September 23, 2024 • 11 mins
More Orthro talk at HHC's Bone & Joint Institute
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
So what do you think we're talking about in.
Speaker 2 (00:02):
X I'm talking about me. These are questions about me
personally as a superstar. Let's get back to the Rob
Dibble show.
Speaker 1 (00:15):
All right, we're back.
Speaker 2 (00:17):
It is bon and Joint Party here Wednesday at the
Bone A Joint Institute, Harvard Healthcare joining us on the line,
Doctor Carl Nissen, Orthopedis and doctor Misson. How are you.
Speaker 1 (00:30):
Do it? Fine? Thanks? How about yourself? Good?
Speaker 2 (00:32):
So what surgeries right now? Are you probably doing the
most on a week to week based Yeah?
Speaker 1 (00:38):
What's hot?
Speaker 2 (00:38):
What's hot? What's what's the biggest injury out there?
Speaker 1 (00:43):
Yeah? Well, from a surgical standpoint, the biggest injuries are
still nees, just like it has been for years and years. Unfortunately,
the A scales are are happening already in meniscal tears.
But for myself personally, I've actually this early season high
school in college has been some of the some of
(01:03):
the slightly different injuries and hips and actually some elbows
even though you actually see those in baseball. We've seen
a few UCLs from lineman trying to arm tackle and
a little bit different from a surgical standpoint, at least
from my bandage points so far this year.
Speaker 3 (01:19):
So you're saying, I'm maybe a linebacker, maybe an offensive lineman,
trying to get a little hold action reaching his arm
out at a you know, a fast paced split second
reactionary and what is that actually doing? How is that
damaging the elbow?
Speaker 1 (01:36):
So it just twisted. So the elbows, as you know,
is like a little bit like a door hint. So
it really doesn't have any rotation built into it. So
if you get it caught levered between two players or
trying to catch running backs they're going past, and it
gets actually bent at the elbow, I mean, obviously you
could break a bone, but if you catch it just
(01:57):
the right way, you can put the property the proper
force or improper forces in case, I mean, you can
actually tear either the inside or the outside. U s
l on inside and the helpl on the outside.
Speaker 2 (02:09):
I know we've talked to a lot of you guys
about the internal brace that you're now putting into. Are
you putting internal braces into these youngsters or is this
more for like, uh, you know, a Trevor story, a
Trevor story a professional kind of athlete. Is there any
timetable on when you're you're thinking about using one.
Speaker 1 (02:32):
Well, so there's probably no timetable with one exception that
added skeletal maturity. So you probably even though you could
use an internal brace and somebody that's scales the immature.
At least for me, most of the time you're you're
drilling a hole close to the growth plate, and if
you do damage the growth plate, we give a lifelong
problem to the youngsters. So that's that's probably the one.
(02:55):
Doesn't mean you can't use it, You just have to
be really careful. For myself, I don't use it in
the skill of the immature for that reason, but also
because I think a heal young folks heal so well
that if you do a repair or if you do
a reconstruction, you'll get a good result. It'll be durable,
it lasts a long time.
Speaker 2 (03:12):
Talking to doctor Carl Nissan of the Moon Joint Institute
and Heart of Healthcare, Well, you know, I'm in my
third season right now, spring summer. I'm into the fall
with pitchers. I don't love it, and I try to
limit them on pitching. Can you explain I'm in sixteen
U seventeen you baseball games right now? Explain growth plates
to the listeners and their parents on how important it
(03:35):
is to limit a lot of these young athletes because
they're still growing.
Speaker 1 (03:41):
Yeah, so you know, we've learned, we've learned a lot
over the past. However, many here since you know, the
folks in California, Doctor Joe taught us what a UCL was,
and you can injury at UCL with a single event,
you know, like the football players that we just discussed.
But when you talk about baseball players, rarely is it
(04:04):
just one throw, or even if it's just you know,
ten throws with bad mechanics, it usually it takes a
lot more than that. So if you start to especially
in the younger folks, if you start to throw more
than ten times your age throws in a day or
in a game, you're really putting yourself at risk. And
(04:24):
the weakest part of the system, of the of all
of our muscular scull systems when you're growing, is the
growth plates. The gross plate itself is not fully fused.
It's not normal bones, so it doesn't have that firmness
that the rest of the bone around it does. And so
if you continue to throw, you could have a ligament injuries.
So you could do that, but you also repetitively stress
the growth plates, and that is probably it was best
(04:48):
seen in gymnasts in their risks. The gymnasts, as you know,
where they're competing at younger and younger ages, and when
they were hitting the vaults and hitting, you know, doing
incredible aerials but launching himself off of their arms, gymnasts
started to come up with wrist problems as the growth
place really was badly deforming. And so that kind of
started us all thinking and realizing that the same stress
(05:10):
can put up he put on a thrower's arm, and
the first place that happens is usually around the shoulder.
Was some rotational problems little league or shoulder it's referred
to it as, but it also can absolutely happen around
the elbow. Sometimes you don't see it for a long time,
but overuse and throwing too much, not just during the game,
but a week in a season, or for that matter,
over a year, like you just mentioned the third season
(05:31):
you're entering can lead to a long long term problem
and bonestone. Once they start growing abnormally, it's really hard
to put them back on the right course.
Speaker 3 (05:41):
We watched a lot of Little League World Series this summer.
I don't know if you did, Doc or not. These
are twelve and unders, and the pitchers that we saw
this year more than ever, everyone, not just one guy.
Everyone are throwing curves and some of these pictures, man,
that's all they had in their bag was just nothing. Curveball, curveball,
(06:01):
curveball again, Doc, twelve years old. What's your curveball rules
for youngsters?
Speaker 1 (06:08):
Yeah? So the so from a medical point of view
at least, the curveball rule for me is, if you
can throw it with normal mechanics, go right ahead and
throw it. Because if you're twelve and you throw it
with perfect mechanics, the curveball is slower than a fastball.
So just by the pure stress you know, inverse dynamics,
so the weight of the ball, the speed of the
(06:28):
ball being exerted back on your arm. If you have
perfect mechanics, you can throw a curveball more safely then
you can throw a fastball. The problem is is that
those young twelve year olds you're talking about, when they
start throwing you know, obviously they call it a hook.
It's not supposed to throw a curveball at age twelve,
but they started throwing those. Yeah, or the sweeper, right,
(06:51):
And that's because that's what the pros are calling them.
So if you start throwing those things, if you have
if you throw a slurve, so ball leaves between your
face and your thumb and it falls out as opposed
to pretty pure spin on the ball through your wrist,
that's not good mechanics and that does increase the stress
dramatically and definitely will increase the risk of injury, either
(07:12):
to goostplates or to the ligap.
Speaker 2 (07:15):
Well said, that's what I try to teach these kids,
especially at the younger ages, of not getting underneath or
around it to possibly hurt them. All Right, let's talk
about some of the other stuff you were talking about though. Knees,
a lot of injuries, the hamstrings, knees, things like that,
stretching and even the different fields that you have right now.
You've got like the phot turf and grass, so sometimes
(07:38):
you're going from sneakers to long spikes and things like that.
What's your what's your thoughts on proper stretching and warm
up for these young athletes.
Speaker 1 (07:52):
It's paramount for sure, And obviously, and you know this
as an athlete yourself, you got to do it, not
just for twenty minutes before game or practice. You're going
to do it after practice, you have to do it
on off days. You've got to make sure your flexibility
is not only present, but it's symmetric. So probably the
thing that patients are young patients especially hate to hear
(08:14):
me say because I say it over and over, is
that you've got to be symmetric. We all play sports.
You know, maybe baseball with arm injuries is a little
bit different, but almost all sports that is playing with
both legs and both arms. If you're not symmetric flexibility,
if you're not symmetric in your strength, it increases the
stress tremendously increases your risk of injury. That's been shown
(08:35):
over and over again, especially in the knees. Ham Strings
is probably the one that I'm seeing the most of
where folks have had a previous hamstring strain, and when
you examine them in their preseason physicals and whatnot, you
see a difference in maybe ten degrees of extension through
their hamstrings, and that just sets them up for a problem.
(08:57):
Nowther no matter how much they stretch dr here, they
don't spend the time to get to the metric flexibility.
They're going to end up with the problem. So symmetry
is not more important than flexibility, but it's it's, you know,
synonymous in my opinion, making sure we reduced an over
answering injuries. Obviously, we're seeing those all over the place,
the NFL seeing a few this year that's got people's sidelines. Certainly.
(09:19):
I've seen them both high school and college so far
this year.
Speaker 3 (09:22):
Talking to doctor Carl Nissan, orthopedic surgeon here at the
Boner Joint Institute Harford Healthcare. One thing that's kind of
been a good thing to see, even though these are
bad to see when they happen. Back in our day,
Dibbs and me included and ACL injury was a death
sentence to your sports career. Nowadays you can get an
ACL injury and we're seeing these guys play within the
same season. What's been the evolution of that. How has
(09:45):
that become from a death sentence to basically you can
get back out there in a couple of months.
Speaker 1 (09:52):
Yeah, it's I agree with you. It's amazing. I have
short white hair. Obviously you can't see that, but I
was around when it was a death fender that I
I can remember some of my my friends having acal
injuries and not having surgery just because they thought it
was never going to get better again. So they're walking
around with unstable needs. Now it's it's you know, at
least for young folks, it's almost unheard of not to
(10:13):
fix them. And I think it's not. It's not just technique.
It's not just understanding of the biomechanics or how to
fix the tending into a need to make a new ligament,
or even if you're starting to as you know, they're
starting to truly repair acls and putting internal braces in them,
no matter what your technique were better at those. But
(10:34):
I think it's all the other things that wrap around.
So it's the therapy that these kids are getting. It's
the exercises that we know they need as opposed to
the ones that they want to do. So we get
them off the couch and doing exercises, get them back
and start rehabbing them. So when they do get some
early healing, they have some initial healing of whatever the
graft or the internal brace or whatever it might be
(10:55):
that's started to heal, they've got they've got a baseline,
they're not starting from zero, and then they can start building,
and the therapist has done an amazing job. Athletic trainers
at the schools have done an amazing job to do
that with all these guys, and I think that's probably why,
even more than the surgical technique, that's why it's not
a death sense anymore.
Speaker 2 (11:15):
Doctor Nissan, thank you so much for a few minutes
of your time. We really appreciate it, and thanks for
all the great information you gave the people out.
Speaker 1 (11:23):
There my pleasure. Thanks very much for having me
So what do you think we're talking about in.
Speaker 2 (00:02):
X I'm talking about me. These are questions about me
personally as a superstar. Let's get back to the Rob
Dibble show.
Speaker 1 (00:15):
All right, we're back.
Speaker 2 (00:17):
It is bon and Joint Party here Wednesday at the
Bone A Joint Institute, Harvard Healthcare joining us on the line,
Doctor Carl Nissen, Orthopedis and doctor Misson. How are you.
Speaker 1 (00:30):
Do it? Fine? Thanks? How about yourself? Good?
Speaker 2 (00:32):
So what surgeries right now? Are you probably doing the
most on a week to week based Yeah?
Speaker 1 (00:38):
What's hot?
Speaker 2 (00:38):
What's hot? What's what's the biggest injury out there?
Speaker 1 (00:43):
Yeah? Well, from a surgical standpoint, the biggest injuries are
still nees, just like it has been for years and years. Unfortunately,
the A scales are are happening already in meniscal tears.
But for myself personally, I've actually this early season high
school in college has been some of the some of
(01:03):
the slightly different injuries and hips and actually some elbows
even though you actually see those in baseball. We've seen
a few UCLs from lineman trying to arm tackle and
a little bit different from a surgical standpoint, at least
from my bandage points so far this year.
Speaker 3 (01:19):
So you're saying, I'm maybe a linebacker, maybe an offensive lineman,
trying to get a little hold action reaching his arm
out at a you know, a fast paced split second
reactionary and what is that actually doing? How is that
damaging the elbow?
Speaker 1 (01:36):
So it just twisted. So the elbows, as you know,
is like a little bit like a door hint. So
it really doesn't have any rotation built into it. So
if you get it caught levered between two players or
trying to catch running backs they're going past, and it
gets actually bent at the elbow, I mean, obviously you
could break a bone, but if you catch it just
(01:57):
the right way, you can put the property the proper
force or improper forces in case, I mean, you can
actually tear either the inside or the outside. U s
l on inside and the helpl on the outside.
Speaker 2 (02:09):
I know we've talked to a lot of you guys
about the internal brace that you're now putting into. Are
you putting internal braces into these youngsters or is this
more for like, uh, you know, a Trevor story, a
Trevor story a professional kind of athlete. Is there any
timetable on when you're you're thinking about using one.
Speaker 1 (02:32):
Well, so there's probably no timetable with one exception that
added skeletal maturity. So you probably even though you could
use an internal brace and somebody that's scales the immature.
At least for me, most of the time you're you're
drilling a hole close to the growth plate, and if
you do damage the growth plate, we give a lifelong
problem to the youngsters. So that's that's probably the one.
(02:55):
Doesn't mean you can't use it, You just have to
be really careful. For myself, I don't use it in
the skill of the immature for that reason, but also
because I think a heal young folks heal so well
that if you do a repair or if you do
a reconstruction, you'll get a good result. It'll be durable,
it lasts a long time.
Speaker 2 (03:12):
Talking to doctor Carl Nissan of the Moon Joint Institute
and Heart of Healthcare, Well, you know, I'm in my
third season right now, spring summer. I'm into the fall
with pitchers. I don't love it, and I try to
limit them on pitching. Can you explain I'm in sixteen
U seventeen you baseball games right now? Explain growth plates
to the listeners and their parents on how important it
(03:35):
is to limit a lot of these young athletes because
they're still growing.
Speaker 1 (03:41):
Yeah, so you know, we've learned, we've learned a lot
over the past. However, many here since you know, the
folks in California, Doctor Joe taught us what a UCL was,
and you can injury at UCL with a single event,
you know, like the football players that we just discussed.
But when you talk about baseball players, rarely is it
(04:04):
just one throw, or even if it's just you know,
ten throws with bad mechanics, it usually it takes a
lot more than that. So if you start to especially
in the younger folks, if you start to throw more
than ten times your age throws in a day or
in a game, you're really putting yourself at risk. And
(04:24):
the weakest part of the system, of the of all
of our muscular scull systems when you're growing, is the
growth plates. The gross plate itself is not fully fused.
It's not normal bones, so it doesn't have that firmness
that the rest of the bone around it does. And so
if you continue to throw, you could have a ligament injuries.
So you could do that, but you also repetitively stress
the growth plates, and that is probably it was best
(04:48):
seen in gymnasts in their risks. The gymnasts, as you know,
where they're competing at younger and younger ages, and when
they were hitting the vaults and hitting, you know, doing
incredible aerials but launching himself off of their arms, gymnasts
started to come up with wrist problems as the growth
place really was badly deforming. And so that kind of
started us all thinking and realizing that the same stress
(05:10):
can put up he put on a thrower's arm, and
the first place that happens is usually around the shoulder.
Was some rotational problems little league or shoulder it's referred
to it as, but it also can absolutely happen around
the elbow. Sometimes you don't see it for a long time,
but overuse and throwing too much, not just during the game,
but a week in a season, or for that matter,
over a year, like you just mentioned the third season
(05:31):
you're entering can lead to a long long term problem
and bonestone. Once they start growing abnormally, it's really hard
to put them back on the right course.
Speaker 3 (05:41):
We watched a lot of Little League World Series this summer.
I don't know if you did, Doc or not. These
are twelve and unders, and the pitchers that we saw
this year more than ever, everyone, not just one guy.
Everyone are throwing curves and some of these pictures, man,
that's all they had in their bag was just nothing. Curveball, curveball,
(06:01):
curveball again, Doc, twelve years old. What's your curveball rules
for youngsters?
Speaker 1 (06:08):
Yeah? So the so from a medical point of view
at least, the curveball rule for me is, if you
can throw it with normal mechanics, go right ahead and
throw it. Because if you're twelve and you throw it
with perfect mechanics, the curveball is slower than a fastball.
So just by the pure stress you know, inverse dynamics,
so the weight of the ball, the speed of the
(06:28):
ball being exerted back on your arm. If you have
perfect mechanics, you can throw a curveball more safely then
you can throw a fastball. The problem is is that
those young twelve year olds you're talking about, when they
start throwing you know, obviously they call it a hook.
It's not supposed to throw a curveball at age twelve,
but they started throwing those. Yeah, or the sweeper, right,
(06:51):
And that's because that's what the pros are calling them.
So if you start throwing those things, if you have
if you throw a slurve, so ball leaves between your
face and your thumb and it falls out as opposed
to pretty pure spin on the ball through your wrist,
that's not good mechanics and that does increase the stress
dramatically and definitely will increase the risk of injury, either
(07:12):
to goostplates or to the ligap.
Speaker 2 (07:15):
Well said, that's what I try to teach these kids,
especially at the younger ages, of not getting underneath or
around it to possibly hurt them. All Right, let's talk
about some of the other stuff you were talking about though. Knees,
a lot of injuries, the hamstrings, knees, things like that,
stretching and even the different fields that you have right now.
You've got like the phot turf and grass, so sometimes
(07:38):
you're going from sneakers to long spikes and things like that.
What's your what's your thoughts on proper stretching and warm
up for these young athletes.
Speaker 1 (07:52):
It's paramount for sure, And obviously, and you know this
as an athlete yourself, you got to do it, not
just for twenty minutes before game or practice. You're going
to do it after practice, you have to do it
on off days. You've got to make sure your flexibility
is not only present, but it's symmetric. So probably the
thing that patients are young patients especially hate to hear
(08:14):
me say because I say it over and over, is
that you've got to be symmetric. We all play sports.
You know, maybe baseball with arm injuries is a little
bit different, but almost all sports that is playing with
both legs and both arms. If you're not symmetric flexibility,
if you're not symmetric in your strength, it increases the
stress tremendously increases your risk of injury. That's been shown
(08:35):
over and over again, especially in the knees. Ham Strings
is probably the one that I'm seeing the most of
where folks have had a previous hamstring strain, and when
you examine them in their preseason physicals and whatnot, you
see a difference in maybe ten degrees of extension through
their hamstrings, and that just sets them up for a problem.
(08:57):
Nowther no matter how much they stretch dr here, they
don't spend the time to get to the metric flexibility.
They're going to end up with the problem. So symmetry
is not more important than flexibility, but it's it's, you know,
synonymous in my opinion, making sure we reduced an over
answering injuries. Obviously, we're seeing those all over the place,
the NFL seeing a few this year that's got people's sidelines. Certainly.
(09:19):
I've seen them both high school and college so far
this year.
Speaker 3 (09:22):
Talking to doctor Carl Nissan, orthopedic surgeon here at the
Boner Joint Institute Harford Healthcare. One thing that's kind of
been a good thing to see, even though these are
bad to see when they happen. Back in our day,
Dibbs and me included and ACL injury was a death
sentence to your sports career. Nowadays you can get an
ACL injury and we're seeing these guys play within the
same season. What's been the evolution of that. How has
(09:45):
that become from a death sentence to basically you can
get back out there in a couple of months.
Speaker 1 (09:52):
Yeah, it's I agree with you. It's amazing. I have
short white hair. Obviously you can't see that, but I
was around when it was a death fender that I
I can remember some of my my friends having acal
injuries and not having surgery just because they thought it
was never going to get better again. So they're walking
around with unstable needs. Now it's it's you know, at
least for young folks, it's almost unheard of not to
(10:13):
fix them. And I think it's not. It's not just technique.
It's not just understanding of the biomechanics or how to
fix the tending into a need to make a new ligament,
or even if you're starting to as you know, they're
starting to truly repair acls and putting internal braces in them,
no matter what your technique were better at those. But
(10:34):
I think it's all the other things that wrap around.
So it's the therapy that these kids are getting. It's
the exercises that we know they need as opposed to
the ones that they want to do. So we get
them off the couch and doing exercises, get them back
and start rehabbing them. So when they do get some
early healing, they have some initial healing of whatever the
graft or the internal brace or whatever it might be
(10:55):
that's started to heal, they've got they've got a baseline,
they're not starting from zero, and then they can start building,
and the therapist has done an amazing job. Athletic trainers
at the schools have done an amazing job to do
that with all these guys, and I think that's probably why,
even more than the surgical technique, that's why it's not
a death sense anymore.
Speaker 2 (11:15):
Doctor Nissan, thank you so much for a few minutes
of your time. We really appreciate it, and thanks for
all the great information you gave the people out.
Speaker 1 (11:23):
There my pleasure. Thanks very much for having me
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