SIX MONTHS OFF.
USUALLY IN THE SUMMER I JOG,
AND IN THE WINTER, I DON'T.

David says RIGHT.
SO IT SOUNDS LIKE YOU
HAVEN'T BEEN JOGGING BEFORE
THIS, AND YOU'VE STARTED
ONE THE RACQUETBALL.
I THINK, MY
SUGGESTION WOULD BE,
CERTAINLY THE STRETCHING
SOUNDS LIKE YOU'RE DOING
A GOOD JOB WITH THAT, BUT
TO START WORKING ON
A STRENGTHENING PROGRAM
WITH YOUR CALVES.
AND THAT CAN BE AS SIMPLE
AS STANDING OVER A STEP
AN DOING TOE RAISES,
DROPPING DOWN A LITTLE BIT,
AND DOING REPETITIVE
EXERCISE LIKE THAT,
TO TRY AND
STRENGTHEN THEM UP.
BECAUSE NOT ONLY DO YOU NEED
TO INCREASE THE STRENGTH,
BUT ALWAYS THE ENDURANCE
BECAUSE OF THE TYPE
OF ACTIVITY INVOLVED
IN RACQUETBALL.

Maureen says HOW IMPORTANT ARE SHOES
IN THESE KINDS OF SPORTS?
BECAUSE THEY CERTAINLY WANT
TO SELL YOU DIFFERENT
SHOES FOR
DIFFERENT SPORTS.

David says YEAH, IT'S
QUITE AMAZING.
I THINK, I GUESS,
30 YEARS AGO,
YOU HAD ONE PAIR OF
SHOES TO DO EVERYTHING.

Maureen says YOUR KEDS
RUNNING SHOES.

David says AND NOW YOU HAVE TO HAVE A
DIFFERENT PAIR OF SHOES TO
WALK TO THE STORE, AND A
DIFFERENT PAIR OF SHOES
TO DO EVERYTHING.
THERE IS APPARENTLY
SOME SCIENCE INVOLVED.
AND I THINK FOR
DIFFERENT FOOT TYPES,
THERE ARE DIFFERENT
TYPES OF FEET,
AND I THINK THAT'S THE
MOST IMPORTANT THING,
THAT YOU GET A SHOE
THAT FITS PROPERLY,
FIRST OF ALL.
THAT YOU MAYBE HAVE SOMEONE
HAVE A LOOK AT YOUR GAIT,
IF YOU'RE IN A STORE, TO
SEE WHETHER YOU'RE -
THE TWO MOST COMMON FOOT
TYPES ARE PRONATOR,
WHICH MEANS YOUR ANKLES
TURN IN A LITTLE BIT,
OR SUPINATOR, WHICH MEANS
THEY TURN OUT A BIT.
AND THERE ARE
SPECIFIC SHOES,
PARTICULARLY
FOR RUNNING.
I THINK THAT'S THE MOST
COMMON THING THAT YOU NEED
TO MAKE SURE YOU'VE GOT THE
RIGHT KIND OF SHOES FOR THAT.
FOR OTHER ACTIVITIES, I
THINK MAKING SURE YOU'VE
GOT THE RIGHT AMOUNT OF
CUSHIONING TO DO SPORTS
LIKE THAT IS
PROBABLY IMPORTANT.
YEAH, THERE'S A LOT
OF MONEY TO BE MADE
IN THE SHOE INDUSTRY.

Maureen says BUT IF THEY SAY CROSS
TRAINERS, CATCH ALL.

David says CATCH ALL.
AND IT'S PROBABLY GOOD
ENOUGH FOR MOST PEOPLE
AT THE LEVEL THEY'RE GOING
TO BE PARTICIPATING.

Maureen says I JUST LOOK
FOR THE SALE.
OKAY, ANDREA SAYS...

She turns to her computer and reads
“I HAVE A TERRIBLE PAIN
IN MY LOWER BACK
AND RIGHT LEG.
I HAD A CT SCAN DONE
AND THE RESULTS
WERE L3, L4, FINE.
L5, S1, MINIMAL
DEGENERATION AND DISC BULGE.
THIS IS WHAT I'M TOLD
CAUSES THE SCIATICA.
WHAT CAN PHYSIOTHERAPY
DO FOR ME,
AS SURGERY IS NOT AN
OPTION, AT THIS TIME,
AND WHAT TYPES OF
PROCEDURES WILL I ENCOUNTER?”

David says SCIATICA, I GUESS WHAT
YOU'RE DESCRIBING,
IS A PRETTY COMMON
INJURY WE SEE,
TYPICALLY KIND OF BETWEEN
20 AND 45-YEAR-OLD PEOPLE
IS THE MOST COMMON.
THE CT SCAN, CERTAINLY
SHOWS THAT YOU HAVE
A PROBLEM BETWEEN THE
LOWER TWO VERTEBRAE IN
YOUR LUMBAR SPINE, AND IS
PUTTING PRESSURE ON
A NERVE THAT
CAUSES THIS PAIN.
WHAT PHYSIOTHERAPY TRIES
TO DO, FIRST OF ALL,
IS TRY TO ALLEVIATE SOME
OF THE MUSCLE TENSION
AROUND THE AREA.
BECAUSE ONCE YOU GET
PRESSURE IN AN AREA,
OR PAIN AND DISCOMFORT, THE
MUSCLES TRY TO PROTECT
THAT AREA, AND THEY
GO INTO SPASM.
AND EVENTUALLY, THAT STARTS
TO BECOME PART OF THE PROBLEM,
IS THOSE MUSCLES
ARE WORKING TOO HARD,
AND WORKING TOO FREQUENTLY,
AND THAT RESULTS IN SOME PAIN.
THE OTHER THINGS THEY WILL
TRY TO DO IS BY DOING CERTAIN
MOVEMENTS, TRY AND
RELIEVE THE PRESSURE,
AND ACTUALLY TRY AND HELP
THE DISC GO BACK INTO PLACE.
THAT SOUNDS A LITTLE
WISHY WASHY, AND SOUNDS,
HOW IS THAT
GOING TO HAPPEN?
BUT A LOT OF RESEARCH HAS
SHOWN THAT A PARTICULAR
EXERCISE CALLED AN
EXTENSION PROGRAM,
WHERE YOU'RE ACTUALLY
BENDING YOUR BACK BACK,
MAY HELP TO REDUCE
THE IRRITATION,
AND TO GET THOSE
THINGS BACK.
THE OTHER THING
THEY MAY USE,
CERTAIN MODALITIES
TO HELP REDUCE PAIN.
THINGS LIKE
ELECTRIC CURRENT,
ULTRASOUND THAT WE'VE
TALKED ABOUT BEFORE,
ARE COMMONLY USED IN THESE
AREAS TO TRY AND REDUCE
THE DISCOMFORT, AND HOPEFULLY,
WITH MOST OF THESE PROBLEMS,
PEOPLE RECOVER WITHIN
FOUR TO SIX WEEKS.
IF IT'S DRAGGING ON
LONGER THAN THAT,
THAT'S WHEN THEY START
DOING THESE INVESTIGATIONS,
AND STARTING TO WONDER
WHAT THE OTHER OPTIONS
ARE AROUND TREATMENT.

Maureen says HOW IS COMPLIANCE
AMONG YOUR PATIENTS?
SOMETIMES, PEOPLE
ARE VERY ATHLETIC,
AND THEY HATE TO GIVE
UP, YOU KNOW, THAT JOG,
BUT ASK THEM TO DO BACK
STRETCHES, SIX TIMES A DAY,
AND THEY CAN'T
FIND THE TIME.

David says WELL, I WOULD SAY,
THAT'S ONE OF THE THINGS
WITH SPORTS MEDICINE,
OFTEN, COMPLIANCE IS NOT
THE PROBLEM, IT'S THE OTHER
ISSUE THAT YOU TALKED ABOUT,
IS GETTING SOMEONE
TO STOP DOING SOMETHING
THAT'S CAUSING
THEM TROUBLE,
IS MORE OF A PROBLEM.
RUNNERS ARE
PROBABLY THE WORST.
I MEAN, ANYBODY
WHO IS A RUNNER,
THEY KNOW THE HIGH THAT'S
ASSOCIATED WITH THAT.
AND THERE IS PRETTY MUCH
NOTHING ELSE IN THEIR
LIFE THAT REPLACES THAT.
AND WHEN SOMEBODY HAS AN
INJURIES THAT WE WOULD
LIKE TO HAVE THEM SLOW DOWN,
WE FIND THAT DIFFICULT.
ONE OF THE THINGS WE TRY
TO DO IS WE TRY TO NOT SAY
REST, WE TRY TO GIVE
THEM MODIFIED ACTIVITIES.
SO TELL THEM
WHAT THEY CAN DO,
RATHER THAN TELL THEM WHAT
THEY CAN'T - WE OBVIOUSLY
HAVE TO TELL THEM
WHAT THEY CAN'T DO,
BUT WE TRY TO GIVE THEM
SOME THINGS THEY CAN DO,
WHICH FOR MOST OF THE
ACTIVE PEOPLE THAT WE'RE
SEEING, THAT'S WHAT
THEY WANT TO HEAR.
THEY ALWAYS COME IN AND
SAY, I DON'T WANT TO GO TO
SOMEBODY ELSE BECAUSE THEY
ARE GOING TO TELL ME JUST
SIT AROUND AND DO NOTHING.

Maureen says I LIKE THAT SIT AROUND AND
DO NOTHING PRESCRIPTION.
I LOOK FOR THOSE DOCTORS.

[laughing]

Maureen says OKAY, SUMMER IS
IN TORONTO.
HI, SUMMER.

Summer says HI.

Maureen says HI.

Summer says HOW ARE YOU?

Maureen says GOOD, THANKS.

Summer says OKAY, I HAVE BEEN GOING
UP AND DOWN 11 FLIGHTS
OF STAIRS, LIKE A
FORM OF EXERCISE,
AND ALL OF A SUDDEN, THERE
IS THE PAIN IN MY RIGHT
KNEE
BELOW THE KNEECAP,
AND I CAN'T DO IT ANYMORE.
I'M JUST WONDERING IF THERE
IS A SOLUTION TO THIS?

David says I THINK SO.
IF THE PAIN IS
BELOW YOUR KNEECAP,
AND THE ACTIVITY
YOU DESCRIBED,
THE MOST LIKELY DIAGNOSIS IS
SOMETHING CALLED PATELLAR
TENDONITIS, WHICH IS
INFLAMMATION OF
THE TENDON BELOW
YOUR KNEECAP.
AND ONE OF THE THINGS, OR
A FEW THINGS THAT WOULD BE
HELPFUL TO YOU, THE
MOST IMPORTANT THING
IS STRETCHING.
STRETCHING THE QUADRICEPS
GROUP OF MUSCLES WHICH IS
THE GROUP OF MUSCLES IN
THE FRONT OF YOUR THIGH,
JUST ABOVE YOUR KNEE, AND
THE WAY TO STRETCH THAT IS
TRYING TO PULL YOUR FOOT
BACK TOWARDS YOUR BUTTOCKS,
OKAY, AND DOING THAT, AND
MAKING SURE THE FLEXIBILITY
THERE IS WORKING
PROPERLY IS PROBABLY
THE BIGGEST THING
YOU CAN DO.
SECONDARILY, ICING THE
AREA IS QUITE HELPFUL
IN REDUCING THE
INFLAMMATION IN THE TENDON.
AND TAKING A MEDICATION
LIKE IBUPROFEN,
WHICH IS THE ACTIVE
INGREDIENT IN ADVIL
OR MOTRIN WILL HELP
REDUCE THE IRRITATION
AND THE DISCOMFORT.
IF DOING THOSE THINGS ON
YOUR OWN IS NOT HELPING,
I THINK YOU NEED TO EITHER
SPEAK TO YOUR PHYSICIAN TO
SEE WHETHER THERE ARE SOME
OTHER OPTIONS FOR YOU.

Maureen says OKAY, ICE BETTER
THAN HEAT?

David says IN THIS KIND
OF PROBLEM, YES.
BECAUSE THERE IS
INFLAMMATION THERE,
IF WE BRING MORE BLOOD
BY SUPPLYING HEAT,
THEN IT'S GOING TO MAKE
THE INFLAMMATION WORSE.

Maureen says OKAY.
IS THERE ANY PLACE FOR
HEAT IN SPORTS MEDICINE?

David says YEAH.
TYPICALLY, GENERALLY,
WITHIN THE FIRST 48 HOURS
WE PRETTY MUCH
ALWAYS SUGGEST ICE.
WHEN THERE IS STIFFNESS
ASSOCIATED WITH PROBLEMS,
AND IT'S PAST
THAT 48-HOUR TIME,
THAT'S WHEN HEAT BECOMES
MUCH MORE APPROPRIATE.

Maureen says OKAY.
ALL RIGHT.
BEST OF LUCK, SUMMER.
THANK YOU.
GAIL IS IN MARKHAM.
HELLO, GAIL.

Gail says HI.

Maureen says HI.

Gail says HI, I HAVE A QUESTION.
I'M A VOLLEYBALL PLAYER,
AND I GOT MY INDEX FINGER
KNUCKLE, ON THE INSIDE.
IT'S STICKING
OUT A LITTLE BIT.
IT'S SORE IF I HIT IT ON
SOMETHING, OBVIOUSLY.
I ICED IT.
I'M TERRIFIED TO GO GET IT
LOOKED AT BECAUSE A FRIEND
OF MINE HAD TO HAVE
A STEEL CONTRAPTION,
WITH A BIG CIRCLE, AND WAS
UNABLE TO DO ANYTHING.
IS THERE ANYTHING
YOU COULD ADVISE?

David says HOW LONG AGO
DID IT HAPPEN?

Gail says ABOUT SIX WEEKS AGO.

David says OKAY.
FINGER INJURIES ARE QUITE
COMMON FOR LASTING A LONG TIME.
THE SWELLING,
PARTICULARLY.
IT'S A VERY SMALL JOINT,
PRETTY EASY TO INJURE,
AND VOLLEYBALL IS ONE OF
THOSE SPORTS THAT SOMETIMES
YOU DON'T HAVE CONTROL
WHERE THE BALL IS COMING.
IT COMES IN AT
PRETTY HIGH VELOCITY,
AND YOU CAN HAVE SOME ODD
MOVEMENTS HAPPEN TO YOUR
FINGER, AND IRRITATE
SOME OF THE LIGAMENTS
AROUND YOUR FINGER.
ONE OF THE THINGS THAT MIGHT
BE HELPFUL TO YOU IS TAPING
THE FINGERS TOGETHER IF
YOU'RE GOING TO BE
PLAYING VOLLEYBALL.
THAT RELIEVES
ANY ADDED STRESS,
AND IT PROVIDES STABILITY
TO THAT JOINT THAT'S IRRITATED.
THE OTHER THING THAT YOU MAY
WANT TO TRY IS SOMETHING
CALLED CONTRAST BATHS.
WE'VE JUST BEEN TALKING
ABOUT HEAT AND COLD,
AND THIS IS ONE TIME WHEN
WE USE BOTH OF THEM.
WHERE YOU START OFF
BY HAVING, I GUESS,
FOR A FINGER, YOU COULD
USE A CUP OF WARM WATER.
PUT THE FINGER IN IT, AND
LEAVE IT IN THERE FOR FIVE
TO SEVEN MINUTES, AND
THEN HAVE ANOTHER CUP
WITH COLD WATER.
AND TRANSFER
THE FINGER OVER,
AND LEAVE IT IN THERE
FOR FIVE MINUTES,
AND THEN GO BACK TO
RE-WARM THE WATER,
AND PUT IT IN FOR
THREE MINUTES,
AND BACK TO THE
COLD WATER.
IN THE WARM WATER,
YOU MAY ALSO WANT TO
DO SOME EXERCISES.
MOVING THE FINGER, TRYING
TO WORK ON THE MOBILITY
AND THE STRENGTH.
AND THAT FREQUENTLY HELPS TO
REDUCE THAT SWELLING
THAT YOU'RE FEELING.
OTHER THINGS LIKE USING
THINGS LIKE SILLY PUTTY
OR PLASTICINE TO HELP
STRENGTHEN THE JOINT,
MAY BE HELPFUL TO YOU.

Maureen says SO HOW OFTEN DO YOU DO THAT
LITTLE FINGER SWITCHY THING?

David says ONCE A DAY IF YOU
HAVE TIME FOR IT.

Maureen says ONCE A DAY.
OKAY, GOOD LUCK.
THANK YOU, GAIL.
AN EMAIL HERE FROM
JOHN IN OWEN SOUND.

She reads from the computer
“I RUN ABOUT 20
KILOMETRES A WEEK.
ABOUT TWO YEARS AGO, I
DEVELOPED A GREAT DEAL
OF PAIN IN MY HEELS.
I SAW MY CHIROPRACTOR,
PHYSIOTHERAPIST, AND DOCTOR.
THEY PRESCRIBED
ANTI-INFLAMMATORIES,
STRETCHING AND EXERCISE.
NONE OF THOSE
THERAPIES WORKED.
NO ONE SEEMED TO BE ABLE
TO FIX THE PROBLEM UNTIL
I SAW A CHIROPODIST.
THEY PRESCRIBED A PAIR OF
CUSTOM MADE ORTHOTICS.
I WAS GOING TO
RECOMMEND ORTHOTICS.
I WAS VIRTUALLY PAIN FREE
AFTER ABOUT A MONTH OR SO.
IS THIS A COMMON EXPERIENCE
WITH FOOT PROBLEMS?”

David says YES.
WE WERE BOTH SITTING HERE
THINKING WE WERE GOING
TO HAVE THE EASY ANSWER FOR
YOU, BUT HE GOT IT ALREADY.
YES, IT'S A COMMON PROBLEM
WITH FOOT, KNEE PROBLEMS,
THE BIOMECHANICS
OF YOUR FOOT,
THE CONDITION THAT YOU'RE
DESCRIBING IS QUITE
A COMMON ONE WITH RUNNERS
AND ACTIVE PEOPLE.
IT'S CALLED
PLANTAR FASCIITIS.
AND IT'S AN IRRITATION
OF WHERE THE SUPPORTING
STRUCTURES UNDER YOUR
FEET ATTACH TO YOUR HEEL.
AND CERTAINLY, AS WE
DISCUSSED EARLIER,
WHEN WE WERE TALKING ABOUT
FOOTWEAR, SOMETIMES,
CERTAIN PEOPLE HAVE A
BIOMECHANICAL FEATURE
THAT JUST GETTING PROPER
FOOTWEAR WILL SOLVE IT,
BUT FOR OTHER PEOPLE,
YOU NEED TO HAVE
CUSTOM MADE ORTHOTICS.
AND IT SOUNDS
LIKE, OBVIOUSLY,
THAT WAS THE
ANSWER FOR YOU.
AND FOR A LOT
OF PEOPLE IT IS.

Maureen says FOR SOME PEOPLE, IT'S WORSE
FIRST THING IN THE MORNING.

David says THAT'S VERY TYPICAL
WITH PLANTAR FASCIITIS,
IS THAT FIRST THING
IN THE MORNING,
THOSE FIRST FEW STEPS
TO GO TO THE BATHROOM,
ARE THE WORST
STEPS OF THE DAY.
THEN IT GETS A
LITTLE BIT BETTER,
AND THEN DEPENDING ON
YOUR ACTIVITY LEVEL,
IT MAY THEN AGAIN
GET WORSE ONCE MORE.

Maureen says WELL, VERY GOOD.
I'M GLAD IT'S BETTER.
THANKS, JOHN.
KIM IS IN THORNHILL.
HI, KIM.

Kim says HI.
THE REASON I'M CALLING IS I
HAVE COMPARTMENT SYNDROME,
WHICH I DEVELOPED.
I GOT A SPRAIN IN MY LEG,
AND I HAD A TENSOR BANDAGE
ON TOO TIGHT FOR 16 HOURS,
AND I DEVELOPED
COMPARTMENT SYNDROME.
AND I JUST WONDERED, IT'S
THE SECOND YEAR NOW.
I WAS IN THE HOSPITAL THREE
MONTHS BECAUSE OF IT,
AND I JUST WONDER IF YOU
HAVE ANY SUGGESTIONS
FOR ME BECAUSE IT'S
ALWAYS VERY STIFF.
IT'S IN THE
ANKLE IN MY FOOT.

David says OKAY.
SO THEY SAID
COMPARTMENT SYNDROME,
NOT REFLEX SYMPATHETIC
DYSTROPHY?

Kim says NO.
AND I HAD A FASCIOTOMY.
I HAD AN EMERGENCY
FASCIOTOMY DONE.

Maureen says OKAY, WAIT A MINUTE.
THIS WOMAN PUTS A TENSOR
BANDAGE ON HER KNEE AND ENDS
UP IN THE HOSPITAL FOR,
DID SHE SAY, THREE WEEKS,
OR THREE MONTHS.
KIM, HOW LONG?

Kim says THREE MONTHS.

Maureen says HOLY COW.
WHAT HAPPENED?

David says BASICALLY, THE ISSUE
IS WHEN SHE SUFFERED
THE ORIGINAL INJURY, THERE WAS
STILL SWELLING HAPPENING,
AND SOMETIMES, IF YOU PUT
ON A COMPRESSIVE BANDAGE
AND LEAVE IT ON OVERNIGHT,
THE SWELLING IS HAPPENING
WITH NOWHERE
FOR IT TO GO.
INSIDE YOUR LOWER LEG,
THERE ARE FOUR OF FIVE
COMPARTMENTS, BASICALLY
THAT ENCLOSE MUSCLES,
BLOOD VESSELS
AND NERVES.
AND THERE IS ONLY A CERTAIN
AMOUNT OF ACCESSIBILITY
WITHIN THAT TISSUE.
SO IF SWELLING
HAPPENS WITHIN THERE,
AND THERE IS NO
PLACE FOR IT TO GO,
IT STARTS TO CAUSE DAMAGE
TO THE NERVE SUPPLY,
AND THE BLOOD SUPPLY TO THE
LOWER PART OF THE FOOT.
AND IT'S QUITE A PAINFUL,
AND UNCOMFORTABLE CONDITION.
VERY RARELY DO WE SEE
PEOPLE GO TO THE EXTENT
WHERE THEY NEED TO
HAVE THIS FASCIOTOMY,
WHICH IS BASICALLY A SURGERY
TO OPEN UP THAT TISSUE
SO THERE IS ROOM FOR THINGS
TO SPREAD OUT A LITTLE BIT.
FREQUENTLY, WITH
PEOPLE THAT WE SEE,
IT HAPPENS COMMONLY
IN RUNNERS,
THEY WILL RUN FOR
A LITTLE WHILE,
THEY'LL START
TO FEEL PAIN.
THEY'LL START TO FEEL
THAT THEIR LEG IS HEAVY.
THEY MAY EVEN GET SOMETHING
CALLED A DROP FOOT,
WHERE THEY CAN'T LIFT
UP THEIR FOOT ANYMORE,
AND THEY GET
NUMBNESS AND TINGLING.
AND IN THOSE CASES, OFTEN,
LOOKING AT THE BIOMECHANICAL
FACTOR, STRETCHING, THOSE
THINGS, ARE USUALLY HELPFUL.
THIS IS A MUCH MORE
SIGNIFICANT CASE.
AND, YOU KNOW, I THINK IT'S
A LITTLE TOUGHER FOR ME
TO COMMENT ON THE
SPECIFICS OF THIS.
BUT I WOULD SUGGEST LOOKING
AT THE BIOMECHANICS
OF YOUR FOOT
WOULD BE HELPFUL.
I DON'T KNOW WHETHER YOU'VE
HAD ANY PHYSIOTHERAPY
TO DEAL WITH THIS
YET, BUT PROBABLY,
AS OUR LAST CALLER POINTED
OUT THAT MAYBE ORTHOTICS
MIGHT BE AN ANSWER
IN THIS CASE.

Maureen says OKAY, HOPE SO.
THANK YOU, KIM.
TRACY IS IN OTTAWA.
HI, TRACY.

Tracy says HI.
I'VE GOT TWO QUESTIONS.
I HAVE TWO KIDS.
ONE'S IS 12-YEAR-OLD,
AND ONE'S A 10-YEAR-OLD.
AND THE 12-YEAR-OLD,
SHE FIGURE SKATES,
AND SHE PLAYS SOCCER,
AND SHE'S NOT EXTREMELY
ACTIVE ABOUT IT.
BUT SHE ALMOST CRAWLS
OFF THE FIELD WHEN SHE
IS DONE BECAUSE HER
KNEES ARE SO BAD.
NOW, LAST YEAR, WE GOT
HER INTO PHYSIO TO
STRENGTHEN UP THE
KNEE ISSUE.
SHE STILL HAS A
LITTLE BIT OF PROBLEM,
AND WHAT WE DID IS WE
DIDN'T SIGN HER UP FOR
SOCCER THIS YEAR BECAUSE
WE WERE WORRIED ABOUT
THE EXTENT OF THE RUNNING.
AND THE 10-YEAR-OLD, HE
WAS AN ACTIVE LITTLE GUY,
BUT THE PROBLEM IS, HE
ALWAYS PLAYS DEFENCE
BECAUSE HE DOESN'T LIKE TO
RUN BECAUSE WHEN HE GETS OFF,
YOU HAVE TO MASSAGE
THIS KID'S FEET AND CALVES
BECAUSE THEY HURT SO BADLY.
SO HE'LL RUN IF THE
BALL IS COMING FOR HIM,
AND HE'S OUT THERE AND
HE'LL DO HIS THING,
BUT AS SOON AS IT'S
OUT OF HIS AREA,
HE STOPS DEAD AND
HE STANDS AND WAITS.
WHAT WOULD YOU SUGGEST?

David says FIRST OF ALL, I JUST
HAD ANOTHER QUESTION
ABOUT THE 10-YEAR-OLD.
HOW LONG HAS HE
BEEN COMPLAINING
OF THE PROBLEM WITH
HIS HEELS AND CALVES?

Tracy says HE ALWAYS HAS.

David says OKAY.
THERE IS A CONDITION THAT
HAPPENS WITH BOYS IN THAT
AGE RANGE WHERE THERE IS A
GROWTH PLATE IN THEIR
HEEL THAT CAN GET
IRRITATED AND INFLAMED,
AND CAN BECOME
QUITE PAINFUL.
ONE OF THE DIFFICULTIES
WITH SOCCER
IS THE TYPE OF SURFACES
THEY'RE PLAYING ON.
NOT ALWAYS THE
BEST FIELDS.
AND SOCCER SHOES ARE
PROBABLY ONE OF THE LEAST
SUPPORTIVE SHOES
THAT ARE MADE.
I THINK IN THE
CASE OF YOUR SON,
THE FIRST THING I WOULD DO
IS SUGGEST HE HAVE HIS HEEL
LOOKED AT TO MAKE SURE
IT'S NOT THIS PROBLEM
WITH THE GROWTH PLATE.
SECONDARILY, FOR HIM,
REALLY A BIG ISSUE, AGAIN,
WITH STRENGTHENING AND
STRETCHING IN THE
CALF REGION WOULD BE
HELPFUL FOR HIM.
WITH YOUR DAUGHTER,
SHE'S, AGAIN,
IN A TYPICAL AGE RANGE FOR
DEVELOPING KNEE PAIN
THAT'S NOT NECESSARILY
STRUCTURALLY RELATED,
BUT RELATED TO SOME WEAKNESS
OR TIGHTNESS AROUND THE KNEE.
AND IT DOES RESULT IN
PROBLEMS WITH HOW
THE KNEECAP MOVES.
ONE OF THE THINGS, SHE'S
HAD SOME PHYSIOTHERAPY,
AND HOPEFULLY SHE REMEMBERS
THE EXERCISES SHE WAS TAUGHT,
AND SHE CAN
CONTINUE WITH THOSE.
SOME PEOPLE NEED TO GET A
BRACE THAT HELPS SUPPORT
THE KNEECAP TO KEEP IT
IN PROPER ALIGNMENT.
AND THAT MAY BE SOMETHING
THAT ALLOWS HER TO CONTINUE
COMPETING IN THINGS THAT
SHE'S INTERESTED IN DOING.

Maureen says CAN THE FIGURE SKATING BE
RELATED TO THE KNEE PROBLEM?

David says FIGURE SKATING IS LESS
COMMON IN RESULTING IN
THE TYPE OF PAIN THAT OUR
CALLER IS DESCRIBING.
CERTAINLY, FIGURE SKATING
IS USUALLY MORE COMMONLY
ASSOCIATED WITH, I GUESS,
A TRAUMATIC INJURY,
WHERE YOU LAND, AND
CAUSE TROUBLE FROM THAT.

Maureen says BACK TO SOCCER.
I'M NOT A SOCCER MUM, BUT THERE
ARE MANY OF THEM OUT THERE.
SO WHAT IN GENERAL, AS
FAR AS, I DON'T KNOW,
ARE HAMSTRING
INJURIES A PROBLEM?
YOU MENTIONED
THE CALVES.

David says IN MOST SPORTS, PROBABLY
ANKLE INJURIES WITH
THE CLEATED SHOES, AND
RUTS IN THE FIELD,
ARE PROBABLY STILL THE
MOST COMMON INJURY.
THE KNEE PAIN THAT OUR
LAST CALLER DESCRIBED
IS QUITE COMMON.
AND HAMSTRING PULLS, YOU
KNOW, PLAYING ON COLD DAYS,
PARTICULARLY, MUSCLES
GET A LITTLE TIGHTER.
AND THE OTHER PROBLEM, AS
PEOPLE GET MORE ACTIVE
IN SOCCER, ARE
GROIN INJURIES.
BECAUSE OF THE SIDE
TO SIDE MOVEMENT,
THE KICKING OF THE BALL,
GROIN INJURIES BECOME QUITE,
CAN BECOME
MORE EXTENSIVE,
AND MORE DIFFICULT
IN SOCCER.

Maureen says I MEAN, THEY DON'T
SEEM WELL PROTECTED;
THERE'S NO protection
EQUIPMENT LIKE IN HOCKEY.
BUT IS IT'S A
FAIRLY SAFE SPORT?

David says ACTUALLY, GOING BACK TO
WHEN WE WERE TALKING ABOUT
CONCUSSIONS, THERE IS A LOT
OF TALK ABOUT THE ISSUES
WITH SOCCER, AND CERTAINLY,
IT WAS WORSE BEFORE
WHEN THEY USED TO USE
LEATHER BALLS,
AND YOU'D PLAY IN THE RAIN,
AND THAT BALL WOULD END UP
WEIGHING, I DON'T
KNOW HOW MANY POUNDS,
AND HIT SOMEBODY
IN THE HEAD.
AND THERE IS RESEARCH
IN EUROPE TALKING ABOUT
EX-SOCCER PLAYERS ALMOST
BEING LIKE BOXERS BECAUSE
OF THE NUMBER OF TIMES
THEY'VE HIT THEIR HEAD ON
THE BALL, OR GOING UP TO
HIT THEIR HEAD ON A BALL
AND HITTING ANOTHER
PLAYER'S HEAD.
PROBABLY THE MOST
SIGNIFICANT CONCUSSION
I SAW THIS YEAR WAS
WITH A SOCCER PLAYER.

Maureen says OKAY.
ALL RIGHT, THANKS VERY MUCH,
TRACY, FOR THE QUESTION.
MAYA SAYS...

She reads from her computer
“MY HUSBAND WAS
INJURED IN A CAR ACCIDENT
AND SUSTAINED A TORN
MENISCUS AND PARTIALLY
TORN LIGAMENT
IN HIS KNEE.
THE ORTHOPEDIC SURGEON HAS
SUGGESTED AN ARTHROSCOPY,
IN WHICH THE TORN
PORTION OF THE MENISCUS
IS APPARENTLY REMOVED.
ISN'T THE RESULT OF THIS
THAT BONE WILL RUB AGAINST
BONE, AND THERE WILL STILL BE
PAIN IN THE KNEE AFTERWARDS?”

David says THAT'S A GOOD QUESTION.
AGAIN, HARD FOR ME TO
TALK ABOUT THE SPECIFICS
OF YOUR HUSBAND'S CASE, BUT
DEPENDING ON THE AMOUNT
OF MENISCUS TISSUE THAT'S
REMOVED WILL HAVE
IMPLICATIONS ON HOW MUCH
BONE WILL ACTUALLY
BE RUBBING ON BONE.
THE MENISCUS, FOR THOSE OUT
THERE WHO DON'T KNOW WHAT IT IS,
I GUESS WHEN YOU
HEAR ABOUT AN ATHLETE
TEARING THEIR CARTILAGE,
THEY'RE TALKING
ABOUT THIS STRUCTURE.
IT'S KIND OF A RUBBERY
TISSUE THAT SITS BETWEEN
THE TWO MAJOR
BONES OF YOUR KNEE,
AND THEY'RE KIND OF
C-SHAPED STRUCTURES.
AND WHEN THEY'RE TORN, THEY
CAUSE IRRITATION BECAUSE
THEY KIND OF CAUSE
A MECHANICAL BLOCK.
SO THE TORN TISSUE, THEN,
CAN START RUBBING ON THE
SURFACE CARTILAGE, WHICH IN
ITSELF CAN CAUSE PROBLEMS
DOWN THE ROAD.
TYPICALLY, WHEN
WE SEE PEOPLE,
AND WE MAKE THAT DIAGNOSIS,
WE LIKE TO GIVE THEM A
CHANCE TO SEE WHETHER IT'S
GOING TO HEAL ON ITS OWN.
LIKE MOST THINGS, WE
LIKE TO ALLOW PEOPLE
TO SURVIVE WITHOUT
NEEDING SURGERY.
HOWEVER, IF IN YOUR
HUSBAND'S CASE,
THAT THE MENISCUS IS NOT
SETTLING DOWN, IN MOST CASES,
THE SURGERY WILL ACTUALLY
REMOVE THE DISCOMFORT
THAT HE FEELS NOW.
THERE IS SOME RISK
DOWN THE ROAD, THOUGH,
THAT HE MAY DEVELOP
OSTEOARTHRITIS AS A RESULT
OF HAVING THE
CARTILAGE REMOVED.
BUT IF HE DOESN'T
HAVE IT REMOVED,
HE'S UNLIKELY TO GET BACK
TO DOING THE KIND OF THINGS
THAT HE'S USED TO DOING,
AND JUST EVERYDAY LIFE
MIGHT CONTINUE
TO BE PAINFUL.
SO REALLY, IN THE LONG
RUN, HAVING IT REMOVED,
IF NECESSARY, IS PROBABLY
YOUR BETTER CHOICE THAN
DEALING WITH
CONTINUED DISCOMFORT,
WHICH IN ITSELF MAY BE
CAUSING PROBLEMS
THAT COULD LEAD TO
ARTHRITIS.

Maureen says OKAY, THANKS, MAYA.
PAUL IS IN THE SIOUX.
HI, PAUL.

Paul says HI.

Maureen says HI.

Paul says Dr. LOWE, I PROSPECT, AND
WHEN I DO, I GO IN THE BUSH,
AND I WALK FOR
TEN HOURS A DAY.
EVERYTHING IS OKAY.
WHEN I GET BACK HOME, I GET
CHARLIE HORSES SO BAD THEY
ALMOST FEEL LIKE THEY'RE
GOING TO BREAK THE BONES.

David says HOW OFTEN ARE
YOU DOING THAT?

Paul says I DO IT QUITE A BIT
IN THE SUMMERTIME.

David says AND DOES IT SEEM TO
BE MORE OF A PROBLEM
AT THE START
OF THE SUMMER?

Paul says IT IS, WHEN I
FIRST START, YEAH.

David says YEAH, AND THAT'S A
COMMON THING THAT WE SEE
WITH ANYBODY WHO DOES ANY
KIND OF ACTIVITY.
SO I GUESS WHAT YOU DO,
ALTHOUGH IT WOULDN'T
BE CALLED A SPORT,
NECESSARILY,
IS PROBABLY MORE THAN MOST
PEOPLE WHO ARE PLAYING
IN A SPORT
WOULD DEAL WITH.
THE PROBLEM THAT WE SEE THAT
PEOPLE WHO HAVE NOT DONE
A PARTICULAR ACTIVITY
FOR A LONG TIME,
GO BACK TO DOING IT.
AND IT'S NOT LIKE YOU CAN
BUILD UP TO WALKING TEN HOURS
A DAY IF THAT'S WHAT
YOU HAVE TO DO FOR YOUR JOB,
SO WHAT YOU'RE
DEVELOPING IS SOMETHING
CALLED DELAYED ONSET
MUSCLE SORENESS.
SO WHAT HAPPENS IS
WHILE YOU'RE DOING IT,
YOU FEEL FINE.
BUT WHEN YOU FINISH, THE
MUSCLES HAVE BEEN THROUGH
SUCH A STRAIN THAT
THEY'RE NOT USED TO,
THAT THEY START PRODUCING
THINGS LIKE MORE LACTIC ACID,
AND IT BECOMES
QUITE UNCOMFORTABLE,
AND IT LASTS FOR A WHILE.
AND I GUESS THE DIFFICULTY
FOR YOU IS YOU DON'T HAVE
TIME TO NOT GO OUT AND DO
YOUR PROSPECTING THE NEXT DAY.
SO MY SUGGESTION WOULD BE
THAT YOU REALLY NEED TO,
IN I GUESS WHAT WE WOULD
CALL YOUR OFF-SEASON,
START DOING SOME EXERCISE,
START WORKING ON WALKING,
START WORKING ON
STRENGTHENING THE MUSCLES,
SO THAT WHEN YOU GO BACK,
THERE'S LESS OF A CHANCE
OF THIS HAPPENING.

Maureen says WHAT DO YOU LIKE AS FAR AS
HOME EXERCISE EQUIPMENT,
IF HE'S GOING TO
GO THAT ROUTE?

David says I THINK THE MOST IMPORTANT
PART OF ANY HOME
EXERCISE PROGRAM IS
THE AEROBICS STUFF.
SO EITHER A STATIONARY
BICYCLE OR TREADMILL
WOULD PROBABLY BE
THE BEST THING.
AND I THINK FOR MOST PEOPLE,
YOU'RE GOING TO BE ABLE TO
GET BY WITH HAVING A FEW
KIND OF LOOSE FREE WEIGHTS,
DUMBBELLS OR A BARBELL,
I THINK WOULD BE
SUFFICIENT
FOR MOST PEOPLE.
OBVIOUSLY, AS YOU
GET MORE INTO IT,
YOU'RE GOING TO WANT TO
INVEST A LITTLE MORE,
BUT A LOT OF HOME EXERCISE
EQUIPMENT BECOMES
A PLACE TO HANG
LAUNDRY ON.
I HAVE QUITE A BIT OF
EXPERIENCE WITH THAT.

Maureen says ME, TOO.
GOOD FOR WET TOWELS.
GOOD LUCK, PAUL.
THANK YOU.
FROM CLIFF.

She reads from her computer
“I'M ALMOST CERTAIN I HAVE
THE CONDITION JUMPER'S KNEE.
I PLAY A LOT OF BASKETBALL,
AND AFTER A GAME,
MY JOINTS ARE PRETTY
MUCH A WRITE-OFF.
THE DAY AFTER, I'M UNABLE
TO STRAIGHTEN MY KNEE
WITHOUT PAIN OR COMFORT.
WHAT CAN I DO?
WILL TAKING
GLUCOSAMINE HELP ME?
IF SO HOW LONG DOES
IT TAKE TO WORK?
AND WHAT'S THE MEDICAL
TERM FOR THIS CONDITION?”

David says WELL, JUMPER'S KNEE
IS PRETTY MUCH ONE WE -
WE DO USE THAT ONE.
IT'S PATELLAR TENDONITIS,
THAT WE TALKED ABOUT
WITH ONE OF OUR
PREVIOUS CALLERS.
THE WAY YOU
DESCRIBE IT, THOUGH,
IS NOT TYPICAL FOR
WHAT PEOPLE PRESENT
WITH THAT PROBLEM.
YOUR PROBLEM SOUNDS MORE
LIKE A JOINT RELATED
PROBLEM THAN A TENDON
RELATED PROBLEM.
WE DON'T USUALLY SEE
RESTRICTIONS IN THE RANGE
OF MOTION WHEN SOMEBODY
HAS A PROBLEM
WITH ONE OF THE TENDONS.
SO I WOULD BE MORE
INTERESTED IN FINDING OUT
WHETHER YOU HAD A PROBLEM
WITH EITHER A MENISCUS
CARTILAGE, OR WHETHER IT'S
MORE OF AN ARTHRITIC
TYPE CHANGE THAN
THE TENDON PROBLEM.
THE TENDON PROBLEM IS
USUALLY QUITE SPECIFIC
IN THAT YOU'LL FEEL THE
DISCOMFORT IN FRONT
OF THE KNEE, BELOW
THE KNEECAP.
AND IF YOU'RE NOT
HAVING THOSE SPECIFICS,
THEN I THINK YOU MAY BE
MAKING A MISDIAGNOSIS.

Maureen says HOW DO THEY DETERMINE
IF IT'S ARTHRITIS?

David says ARTHRITIS TENDS TO
SHOW UP ON PLAIN X-RAYS.
SO WE SEE SPECIFIC PATTERNS
OF CHANGES IN X-RAY FILMS
THAT INDICATE AN
OSTEOARTHRITIC
PROCESS IS GOING ON.
SO THAT'S THE ONLY
THING, REALLY.
X-RAYS ARE GOOD AT
SHOWING US BONE.
SO THEY SHOW US WHETHER
YOU'VE GOT A BROKEN BONE,
OR YOU'VE GOT ARTHRITIS.
UNFORTUNATELY, CAN'T TELL
US MUCH ABOUT THINGS
LIKE LIGAMENTS,
MUSCLES, AND CARTILAGE.

Maureen says CLIFF, WE ARE GOING TO HAVE
THE ARTHRITIS EXPERT ON
IN A COUPLE OF WEEKS, SO WE'LL
DEFINITELY BE TALKING
ABOUT GLUCOSAMINE.
BUT I HAVE A FEELING
YOU'D WANT HIM TO GET
THE DIAGNOSIS BEFORE HE
STARTS TAKING IT.

David says CERTAINLY, WITH
GLUCOSAMINE,
IF IT'S AN ARTHRITIC
PROBLEM, GLUCOSAMINE,
RECENT STUDIES HAVE
SHOWN THAT PROBABLY
IT'S EFFECTIVE, ALTHOUGH THERE
HASN'T BEEN A GOOD QUALITY
STUDY FINISHED THAT
RANDOMIZES PEOPLE
TO EITHER GLUCOSAMINE
OR NOT GLUCOSAMINE,
AND WHETHER THEY
DO IMPROVE.

Maureen says OKAY, ALL RIGHT.
GOOD LUCK, CLIFF.
DAMIAN IS IN MARKHAM.
HI, DAMIAN.

Damian says HI, HOW ARE YOU?

Maureen says GOOD, THANKS.

Damian says THAT'S GOOD.
I'VE JUST BEEN PLAYING
VARSITY BASKETBALL.
I HAD TO STOP BECAUSE I WAS
DIAGNOSED WITH TENDONITIS,
THEN IT PROGRESSED TO
CHRONIC TENDONITIS.
THEY DIAGNOSED IT AS
AN OVERUSE INJURY.
I JUST WANT TO KNOW THE
SEVERITY OF TENDONITIS,
AND ALONG WITH THAT,
THERE'S A CLICKING OF
THE POPLITEAL LIGAMENT
BEHIND THE KNEE.
I JUST WANTED TO KNOW IF
THAT WAS RELATED TO EITHER
THE TENDON PROBLEM,
OR A JOINT PROBLEM.

David says OKAY.
WHICH TENDON ARE
WE TALKING ABOUT?

Damian says THIS IS THE KNEE TENDON.

David says OKAY, THE PATELLAR TENDON.
SO WE'VE GOT A FEW PEOPLE
WHO ARE DEALING WITH
THE SAME PROBLEM,
AND OBVIOUSLY,
PLAYING BASKETBALL, IT'S
A PRETTY COMMON INJURY.
WHEN THEY START TALKING
ABOUT CHRONIC TENDONITIS
PROBLEMS, YOU START GETTING
SOME MORE STRUCTURAL
CHANGES WITHIN THE
SUBSTANCE OF THE TENDON,
AND IT BECOMES MORE
DIFFICULT TO RESOLVE IT.
USUALLY, WITH THAT, THEY'RE
GOING TO PROBABLY WANT YOU
HAVING MUCH MORE REST
AND REMOVING YOURSELF
FROM THE ACTIVITY WHICH
IS THE OFFENDING THING.
SO IT SOUNDS LIKE THEY
DID THAT WITH YOU.
VERY RARELY, THEY MAY
SUGGEST SURGERY TO TRY
AND CLEAN UP SOME OF THIS
TISSUE THAT'S DAMAGED IN THERE.
SO IT SOUNDS LIKE YOU HAVE
A RELATIVELY SEVERE END
OF THIS PROBLEM.
MOST PEOPLE WILL START WITH
JUST A LITTLE DISCOMFORT.
BUT IT SOUNDS LIKE IN YOUR
CASE IT'S GOTTEN TO MORE
EXTREME WHERE YOU'VE HAD TO
ACTUALLY STOP THE ACTIVITY.
HOPEFULLY, WITH THAT REST,
YOU WON'T REQUIRE SURGERY,
BUT IN SOME CASES,
THAT IS NECESSARY.
THE POPLITEAL TENDON ISSUE
IS A SEPARATE ISSUE.
PROBABLY, UNRELATED
TO THE TENDON,
ALTHOUGH IF THERE ARE SOME
OTHER PROBLEMS GOING ON
IN YOUR KNEE, IT COULD BE
AN UNDERLYING REASON
FOR BOTH THINGS
HAPPENING.
DOCTORS, AGAIN,
LIKE TO BE SIMPLE,
AND LIKE TO FIND ONE
PROBLEM THAT ANSWERS
EVERYTHING, BUT I
THINK IN THIS CASE,
THEY PROBABLY ARE
TWO SEPARATE ISSUES.

Maureen says DID HE SAY IT
WAS CLICKING?

David says YEAH.
IT'S MORE OF A
SNAPPING.
A LOT OF PEOPLE COME IN
TALKING ABOUT NOISES
THAT THEY HEAR.
IF THEY'RE NOT CAUSING PAIN,
WE DON'T TEND TO GET
TOO EXCITED ABOUT THEM.
WE LIKE TO HEAR THEM, BUT
WE DON'T NECESSARILY
HAVE TO DO MUCH ABOUT THEM.

Maureen says IS THAT RIGHT?
OKAY, NEAT.
THANKS, DAMIAN.
SUSAN IN IS MUSKOKA.
HI, SUSAN.

Susan says HELLO.

Maureen says HI.
GO AHEAD.

Susan says MY QUESTION IS, I HAVE
A 14-YEAR-OLD DAUGHTER
WHO IS IN TRACK AND
FIELD TRAINING.
AND ONE OF THE EXERCISES
THAT THEY'RE DOING
IS STAIR HOPPING.
AND WE'VE JUST HAD
SOME CONCERNS ABOUT
THE INTENSITY OF
THIS EXERCISE.
WHAT THEY'RE DOING
IS ON ONE FOOT,
HOPPING UP 10 TO 12 STAIRS
THAT ARE ABOUT SIX INCHES
IN HEIGHT, CHANGING FOOT,
AND THEN DOING ANOTHER
10 TO 12 ON THE OTHER FOOT,
AND THEN THEY RUN DOWN.
AND THAT WHOLE THING IS
REPEATED THREE TIMES,
SO FOUR TIMES SEQUENCE.
AND SHE'S NOW
INJURED HER KNEE.
MY QUESTION TO
THE COACHES WAS,
IS THIS NOT TOO INTENSE
FOR YOUNG TEENAGE KIDS
WHO AREN'T FULLY
DEVELOPED?
THEY SAY IT'S AN ACCREDITED
EXERCISE THAT'S DONE
FOR TRACK AND FIELD, BUT MY
CONCERN IS SHOULD WE BE
DOING THEM AT THE SAME
INTENSITY FOR THESE YOUNG KIDS?

Maureen says WHAT DO YOU
THINK, Dr. LOWE?

David says WHAT THEY'RE DESCRIBES
IS IT SOUNDS TO MY LIKE
A PLYOMETRIC TYPE OF
TRAINING PROBLEM,
WHERE YOU'RE PUTTING A
FAIR AMOUNT OF FORCE
THROUGH THE KNEE JOINT.
IN MOST CASES, THAT IS
PROBABLY APPROPRIATE.
THE THING IS, YOU KNOW,
TRACK AND FIELD HAS
PROBABLY JUST STARTED,
I WOULD IMAGINE,
UP IN MUSKOKA,
SO THE ISSUE IS,
HOW PREPARED WERE
THE PEOPLE TO START
THAT KIND OF INTENSITY.
AND I THINK THE PROBLEM
IS LIKELY AND NEEDS TO
BE GRADUALLY BROUGHT ON, AS
OPPOSED TO STARTING OFF
AND DOING THAT INTENSITY
RIGHT FROM THE BEGINNING.
I DON'T THINK THERE'S A
PARTICULAR PROBLEM
WITH THAT TYPE OF
EXERCISE GIVEN THE AGE,
BUT I THINK IT'S PROBABLY
MORE THE INTENSITY
AND HOW QUICKLY IT
WAS BROUGHT ON.

Maureen says AND IN YOUR OPINION, WE
ONLY HAVE 30 SECONDS,
IF SHE'S GOT KNEE PAIN,
SHOULD SHE BE DOING
THAT EXERCISE?

David says CERTAINLY, ONCE
YOU'VE GOT THE PROBLEM,
YOU NEED TO CUT BACK ON
YOUR ACTIVITIES AND
HAVING IT SETTLE DOWN,
BEFORE, PARTICULARLY,
THAT TYPE OF
INTENSE PROGRAM.

Maureen says OKAY, THANK YOU
SUSAN, GOOD LUCK.
AND THANK YOU.
NICE TO HAVE YOU HERE.
LOTS OF GOOD INFORMATION.
THANKS.
Dr. DAVID LOWE IS A SPORTS
MEDICINE SPECIALIST.
YOU CAN CONTACT
Dr. LOWE AT...

A slate pops up that reads “The University of Toronto Sports Injury Clinic. 416-978-4678.

Maureen continues FOR MORE INFORMATION ON
SPORTS MEDICINE, CONTACT...

The slate changes to “Canadian Academy of Sports Medicine. 1-877-585-2394.
www.casm-acms.org

Maureen continues AND THAT'S ALL THE
TIME WE HAVE
FOR
MORE TO LIFE
TODAY.
BUT I HOPE YOU'LL
TUNE IN AGAIN ON TVO,
MONDAY THROUGH
FRIDAY AT 1:00.

A closing slate reads “The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances.”

Watch: Sports Injuries