Time to see the doctor?

Personal note: The first week of blogging has been a terrific experience. It seems to have been a tremendous success, in my opinion. I’ve gotten tremendous feedback about the site, and I look forward to many great posts and discussions in the future. I’ve received numerous questions via the contact form, and several of them have dealt with topics that would be perfect for discussion with a larger audience. Therefore, I’m considering an “Ask Dr. Geier” monthly or weekly post, where I address questions in more general terms to provide information about that particular topic to anyone interested. Having said that, many of the questions have dealt with whether some sort of ache or pain is a serious problem and when that person can go back to sports or exercise. I decided that a post addressing signs that might be worrisome and when to see a doctor might be appropriate.

One of the most common questions I get as an orthopaedic surgeon and sports medicine physician is whether or not a sports injury is a big deal. On almost every clinic day, I’ll have patients whose complaints fall into one of two scenarios. First, I’ll have a team athlete or weekend warrior who has a seemingly mild injury, such as a mild ankle sprain, and the injury occurred less than 24 hours ago. While I appreciate that they are concerned, I often think to myself that if this person had put some ice on the body part and had taken it easy for a day or two, the pain might have gone away on its own. On the opposite end of the spectrum, I often have patients who present with shoulder or knee pain. When I ask the patient how long the pain, clicking, popping, etc. has been present, it is not uncommon to hear 6 or 12 months or even longer. The patient usually says that he thought the pain would go away on its own by just avoiding the offending activity, but now it has been six months or a year, and he is no better.

Initial Treatments of Sports Injuries
First off, let’s talk about what to do when an injury first occurs. The initial treatment is usually straightforward. The acronym RICE, which stands for Rest, Ice, Compression, and Elevation, is appropriate for the first few hours or days after most sports injuries and pains. Some experts add a P to the acronym, or PRICE, for Protection. Regardless of whether the symptom is ankle swelling, knee pain and catching, or deep shoulder pain with overhead activity, these principles apply. Protect the injured bone or joint by staying off of the painful limb or using a device such as a brace or sling, if necessary. Rest the injury by staying out of the offending activity or sport. Use an ice bag for 20 minutes at a time several times a day in conjunction with mild compression with an ACE bandage and elevation of the injured extremity to minimize swelling. If the swelling and pain are better after PRICE but not resolved, short-term anti-inflammatory medications and continued rest are often appropriate. Certainly if symptoms do not resolve or worsen, the athlete should seek medical advice.

Fear of Being Shut Down
One of the fears many athletes have about going to the doctor is the concern that they will be told they have to stop playing or competing. Most of the time the problem is straightforward, and fortunately surgery is often not the first-line treatment. Usually activity modification is utilized instead of complete inactivity. For many injuries, decreasing the number of days a week the athlete performs the desired sport or activity and adding non-harmful activities is all that is needed. Occasionally home exercises or several sessions with a sports medicine physical therapist can aid the rehabilitation. Only if the activity is harmful will the doctor pull the athlete out of the sport or activity. By seeing a specialist when the pain impairs ability to participate, he or she may lessen any chance of making the problem worse or having it persist for months or years.

How Long Do You Wait?
So what’s the right amount of time a bone or joint or muscle pain has to be present before you decide that it’s time to have it checked out? Unfortunately, it’s hard to answer that question with a specific time period. The answer might be one week, six weeks, or six months. What I think is more important than the amount of time since the injury is how the injury affects the ability to play.

For example, if it’s obviously a serious injury, such as a broken bone or dislocated joint, the athlete is going to seek treatment right away. I saw of list of guidelines in a family medicine textbook once addressing when a sports injury should be referred to an orthopaedic surgeon. The first two rules were fairly straightforward. If the arm or leg hurts so badly that the athlete cannot put weight on it and continue playing, then he or she should see a physician. If the bone is obviously deformed or the joint is obviously dislocated, the athlete should see an orthopaedic surgeon. I don’t want to sound condescending, but I think everyone would know to have those injuries evaluated. Obviously if the knee, ankle, shoulder, or any body part hurts so badly that he or she cannot play or perform exercise, then I would recommend that they seek medical evaluation and hold off of sports.

Does Your Injury Hamper Your Ability to Play?
What I ask athletes is whether or not they can play their sport or perform their exercise at the level they would like to. Usually the problem is not that the runner can’t run at all but maybe that her knee hurts running the downhill portion of hill training. Or the baseball pitcher that can pitch, but his elbow pain is causing him to lose velocity and location on his curveball. Or a golfer who has pain in the back of the shoulder in the initial part of the downswing motion, and it is affecting his scores and enjoyment of the game. In my opinion, all of these are reasons to seek evaluation from a sports medicine physician. If the pain or any other symptom is limiting not only the ability to play at all, but more importantly, the ability to play as well as he or she wants to play, then it is reasonable to see a doctor.

Take Home Message
The take home message is simple. If bone or joint pain is limiting ability to play or exercise at all or simply impairing the ability to compete at a high level, a sports medicine specialist may be able to help athletes at all levels get back in the game. Tweet this message.

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ABOUT ME
david-headshot I am an orthopaedic surgeon and sports medicine specialist in Charleston, South Carolina.

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