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Christopher stark, m.d. on injuries in outdoor activities.

Dr. Stark, can you tell me a little bit about yourself and your specialty?

I’m an orthopaedic surgeon here at Bone and Joint Institute and have been part of the group for 20 plus years. I do a lot of outdoor activities as well.  I enjoy mountain biking, running, and adventure races, so I’ve seen a lot of accidents involved with outdoor activities, unfortunately, and other injuries.  I’m a general orthopedist and that’s my training. But my background is primarily sports medicine, so that’s the biggest part of it.  I still do see a little bit of all the aspects and a lot of the trauma too.

People are getting more out and about and enjoying the outdoors. You don’t have to be the adventure race type even to do that, but even just going for a hike with your family or being outside. What types of injuries do you see most common in your practice?

There are two categories.  The first type is acute injuries. Unfortunately, the bike wreck or twisted (sprained) ankle. Biking, it’s more upper extremity, you see a lot of elbow wrist or clavicle type injuries. Hopefully, those are minor. And then the other side of it is overuse. And that’s probably the bigger part of what we see a lot of. When caught early, it is much easier to treat. Nipping it in the bud is kind of the key with overuse injuries.

For those kinds of injuries, like tendinitis, what types of treatment can you offer?

Tendinitis is common in our endurance sports, everything from the Achilles, plantar fasciitis, and knee- all very common.  For our initial goal, there’s some role of rest, but I think we overdo that, actually. So rest should be pretty short. And so it’s, I think, of three things I tell patients to decrease inflammation- rest, ice, and medicines.  Stretching plays a bigger part and then probably the biggest part is actually strengthening that area. I approach every problem like that. We talk a lot about active recovery, so if you’re running a marathon, or maybe just running a 5k,  and you’re not used to it, you pick up some tendinitis on the outside of the knee, like runner’s knee- very common. The key is not just rest, because as soon as you run, it comes back. It’s really stretching and strengthening and finding a way to strengthen that outside of running, you usually have to give it a little break from running.

What role does physical therapy play in injury recovery?

You know, it’s a team approach, for sure.  I may be the quarterback, but a lot of the therapists are very, very good. Many times we go to therapy first if it’s a minor problem.  If it’s more serious, causing limping, slowing you down, or lasting longer than often, go to a physician first then a therapist. They’ll work in conjunction with what we instruct. It’s working with therapists, sometimes an athletic trainer, and then a lot of work at home too. If the patient is able to do the work at home, it accelerates the healing.

Let’s talk about a traumatic injury. You mentioned either a fracture or a sprained ankle.  Talk about a fracture with biking that you would see most often.

Biking is still safe, just pick your routes. The clavicle (collar bone)would be the most commonly broken bone in the body. Many times, a lot of them are nonsurgical, as long as it’s pretty well in line. Clavicles and membranous bones heal very quickly.  If they’re displaced, it means they’re out of position more than about a centimeter. If overlapping or in a lot of pieces, then that can become surgical.   

What would that recovery look like?  Do you need to go to physical therapy after something like that?

It’s an outpatient procedure.  Once fixed, it’s so much quicker you can actually start using your arm quite quickly.  We want you to avoid contact and heavy lifting for six to eight weeks, depending on the healing.  Getting the shoulder moving in therapy after this injury is very important because the shoulder can get tight.

We’ll treat patients with all injuries, but we also want to be able to teach them something to prevent injury. You mentioned flexibility, what are some tips and pointers so that someone doesn’t have to come in with an overuse injury.

The biggest thing, especially for the newer runners- actually all runners or any endurance sport athletes- is that mixing and cross-training is the key. If you just run, most of us will get hurt, so it’s important to do some weights and stretching. Even if you’re training for a marathon and you’re trying to get those miles in, sometimes it’s more valuable to run less, and spend some time on the bike or with weights and stretching.  Stretching before is okay, but stretching after is probably better. If you start to get sore and start having problems, don’t worry about your schedule; back off that plan, get healthy, and then finish your event that way. It is better to come into a race healthy, not injured, and be able to finish.  It is much better than going in injured and trying to struggle through.

What things could I do before going on a hike- especially with kids?

A little bit of practice.  If you’re going to be going longer, build-up, and consider using Trekking Poles.  Maybe not with the kids, but for the rest of us, Trekking Poles are really nice if you’re new or a walker, or if you’re going long. They make a huge difference. It may decrease 20% of the pressure on your knees, making a big difference. With the kids, get out and do some shorter walks first.  Get the feeling of it and once they get into it, they’ll love it.  Be consistent. Warm-up, and it will be a lot of fun.  

Does shoe wear make a big difference when you’re out doing activities?

Good shoes for your activities are important.. If you have the tennis shoes and it’s muddy, it’s not great. You’re gonna have that sprained ankle and tendonitis.  Supportive shoes or a good hiking shoe are important when on trails to decrease the incidence of injury.

How does the comprehensive care that we offer at Bone and Joint Institute add to the overall patient experience? 

I think what’s unique is that we do work so closely with our therapists, and also the athletic trainers that are often involved in schools. And our staff technicians are amazing; they work on education and will spend more time educating someone about tendinitis than I will. They will spend more one-on-one time because they want the patient to buy-in. If the patient commits, even if they’ve had a problem for six months, they’ll get better.