Sports Injuries and Orthopedic Treatments with Michael Scherb, MD

Carol Gifford:

Welcome to Mason City Docs on Call, a podcast series with North Iowa specialists, who educate us about how to stay healthy. I’m your host, Carol Gifford. We often hear about sports related injuries among some of our favorite professional baseball, basketball, and football players, but in 2022, 3.6 million people were treated in emergency departments for injuries involving amateur and recreational sports. Here to help us understand what to do if we, as recreational runners, bikers, hikers, or pickleball players, think we have broken a bone or sprained a ligament, is board certified orthopedic surgeon at the Mason City Clinic, Michael Sherb. Welcome to the program, Dr. Sherb.

Michael Sherb:

Thank you for having me today.

Carol Gifford:

So tell me what percentage of your patients are coming to you with sprains or strains or breaks from recreational sports, weekend warriors?

Michael Sherb:

I’d say maybe 15% to 20%. The beauty of orthopedics, you get to see people of all ages, so it’s not just confined to younger people. There seems to be a huge interest in pickleball currently, and it seems like people who play that the most tend to trend a little bit older than what you typically think of the athletes you used to see in the office.

Carol Gifford:

Right. So amongst, let’s say, high school, college age all the way up to I guess Baby Boomers, what kind of injuries are you seeing for those people?

Michael Sherb:

I’ve mainly focus on lower extremity, but I’ve seen some people fall playing racquet sports and break their wrist. Upper extremity injuries seem to be a little bit more common in women, and lower extremity injuries seem to be a little bit more common in males.

Carol Gifford:

Right. So how do you diagnose these strains and sprains and possible breaks, and then what are some of the treatment options? You’re not going to be doing a knee replacement or a hip replacement, or are you? What’s the range of treatments for these kind of injuries?

Michael Sherb:

In some instances, if you see somebody with a wrist fracture, if it’s non-displaced, in other words, if it’s perfectly lined up, you can treat that with a cast. If it’s displaced or, in other words, not pointing in the right direction, sometimes you have to fix out the plate and screws, and that’s actually a pretty well-described injury. And pickleball players, it’s a little bit more common in women just because women are a little more prone to osteoporosis than men are. For strains and sprains, things like that, that’s very common. The lower extremity, a little bit more common in males. Frequently, usually get some X-rays, then also do a clinical exam, and in some instances an MRI is beneficial to either confirm the diagnosis, such as something like an Achilles tendon rupture or a severe sprain or what the so-called high-ankle sprain, which can take a much longer period of time to recover from than the more common low-ankle sprain.

Carol Gifford:

Right. I’ve heard about this Achilles heels injury. So tell me about that specifically. Is that hard to treat?

Michael Sherb:

It can be difficult in some instances. We actually fixed one of those this morning in a pickleball player where it happened in Florida a few weeks ago, and then they live up here, at least during the warmer months, and he was playing pickleball, he’d been playing it for several years. The classic description, which matched this person’s description quite well as he felt something hit him in the back of the heel, and then he was kind of not able to push off and was somewhat weak, and being a male, a little bit more stubborn than women frequently are, and then he didn’t really do anything for a while. Then we saw him, and then we were able to fix it. Like I say, he is early on the road to recovery, but like I say, that’s pretty common, the sensation of feeling something hit the back of your heel. Sometimes, it can be associated with certain antibiotics. Sometimes people have some pain prior to the injury, but a lot of times, people don’t really have any problems until they do, so to speak.

Carol Gifford:

So do you have any advice for people that are just like to go out for a run or a hike or ride their bike? Do you have any recommendation for preventing these injuries or these strains or breaks, or what do you tell your patients?

Michael Sherb:

To start slow even if you’re healthy, otherwise healthy and in your mid-20s. If you haven’t done sports for a while, kind of start gradually. I usually recommend people warm up for a lot of sports. Like I say, a lot of people play pickleball and badminton at our local YMCA, and I recommend people, “Hey, there’s a track there. Walk around for five or six minutes, maybe hop on the exercise bike so you get a light sweat going, do some high knee steps. Then you can do some stretching is actually a little more beneficial than trying to just stretch cold to kind of get warmed up, break a light sweat, and then kind of ease into things.”

For pickleball, the USA Pickleball Association actually has some warm up routines specifically for pickleball, and that’d probably be applicable to a lot of racket sports. And then start slow. If you haven’t done it forever or not done it for a long time, just do a brief match, give yourself a few days rest. It’s beneficial to cross-train if you’re a runner. Probably would benefit from some weight training if you’re more a weight trainer, or some cardiovascular stuff is beneficial so you’re not just doing the same thing every day. Because a lot of these injuries with pickleball or runners get a lot of it, it’s not so much an acute injury, it’s more of an overuse injury in lower extremities, like shin splints for runners, particularly runners who have flat feet. Sometimes you get what they call runner’s knee where you get a little bit of telephemeral pain. So kind of goes slow, always warm up, kind of stretch afterwards as well, because that’s when stretches are maybe a little more beneficial and improve overall flexibility.

And then everybody has a hard time swallowing their pride. Sometimes for a lot of sports, it’s beneficial to at least take a lesson or two to kind of learn some basic form, the right position for pickleball, tennis, whatever, and that can shorten the learning curve, and good technique is less likely to result in injuries than just trying it without any instruction. Whether that’s a friend or someone, a formal instructor is frequently beneficial. It can kind of keep you in the game longer in the long term, because you avoid some of the unforced errors, so to speak.

Carol Gifford:

Right. So what do you think about people that are aging? Are they more likely to sort of break a bone just because their bone density is less?

Michael Sherb:

Well, clearly everybody’s bone marrow density increases until you’re on your mid-20s, then it declines in everybody over time as part of the aging process. In women, it accelerates at the time of menopause, so that’s why fragility fractures are probably a little bit more common in women than men. And we tend to see more probably upper extremity fractures in pickleball and racquet sports in women than men, because once again, that lower bone marrow density. It doesn’t mean people shouldn’t participate, just kind of be cognizant to trying to eat a good diet, talk to your family doctor about, especially women, that can screen your bone marrow density and do some things to potentially improve that.

Carol Gifford:

So in terms of the orthopedic department, why would, I guess, amateur athletes, and maybe professional athletes, but why would amateur athletes come to your department versus going somewhere else? What do you feel like you bring to the table?

Michael Sherb:

We have several orthopedic surgeons, a podiatrist. We have six physician assistants. We have a good staff, and we kind of can cover over the gamut from lower extremity to upper extremity injuries. Because we have a lot of people to see patients, we can get people in a timely fashion. Between the collective, we’ve been here a long time. We know a lot of the athletic trainers and we know a lot of physical therapists to try and work with them and get people back in the game in a timely fashion.

Carol Gifford:

Physical therapy is a big part of rehabbing, right?

Michael Sherb:

Yeah. A lot of these, especially these overuse injuries, a lot of times, you don’t need, not everything needs surgery, of course. Some conditions obviously benefit from that, but a lot of them, therapy is a very important part, either whether they need surgery or not or after surgery and the instances where surgery is recommended.

Carol Gifford:

So what do you like the most about taking care of your patients, especially these patients that are active? They’re active, and so they’re leading an active life, but then they might get sidelined by an injury. I think people want to get back quickly, but how do you work with patients to make sure that they’re not re-injuring themselves?

Michael Sherb:

These are gratifying patients to work with, because they’re truly motivated and want to get back more quickly than some other people in other patient populations. It’s very gratifying to see them kind of get better and ultimately get back in the sport. And the main thing, you have a conversation when you first see them, “Hey, this,” depending on what the injury is, can take a kind of realistic talk, how long it takes to get back and the kind of expected timeline, and then try and prepare people for that. But like I said, the gratifying thing about these is they’re just people really motivated to get back, and then you see them at the Y or see how they’re doing or see them outside of the clinic, and then it’s very gratifying to say, “Hey, I’m doing well, and thanks for your help.”

Carol Gifford:

Yeah, that’s awesome. And are you an athlete?

Michael Sherb:

I work out some. I can’t claim to be particularly athletic.

Carol Gifford:

Oh, okay. So that’s great. And how long have you been at the clinic?

Michael Sherb:

I came here in August of 2007, actually, so I guess coming up on 17 years this summer, so it goes fast. I can’t believe I’m middle-aged, whatever. It goes quickly. Everybody thinks we’re always, I guess maybe not if you’re 18, everybody thinks if you’re over 18, “Hey, I’m 18, and you get back to doing whatever you want to do.” So the main thing is to kind of ease back into things. Slow and steady wins the race.

Carol Gifford:

Right, right. Okay. Well, thank you so much for this advice, and it sounds like we should be stretching and starting slow and getting instruction before we jump in to play pickleball or run a marathon. Right?

Michael Sherb:

Running, biking, anything, if you haven’t done it for a while or have never done it, benefit from maybe some, either a knowledgeable friend or some instruction, and then kind of go slow. Even if you’re a really good tennis player 15, 20 years ago, you’re probably not going to be able to hit the ball or move around as well as you did before, so go slow. Like I say, I always tell people life’s a marathon, not a sprint.

Carol Gifford:

Right, okay. And slow and steady wins the race, I guess

Michael Sherb:

That’s my feeling.

Carol Gifford:

All right. Thanks for being on the program, Dr. Sherb.

Michael Sherb:

Well, thank you for having me.

Carol Gifford:

Thank you for listening to Mason City Docs On Call. For more episodes, go to Mcclinic.com/radio-podcast.