WEBVTT
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Hi guys, Welcome to another episode
of The Factor podcast. I'm your host
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Jessica Riddle. If this is your
first time tuning in, welcome and thank
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you for listening. In today's episode, we wrap up our two part training
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on bone stress injuries with doctor Tyler
Kemp. In part one, we talked
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about the differences between bone stress injuries
and overuse injuries. We also covered the
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type of stress fractures and how they're
graded, and then we walk through physical
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examination, imaging, and diagnostic tools
that you can use. Today, we'll
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chat more about how to treat these
injuries with examples and case studies. We'll
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also discuss the phases of return to
sport and go over some helpful exercise progressions
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that you can use to build strength
and shorten the recovery period for your patients.
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So kick back, turn up the
volume and take some notes. Let's
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dive in. Gets kind of fun
to as a transition over here to manage
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the return. You had somebody come
in, you identified it, you confirmed
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on imaging. Now what do you
want to do? So? I'm a
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big fan of d Rose, especially
for his time in the Bulls. There
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was a really good promo that Adidas
did after he heard his ACL. It
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was called the Return, where they
were promote a He's coming back, He's
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going to return better than ever and
all that. The problem was d Rose
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has been plagued with injuries for the
remaining bit of his career. Things did
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not work out at all the way
they were hoping. And you contrast that
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with someone like Adrian Peterson, similar
injury ACL obviously different sports, who when
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he came back he came back stronger
and faster than ever, And there was
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two kinds of distinct mindsets with it. Derek Rose was just trying to get
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back in general. Adrian Peterson,
if you look at interviews, he talks
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about how his mindset became, if
I'm going to be stuck here having to
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work on my knee, I might
as well work on everything else as an
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athlete so that when I get back, I'm back way better than before.
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And I want you to adopt that
mindset with these patients and with your athletes,
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of if we're going to get them
back to running back to their activity,
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what are the other things we're going
to do while we're stuck here to
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get them to the next level.
So when we talk about the return,
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quote unquote, I want to split
it into three things, so return to
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participation, return to sport, and
return to performance. So return to participation
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meaning just them getting back to some
kind of activity, so if they're a
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runner, just them starting to run
a little bit or be able to do
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stuff on their own period without any
issues. Return to sport meaning getting them
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back to playing in some way,
shape or form. And then return to
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performance is return to game day,
return to race day, being back today
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where they were. Essentially, Now, the hard question and the question every
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patient's going to ask you is how
long is this going to take? And
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that's something you have to be able
to be really clear with your communication.
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So this table here is from Marnet
at All. It's honestly one of my
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favorites to references. So this takes
all of the information we talked about before
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and synthesizing it down to some part
numbers, so it splits it into the
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low risk low grade and the up
to high risk high grade. And if
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you look at it, you can't
you know something pretty quickly of low risk
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low grade is about nine weeks,
low risk high grades twenty two weeks.
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High risk low grade is about nineteen
weeks and then about the same for high
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risk high grade. So if you
know you have somebody coming in with a
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low grade for moral shaft injury,
you can constantly tell them, hey,
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this will take about nine weeks to
to heal properly, and that's going to
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be our kind of timeline going forward. So, being practicing in Cincinnati,
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everybody loves driving out to Hiltonhead and
the Carolina is it's a beach town.
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It takes about ten hours to get
there. So the analogy I give to
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patients is how long is the drive
to Hilton Head? And most will say
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ten eleven inch hours depending on traffic. I'm like, yeah, is that?
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Is there a way to make that
drive shorter? And yeah, we
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could probably do ten ish on the
dot, nine ish, don't stop for
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the restroom, pack a lunch,
drive a little fast, all that.
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Like can you make that six hours? Like? Well, probably not.
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And I'm like, on the flip
side, is that could that be longer?
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Could that be twelve hours? Four
pen hours? Like? Oh?
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Absolutely? So you have this loose
range and what I always tell patients is
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this is kind of our time frame. We can go above this or below
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this. My job is to keep
you as close to this timeframe as possible.
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And bone has defined healing time like
any other tissue. So biology drives
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the bus on this and we need
to be able to expand that clearly.
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So again, the low risk glow
grade is about nine weeks, lower risk
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high grade about twenty two weeks,
High risk glow grade nineteen and then the
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same for the high risk high grade. And then this helps inform the kind
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of hard conversation as well of if
you have somebody come in, say they're
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a high school runner, and end
of September, if they have a high
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risk stress fracture in a risky area, they're season's over now, then your
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mindset needs to be how can I
prepare them for the next season? How
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can I get them back better and
stronger than before. Again, here's the
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MRI classification showing the different grading scales
here. So getting into the nitty gritty
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of the return three phases, we
want to do an active rest, an
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active rest with some kind of rehab
or physical exercise, and then rehab with
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tolerance testing with the return to sports. So the active rest of finding something
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when they're in the ACUT stage,
again, assuming they don't have any reason
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to be non weight bearing or something
like that. Finding something they can do
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that at least keeps them active,
and especially for runners, to keeps them
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a little samee. So if running
is entirely out of the question, or
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if they have a high grade injury, finding alternatives swimming and biking are two
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great examples, just so that they
can keep some cardiovasque their endurance at that
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time. Phase two, once they're
at a pain free stage, being able
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to add some kind of exercise in
there. We know that runners are chronically
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undertrained on the strength and conditioning side, This is a great time to fix
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those issues. And then Phase three
is the rehab tolerance testing, starting to
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test drive different mileage and speed and
grading their symptoms and then ultimately getting them
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back to their sport. So getting
specific with the return to run a couple
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of things. One, it needs
to be boring and pain free. Boring
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and pain free and boring is exactly
what it sounds like. It's not going
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to be them doing a four minute
mile up a trail or something. They're
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gonna have to drastically reduce their page. The other thing is that it has
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to be pain free. So if
they have anything zero to ten scale.
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If they have anything above a zero, you need to regress because the bone
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is actively healing. We need to
make sure we're not irritating it. I
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had a personal situation with a patient
where I had cleared them to run way
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too soon and they ended up re
injuring it. Why well, one I
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told them they were fine to run, and they decided to run. They
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went back to their same amount of
mileage, and they actually had a recurrence
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of their stress injury. I don't
think it had healed one hundred percent.
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So we basically reversed our clock.
But you need to be if you're going
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to use the timeline, have that
framework moving forward. So using things easily
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like walking. So if they're going
to go run for thirty minutes at their
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stage, have them to go five
to ten in a walk on either end
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book at that and then it's easy
of easy way to kind of be honest
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with themselves of hey, I'm walking
down this trail, I'm starting to feel
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these simoms maybe all bail on this
run. And then you can even play
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with some programming things of alternating days, having them walk two days, run
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another, walk one day, run
another and kind of changing it as you
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add back in or increase their amount
of days that they're active running progression.
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Really great rule of thumb is the
ten percent rule, So don't add more
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than ten percent either mileage or intensity
week to week. It's a great way
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to kind of keep the lid on
things for somebody that's going to want to
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jump their mileage something dramatic from thirty
miles a week to sixty miles a week.
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And within that you can play with
three specific variables, frequency, duration,
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and intensity. So frequency the number
of times in a week or a
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set period that activities performed, duration, how long that occurred, and then
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the intensity their their pace, their
RPE if you want to play to something
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like that, So frequency getting them
from if they're normally somebody who's ten days
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a week, let's go for something
like five or six, and we can
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start them from two days a week
and then getting up to three and then
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four, five, and then get
them back to their normal training frequency in
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the week. So if it's five, gradually get them back to five.
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After that, you can start to
play with the duration in terms of mileage
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or minutes. I like playing with
minutes because their intensity. When we change
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that later they might be doing an
eight minute mile versus a six minute mile,
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and then I'll obviously change their mileage. So play for the duration at
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time and then the intensity getting them
back to what their preferred paces. So
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if they're training for a seven to
fifteen minute mile pace, you might be
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starting somewhere high at eleven minute mile
and then working your way down as the
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last variable. So the three things
we play with are the frequency, the
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duration, and then the intensity.
A little chart from British Journal Sports Medicine
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just emphasizing the role of strength training
for runners, a number of number of
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great health side effects with that,
and then what I touched on before with
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the Adrian Peterson example, this is
a great time. Strength training two to
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three times a week is considered the
minimum for a healthy lifestyle for all of
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Americans. This is a great time
for them to fill in those gaps.
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Do they have decreased hipp endurance because
you get this deadlifting, putting some weight
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on, it's not going to hurt
them to return stronger than they were before.
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And then also them working out will
have a positive effect on the bone.
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We talk about that dynamic tissue of
bone. They're gonna build muscle,
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but they can also build boney they're
loading it up, it's gonna give it
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a great training stimulus. And there
are some ways you can creatively have them
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train deadlifting, squatting, things like
that while you're waiting to see if it's
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going to even be safe for them
to run. And it's a great way
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to test drive things further. And
again, what can we strengthen for the
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long term? Do they have other
issues? I've always had any glue A
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week quad great, now is our
time while we're waiting for this bone to
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heal, for us to get back
in a lot better fashion. And then
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practically some nutrition or lifestyle things.
So do the basics very well. Sleep?
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Are they getting seven eight hours a
night of sleep? If they're getting
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two and a half, all the
perfect programming and training in the world is
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going to be lost on them.
If they're never having a chance to recover
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nutrition, their chloric intake. Are
they just are they eating enough or are
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they chronically under calorie because them being
under calorie is going to make things really
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difficult from that bone debt perspective,
and they're never going to be able to
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pay that off. And then nutrition
wise, there's a few studies with stress
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fractures in US military recruits going through
basic training. Vitamin D and calcium have
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consistently been shown to help the recovery
of b sis. And this kind of
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makes sense. If someone had a
muscle injury and you could increase their approaching
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update in a given day, that's
probably going to help them. It's going
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to make things more bioavailable. Bone
is made up of calcium, indeed,
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magnesium, a bunch of other things. If you can make that more available
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for that person, it's certainly not
going to hurt. I'm moving forward in
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some ranges that have been thrown out
or about six hundred one thousand I use
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and then calcium about two hundred milligrams
a day. So and also I'm not
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really proponent of supplements, but you
can generally get it relatively cheap Walmart,
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Kroger, stuff like that. Easy
way to add that into their diet as
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they're bouncing back from this injury factors. Black Friday deals are going on now,
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of us at Factor to all of
you in the US and around the globe,
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we wish you a very happy Thanksgiving. We are so grateful for you.
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Now back to the show with Dan, what we ended up doing is
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basically had to shut down his cross
country season, which is super unfortunate,
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and then since his high grade in
a high risk area, we ended up
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having to shut him down for the
twenty some weeks and then at that point
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we got him back to a little
bit of biking and swimming. We did
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that for about six weeks and then
at that point we had it in some
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strength conditioning stuff. He will be
returning back to track this year, so
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it should be pretty exciting. But
it was a really long process and it
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was the conversation of fighting. I
want to get back to running as quick
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as possible, but it's one of
those you have to just do once and
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get it over with in a good
fashion. So now I'll kind of open
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up to some Q and a I'm
sorry if I rambled too much. Wonderful,
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Thank you so much. I think
this was a great presentation and really
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gave some insight into these bone stress
injuries. I do have a few that
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have come in. One person was
asking about how you approach discussing these injuries
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with your patients. Obviously, a
bone stress injury is something that comes from
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overuse. It's something that a lot
of times very how do we say,
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maybe motivated athletes and those that love
to run, love to do their sport,
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they end up getting these type of
injuries. How do you approach these
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conversations in a way that makes them
actually listen to your recommendations, pause on
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some of those activities that could cause
their injury to get worse, or as
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you mentioned before you had a patient
that went back a little too early and
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had to reinjury. First off,
it's really hard because some people are stubborn
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and they will not listen to you, and I don't I don't have a
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good answer for the person that don't
listen to you at all, but that's
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one that it sounds terrible. That's
one of the reasons I really like the
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MRI because sometimes patients don't believe you
even though you have just checking all the
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boxes for what's going on. I
really like being able to show the MURY
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report of you have a fracture,
you have an active fracture, or the
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beginning stages of a fracture in your
leg. If I broke my arm,
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I wouldn't continue to live my life. I would obviously change things, like
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for where we're at right now,
we have to change otherwise this is gonna
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get worse. And generally that can
get some buy in. And then one
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of my favorite phrases is just growing
in. I do this once, so
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it's gonna stink. We're gonna have
to modify your training for now. I
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never say I'm gonna shut you down
or you can't run. I really try
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to avoid that. But I'll just
say we're going to modify your training for
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now and give them a clear narrative
about what their PAS is going to look
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like. If hey, mister Smith, you have all the signs of a
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stress fracture, it's this grade.
The timeline for this is X amount of
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weeks. My goal is to keep
you as close to that timeline as possible,
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and then after that kind of have
an open conversation. Absolutely, and
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we've talked about this several times before
on our other webinars as well, that
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whole component of that patient conversation of
making sure that you're keeping it positive,
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that you're not necessarily using negative language
or things that really leave your patient feeling
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defeated or like catastrophizing what's already going
on. One of our other attendees was
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asking, in your example of the
runner who went back too fast and did
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too much and had that reinjury,
were you kind of back to square one
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after that? Or when that happens, is there a setback that maybe requires
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a different approach, such as something
that's low risk or some stress related signals
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that reappear on the MRI. So
with that person, it was not quite
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back to square one. It was
a maybe a square twoish, and at
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that point I didn't understand the framework
for the different weeks depending on the injury,
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so I was way too confident of
I think he was five weeks out
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and I had cut him loose to
said, hey, you're paying free to
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go for it. After that,
we basically had the conversation of look,
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I based on your exam, I
think you're in not square one but square
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two, and we're gonna have to
wait about six weeks minimum for any activity
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before you go into that. And
then another detail with that specific patient was
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he got briefly into bodybuilding of that
time, so he had put a very
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very lean guy put on a good
deal of muscle in a very short period
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of time. And then just the
reality of him adding another fifteen pounds of
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muscle and then pounded the pavement with
that. That was just a new stimulus
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for his bones as well. So
that was another variable with him, absolutely,
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And that's actually a great segue into
the next question. In your experience
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with these injuries, and obviously in
the research that you've also reviewed, are
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you finding that there are specific comorbidities
that oftentimes are present with these injuries or
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certain specific maybe even if people are
playing multiple sports within the same season,
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or like you mentioned someone who's an
avid runner and they're also bodybuilding. What
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are you seeing kind of across the
board that might show some correlation to this
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type of injury specifically. Yeah,
So the multi sport athlete is a more
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common one of just their go,
go go, They're doing a ton of
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things. That's something I've seen.
The other thing is just nutrition of they're
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just not eating enough for their correct
demands. You'll hear about the female athlete
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triangle where they might be some disminor
reage and just not eating enough calories.
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So it's the multi sport athlete and
the person that is just not eating anough
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that I see as kind of indicators. So that's something you want to have
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that chat with the athlete or their
parents there they're just like, hey,
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they can have a calorie surplus,
and especially on the recovery side, like
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if they have this injury and they're
trying to get back, you want there
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to be as much as many calories
and nutrients available to their bodies. That's
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healing. You don't want to be
trying to short change that absolutely, and
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I think that's another really great question
too. What type of supportive therapies do
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you recommend for your patients while they're
healing. I know you probably have some
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go to recommendations for that recovery trifecta
of sleep, hydration, and nutrition,
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but then beyond that, what are
the types of things that you encourage your
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patients to do while they're not necessarily
hitting that specific exercise the same way they
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used to, or maybe they're doing
their rehab exercises instead. How do you
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support them throughout their recovery? I
guess on the automodality side, like I
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have not seen anything on the from
research standpoint or personally that's been super helpful.
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There was some research for like some
shockwave therapy to help with healing bone
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stress injuries. The problem with that
though, is it showed the same timeline
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of recovery with or without it.
So I have a discourage patients from using
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that just because if the timeline for
them is nine weeks, and if they
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have the shockwave then it's nine weeks
as well, it's not really going to
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make much of a difference. So
I haven't seen anything on like modalities like
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that or norma tech or anything fancy. It's just it's not super fancy.
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It's just eating, giving their body
time to recover, and then managing the
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return to run. Speaking about the
multi sport athletes that you've seen with this
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type of injury, oftentimes we hear
from a lot of sports docks that they're
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encountering more and more young athletes,
your youth that are ages between even as
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young as eight into high school that
tend to have these overused injuries. We
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see a lot of uptick in Tommy
John's injuries obviously, I'd imagine you're seeing
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a lot of bone stress for these
multi sport athletes as well. How do
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you have that conversation with the parents, how do you involve the coaches or
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even the healthcare support team at their
school or on their team to make this
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a better conversation and a conversation that
kind of sticks with these people who were
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kind of the decision makers guiding these
young athletes. Yeah, so the biggest
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thing is it sounds cliche, but
having good communication, especially with the coaches.
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I don't chiropractor. There's a lot
of baggage or assumptions that can come
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with that. So whenever I reach
out to the coach. It's never in
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the framework or the mindset of here's
my way, this is how we're going
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to do it. It's always couched
with this is your athlete, I'm just
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coming alongside to help, and here
are my concerns. So I found that's
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a lot more receptive with chatting with
coaches and communicating of just I'm just coming
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alongside to help your athees and if
they perform better or get better quicker,
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we all went. So that's helped
the same thing with on the healthcare side.
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Can think of a situation where we
just had to email and work with
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the surgeon because we're really concerned it
was a high grade for moral stress injury
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that it was going to be a
possible displacement case. And it worked out
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because the athlete was very resistant to
us changing their training. We basically had
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to have them stop running for a
three week minimum period and they actually needed
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to be non weight bearing. And
it worked out that us and the arth
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were on the same page because good
Way, that author gave them a kind
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of come to Jesus meeting about hey, you have to be non weight bearing.
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I'm having you get a pair of
crutches right now. In a great
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00:22:40.240 --> 00:22:42.480
way that actually kind of scared them
into thinking, Okay, this is actually
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serious. I have a fracture in
my hip that I'm walking around with.
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I need to be actually really careful
with this. Absolutely, And in your
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00:22:49.759 --> 00:22:56.359
experience, who do you feel like
has been one of the biggest advocates and
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00:22:56.440 --> 00:23:00.039
one of your biggest supporters in terms
of other healthcare providers that you can usually
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00:23:00.079 --> 00:23:04.839
count on to kind of get on
board with your recommendations and really support them
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00:23:04.880 --> 00:23:10.400
so that it's not just one voice
but multiple for that athlete. I think
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00:23:10.400 --> 00:23:15.400
it orthow has been really helpful because
more and more orthopedics are getting picky,
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00:23:15.440 --> 00:23:17.720
which is great, Like, you
don't want to have a surgery unless you
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00:23:17.839 --> 00:23:21.160
absolutely need it, so their job
is to figure out if this is surgical
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00:23:21.240 --> 00:23:23.240
or not as quickly as possible,
but for them to see it, and
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00:23:23.279 --> 00:23:27.680
I think there's a lot more credibility
with the orthopedic telling you. But it's
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00:23:27.720 --> 00:23:34.119
always it's really convincing when you have
two providers, especially like a surgeon telling
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00:23:34.160 --> 00:23:38.400
you the same thing and being on
the same page, or even setting it's
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00:23:38.440 --> 00:23:42.319
silly in old school, but even
setting a facts ahead before their appointment that
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00:23:42.400 --> 00:23:45.079
just allows us to all be on
the same page and we're all saying the
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00:23:45.119 --> 00:23:49.960
same message and narrative with the patient. So to answer your question orthopedics and
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00:23:51.000 --> 00:23:55.519
having a chat beforehand is really helpful. Absolutely, and we've heard that time
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and time again from providers that if
you really want to work well with other
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00:23:59.720 --> 00:24:03.319
provide is part of that. Sports
med team communication is key and just being
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00:24:03.359 --> 00:24:07.480
sure that you're having that conversation as
soon as that patient comes in your office
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so that they're in the loop.
Someone else was asking for a ball sport
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00:24:11.920 --> 00:24:18.319
athlete, how do you test return
to run still building up run walk intervals
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00:24:18.799 --> 00:24:22.920
or do you use a different approach
to prep for return to sports such as
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00:24:22.920 --> 00:24:26.920
sprinting, start and stop. This
person mentions that there's a lot of research
337
00:24:26.000 --> 00:24:30.599
for cross country runners, but a
little less published on ball sport athletes.
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00:24:32.000 --> 00:24:36.000
But as you noted, there seems
to have been a really big uptick post
339
00:24:36.039 --> 00:24:40.039
COVID in these type of injuries with
ball sport athletes. Yeah, that's a
340
00:24:40.079 --> 00:24:45.759
really fantastic question. It's a lot
a little different because the cross country athlete,
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00:24:45.759 --> 00:24:48.079
they're running up to twelve miles or
whatever, they're doing much for their
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00:24:48.240 --> 00:24:52.039
distance. I haven't seen a lot
of great specific testing for the multi sport
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00:24:52.079 --> 00:24:56.000
athlete, basketball, baseball, things
like that. The biggest thing is just
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tolerance testing. Start low of is
it painful for them to walk around?
345
00:25:00.000 --> 00:25:03.839
If it's If it's painful for them
to walk into your office, that's going
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00:25:03.880 --> 00:25:07.079
to be a problem. You need
to wait till it's pain free and without
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00:25:07.160 --> 00:25:11.200
issue, and then just start playing
with it. Like I have a pair
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00:25:11.240 --> 00:25:14.440
of cones in the back, Like
I will go out to the our back
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office. We have a little parking
lot area, and like just have them
350
00:25:17.279 --> 00:25:18.880
light jog and sprint and things like
that, and we'll check in with that
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00:25:19.119 --> 00:25:23.119
after a few visits and see if
they can even handle that. So,
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00:25:23.559 --> 00:25:27.640
more specifically, with returning to run, I would say, for the person
353
00:25:27.680 --> 00:25:33.119
that asked that question, could they
be more specific about running in general or
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00:25:33.200 --> 00:25:38.160
running within that sport. It looks
like they were specifically talking about ball sport,
355
00:25:38.200 --> 00:25:41.759
and of course please write in and
let us know if there's something better
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00:25:41.799 --> 00:25:45.680
to clarify there. But the options
were do you do kind of building up
357
00:25:45.759 --> 00:25:51.319
run walk intervals or do you have
a different approach such as sprinting with starts
358
00:25:51.319 --> 00:25:55.640
and stops. I would imagine this
would be especially critical for like a basketball
359
00:25:56.160 --> 00:25:59.759
player or someone that's doing a lot
of those sprints where they're starting and stopping
360
00:25:59.759 --> 00:26:03.480
a good Yeah, and it's specific
to the sport, but you just have
361
00:26:03.559 --> 00:26:07.119
to start tailoring it to what their
activity is going to be. So for
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00:26:07.200 --> 00:26:11.799
the basketball example, get out the
cones and see how they can handle or
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00:26:11.960 --> 00:26:15.920
see what they can do with the
running back and forth. Wonderful. And
364
00:26:15.960 --> 00:26:18.279
again, if you have any further
points of clarification on that, if you
365
00:26:18.319 --> 00:26:22.880
could write in with those, I'll
go ahead and ask the last question we've
366
00:26:22.920 --> 00:26:26.160
received now while you're doing that,
and then we can certainly circle back to
367
00:26:26.240 --> 00:26:32.359
it. One question was involving supplements. Do you have any specific supplementation that
368
00:26:32.480 --> 00:26:37.480
you recommend for these athletes, not
only while they're recovering from this injury,
369
00:26:37.559 --> 00:26:41.160
but something that they could implement into
their diet moving forward to prevent reinjury in
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00:26:41.160 --> 00:26:45.799
the future. Yeah, that's a
great question. What I've done is that
371
00:26:45.839 --> 00:26:51.440
protocol of the two hundred million grand
with calcium and then six hundred minimum for
372
00:26:51.759 --> 00:26:55.559
the I use a vitamin D if
I have an active athlete, especially if
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they've had a previous history of this, I recommend not year round, but
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00:26:59.440 --> 00:27:07.039
within season that they are supplementing with
those two specifically, that's a great option.
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00:27:07.079 --> 00:27:10.440
And then just from the nutrition standpoint, I think the criteria is now
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00:27:10.839 --> 00:27:15.119
one gram of protein per day for
preferred body weight, So if their preferred
377
00:27:15.119 --> 00:27:18.160
body weight is two hundred pounds,
that they're at least getting tw hundred grams
378
00:27:18.160 --> 00:27:22.119
of protein in their day. And
especially with the run, they're using so
379
00:27:22.200 --> 00:27:25.559
much muscle tissue things like that,
that helps with the recovery process. And
380
00:27:25.680 --> 00:27:30.000
also protein is used in some small
ways with bone reconstruction as your body's repairing,
381
00:27:30.119 --> 00:27:34.519
So those three would be a great
place to start. Absolutely, thank
382
00:27:34.559 --> 00:27:38.680
you. Another question here, do
you do much with lower weight bearing such
383
00:27:38.680 --> 00:27:44.640
as crutches initially, boots for lower
extremity, et cetera. What type of
384
00:27:44.720 --> 00:27:49.200
devices or racing do you recommend?
Generally, I'll just have an crutches or
385
00:27:49.240 --> 00:27:52.480
something like that from Walmart, CBS, things like that. I don't have
386
00:27:52.519 --> 00:27:57.640
a preference on the boot, whatever
is just most practical for them. If
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00:27:57.640 --> 00:28:02.559
the question is more of able to
do anything with them when they're in a
388
00:28:02.599 --> 00:28:06.640
crutch or things like that, the
answer is yes. So that's where we
389
00:28:06.680 --> 00:28:10.400
get to be a little creative.
So say somebody has a significant stress fracture
390
00:28:10.400 --> 00:28:12.279
of their foot, like bikings out
of the question. We can't do any
391
00:28:12.319 --> 00:28:15.799
swimming things like that. If they
have access to their local gym or even
392
00:28:15.839 --> 00:28:18.839
their why like something like a handbike
just for them to get some kind of
393
00:28:18.839 --> 00:28:23.920
stimulus. And then also there's some
research about any kind of strengthening having an
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00:28:23.960 --> 00:28:30.240
osteogenic effect. So if they can
do anything lower limb for six weeks,
395
00:28:30.519 --> 00:28:33.559
this is a great time for us
to explore what kind of upper body exercises
396
00:28:33.599 --> 00:28:37.079
they can do. It just is
not going to hurt them as an athlete
397
00:28:37.160 --> 00:28:41.319
or a runner to get stronger.
But then also from a hormone standpoint,
398
00:28:41.519 --> 00:28:47.559
if they are working out, they
are sending off cellular signals for anabolic production
399
00:28:48.119 --> 00:28:49.799
and that's going to go everywhere.
That's a signal that is sent through the
400
00:28:49.799 --> 00:28:56.519
bloodstream. So them working out in
general is going to send cellular signals throughout
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00:28:56.519 --> 00:29:00.839
the body, which can certainly help
that bone as a lower left Again,
402
00:29:00.920 --> 00:29:15.119
Doctor Camp, thank you so much. We really appreciate you coming on today.
403
00:29:15.480 --> 00:29:18.599
That's it for today's episode. Be
sure to tune in for episode sixty
404
00:29:18.640 --> 00:29:22.400
eight, where we dive into a
brand new training in the world of cutting
405
00:29:22.559 --> 00:29:27.640
edge treatment tech with shockwave therapy for
post surgical care with doctor David Rednick.
406
00:29:29.119 --> 00:29:33.279
This is one you won't want to
miss, especially if you've been considering adding
407
00:29:33.319 --> 00:29:38.400
a shockwave device to your clinical toolkit. Episode sixty nine drops in two weeks.
408
00:29:38.960 --> 00:29:41.759
Be sure to keep an eye on
your inbox. Follow us on social
409
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be sure to check this is out
1
00:00:15.119 --> 00:00:19.440
Hi guys, Welcome to another episode
of The Factor podcast. I'm your host
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00:00:19.559 --> 00:00:23.359
Jessica Riddle. If this is your
first time tuning in, welcome and thank
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00:00:23.399 --> 00:00:27.719
you for listening. In today's episode, we wrap up our two part training
4
00:00:27.760 --> 00:00:33.200
on bone stress injuries with doctor Tyler
Kemp. In part one, we talked
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00:00:33.200 --> 00:00:38.520
about the differences between bone stress injuries
and overuse injuries. We also covered the
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00:00:38.560 --> 00:00:42.640
type of stress fractures and how they're
graded, and then we walk through physical
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00:00:42.679 --> 00:00:47.960
examination, imaging, and diagnostic tools
that you can use. Today, we'll
8
00:00:48.039 --> 00:00:52.439
chat more about how to treat these
injuries with examples and case studies. We'll
9
00:00:52.479 --> 00:00:58.079
also discuss the phases of return to
sport and go over some helpful exercise progressions
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00:00:58.119 --> 00:01:02.399
that you can use to build strength
and shorten the recovery period for your patients.
11
00:01:03.200 --> 00:01:07.079
So kick back, turn up the
volume and take some notes. Let's
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00:01:07.159 --> 00:01:19.840
dive in. Gets kind of fun
to as a transition over here to manage
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00:01:19.879 --> 00:01:23.400
the return. You had somebody come
in, you identified it, you confirmed
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on imaging. Now what do you
want to do? So? I'm a
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00:01:26.680 --> 00:01:30.319
big fan of d Rose, especially
for his time in the Bulls. There
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00:01:30.560 --> 00:01:36.000
was a really good promo that Adidas
did after he heard his ACL. It
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00:01:36.120 --> 00:01:38.000
was called the Return, where they
were promote a He's coming back, He's
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00:01:38.000 --> 00:01:42.799
going to return better than ever and
all that. The problem was d Rose
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has been plagued with injuries for the
remaining bit of his career. Things did
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not work out at all the way
they were hoping. And you contrast that
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with someone like Adrian Peterson, similar
injury ACL obviously different sports, who when
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he came back he came back stronger
and faster than ever, And there was
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00:01:59.519 --> 00:02:01.840
two kinds of distinct mindsets with it. Derek Rose was just trying to get
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back in general. Adrian Peterson,
if you look at interviews, he talks
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about how his mindset became, if
I'm going to be stuck here having to
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work on my knee, I might
as well work on everything else as an
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athlete so that when I get back, I'm back way better than before.
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And I want you to adopt that
mindset with these patients and with your athletes,
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of if we're going to get them
back to running back to their activity,
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what are the other things we're going
to do while we're stuck here to
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get them to the next level.
So when we talk about the return,
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quote unquote, I want to split
it into three things, so return to
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participation, return to sport, and
return to performance. So return to participation
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meaning just them getting back to some
kind of activity, so if they're a
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runner, just them starting to run
a little bit or be able to do
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stuff on their own period without any
issues. Return to sport meaning getting them
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back to playing in some way,
shape or form. And then return to
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performance is return to game day,
return to race day, being back today
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where they were. Essentially, Now, the hard question and the question every
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patient's going to ask you is how
long is this going to take? And
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that's something you have to be able
to be really clear with your communication.
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So this table here is from Marnet
at All. It's honestly one of my
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favorites to references. So this takes
all of the information we talked about before
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and synthesizing it down to some part
numbers, so it splits it into the
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low risk low grade and the up
to high risk high grade. And if
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you look at it, you can't
you know something pretty quickly of low risk
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low grade is about nine weeks,
low risk high grades twenty two weeks.
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High risk low grade is about nineteen
weeks and then about the same for high
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risk high grade. So if you
know you have somebody coming in with a
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low grade for moral shaft injury,
you can constantly tell them, hey,
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this will take about nine weeks to
to heal properly, and that's going to
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00:04:02.039 --> 00:04:06.479
be our kind of timeline going forward. So, being practicing in Cincinnati,
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00:04:06.719 --> 00:04:11.080
everybody loves driving out to Hiltonhead and
the Carolina is it's a beach town.
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It takes about ten hours to get
there. So the analogy I give to
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patients is how long is the drive
to Hilton Head? And most will say
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ten eleven inch hours depending on traffic. I'm like, yeah, is that?
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Is there a way to make that
drive shorter? And yeah, we
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could probably do ten ish on the
dot, nine ish, don't stop for
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00:04:27.600 --> 00:04:30.600
the restroom, pack a lunch,
drive a little fast, all that.
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Like can you make that six hours? Like? Well, probably not.
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And I'm like, on the flip
side, is that could that be longer?
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Could that be twelve hours? Four
pen hours? Like? Oh?
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Absolutely? So you have this loose
range and what I always tell patients is
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this is kind of our time frame. We can go above this or below
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this. My job is to keep
you as close to this timeframe as possible.
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And bone has defined healing time like
any other tissue. So biology drives
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the bus on this and we need
to be able to expand that clearly.
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00:04:59.079 --> 00:05:03.199
So again, the low risk glow
grade is about nine weeks, lower risk
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00:05:03.279 --> 00:05:08.160
high grade about twenty two weeks,
High risk glow grade nineteen and then the
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00:05:08.199 --> 00:05:12.439
same for the high risk high grade. And then this helps inform the kind
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of hard conversation as well of if
you have somebody come in, say they're
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a high school runner, and end
of September, if they have a high
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risk stress fracture in a risky area, they're season's over now, then your
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mindset needs to be how can I
prepare them for the next season? How
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00:05:28.040 --> 00:05:30.439
can I get them back better and
stronger than before. Again, here's the
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00:05:30.759 --> 00:05:38.040
MRI classification showing the different grading scales
here. So getting into the nitty gritty
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of the return three phases, we
want to do an active rest, an
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active rest with some kind of rehab
or physical exercise, and then rehab with
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tolerance testing with the return to sports. So the active rest of finding something
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00:05:53.519 --> 00:05:56.240
when they're in the ACUT stage,
again, assuming they don't have any reason
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00:05:56.319 --> 00:06:00.279
to be non weight bearing or something
like that. Finding something they can do
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that at least keeps them active,
and especially for runners, to keeps them
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00:06:02.680 --> 00:06:06.000
a little samee. So if running
is entirely out of the question, or
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if they have a high grade injury, finding alternatives swimming and biking are two
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great examples, just so that they
can keep some cardiovasque their endurance at that
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00:06:15.879 --> 00:06:19.560
time. Phase two, once they're
at a pain free stage, being able
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to add some kind of exercise in
there. We know that runners are chronically
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00:06:24.639 --> 00:06:28.399
undertrained on the strength and conditioning side, This is a great time to fix
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those issues. And then Phase three
is the rehab tolerance testing, starting to
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test drive different mileage and speed and
grading their symptoms and then ultimately getting them
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back to their sport. So getting
specific with the return to run a couple
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00:06:44.199 --> 00:06:48.120
of things. One, it needs
to be boring and pain free. Boring
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and pain free and boring is exactly
what it sounds like. It's not going
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00:06:53.600 --> 00:06:57.800
to be them doing a four minute
mile up a trail or something. They're
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00:06:57.800 --> 00:07:00.160
gonna have to drastically reduce their page. The other thing is that it has
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00:07:00.199 --> 00:07:04.680
to be pain free. So if
they have anything zero to ten scale.
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00:07:04.800 --> 00:07:10.240
If they have anything above a zero, you need to regress because the bone
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00:07:10.279 --> 00:07:13.839
is actively healing. We need to
make sure we're not irritating it. I
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00:07:13.879 --> 00:07:18.920
had a personal situation with a patient
where I had cleared them to run way
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00:07:18.959 --> 00:07:25.959
too soon and they ended up re
injuring it. Why well, one I
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00:07:26.000 --> 00:07:29.519
told them they were fine to run, and they decided to run. They
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00:07:29.519 --> 00:07:32.240
went back to their same amount of
mileage, and they actually had a recurrence
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00:07:32.240 --> 00:07:35.519
of their stress injury. I don't
think it had healed one hundred percent.
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00:07:35.600 --> 00:07:40.720
So we basically reversed our clock.
But you need to be if you're going
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00:07:40.800 --> 00:07:45.120
to use the timeline, have that
framework moving forward. So using things easily
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00:07:45.160 --> 00:07:47.879
like walking. So if they're going
to go run for thirty minutes at their
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00:07:47.920 --> 00:07:50.920
stage, have them to go five
to ten in a walk on either end
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00:07:50.920 --> 00:07:56.000
book at that and then it's easy
of easy way to kind of be honest
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00:07:56.000 --> 00:07:59.680
with themselves of hey, I'm walking
down this trail, I'm starting to feel
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00:07:59.720 --> 00:08:03.199
these simoms maybe all bail on this
run. And then you can even play
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00:08:03.240 --> 00:08:07.560
with some programming things of alternating days, having them walk two days, run
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00:08:07.600 --> 00:08:11.800
another, walk one day, run
another and kind of changing it as you
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00:08:11.920 --> 00:08:16.800
add back in or increase their amount
of days that they're active running progression.
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00:08:16.920 --> 00:08:20.720
Really great rule of thumb is the
ten percent rule, So don't add more
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00:08:20.759 --> 00:08:24.560
than ten percent either mileage or intensity
week to week. It's a great way
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00:08:24.600 --> 00:08:28.560
to kind of keep the lid on
things for somebody that's going to want to
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00:08:28.639 --> 00:08:31.600
jump their mileage something dramatic from thirty
miles a week to sixty miles a week.
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00:08:31.840 --> 00:08:37.000
And within that you can play with
three specific variables, frequency, duration,
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00:08:37.120 --> 00:08:41.320
and intensity. So frequency the number
of times in a week or a
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00:08:41.360 --> 00:08:46.480
set period that activities performed, duration, how long that occurred, and then
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00:08:46.600 --> 00:08:50.799
the intensity their their pace, their
RPE if you want to play to something
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00:08:50.840 --> 00:08:54.200
like that, So frequency getting them
from if they're normally somebody who's ten days
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00:08:54.240 --> 00:08:58.799
a week, let's go for something
like five or six, and we can
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00:08:58.840 --> 00:09:01.000
start them from two days a week
and then getting up to three and then
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00:09:01.080 --> 00:09:05.279
four, five, and then get
them back to their normal training frequency in
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00:09:05.320 --> 00:09:09.440
the week. So if it's five, gradually get them back to five.
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00:09:09.919 --> 00:09:13.279
After that, you can start to
play with the duration in terms of mileage
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00:09:13.320 --> 00:09:18.320
or minutes. I like playing with
minutes because their intensity. When we change
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that later they might be doing an
eight minute mile versus a six minute mile,
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00:09:20.639 --> 00:09:24.039
and then I'll obviously change their mileage. So play for the duration at
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00:09:24.080 --> 00:09:30.360
time and then the intensity getting them
back to what their preferred paces. So
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00:09:30.399 --> 00:09:33.159
if they're training for a seven to
fifteen minute mile pace, you might be
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00:09:33.200 --> 00:09:37.600
starting somewhere high at eleven minute mile
and then working your way down as the
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00:09:37.639 --> 00:09:41.159
last variable. So the three things
we play with are the frequency, the
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00:09:41.240 --> 00:09:46.399
duration, and then the intensity.
A little chart from British Journal Sports Medicine
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00:09:46.600 --> 00:09:52.799
just emphasizing the role of strength training
for runners, a number of number of
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00:09:52.879 --> 00:09:56.360
great health side effects with that,
and then what I touched on before with
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00:09:56.480 --> 00:10:01.720
the Adrian Peterson example, this is
a great time. Strength training two to
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00:10:01.759 --> 00:10:05.000
three times a week is considered the
minimum for a healthy lifestyle for all of
140
00:10:05.039 --> 00:10:09.559
Americans. This is a great time
for them to fill in those gaps.
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00:10:09.600 --> 00:10:13.559
Do they have decreased hipp endurance because
you get this deadlifting, putting some weight
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00:10:13.600 --> 00:10:18.600
on, it's not going to hurt
them to return stronger than they were before.
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00:10:18.960 --> 00:10:24.759
And then also them working out will
have a positive effect on the bone.
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00:10:24.919 --> 00:10:28.720
We talk about that dynamic tissue of
bone. They're gonna build muscle,
145
00:10:28.919 --> 00:10:33.919
but they can also build boney they're
loading it up, it's gonna give it
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00:10:33.480 --> 00:10:39.559
a great training stimulus. And there
are some ways you can creatively have them
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00:10:39.600 --> 00:10:43.519
train deadlifting, squatting, things like
that while you're waiting to see if it's
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00:10:43.559 --> 00:10:46.080
going to even be safe for them
to run. And it's a great way
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00:10:46.120 --> 00:10:48.759
to test drive things further. And
again, what can we strengthen for the
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00:10:48.759 --> 00:10:52.720
long term? Do they have other
issues? I've always had any glue A
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00:10:52.720 --> 00:10:56.519
week quad great, now is our
time while we're waiting for this bone to
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00:10:56.600 --> 00:11:00.960
heal, for us to get back
in a lot better fashion. And then
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00:11:01.000 --> 00:11:07.600
practically some nutrition or lifestyle things.
So do the basics very well. Sleep?
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00:11:07.679 --> 00:11:11.759
Are they getting seven eight hours a
night of sleep? If they're getting
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00:11:11.799 --> 00:11:16.960
two and a half, all the
perfect programming and training in the world is
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00:11:16.039 --> 00:11:20.559
going to be lost on them.
If they're never having a chance to recover
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00:11:20.919 --> 00:11:24.759
nutrition, their chloric intake. Are
they just are they eating enough or are
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00:11:24.799 --> 00:11:28.559
they chronically under calorie because them being
under calorie is going to make things really
159
00:11:28.600 --> 00:11:31.919
difficult from that bone debt perspective,
and they're never going to be able to
160
00:11:31.960 --> 00:11:37.480
pay that off. And then nutrition
wise, there's a few studies with stress
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00:11:37.519 --> 00:11:41.759
fractures in US military recruits going through
basic training. Vitamin D and calcium have
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00:11:41.919 --> 00:11:46.840
consistently been shown to help the recovery
of b sis. And this kind of
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00:11:46.879 --> 00:11:50.720
makes sense. If someone had a
muscle injury and you could increase their approaching
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00:11:50.799 --> 00:11:54.519
update in a given day, that's
probably going to help them. It's going
165
00:11:54.600 --> 00:12:00.320
to make things more bioavailable. Bone
is made up of calcium, indeed,
166
00:12:00.360 --> 00:12:03.480
magnesium, a bunch of other things. If you can make that more available
167
00:12:03.559 --> 00:12:05.799
for that person, it's certainly not
going to hurt. I'm moving forward in
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00:12:05.840 --> 00:12:09.799
some ranges that have been thrown out
or about six hundred one thousand I use
169
00:12:09.960 --> 00:12:15.120
and then calcium about two hundred milligrams
a day. So and also I'm not
170
00:12:15.159 --> 00:12:18.080
really proponent of supplements, but you
can generally get it relatively cheap Walmart,
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00:12:18.240 --> 00:12:22.559
Kroger, stuff like that. Easy
way to add that into their diet as
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00:12:22.559 --> 00:12:31.600
they're bouncing back from this injury factors. Black Friday deals are going on now,
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here's the scoop. So click on
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notes to get on the list.
You'll immediately get an email with exclusive deals
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excitement, and let's make this year
the best Black Friday yet. From all
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of us at Factor to all of
you in the US and around the globe,
185
00:13:24.559 --> 00:13:28.480
we wish you a very happy Thanksgiving. We are so grateful for you.
186
00:13:30.440 --> 00:13:35.759
Now back to the show with Dan, what we ended up doing is
187
00:13:35.320 --> 00:13:39.080
basically had to shut down his cross
country season, which is super unfortunate,
188
00:13:39.399 --> 00:13:45.399
and then since his high grade in
a high risk area, we ended up
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having to shut him down for the
twenty some weeks and then at that point
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we got him back to a little
bit of biking and swimming. We did
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that for about six weeks and then
at that point we had it in some
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strength conditioning stuff. He will be
returning back to track this year, so
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it should be pretty exciting. But
it was a really long process and it
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was the conversation of fighting. I
want to get back to running as quick
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as possible, but it's one of
those you have to just do once and
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get it over with in a good
fashion. So now I'll kind of open
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up to some Q and a I'm
sorry if I rambled too much. Wonderful,
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Thank you so much. I think
this was a great presentation and really
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gave some insight into these bone stress
injuries. I do have a few that
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have come in. One person was
asking about how you approach discussing these injuries
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with your patients. Obviously, a
bone stress injury is something that comes from
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overuse. It's something that a lot
of times very how do we say,
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maybe motivated athletes and those that love
to run, love to do their sport,
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they end up getting these type of
injuries. How do you approach these
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conversations in a way that makes them
actually listen to your recommendations, pause on
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some of those activities that could cause
their injury to get worse, or as
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you mentioned before you had a patient
that went back a little too early and
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had to reinjury. First off,
it's really hard because some people are stubborn
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and they will not listen to you, and I don't I don't have a
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good answer for the person that don't
listen to you at all, but that's
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one that it sounds terrible. That's
one of the reasons I really like the
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MRI because sometimes patients don't believe you
even though you have just checking all the
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boxes for what's going on. I
really like being able to show the MURY
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report of you have a fracture,
you have an active fracture, or the
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beginning stages of a fracture in your
leg. If I broke my arm,
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I wouldn't continue to live my life. I would obviously change things, like
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for where we're at right now,
we have to change otherwise this is gonna
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get worse. And generally that can
get some buy in. And then one
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of my favorite phrases is just growing
in. I do this once, so
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it's gonna stink. We're gonna have
to modify your training for now. I
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never say I'm gonna shut you down
or you can't run. I really try
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to avoid that. But I'll just
say we're going to modify your training for
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now and give them a clear narrative
about what their PAS is going to look
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like. If hey, mister Smith, you have all the signs of a
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stress fracture, it's this grade.
The timeline for this is X amount of
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weeks. My goal is to keep
you as close to that timeline as possible,
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and then after that kind of have
an open conversation. Absolutely, and
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we've talked about this several times before
on our other webinars as well, that
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whole component of that patient conversation of
making sure that you're keeping it positive,
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that you're not necessarily using negative language
or things that really leave your patient feeling
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defeated or like catastrophizing what's already going
on. One of our other attendees was
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asking, in your example of the
runner who went back too fast and did
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too much and had that reinjury,
were you kind of back to square one
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after that? Or when that happens, is there a setback that maybe requires
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a different approach, such as something
that's low risk or some stress related signals
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that reappear on the MRI. So
with that person, it was not quite
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back to square one. It was
a maybe a square twoish, and at
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that point I didn't understand the framework
for the different weeks depending on the injury,
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so I was way too confident of
I think he was five weeks out
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and I had cut him loose to
said, hey, you're paying free to
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go for it. After that,
we basically had the conversation of look,
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I based on your exam, I
think you're in not square one but square
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two, and we're gonna have to
wait about six weeks minimum for any activity
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before you go into that. And
then another detail with that specific patient was
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he got briefly into bodybuilding of that
time, so he had put a very
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very lean guy put on a good
deal of muscle in a very short period
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of time. And then just the
reality of him adding another fifteen pounds of
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muscle and then pounded the pavement with
that. That was just a new stimulus
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for his bones as well. So
that was another variable with him, absolutely,
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And that's actually a great segue into
the next question. In your experience
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with these injuries, and obviously in
the research that you've also reviewed, are
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you finding that there are specific comorbidities
that oftentimes are present with these injuries or
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certain specific maybe even if people are
playing multiple sports within the same season,
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or like you mentioned someone who's an
avid runner and they're also bodybuilding. What
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are you seeing kind of across the
board that might show some correlation to this
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type of injury specifically. Yeah,
So the multi sport athlete is a more
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common one of just their go,
go go, They're doing a ton of
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things. That's something I've seen.
The other thing is just nutrition of they're
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just not eating enough for their correct
demands. You'll hear about the female athlete
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triangle where they might be some disminor
reage and just not eating enough calories.
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So it's the multi sport athlete and
the person that is just not eating anough
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that I see as kind of indicators. So that's something you want to have
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that chat with the athlete or their
parents there they're just like, hey,
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they can have a calorie surplus,
and especially on the recovery side, like
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if they have this injury and they're
trying to get back, you want there
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to be as much as many calories
and nutrients available to their bodies. That's
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healing. You don't want to be
trying to short change that absolutely, and
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I think that's another really great question
too. What type of supportive therapies do
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you recommend for your patients while they're
healing. I know you probably have some
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go to recommendations for that recovery trifecta
of sleep, hydration, and nutrition,
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but then beyond that, what are
the types of things that you encourage your
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patients to do while they're not necessarily
hitting that specific exercise the same way they
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used to, or maybe they're doing
their rehab exercises instead. How do you
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support them throughout their recovery? I
guess on the automodality side, like I
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have not seen anything on the from
research standpoint or personally that's been super helpful.
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There was some research for like some
shockwave therapy to help with healing bone
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stress injuries. The problem with that
though, is it showed the same timeline
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of recovery with or without it.
So I have a discourage patients from using
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that just because if the timeline for
them is nine weeks, and if they
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have the shockwave then it's nine weeks
as well, it's not really going to
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make much of a difference. So
I haven't seen anything on like modalities like
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that or norma tech or anything fancy. It's just it's not super fancy.
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It's just eating, giving their body
time to recover, and then managing the
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return to run. Speaking about the
multi sport athletes that you've seen with this
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type of injury, oftentimes we hear
from a lot of sports docks that they're
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encountering more and more young athletes,
your youth that are ages between even as
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young as eight into high school that
tend to have these overused injuries. We
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see a lot of uptick in Tommy
John's injuries obviously, I'd imagine you're seeing
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a lot of bone stress for these
multi sport athletes as well. How do
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you have that conversation with the parents, how do you involve the coaches or
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even the healthcare support team at their
school or on their team to make this
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a better conversation and a conversation that
kind of sticks with these people who were
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kind of the decision makers guiding these
young athletes. Yeah, so the biggest
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thing is it sounds cliche, but
having good communication, especially with the coaches.
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I don't chiropractor. There's a lot
of baggage or assumptions that can come
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with that. So whenever I reach
out to the coach. It's never in
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the framework or the mindset of here's
my way, this is how we're going
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to do it. It's always couched
with this is your athlete, I'm just
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coming alongside to help, and here
are my concerns. So I found that's
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a lot more receptive with chatting with
coaches and communicating of just I'm just coming
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alongside to help your athees and if
they perform better or get better quicker,
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we all went. So that's helped
the same thing with on the healthcare side.
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Can think of a situation where we
just had to email and work with
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the surgeon because we're really concerned it
was a high grade for moral stress injury
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that it was going to be a
possible displacement case. And it worked out
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because the athlete was very resistant to
us changing their training. We basically had
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to have them stop running for a
three week minimum period and they actually needed
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to be non weight bearing. And
it worked out that us and the arth
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were on the same page because good
Way, that author gave them a kind
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of come to Jesus meeting about hey, you have to be non weight bearing.
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I'm having you get a pair of
crutches right now. In a great
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way that actually kind of scared them
into thinking, Okay, this is actually
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serious. I have a fracture in
my hip that I'm walking around with.
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I need to be actually really careful
with this. Absolutely, And in your
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experience, who do you feel like
has been one of the biggest advocates and
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one of your biggest supporters in terms
of other healthcare providers that you can usually
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count on to kind of get on
board with your recommendations and really support them
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so that it's not just one voice
but multiple for that athlete. I think
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it orthow has been really helpful because
more and more orthopedics are getting picky,
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which is great, Like, you
don't want to have a surgery unless you
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absolutely need it, so their job
is to figure out if this is surgical
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or not as quickly as possible,
but for them to see it, and
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I think there's a lot more credibility
with the orthopedic telling you. But it's
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always it's really convincing when you have
two providers, especially like a surgeon telling
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you the same thing and being on
the same page, or even setting it's
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silly in old school, but even
setting a facts ahead before their appointment that
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just allows us to all be on
the same page and we're all saying the
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same message and narrative with the patient. So to answer your question orthopedics and
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having a chat beforehand is really helpful. Absolutely, and we've heard that time
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and time again from providers that if
you really want to work well with other
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provide is part of that. Sports
med team communication is key and just being
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sure that you're having that conversation as
soon as that patient comes in your office
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so that they're in the loop.
Someone else was asking for a ball sport
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athlete, how do you test return
to run still building up run walk intervals
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or do you use a different approach
to prep for return to sports such as
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sprinting, start and stop. This
person mentions that there's a lot of research
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for cross country runners, but a
little less published on ball sport athletes.
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But as you noted, there seems
to have been a really big uptick post
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COVID in these type of injuries with
ball sport athletes. Yeah, that's a
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really fantastic question. It's a lot
a little different because the cross country athlete,
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they're running up to twelve miles or
whatever, they're doing much for their
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distance. I haven't seen a lot
of great specific testing for the multi sport
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athlete, basketball, baseball, things
like that. The biggest thing is just
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tolerance testing. Start low of is
it painful for them to walk around?
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If it's If it's painful for them
to walk into your office, that's going
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to be a problem. You need
to wait till it's pain free and without
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issue, and then just start playing
with it. Like I have a pair
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of cones in the back, Like
I will go out to the our back
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office. We have a little parking
lot area, and like just have them
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light jog and sprint and things like
that, and we'll check in with that
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after a few visits and see if
they can even handle that. So,
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more specifically, with returning to run, I would say, for the person
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that asked that question, could they
be more specific about running in general or
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running within that sport. It looks
like they were specifically talking about ball sport,
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and of course please write in and
let us know if there's something better
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to clarify there. But the options
were do you do kind of building up
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run walk intervals or do you have
a different approach such as sprinting with starts
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and stops. I would imagine this
would be especially critical for like a basketball
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player or someone that's doing a lot
of those sprints where they're starting and stopping
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a good Yeah, and it's specific
to the sport, but you just have
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to start tailoring it to what their
activity is going to be. So for
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the basketball example, get out the
cones and see how they can handle or
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see what they can do with the
running back and forth. Wonderful. And
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again, if you have any further
points of clarification on that, if you
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could write in with those, I'll
go ahead and ask the last question we've
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received now while you're doing that,
and then we can certainly circle back to
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it. One question was involving supplements. Do you have any specific supplementation that
368
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you recommend for these athletes, not
only while they're recovering from this injury,
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but something that they could implement into
their diet moving forward to prevent reinjury in
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the future. Yeah, that's a
great question. What I've done is that
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protocol of the two hundred million grand
with calcium and then six hundred minimum for
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the I use a vitamin D if
I have an active athlete, especially if
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they've had a previous history of this, I recommend not year round, but
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within season that they are supplementing with
those two specifically, that's a great option.
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And then just from the nutrition standpoint, I think the criteria is now
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one gram of protein per day for
preferred body weight, So if their preferred
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body weight is two hundred pounds,
that they're at least getting tw hundred grams
378
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of protein in their day. And
especially with the run, they're using so
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much muscle tissue things like that,
that helps with the recovery process. And
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also protein is used in some small
ways with bone reconstruction as your body's repairing,
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So those three would be a great
place to start. Absolutely, thank
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you. Another question here, do
you do much with lower weight bearing such
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as crutches initially, boots for lower
extremity, et cetera. What type of
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devices or racing do you recommend?
Generally, I'll just have an crutches or
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something like that from Walmart, CBS, things like that. I don't have
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a preference on the boot, whatever
is just most practical for them. If
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the question is more of able to
do anything with them when they're in a
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crutch or things like that, the
answer is yes. So that's where we
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get to be a little creative.
So say somebody has a significant stress fracture
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of their foot, like bikings out
of the question. We can't do any
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swimming things like that. If they
have access to their local gym or even
392
00:28:15.839 --> 00:28:18.839
their why like something like a handbike
just for them to get some kind of
393
00:28:18.839 --> 00:28:23.920
stimulus. And then also there's some
research about any kind of strengthening having an
394
00:28:23.960 --> 00:28:30.240
osteogenic effect. So if they can
do anything lower limb for six weeks,
395
00:28:30.519 --> 00:28:33.559
this is a great time for us
to explore what kind of upper body exercises
396
00:28:33.599 --> 00:28:37.079
they can do. It just is
not going to hurt them as an athlete
397
00:28:37.160 --> 00:28:41.319
or a runner to get stronger.
But then also from a hormone standpoint,
398
00:28:41.519 --> 00:28:47.559
if they are working out, they
are sending off cellular signals for anabolic production
399
00:28:48.119 --> 00:28:49.799
and that's going to go everywhere.
That's a signal that is sent through the
400
00:28:49.799 --> 00:28:56.519
bloodstream. So them working out in
general is going to send cellular signals throughout
401
00:28:56.519 --> 00:29:00.839
the body, which can certainly help
that bone as a lower left Again,
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00:29:00.920 --> 00:29:15.119
Doctor Camp, thank you so much. We really appreciate you coming on today.
403
00:29:15.480 --> 00:29:18.599
That's it for today's episode. Be
sure to tune in for episode sixty
404
00:29:18.640 --> 00:29:22.400
eight, where we dive into a
brand new training in the world of cutting
405
00:29:22.559 --> 00:29:27.640
edge treatment tech with shockwave therapy for
post surgical care with doctor David Rednick.
406
00:29:29.119 --> 00:29:33.279
This is one you won't want to
miss, especially if you've been considering adding
407
00:29:33.319 --> 00:29:38.400
a shockwave device to your clinical toolkit. Episode sixty nine drops in two weeks.
408
00:29:38.960 --> 00:29:41.759
Be sure to keep an eye on
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like what you heard today, I
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