Virtua Health-Kristen Herrmann interviews Dr. Christoper Chong aboutSports Medicine
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00:00Hi, and thank you so much for joining us. I am Kristen Herman, and with me virtually is Dr.
00:04Christopher Chong, a board-certified physician in family medicine and sports medicine at Virtual
00:09Health. Hi, Dr. Chong. Hi. So we are getting into winter, and a lot of people, you know,
00:14are thinking about New Year's resolutions and about maybe they got new sports equipment for
00:19Christmas, things like that. Trying out some new exercises, there's always a risk for injury,
00:24and that's where you come in. What exactly is sports medicine, and how does it differ
00:28from treating other types of injuries? Sure. Yeah, thanks for having me on. You know,
00:33it's interesting. Sports medicine has always been, I feel like, a misnomer, right? You know,
00:37where a lot of patients think, oh, I'm not a varsity athlete. You know, I don't do professional
00:45CrossFit or anything. Sports medicine isn't for me. And, you know, I see my role as a sports medicine
00:52physician as restoring function, right? And that can span many different categories. It can be
00:58that elite athlete, right? That's trying to, you know, go to a D1 college. But it's also,
01:04you know, the grandma, the grandpa that wants to run around with their grandkids, right? It's the,
01:10it's the landscaper that wants to be able to, you know, run his business without any issues,
01:17right? And so that's kind of how I more see it, right? Is a restoration of function to whatever
01:23activity. And it could be high level athletics, or it could just be, I want to go for a walk around
01:28Cooper River, you know? So that's kind of who I see, you know, that I'm a good option for folks who
01:35are limited in function, and want a restoration of function across a variety of different activity
01:42levels. And there are definitely more of us than there are the Tom Brady's out there, for sure. There
01:47are more regular folks that just want to be able to exercise and stay in shape, maybe, but
01:51not necessarily be practicing seven hours a day like those guys, and we get injured too. So I know
01:58you have a big background in sports medicine, you know, you've covered the Rock and Roll Half Marathon,
02:03the Marine Corps Marathon, the Philadelphia Marathon, but then also Philadelphia Union you've worked with,
02:08Widener University, the football program at University of Delaware. So I'm sure you've seen
02:13basically everything as far as these common types of sports injuries go. What are the most common
02:18conditions that you see? Yeah, so I see a lot of knee and shoulder issues, right? A lot of,
02:27you know, because if you think about just our daily activities, right, we're always walking,
02:31we're always climbing stairs, we're always using our hands, lifting overhead. And so those are very
02:37common type of injuries that I see, even amongst the non athletes, it's still going to be primarily a
02:42lot of knee issues, a lot of shoulder issues. And, you know, the different diagnoses that fall into
02:47those categories will vary by age, right? You know, in the younger folks, more, maybe different
02:53types of tendonitis, patellar tendonitis, IT band friction syndrome in young runners, when it comes
03:00to the knee, and then as you know, folks get older, then we're looking at more knee arthritis,
03:05maybe even some degenerative meniscal tears. And then for the shoulder, you know, rotator cuff
03:11tendonitis is a common injury throughout all ages. But you also have more sports related issues like
03:19labral tears, even different muscle components, bursitis, stuff like that. So in terms of the
03:25joint, I think it's primarily the shoulder and the knee, but those diagnoses will vary based on the age
03:30of the patient, the activity, so on and so forth. So you're listing a bunch of those there. And then
03:37I've heard of most of these, but I don't really know what all of them are. Like, what's the
03:41difference, for instance, between like a sprain and a strain? Sure. So a sprain is more when we're
03:50talking about a ligament, right? So a ligament is a structure that connects bones to bones. And so
03:56when you say, oh, I sprained my ankle, what we're really getting at is you've injured that ligament in
04:03the ankle that is commonly injured when you turn that ankle, right? A strain is more muscular related.
04:10So a hamstring strain is, you know, you know, you see it in people who run, people play soccer,
04:18and that's a muscle type of injury. Both of these are small types of tears, right? So a sprain is going
04:27to be a small tear in the ligament, and a strain is going to be a small tear in a muscle. The difference
04:33is kind of the structure that's injured. And as far as recovery time for both of those,
04:38is it kind of similar recovery time? Yeah. So recovery, recovery is variable,
04:42because, you know, there's, you know, it's really individualized. I think that's a good,
04:48you know, takeaway home, like in sports medicine, it's so individualized to the person, right? A
04:56recovery for a non-athlete is going to be vastly different in terms of like, you know, end goal
05:03for the athlete, right? And so, so there's a difference in terms of kind of what the goal of
05:09the individual is. And there's also a difference in terms of age, severity of injury. So it's tough
05:16to really exactly pinpoint that for you. You know, but I think the key is, it's just so individualized,
05:23but I think that's also what makes sports medicine so great is you can have different end goals
05:28based on, you know, the patient that you're working with. That's why you see a sports medicine doctor
05:33so they can treat you specifically. And as far as a common, like an overuse injury, you would think
05:40that people like Tom Brady or people that are working out all the time that they would have this
05:44constantly. But I know everyday people that get this too. What exactly is an overuse injury? Is it just
05:50using it too much? Yeah. And overuse it, that is a good way to explain it. And really what it comes
05:59down to is repetitive movements, right? And oftentimes it's repetitive movements that are not
06:06backed by adequate muscle strength and technique, right? And so, you know, you see this in people who
06:14play no sports at all, maybe who just work at a desk job and they're typing, right? And they're just
06:20but maybe the ergonomics are off, right? We've seen this a lot ever since the pandemic, people are
06:24working from home, they're camping out on their dining table and it is just not adequate, right?
06:30And so you've got like, their wrists are too high and they're just typing over and over again. And
06:34you develop tennis elbow like that, even though they have never even picked up a tennis racket. So
06:39I think overuse injuries occur when you have a repetitive movement that's being used
06:45and that movement is not optimized, right? When you talk about Tom Brady, you know, throwing a
06:50football, his technique is, you know, he's been honed over, you know, multiple decades. He's probably
06:57got a very good strength and training program to keep the shoulder, the shoulder blade muscles,
07:02the rotator cuff muscles fully functional, making sure that, you know, he's doing sleeper stretches to
07:09make sure the capsule is loose, right? So for someone like him, even though he's throwing,
07:13you know, hundreds of times, he's optimized that movement versus, you know, someone that
07:19maybe isn't even playing a sport, just, you know, a painter that, you know, is not thinking about,
07:24you know, oh, I need to, yeah, I need to, you know, maintain adequate rotator cuff strength or
07:29posture with the shoulder blades. You know, those are the folks that you see injuries, overuse injuries.
07:35And to see a doctor, I mean, I, as a painter, I wouldn't really know, I know I have to do that
07:39one movement all of the time, but to see a doctor to strengthen other parts of my body that will help
07:45me to not injure myself that that's really interesting. And I should have chosen an eagle
07:50now that I think of it, I should have chosen rather than Tom Brady. So, you know, scratch that
07:56eagles player insert eagles player there. But I selfishly I have, I guess this is a repetitive
08:01motion thing. I I'm a lazier exerciser lately, I've been trying to just kind of walk on the treadmill
08:07while watching television, which, you know, I can watch one show and do like five miles just
08:12walking. But maybe like a month ago, my left ankle just started hurting like the heel of my foot.
08:18And every time I get on there, it does that, but it doesn't bother me in everyday life. You know,
08:22I can come to work and it really doesn't hurt until I try to get on the treadmill again.
08:27And I don't know if it's just my, I don't want to exercise maybe, but it doesn't seem like
08:33something I need to see a doctor for, but you know, a month later, it's still bothering me.
08:37Is that something I would go see a sports medicine doctor for?
08:41Absolutely. Yeah. You know, I think the beauty of what we do is, like I said, right, you,
08:49maybe you have goals to be more active. And now your function, you're losing function,
08:55you're losing the ability to walk on a treadmill regularly. Right. And so I think, absolutely,
09:00that's something that, you know, we would be able to see you for, examine you, you know,
09:05I think the key is so much of orthopedics and sports medicine is the physical exam,
09:11right? It's actually getting hands on the patient, moving their ankle, kind of palpating certain
09:18structures, checking certain aggravating factors, right? Like, you know, weak glutes cause really bad
09:26knee pain in runners. So it's, you know, it's, it's getting a full look at the patient. So then we can
09:31kind of put together like a comprehensive plan to not just get you back to sport, but keep you there.
09:37Right. So you don't get injuries. So absolutely. Yeah. That's definitely something that we see
09:42regularly. I was just going to like join the Y and start swimming, just like switch sports all
09:47together. Just like, I can't walk down. I'll do this. I might go see you. And then, you know,
09:53talking about fractures with fracture, I think I know you, you have to see a doctor because is that
09:58something you need an x-ray for? Yeah. Most of the time, you know, x-rays are really good at
10:03evaluating bone structures and fractures are bone injuries. Right. And, and yeah, um, I definitely
10:09think, uh, seeing a physician, even if there's a concern for a fracture is super important because
10:15fractures do heal if they are adequately treated. Uh, most of the time it's going to be some type of
10:21immobilization, um, and it's gotta be immobilized correctly. And ideally in a timely fashion, um,
10:27because, you know, if the fracture is not immobilized in a timely fashion, you can develop
10:31issues with the bone kind of healing later down the road. If it's just been undiagnosed for months
10:36and months. Um, so definitely getting a, getting a picture, if there's any concern, it is definitely
10:42something that's going to be really helpful. And would you know, if you had a fracture versus
10:47one of those common injuries that you talked about or the overuse injuries, anything like that?
10:52Sure. Yeah. Um, I never want to just, I never want to encourage kind of, um, Dr. Google or patients
11:02just kind of trying to figure things out by themselves, but I will say there are some, um,
11:08loose guidelines again, you know, definitely if there's any question, go see a doctor, but,
11:14you know, definitely with a lot of, um, if there are any, if there, if there is a concern for a fracture,
11:20oftentimes even just pushing on it is extremely painful. Right. And that's kind of one of the big
11:25things we go by. And so obviously if you push on it and it's, you know, you're seeing stars,
11:30probably something to go get checked out, um, inability to do just regular function, you know,
11:36so like your example, right, where your ankle hurts, but only when you're walking on treadmill,
11:41you can walk other, you know, you can go to work, you know, again, you know, the history is less
11:48likely, but again, you know, still something to get checked out. So the fractures, there's a
11:51consistency every time you touch it, every time you use it, man, it's, it's going to be uncomfortable
11:57for you. Um, typically, you know, with a lot of swelling as well. Okay. But again, those do not
12:03replace x-ray and actually having a physician lay eyes on you. Right. And like you said, you don't want
12:09to make it worse and you don't want it to last a really long time, but it does get worse. And I know
12:13sports medicine doctors use the acronym RICE pretty often. In fact, I've had doctors tell me to
12:18RICE it. They almost use it like a verb. What is RICE? Yeah. So RICE stands for rest, ice,
12:25compression, and elevation. And what that's getting at is when injuries initially happen, the,
12:33what's actually happening at the chemical level is very different than say you've had this injury for
12:39like six months, right? It's very different. And so when you first develop an injury, that's
12:46typically going to be highly inflammatory, right? Like an acute tendonitis, um, is probably the ideal
12:53example. And for that type of issue where it's acute, meaning very recent, you know, recently just
13:00started feeling it, those modalities of resting. So avoiding the aggravating activity, icing it to
13:06decrease inflammation, compressing it to minimize the swelling and elevation to kind of, again,
13:12deal with the swelling. Those are, those are good kind of just general safe. You're never going to
13:19cause more damage by doing that. Right. So those are just some, some ways to, you know, if those four
13:27things can kind of completely take away the pain, then, then, you know, maybe it saves a trip to the
13:33doctor, right? A lot of orthopedic things kind of don't necessarily require someone to look at,
13:38you know? And so I think that is a good place to start, um, for acute injuries, definitely.
13:43An initial injury, anything with inflammation or if you're swelling, you know, it certainly couldn't
13:48hurt to rice it first and then go see the doctor or maybe just go see the doctor right away. And,
13:54and with a lot of people, you know, maybe returning to the gym in January as we do, uh, as I do,
13:59and, you know, maybe for Christmas, they got a new elliptical or a Peloton or something, and they're
14:04trying new things. How, what are some tips you have to help prevent injuries in the first place,
14:10especially with trying something new? Sure. Yeah. Um, I think the most important thing I would say
14:17is how you're getting into that activity, right? Um, probably the most common mechanism of injury
14:25that I see is too much too quick. Right. And so, you know, this is someone, you know, new year comes
14:32and they're, they have these aspirations. They've never run before and they go out and they try to
14:38run three miles. That is just a recipe for injury. Right. And so depending on the sport, um, kind of how
14:46you build into it is extremely important. And so there's a, there's an importance of how gradually
14:53you are ramping up the activity, whether it's lifting weights, whether it's running, swimming,
14:59um, you know, whatever it might be, uh, really kind of making sure you increase the intensity and
15:07frequency extremely slowly is going to be one of the, one of the main kind of foundations of avoiding
15:13injury. Um, and then the second thing is actually also, um, having variety to the exercise, right? Um,
15:21again, we see this in, in high school athletes and, you know, as the evidence is really panning out
15:27when, when these young kids start specializing in one sport at six years old, they just get injury
15:34after injury at like, because they're just using the same muscles and everything. And so that's what
15:40we, you know, we, we kind of see as like sports diversification where there is a, you're cross
15:47training, um, you're playing different sports that require different muscles, um, to give certain
15:53muscles rest, you know, throughout a calendar year. And so, you know, the average kind of, you know,
16:00weekend athlete can take that and almost break it up in their week. Right. And so, you know,
16:05kind of running seven days a week, you know, a ton of miles is probably not going to be a great idea
16:12to start off, right. You know, having rest days where you run on Monday, take Tuesday off, uh, you
16:19know, maybe you cross train on Wednesday using the elliptical and then doing another one on Thursday.
16:24So really kind of having variety in the week is also really going to help, uh, avoid injury.
16:30This is such great advice. You know, the variety, especially, and you see like football players or
16:34sports teams, you know, when they're warming up, even they're doing things that have nothing to do
16:38with what they do in their sport. You know, they're not just throwing the ball around all the time.
16:42They'll be skipping and jumping and hopping and all of that for preventative, uh, work for
16:47preventing an injury. And you know what, the, the not overdoing it right away, I think is the best
16:52the tip that you can give me. Cause I'll, I'll go to the gym and I'll join like one of those group
16:56classes. And then the people next to you, you're sort of like competing with the people next to you.
17:00And they've probably been lifting all year round and not just in January as the new year's
17:05resolutions start. So good, good to just walk before we run as they say. And, um, because this is a
17:12specialized brand of medicine, you know, do you need a referral to see a sports medicine doctor?
17:16Would I need to see my primary care physician first before trying to go and see you?
17:21Sure. Yeah. I think a lot of that will depend on the insurance, right? So, you know, again,
17:25certain insurances require, uh, a referral from a primary care doctor, other insurances, you know,
17:30you know, where it's kind of, uh, you know, you can just kind of go and see a specialist without a,
17:36a referral. So I think that'll be something to, uh, talk to your, if there's questions about that,
17:42you can always talk to your private care doctor, talk to your insurance company, um, to make sure
17:46you kind of go through the appropriate channels. Yeah. Gotcha. And, um, there's so many great tips
17:52in one conversation and I'm taking a lot of this myself and just kind of soaking it up. Well,
17:56thank you so much for talking with me, Dr. Chong, uh, so many different tips all in one conversation,
18:01and I definitely soaked it all up. So for more information or to schedule an appointment with a
18:05virtual sports medicine physician, anyone can check out virtua.org slash sports medicine.
18:10And thanks again for talking with me and for all of the great tips. Thanks so much for having me.