DAVID FOLK THOMAS: As far as individual injuries to the regular folk out there, not the world class athletes you're both used to dealing with, how do you know when you have to seek professional help? Maybe you've strained your arm or you've sprained your ankle. It doesn't seem to be that bad. How can you tell when you should see a doctor?
JIM RAMSAY: I guess that's a difficult question to answer. The way that I let individuals know is that if basically the injury they've gotten on the field or getting out of the car, or getting bumped by another person at the grocery store, if the injury doesn't allow you to function in your normal capacity, if it doesn't allow you to continue grocery shopping or you're going home and all of a sudden you notice that there is swelling. You can't get off the couch. You can't get off the chair. You can't get out of the car. That's an indicator to you that you've done some damage to whatever is injured. That's when you should seek the care of a professional; your family physician, your orthopedic surgeon, your athletic trainer or your physical therapist.
DAVID FOLK THOMAS: I would imagine it would be hard, unless you've had injuries recurring over time, it would be hard to diagnose yourself. How would the average person know unless they had had a lot of ankle sprains, whether they had sprained their ankle or perhaps broken their ankle?
JONATHAN GLASHOW, MD: That's a good question. I think a general rule is when in doubt, seek treatment. I think there is a timeframe element. If it lasts more than 24 hours, if it's progressive or getting worse, those are cardinal signs that you may need attention. If it's something that happens again, their knee buckles and then it buckles again, I think that's another cardinal sign. If there is bleeding, of course, people should go. If there is neurologic or nerve damage in which people feel numbness, tingling or weakness, those are key signs that should alert them to seek professional medical help. But in the absence of overt swelling or increase in size, which would be a sign to go the emergency room, and if they can put weight or walk on that leg, then I think they have the luxury of waiting a little bit. Icing it and doing what we talked about, general anti-inflammatory, which one can buy over-the-counter, if it gets better, hold off. But if the trend is a progressive one toward the worsening, then I think they need to seek attention. I guess if they hadn't had problems in that area in the past, it may be safer to wait, where if it's a recurrent injury maybe seeking earlier treatment is a good idea.
DAVID FOLK THOMAS: Let's take a typical example. Say that somebody sprained their ankle, not very severely. They've gone through the PRICE procedure. The swelling has gone down. The temperature is the same on both sides. They are heating it and doing all that. When do they know that they can go back to doing what they were doing? How do you know when is the right time?
JIM RAMSAY: Again, it depends on the degree of sprain, a first degree, a second degree, a third degree, the amount of damage to the ankle. Basically, if you're seeking the advice of a professional, the therapist or physician will be able to give you some direction in terms of when you can return to that sport or activity that you're involved in.
People generally tend to be more aggressive than is actually good for them. They want to get back into playing tennis. They want to get back into the game. They were born to compete. So what they want to do is get back out there and do what they do or what they enjoy that makes them feel good. I tend to hold the athlete back probably a little more than I need to, but when they are functional and they can pass all the functional tests of what they have to do on the tennis court; side-to-side motion and forward and back motion, light jogging, some sprinting. When they feel that there is no pain and no reaction to that joint then it's time. They are good to go back.
DAVID FOLK THOMAS: Jonathan, final thoughts on this subject?
JONATHAN GLASHOW, MD: I agree completely with what Jim said. To give people some guidelines and objective things to look for, a normal range of motion. Normally what happens after a sprain is it gets stiff. If that stiffness does not resolve and they do not have normal motion, then that's something to hold them back from going back to the sport. If they are weak and they can't hop that many times on the affected side as the non-affected side, that should alert them that they are not quite ready. If there strength is back and their motion is back, they should go back gradually. Not trying to go back and compete their first time back on the court, but hit a few ground strokes. See how it feels. Take a little time off. Go back a day later and see how they are doing. Listen to their body.
DAVID FOLK THOMAS: Do you want to have it wrapped in an ACE bandage if it's a wrist?
JONATHAN GLASHOW, MD: A false sense of security. I think that if you're muscles aren't strong enough to support, for example, in the ankle injury, then they probably shouldn't be back unless they've been guided to wear a brace or something specific. Just to wear a brace or an Ace bandage off the top of their head, to me doesn't give anybody direct help. I think they should identify that problem. If they need support, then get the proper support, not just any support.
DAVID FOLK THOMAS: All right. Great gentlemen. Thanks for sharing your insights with us on the world of injury treatment. I've been talked with Jim Ramsay and Dr. Jonathan Glashow. Again guys, thanks for joining us.
Remember, if you have an injury, you want to do that PRICE thing. We're not talking about going down to your supermarket and checking out the prices there. It's Protection, Rest, Ice, Compression and Elevation. Remember, if it's a serious injury and you feel that you may have done something really bad, you should definitely check and consult with a doctor.
Thanks for joining us on this webcast on injury treatment. I'm David Folk Thomas. We'll see you next time.