Mike Bisceglia here with the Cville Podcast Network, introducing Dr. Stewart Chang. Dr. Chang is a local sports medicine podiatrist, practicing at the Blue Ridge Foot and Ankle Clinic. Dr.’s Kevin Murray and Stewart Chang of the Blue Ridge Foot and Ankle Clinic have been serving the Charlottesville community in central Virginia for over 20 years. Dr. Chang is a board-certified surgical podiatrist; he is affiliated with Martha Jefferson Hospital and Augusta Health. He is presenting a series of podcast focusing on common sports injuries. Dr. Chang…take it away.

Dr. Chang:            

Hello everybody out there in Charlottesville podcasting arena, it’s Dr. Stewart Chang here. I’d like to talk with you all about some sports injuries. My plan is to do a series of podcasts that address some of the most common sports injuries that we see among folks in the running sports. That would be running, anything athletic involving the feet, court sports and things like that. All of these are very similar in the mechanisms in which they happen. I know that the people, and the folks here in Charlottesville are very sports-minded, and they like to stay healthy, so I thought that you all would like the opportunity to hear somebody who sees this on a daily basis, and talk about it, and give you some more information with regards to what these injuries are and how they occur, and what we, as medical professionals, do with them. All of these topics I’m going to talk about, you can certainly get a lot of information out there on the internet, if you’re that sort of person. You can also take a look at our website, we’re at the Blue Ridge Foot and Ankle clinic and our website is www.brfootandankle.com and we have a lot of information on all of these injuries, as well as other sports-minded information. We’ve done a lot of work to make our website not only an information source to get information about our practice, but also to basically educate our patients and provide a service to them, so that they can be armed with information to help themselves. We like to see them do that and try to get information on their own to help guide them through their problems. If it gets to a point where they can’t necessarily take care of it by themselves, that’s where we come into play and offer some insight.

My topics over the next several podcast, over the next couple weeks or maybe months, as quickly as I can get out here to record these. I’d like to cover some important things that happen with athletes. Among these are the over-use injury syndrome, that would be my first topic. Then we’re going to move on to Achilles tendonitis, we’ll talk about stress fractures. The Shin splint or the medial tibial stress syndrome, and we’ll end up with one of the most important things, and the most common thing we see, which is heel pain, or plantar fasciitis. If I have an opportunity to do another one, I may put one out there on custom orthotics, which seems to be a very interested topic that people like to talk about, “Hey what are orthotics and what can they do for me to help me in my game? Keep me on the road and moving very well?”

Let’s go ahead and do this. Today, the first thing I want to share with you is the types of athletic injuries that we see and it breaks down into really only a few types. This is the acute injury and these are very easy to recognize, we’re looking at something like an Achilles tendon rupture, it’s a pretty dead ringer to find when you see it. The other sort of things is an ankle sprain, that’s an acute injury, or ankle fracture of sorts, that’s an acute injury. These are easy to find, easily treated, but that’s not what people generally will run into on their own. They run into more of the second type of injury, and this is the over-use injury syndrome. What happens here is that an individual of some sort, I’ll just use runner as a good example, they engage in the activity of running and often times they’ll do it without proper workups and conditioning of their body, etc. They run to a situation where they create a chronic insidious problem. The most common ones would be an over-use injury to a tendon, we call that tendonitis. The second one, most commonly, we see is an over-use injury to the bone structure, and that’s seen as a stress fracture of a bone. I think it’s important to dig down deep and look at exactly what’s happening here, sort of on the tissue level. It’s easy to say, “Oh, you’ve got an injury to a tendon, or an injury to your bone,” but not to many people take the time to explain to you what exactly is happening to your body with regards to that individual structure, or anatomical structure of your body. With the tendon injury, the body is really quite a remarkable thing, in that it responds to the stresses that you place on it. If you’re out there exercising and you do it in a very gradual, building up way, the recommendation out there by most people in the sports arena is to not increase your level of activity, or your mileage, more than 10% in each individual event, whether it be an endurance or a speed event, over a period of time of maybe a week or two. Allow your body to acclimate to that and then gradually step it up over time. So, we have individuals out there who are very anxious to get healthy, and that’s fine, I get it. People want to get healthy and do that, but maybe they’re just doing too much too fast and they run into the ‘terrible 2’s’, sometimes I like to call it ‘too much, too fast, too often’ and they don’t give themselves a chance to recover from what they’re doing. So we’re talking about tendons, they would seem to get over used in a sense, and what do I mean by that? Well, the body is always in a state of equilibrium, homeostasis we call it. You’re constantly building cells and you’re constantly breaking down cells as they become aged. One of the activities of going out there an exercising helps to build, build tissues and build cells, and that’s why you get to see body builders that become really, really large muscular frame people, because they’re in a building process. That’s one of the neat thing, however, there can, at times, be a situation where the destructive process is happening quicker than the building process, that’s where you can run into these injuries. What we’re talking about when we’re talking about this sort of tissue driven process, it’s called the ‘mechanical transduction’ and this method, by which and optimal mechanical stress acting on a cell within a tissue, stimulates intra cellular signaling, promoting cellular activity to determine growth, enhancing the cell survival. That’s really what’s happening down there at the level in which the tissue is in the cellular side. What happens is sometimes that these forces can sometimes overcome, the forces of breakdown can overcome the building forces, and that’s where you run into your over-use injury. The solution to the over-use injury is actually very simple; it’s rest from that particular activity which is causing the problem. Of course, the standard things apply, rest, ice, compression, elevation, that’s it ‘RICE’, ‘RICE’ principle. That is what’s happening down there in the nuts and bolts of the actual process of over use. Now when we talk about tendons, the common term we use is tendonopathy. That captures a lot of different things. The tendon has, tendonopathy as a topic, has several different types of injuries. One is a tendonitis, which is an acute inflammation of the actual tendon structure. Paratendonitis, which is an inflammation around the actual tendon, and later we get to a chronic tendonosis, where the actual tendon is breaking down and the collagen that builds the tendon is being self-destructed. That’s in the late stages of a tendonopathy. I see a lot of those folks that come in, because their tendon is thickened, it’s hardened by this time. Sometimes when you get to that stage it’s difficult to actually effectively repair that tendon back to its normal function without a lot of immobilization and maybe some surgical intervention. My goal is to get people out there and inform them so that they don’t get to that stage. The acute tendonitis and then maybe the chronic paratendonitis phase, they stop and think about what they’re doing and maybe get into see somebody that can help them. The most common tendon that we see, that gets injured would be the Achilles tendon and that’s going to be a whole separate topic. When we look further into other over-use injuries, the next common thing to get an over-use injury is bone. Bone, interestingly enough, is a dynamic living tissue within your body. Some people think that bones are static, they sit there and they hold us and muscles wrap around them and are covered with skin and there you have our body. These bones are constantly turning themselves over. There is, again, an equilibrium within the body, which is building bone and breaking down bone, because after a while some of these bone tissues have reached their life expectancy and they need to be replaced. That sort of thing is happening all the time. Now, when we get out on the road, and say we’re running, and we run into a pain in the bone, a lot of us will continue to say, “Okay, I can run through this pain, maybe it’ll go away.” Some people might get lucky and it do that, others may pain may continue to persist and maybe even worsen. That’s a great signal to say, “Hey, something is going on in here and we need to stop.” When we talk about the repetitive injury that happens with bone, most of all we’re dealing with stress fractures. Let’s get back to the tissue level, here we have excessive, repetitive forces of compression and tensile activities within the bone. The bones begin to signal that ‘let’s do some sort of reabsorption of this bone because we’re breaking it down and we’re putting it through activities,’ and the signal to make bone production and recover form that is overcome by that reabsorption of bone signal. The bone weakens over time and then what you get is, you get a stress fracture, because the bone which was normally able to handle the activity, now is weakened and you get a little crack in the bone. That’s really just what a stress fracture is, it’s a little crack. What happened there is the individual went through the terrible two process, ‘too much, too often, too fast’ without a lot of rest, you end up getting this insidious sort of problem. Eventually the pain becomes so much that you have to actually stop and go see somebody and get it all fixed up. That’s the over-use injury process and then syndrome that’s happening in tendons, it’s happening in bones. It really sets the stage for all my other discussions on individual problems. Because if you don’t have this background knowledge, you can’t really talk in depth into some of these other injury processes, so next time we get together on a podcast, we’re going to talk about Achilles tendonitis.



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