How to Get Back into Working Out After a Long Break?

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Transcript

Host: Chrissy Billau:

Welcome to Prescribed Listening from the University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust. I'm your host, Chrissy Billau. Spring is here and a lot of us are emerging out of our winter exercise hibernation, me included. We took a hiatus, but it is time to dust off those running shoes for school sports. You have baseball, softball, soccer. They're all making a comeback. So as athletes head back to the field or you're getting prepared for that upcoming 5K or a marathon, we are talking with sports medicine and orthopedic surgeon, Dr. David Sohn, about what you can do to prevent an injury as you get back after a break. Let's ask the expert. Dr. Sohn, welcome. Thank you for being here.

Guest: Dr. David Sohn:

Great to be here. Thank you.

Host: Chrissy Billau:

So as we come out of winter, if you've been resting in between what I call the happy seasons, the happy weather seasons, what should you be doing now to get moving again? And I'm guessing it's not go all out hardcore, push yourself to the limits seven days a week.

Guest: Dr. David Sohn:

Well, I would say the first thing is make a plan. So if you have something that you're aiming towards, like a big hike or a half-marathon, or something like that, just realize that your body is going to benefit from gradual increments of your activities rather than just doing something all of a sudden. That's a really good way to help prevent injury. So for example, if you are going to try a new sport or have a big race that you want to do, you can ask your doctor for a return to running protocol. This is a graduated, like in my case, I have an 18-step program where each day is going to have gradually more and more activity, and this way you can kind of acclimate your body towards increased activity. This is a good way to prevent things like shin splints or stress fractures, or these type of things.

So activity is great. Everyone should be, especially with the weather being nicer, everyone should be looking to become more active, but it's nice to do so in a way that's going to be safe and not create any pain or injuries.

Host: Chrissy Billau:

An easier way into it. So what about children and teen sports? What should parents know? What should those kids know?

Guest: Dr. David Sohn:

So one good thing about kids is they're going to respond much faster. They're going to heal much, much faster. But one difficulty is our society these days tends to overdo particular activities. Maybe even 30 years ago, people did a lot more cross-training, like fall might be football, winter might be basketball, and spring might be baseball. These different sports all use very different parts of the body and this will allow for cross-training and also give some rest to the things that are being used a lot. These days, when you have 365 days of baseball, you're not giving shoulders and you're not giving elbows rest. So my concern would be more for the people who are training constantly around the calendar.

For people who are transitioning from no activity to activity, those are the people who are likely going to have things like shin splints or they're going to have knee pain. And so none of these things are dangerous, but gradually returning to sports and increasing your activity level will help.

The other thing that I would also say is for people to keep in mind that whatever body part you are using the most, that's the body part that is most likely going to have some type of overuse and some tightness. Our bodies tend to become tight in whatever we use a lot. An example would be a sprinter. A sprinter, they're primarily using their hamstrings, so their hamstrings are going to be tight. A pitcher is primarily going to be using his or her shoulder. That's what's going to be tight. Stretching before an activity will help prevent injury, stretching afterwards prevents tightness. So as you start to increase your activity level, think about what body part you're using a lot and take some time not only before your activity to stretch, but after the activity to stretched so that you don't develop tightness.

Host: Chrissy Billau:

What are some common sports injuries with high school athletes that they should watch out for? I know we've talked about shin splints and knee injuries. Is that for kids and adults or is it different?

Guest: Dr. David Sohn:

So it's mostly going to be for people who are in some type of regimented sport, because you have to keep up with your peers. So for example, if you've spent the winter either not doing something or doing something that doesn't involve a lot of running, let's say you're a wrestler, and then in the spring all of a sudden you are joining a lacrosse team and the whole team is running, you got to keep up with them. Those are the people who are going to develop shin splints. Whereas if you're an adult and you're like, "Hey, you know what? I want to get into running," you're not going to run yourself to the point that you're going to get... You're going to say, "You know what? I've done enough." Now, that's not to say that they can't develop shin splints, but we are going to see that more in the younger patients or the people who are in regimented activities.

Host: Chrissy Billau:

I have several people I know who've they've never run before and then they're like, "I'm going to start running." And then they just go out in the shoes that they have that they've probably worn for years, and then suddenly they have these foot injuries where they're wearing a boot for weeks and can't do anything.

Guest: Dr. David Sohn:

Yeah. And that can happen. Proper shoe wear is very important and shoes, even if you don't use them, they do have sort of a life expectancy, and properly fitted shoes and shoes that have proper support. If you, for example, don't have enough arch support, you're going to put more stress on the outside of your kneecap and develop pain in that way. So yeah, that's a good point.

Host: Chrissy Billau:

If you aren't sure if something you think happened during a game is something you need to talk to your doctor about, what should you do? You're like, "It hurts, but I don't know if I need to see a doctor."

Guest: Dr. David Sohn:

Well, I'll first go over to some danger signs. There are some danger signs, which if you have these danger signs, just go in immediately. So the first is an injury that prevents you from finishing a game. That's always a warning sign. Swelling. If you develop swelling in a knee or an elbow, that's a warning sign. And if you actually feel something pop, there's a moment where you're like, "This is the moment it happened. I was throwing a ball and pop, or I was sprinting and then I felt pop, or I was wrestling, the guy twisted my knee, I felt a pop." If you feel something, that's something that should be evaluated.

So it gets to the point that actually if you have these three things, a twist and pop in your knee, immediate swelling, and inability to finish the practice or the game, those three things alone are 90% predictive of an ACL tear. So it's not even with an MRI or anything like that. You hear those three things and almost any sports medicine specialist is going to think ACL and they're going to order an MRI. So those three things are things that you're going to immediately seek medical attention if you hear or feel a pop, if you have swelling, or if you are unable to finish competition.

Host: Chrissy Billau:

How can you avoid a sprain or a strain or tearing your ACL?

Guest: Dr. David Sohn:

Yeah, so it's really interesting. Most of the ACL injuries are actually going to be non-contact injury and there are prevention protocols for them. So most ACL tears happen because something happens where there's a lack of coordination between your quadriceps and your hamstrings. So when you think of your upper leg, on the front you've got the quadriceps muscles, those things, those muscles will act to straighten your knee, but then you have your hamstring muscles and those act to bend your knee, and they actually work best together when they're both under tension and then they can kind of oppose each other in a safe way. There's tension, but they're working together.

Most ACL injuries happen when you have lack of coordination between these two firing groups of muscle, so your quadriceps all of a sudden fires and there's unopposed firing of the quadriceps. There's nothing from the hamstrings, there's no co-contractions that are countering it, and that leads to a sudden shift of force on the tibia, which can tear your ACL. So the majority of ACL injuries actually happen without any type of contact. So one way that we have found to prevent injuries is to practice landing with co-contractions.

So you could even do this simple thing, if you go to the bottom of a staircase and just climb up two or three stairs and then just practice jumping and landing on both feet, what this will do is it will ingrain that muscle memory of, "Okay, every time I'm landing, my quadriceps are firing to help absorb the shock, but the hamsters are going to do it together, they're going to work together, co-contraction. That simple thing of just going up and just practicing that jumping, it seems silly, but just doing that has actually been proven to prevent future ACL tears.

Host: Chrissy Billau:

That's a good tip. Are there any other things you have for parents on how you can help your child prepare their body and avoid an injury?

Guest: Dr. David Sohn:

Well, one thing is, particularly if you have teenage kids, you have to realize that teenage kids, as they grow, a lot of times the bones grow first and it takes a while for the tendons and the muscles to catch up to them. So you may have heard the term growing pains, this is what that refers to. It refers to the fact that your bones are long, but the tendons and the muscles have not caught up, so they're overly tight. So that combined with sudden increase in activity, particularly explosive activities like basketball or sprinting, will lead to pain. So how do you mitigate against this? You would want to do daily stretching. So particularly the muscle group that tends to see this the most are your hamstring tendons. So daily hamstring stretching will actually help prevent this type of pain.

Now, going back to what we talked about earlier, is it dangerous? Is it dangerous to have pain if I'm playing basketball and I have pain? Well, if there's no discernible pop, I'm just playing and it's afterwards, "Oh, you know what? The day afterwards I'm sore." But there was no discernible single event injury, there's no swelling. Typically, growing pains is going to cause some overuse like tendonitis and inflammation, but there's not going to be swelling. And they were able to finish, they were able to finish their practice, they were able to run all their hits, they were able to finish the game, it's just the afterwards. It's not to say that that patient doesn't need to be seen, but that patient probably doesn't have anything wrong. They probably just have some tightness of the hamstring, which is causing some overload with explosive activities like running and jumping. And so that patient you'd be less concerned about.

Host: Chrissy Billau:

So stretching.

Guest: Dr. David Sohn:

Stretching is really big, yeah.

Host: Chrissy Billau:

Would you recommend weightlifting?

Guest: Dr. David Sohn:

So weightlifting is good, actually particularly for young women, because one thing people might not know is that for a woman, the calcium that you store in your body, it's a race. You have up until age 25. After that, women have a real difficult time adding any more calcium to their skeleton. So you add up until you're 25, and then after that you just lose calcium. This is why women have more problems with osteoporosis than men do later in life, particularly since a woman is going to give up a lot of that calcium if she becomes pregnant and she gives it up to the fetus. Things that will compound that are things like drinking soda pop. Soda pop, particularly your colas will have phosphoric acid, and phosphoric acid will actually leach calcium from your body.

So this is why I'm a big fan of things like weight training, because weight training is going to strengthen not only your muscles, but your bones, and it will help the young female athlete to have stronger and denser bones in their skeleton and more calcium. So I am a big fan of weight training.

Host: Chrissy Billau:

Okay. Every sport has some kind of gear for support or safety. You have helmets, knee braces, knee pads, the whole shebang. Is there anything you would recommend in terms of gears for teens or adult athletes? Anybody?

Guest: Dr. David Sohn:

So the big thing is helmets. Helmets, helmets, helmets. Most of the things that happen in sports, they're correctable. You might fall and if you're not wearing a knee pad, you could have a contusion or a sprain or something like that. But our growing literature is that concussions, the injury to your brain, is cumulative. So yes, you can have a concussion and then you can recover from it, but then if you have another concussion, and another concussion, and another concussion, then you have a cumulative effect of this, and that's where you really get into problems. It's not really any one concussion, but it's the additive effects.

Think of a paperclip. If you take a paperclip and you bend it straight into the opposite direction and then bend it back, it can still act as a paperclip, do it again, do it a third time. Eventually it doesn't work as a paperclip anymore. Maybe it may even snap. So bicycling, skateboarding, hockey, baseball, obviously football, all of these are sports where you can have a head injury. And the single most important thing that you're going to want to make sure that you protect is your head, because that's the one that's hardest if you have an injury to correct and heal it.

Host: Chrissy Billau:

So for concussions, I coach my kid's sports teams and as part of our league, you have to go through the concussion training and it's watching a video. But I think it would be helpful for our listeners, what are the signs that either my kid or I have a concussion?

Guest: Dr. David Sohn:

Right. So the big thing is, the really dangerous concussions are the ones where you cannot make new memories. That's the one you really have to watch out for. So for example, if you've had any type of blow to the head, you're going to want to ask the athlete, maybe your kid, you're going to want to ask them to remember three words. And so I would encourage you to always have the same words just so that you don't forget what they are. So for me, my words are chair, house, cat. So if I encounter an athlete who has had a head injury, I'm going to ask them chair, house, cat. And then I'm going to go back to them in 10 minutes and say, "What were the three words I said to you?" If they can't remember that, they are done, they're not playing anymore that day. That means that they've had a significant concussion.

There are other signs, but these are probably only going to be exhibited either later or in really, really bad concussions, like things like balance disorders. If you close your eyes, you can't touch your nose with your fingers accurately, you can't walk a straight line, you're acting like you're drunk, or the light hurts. And these are all signs that that athlete has had a really bad concussion and their brain is not healed enough for them to return to sport, but the three words is a really good one to know when to pull someone and not let them get their head injury worse.

Host: Chrissy Billau:

And if you do determine that I think this kid may have a concussion, they're not playing again, do you tell their parents, "Take them to the hospital, or call your doctor, rest"? I don't know. What's the avenue?

Guest: Dr. David Sohn:

Hospital if they've been hit on the side of the head, the side of your head, the temple, is actually the part of the skull that is the thinnest. So that's the one where you want to make sure that a CT scan doesn't show that you've got a fracture or something like that. So a classic example is if you get hit by a baseball side of the head here, in the temple area. Not only is the bone really thin there, there's an artery there, the middle cerebral artery, and that can actually be injured too. So I mean, that could be life-threatening. So that's something you're going to want to catch.

Most concussions, the things that you're going to want to do is you're just going to want to make sure they don't get another hit. So what I would say is ask your athletic trainer at your sport, "Does my child need to go to the emergency room?" Mostly it's not. Mostly what you're going to want to do is just pull them out and don't let them hurt themselves anymore, but watch out for the one where you have some type of blow to the side of the head. That's really dangerous.

Host: Chrissy Billau:

Let's switch over to warming up and why does that matter?

Guest: Dr. David Sohn:

Yeah. So think about how do muscles work? So a muscle is going to transition to a tendon. That's called the musculotendinous junction, and then the tendon inserts on the bone. So what happens is as the muscle contracts, it pulls at the musculotendinous junction on the tendon, which then pulls on the bone. And that's how our muscles move our bones. So the area that's going to actually be most vulnerable in that chain is your musculotendinous junction. So if you all of a sudden have sudden force that's applied without warming up, without stretching, there's going to be more chance that that musculotendinous junction is going to be affected. And then that's how people get sprains and strains. And that's why that's so much more likely to happen in athletes who are just starting up a sport again after a long hiatus.

The other benefit for stretching in addition to getting blood flow into all these muscles is that actually, well, with these activities like light warmups, you're going to get these muscles to work together. There's very few muscles that work in isolation. Almost every muscle is grouped with other muscles that have overlapping function. And so there's safety in numbers, so if you get all those muscles coordinated and working together, there's less of a chance of injury to that one particular muscle.

Finally, the muscles that tend to be the most likely to be torn or injured are the ones that traverse multiple joints. So for example, there are really, really long skinny muscles that will traverse not only the hip but also the knee, and those are the ones that are going to be the most likely to be injured. So those are the ones that you're going to want to stretch and have good blood flow to before competition.

Host: Chrissy Billau:

So what are a few suggestions for ways to warm up? Are we just talking about stretching your muscles or getting your heart rate going too, like a little bit of walking or something?

Guest: Dr. David Sohn:

Yeah, so it would be both. So stretching is important to get your joints limber. But yeah, some light sprints, some jogging. This is going to get your muscles loose, it's going to get blood flow to the muscles, and it's going to get them to coordinate their activities.

Host: Chrissy Billau:

How long do you need to stretch out before you start something? I mean, we're talking about touching your toes or grabbing your foot with your arm and getting your thigh there. I mean, how much time do you have to commit based on what you're doing?

Guest: Dr. David Sohn:

It would depend on your activity. So when you think about something like football, in football you're using all sorts of different parts of your body for all sorts of different things, so you're going to want to stretch everything. You're going to want to stretch your elbows, you're going to want to stretch your shoulders, you're going to want to stretch your back, you're going to want to stretch your glutes, and your hamstrings, and everything. You're going to want to do light sprints, forward, sideways, backwards. You're going to want to do all those things. What if you're just jogging? Probably it's good enough just to stretch your calves and stretch your hamstrings. And so it really depends on the activity.

Host: Chrissy Billau:

Okay. And the other side of this, cooling down. Why is that important?

Guest: Dr. David Sohn:

So in cooling down, that's a good opportunity to stretch. Activity inherently causes some inflammation. Think of a pitcher, maybe they've thrown 70 pitches. That puts a lot of inflammation on your shoulder. You're going to want to get rid of that inflammation because inflammation leads the stiffness. So this is why icing is helpful, but it's also why this is a good time as you're cooling down to stretch, because whatever you've used a lot. Like a sprinter, you've done a lot of sprinting, your hamstrings have inflammation. If you just let that go, that inflammation will cause stiffness in the hamstrings, so that's the time that you're going to want to use to stretch and help prevent that stiffness.

Host: Chrissy Billau:

Can you cool down just by walking back to your car? Say you're at the park. I went to one of the metro parks and I ran the trails for a little bit. Is it enough just to walk back to my car and drive home?

Guest: Dr. David Sohn:

Again, if all you've done is just some light jogging, yeah, that's probably actually good enough because you've probably not generated all that much inflammation. On the other hand, if you've been doing sprints, like wind sprints up a hill or something like that, you're probably going to want to spend some time doing some stretching and a more formal cool down.

Host: Chrissy Billau:

Okay. As you make your plan and you move forward and you want to do great and you want to push your body to its limits and be able to do things you couldn't do before, at what point is it not helpful to push yourself and listen to what your body is telling you versus pushing yourself to do more? I mean, you always hear, like you do the training apps like, "You have to be uncomfortable, make yourself uncomfortable." Well, what's the point where you're like, "I think I went a little too far today"?

Guest: Dr. David Sohn:

That's such a great point. You really do have to listen to your body. You have to listen to your body because if you don't, that's how things can kind of spiral out of control. So I think a general rule is it's okay to push yourself towards discomfort. That's okay. I mean, you want to push yourself and improve, but if you're pushing yourself to the point that you're actually having pain, something's going to happen, something's going to happen, even if it's as simple as that inflammation from pushing yourself is causing undue tightness or overuse of another part of your body.

Believe it or not, when I see a pitcher, if I see a pitcher who has some type of injury to his or her shoulder or elbow, almost always, almost always, there was something that predated it, not even in the shoulder. They tweaked their back or they sprained their ankle, or they had a hangnail in their great toe, something like that that causes them to shift to other parts of the body, to shift the load, and then that leads to some type of problem. So that's why it's important to listen to your body and not just try to always push through things.

Host: Chrissy Billau:

We try to give people some different news, you can use some kind of tips that are a little out of the box that you don't normally hear. Is there anything, and it's okay if there's nothing, something people can do to prevent an injury that you don't really realize might help you?

Guest: Dr. David Sohn:

I would say the big thing is I feel like people are very good at thinking of being aware and wanting to be better at physical fitness. I think of fitness as a tripod. People think a lot about cardio, and that's an important leg of the tripod, and people know about muscle training and the effects of muscle strength in anti-aging, so people are very aware of that, but people don't think about flexibility. But that's really the third leg of your tripod because flexibility is what's going to help prevent pain and flexibility is going to be what helps prevent injury. And that's going to be the thing that's going to allow you to keep going and to stay in the game, flexibility.

I mean, if I see somebody who is very muscular in the gym, one thing that I'm pretty sure about that person, that person's listening to their body, that person's also maintaining good flexibility because if they don't, they're probably going to have too much pain to keep being able to effectively weight train and keep building. And so that's the thing I would say. I would say think of fitness as a tripod and don't only do cardio, don't only do muscle training, but remember to do flexibility as well.

Host: Chrissy Billau:

So is that like do your yoga where you're doing the splits or something, or how can someone become more flexible?

Guest: Dr. David Sohn:

So yeah, one good way to think about it is to have a stretch day. People will think, "Okay, today's leg day, today's arm day, today's my cardio day." Well, have a stretch day. I mean, most people will know that the way the body works is you push your body, but then in order to make gains, you have to have a rest day. Use that rest day for stretching, but work that into the rotation, a rest and stretch day.

Host: Chrissy Billau:

I love that tip. So how do you know if you're at particular risk for injury? I mean, you're a little bit overweight? Is that something?

Guest: Dr. David Sohn:

I actually think that if you try to do too much too fast, those are the people who I find will have injury. They set a goal like, "Oh, I really want to run this particular marathon," or something like that. But we talked about in the earlier part, they haven't been active and then they start to do it and then they push through pain. Those tend to be the people who tend to have injuries or people who try to push through an injury. And this is more for the athletes. And like we talked about, we see this a lot in baseball throwers. They tweak their knee or something, or they sprain their ankle. Now they can't push off.

A good baseball pitcher is going to generate their power in their lower body and then control that force and accelerate it with their upper body. If you're robbed of some of that power because of something wrong in the lower body, then they try to make up for it with their upper body and then they put more stress on their elbow or shoulder than they should, and that's where injuries happen.

Host: Chrissy Billau:

Hydration. And we've touched on the importance of it for athletes in the past on this podcast. We talked with Dr. Coral Matus on how much water you should be drinking a day, and it should be eight glasses, but at this point in training for athletes who are getting back into the game, how should they be handling their hydration?

Guest: Dr. David Sohn:

Well, I'm glad you asked that because one thing that we really should also keep an eye on is the possibility of heat stroke. We're not there right now. Right now we're at the end of March, but particularly with organized competition, something that surprised me when I researched and found this out. Did you know that every year, statistically, there will be a high school football player who will die of heatstroke?

Host: Chrissy Billau:

No.

Guest: Dr. David Sohn:

Every year somebody dies of heat stroke. So it's a very important thing to be hydrated and to have measures in place to particularly an organized competition, something like football, having ice available, having people who know the signs and symptoms of heat stroke, ready and able to address that. To answer your earlier question, the best way to know if you are drinking enough water is actually the color of your urine. Urine should be light, it should be light. It should be either clear or very light yellow. If it's not, you're not drinking enough. And I find that that's actually going to be a better measure than to say, "Well, I should drink seven or whatever." Because different people will have different levels of activity, different sports have different levels of activity. The truth will be in your urine.

Host: Chrissy Billau:

Now, is water the best option or should you consider Gatorade or just adding fruit to your diet? Could that help? What's the best angle?

Guest: Dr. David Sohn:

Yeah, so that's another interesting question. So here's interesting about our body's ability to absorb water. We have difficulty absorbing water if there's not some solute, some sugar or some salt. It's difficult for our body to absorb that water because that's how the transfer system works in the colon. It's salute-driven. That said, very rarely are you going to have somebody who is not eating at the same time that they're drinking water. So you do not have to drink Gatorade to get it to absorb. If you've eaten a sandwich and then you drink water, there'll be plenty of solutes in the lunch or the snack that you ate. So it's not going to help you really hydrate any faster to drink something like a Gatorade. It's more important just to drink something. But if you like the flavor better and it's going to make you drink it better, go ahead.

Just know that there's a saying, every calorie counts. So there are calories in most drinks. And so if that's part of your health plan to monitor that, just don't forget that there are going to be calories. And also for our younger females, remember what we talked about earlier, you only have up until age 25 to pack on as your lifetime supply of calcium in your skeleton. So I would avoid drinks that have phosphoric acid like Coke, diet Coke, root beer. I would avoid them.

Host: Chrissy Billau:

At what point, if you notice something's off after a game, should you call your doctor or should you just rest?

Guest: Dr. David Sohn:

Yeah. So you should never really have any fear to just call a doctor. As a physician, I am never like, "Oh, that was so stupid of you to come in." I mean, doctors just don't think that way. And so when in doubt just go see your doctor. But just some signs, the danger signs, swelling. There are benign things that can cause swelling, but in general, swelling is a concerning thing. Instability. "I can't trust this knee, I can't trust this shoulder." That's a bad sign. Motion that gets stuck. "I'm moving my knee and all of a sudden it seizes up." That's a bad thing. Anything mechanical. Our joints are supposed to have smooth, easy motion. If there's a lot of crunching and popping and Rice Krispies in that motion, and that's new. If that's new, that's something to be concerned about.

And finally, rest pain. Things like tendonitis, I mean, tendonitis is not really a serious thing. You can play through tendonitis, it hurts, but it's safe to play through it. Tendonitis doesn't hurt at rest, Tendonitis hurts with activity. So on the other hand, if you have something more serious like a meniscus tear or something, that'll hurt even at rest. So if you have some pain at rest, that's a danger sign.

Host: Chrissy Billau:

If you're injured, how long until you get back in the game or start back up again?

Guest: Dr. David Sohn:

The return to sport criteria and the time depends on the injury. There are some injuries that you can return in a couple days. There are some injuries that will take three weeks. I mean, different things will have different times. But as a general rule, in order to safely play a sport, your pain level has to be two out of 10 or less, you have to have full range of motion, and you have to have full strength. So for example, I sprained my knee, is it safe for me to go back and play? Well, if it's hurting, that means it ain't healed, not safe to go back because then you could all of a sudden turn something that's a grade-one injury. Grade one means that it's self-healing. To a grade three, which means it's completely torn and now it needs surgery to be reattached. That can happen.

So obviously if it's something that is still hurting, that's a sign, it has not fully recovered. But also, if you don't have your full motion or full strength, not only is that particular joint at risk for future injury, but another one is too. A lot of times what happens if someone returns to sport too soon, it's not that they re-injure whatever has been injured, it's that they injure something else because they're trying to protect it or they're trying to overcome or overcompensate. So to return to sports safely, your pain should be two out of 10 or less, you should have full range of motion, and you should have full strength.

Host: Chrissy Billau:

All right. Well, the next question, it's a two-parter, my favorite. What is the most common question you get from patients and what is your answer?

Guest: Dr. David Sohn:

Let me think about that.

Host: Chrissy Billau:

When can I go home?

Guest: Dr. David Sohn:

Well, actually, I think the most common question I get is, "How much time will I need off from work?" And so obviously that's surgery specific, but as a general rule, it depends on the demands of your job. So sedentary or desk work jobs, most of the time you only need a week or even a long weekend off before you can do that, whether it's a shoulder surgery, a hip surgery, or a knee surgery. If you have to have a job that involves you doing something but not heavy lifting, that's usually six weeks. So for example, if you are like a restaurant greeter and all you really have to do is carry the menus and say, "Come this way," but you have to stand and you have to walk. If you've had a lower extremity surgery, chances are that you are going to want to take six weeks before you go back.

Now, if you're construction, not only are you standing, not only are you walking, but you're carrying beams and things like that, logs or beams of steel or something like that, you better make sure that you have recovered full strength. So that person, you're probably going to need 12 weeks off. So that's kind of a general rule of thumb.

Host: Chrissy Billau:

I like that one. Now, if you are hurt, I guess one of the final questions going out of here is how do you know whether to call your doctor and go in a few days or go to the ER?

Guest: Dr. David Sohn:

Okay. So here are the things, at least in my world, orthopedics, where you want to be seen within six hours. The first is called compartment syndrome. Compartment syndrome is where a part of your body is experiencing so much pressure that blood can go into that limb, but blood cannot come out of that limb. So then what happens is you then have this vicious cycle where blood keeps pumping in and pumping in, tighter and tighter and tighter to the point that the muscles and the nerves in that extremity die. So we're going to see a compartment syndrome in situations of fracture or in situations where a cast is too tight. So a cast is supposed to make someone feel better, if a cast is causing pain, you better go in.

The other one are infections. If you got some kind of really bad infection to the point that you're spiking really high fevers and here's a really, really dangerous thing with an infection, if all of a sudden the skin around an infection becomes hard, that's an emergency. So those are the two broad things that, and obviously things like dislocations or things like that. But yeah.

Host: Chrissy Billau:

Okay. How can people schedule an appointment with you?

Guest: Dr. David Sohn:

Well, just call. So I think there's a misconception that you need to be referred by another doctor to see a specialist. At least with my practice, that's not true. Just call. At our orthopedic center, we have guys who are specialized in foot and ankle, guys who are specialized in hand, guys who are specialized in hip replacement, knee replacement, guys who are specialized in spine or fracture care. So that main number is (419) 383-4878, and you don't have to have a referral or something like that. And one nice thing about us is we really, really, really, really try to have, if you call, to give you the option to see somebody within 48 hours. It might not be able to be the exact person that you have asked for, but we really try to have you be able to see somebody within 48 hours.

Host: Chrissy Billau:

Well, Dr. Sohn, thank you so much for your time and your expertise.

Guest: Dr. David Sohn:

You're welcome.

Host: Chrissy Billau:

That's all for this episode of Prescribed Listening. Tune in next time and subscribe for more on Apple Podcasts and Spotify.