ACL Tears, Tommy John Surgery and Concussions in Young Athletes

This is session number 50 of the Performance Place Sports Care Podcast. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey everybody, this is Dr. Sebastian Gonzales, and welcome to episode 50. This is groundbreaking here. I never thought when we started this, and when I started this, that I would be going through 50 episodes in less than a year. Gosh, how does that work? Well, I guess it must be one every week.

So, we're coming, I think, to the end of the sounds of the 80s and 90s on there, and if you listened to the intro and you had the volume up, you probably recognize that sound. I remember it from when, actually, I was sitting by the computer, and I was playing War in the World with Carmen Sandiego, and we had to print something out, and this is the sound that you heard. It's one of those really crummy nine-hole holes on the side of the paper, and it takes forever to print one page. Printers. Okay, I don't know what the technical name for them was called, but I remember it had to line up all those little holes to get the paper through there, and all the pages were attached, and when the thing came out, you had to rip all the holes off the sides to make it so you can print something in and turn it in.

And I think I was probably, I don't even know if I was at the age where I had to print a lot of things out, but it took forever to do. And where I found the soundbite, actually, was, it was on YouTube. It's funny, it was like a five-minute video. The things just, like, hammer, like, one page. It's just, like, taking forever to print one certain page. So, yeah, I feel really fortunate, actually, that I was part of the group of history that we had no technology, almost. Like, we didn't really have computers, we didn't have iPads and phones and cell phones, especially, and so on. And then all of a sudden, boom, we got, like, everything.

So, in contrast, everyone who is probably about, you know, maybe 15, 20 years old, they might, I mean, I feel like all technology is all they know. They didn't have any house phones they probably grew up with. So, I feel fortunate that I've seen both sides of it. So, today we're going to have on a guest. His name is Dr. David Geier from, so it's drdavidgeier.com. That's G-E-I-E-R. And he is an orthopedic surgeon and sports medicine specialist in South Carolina, in Charleston, to be specific. And he actually has podcasts as well, as well as he's written some e-books. So, one of the e-books he's written is That's Gotta Hurt, and it's in relationship to some injuries that have happened in professional sports that have changed how we look at injuries within sports forever.

So, we're actually going to go through some of those today and just kind of get his take on, you know, why they've been significant injuries and how it relates to, you know, you and your kids and how things like, I know one chapter I was reading on the Tommy John surgery with the ulnar collateral ligament in baseball players. I mean, I remember when I was growing up, I didn't hear anything about ulnar collateral ligaments. I didn't hear anything about people with elbow conditions. I mean, there's a couple people here and there that had elbow issues, but there wasn't a bunch. And it's just interesting that there's all these trends.

So, he's going to talk to him about the trends and some of the top two or three injuries that changed, specifically that changed sports forever. And we're just going to dive right into it and get his opinion. He's actually the first orthopedic surgeon that I've had on the show here. So, I'm looking to have a lot more because, quite honestly, I don't spend a lot of time in talking with post-op surgical cases or even pre-op. I don't deal with a lot of people that end up having repairs because when the cases are that complex, a lot of times I refer them on. So, it's going to be interesting to see some of his side of it because, actually, orthopedic surgeons are some of the hardest people to get on the phone that I've noticed.

So, it's always a pleasure to talk to one. So, this is Dr. David Geyer. He will tell you all about himself and we will learn something from him. So, everybody welcome, Dr. David Geyer. Well, thank you for having me. Yeah, I'm an orthopedic surgeon in Charleston, South Carolina. I focus on sports medicine pretty much exclusively. I do some general orthopedic surgery on call, but most of what I do are taking care of athletes and active people who just like to play sports and exercise. So, how long have you been doing it and, like, why did you want to start in sports medicine? Yeah, it's really interesting.

I've been doing it now, I guess, going on 12 years, I think, if I do the math correctly. Yeah, it's funny. You lose track of time. I got started into it. You know, most of my colleagues in orthopedic sports medicine love the surgeries. You know, it's all through the scope mostly and they love the complex things we can do through the scope. And don't get me wrong, that's fun. But actually, why I have always liked sports medicine more than other fields of orthopedic surgery is I love seeing the excitement on people's faces when you tell them that they are clear to go back to what they love to do.

You know, be it somebody that's recovering from ACL surgery or it's just, you know, tennis elbow or Achilles tendonitis or some broken bone that's healed and now they're safe to go back to tennis or go back to soccer. And they're so excited. You can't, there's nothing better, at least that I've seen in the medical world, than that excitement from letting people do what they love to do. Yeah, I would imagine you get, you probably get them from, do you get them also at the point when they first start and like the shock of, oh my gosh, like this, I won't be able to play for X amount of time. You probably have to coach them through that whole thing, right?

Yeah, I mean, most of the people you get, yeah, they just got hurt or, I mean, maybe they got hurt six months ago and they've been hoping that it would heal on its own, whatever the injury is. But they, usually when they come to see us, they still don't have a good sense of when or what the process is going to entail, what the treatment's going to be, do I need surgery, how long am I going to be out? I mean, you occasionally get people that are second opinions, things like that, but most of the time people have a sense that something good is going, or something bad is going on and it's going to require some time.

But most of the time, yeah, you're starting from the beginning of the process and you follow them through. Yeah, cool. I typically deal with subacute and like chronic conditions, so I don't always get those ones that are like going to end their sporting career, but I can only imagine what it's like on your side over there. Yeah, I mean, I think, too, one of the things that I think is always interesting, I mean, you get the people that, and you may see this a little bit, but you're saying you get more chronic things. I will see people, you know, once or twice a day in clinic that literally they just got hurt yesterday and you think, well, if you had just taken, you know, a day off of, you know, maybe, you know, decrease the impact on it for a day or two or maybe back off of whatever you're doing, if it's your arm or whatever it is, you'd probably be fine.

But then the really fascinating, the alternative that I get, and I get this three or four times a day in clinic, are the people that when you ask them how long they've been hurting, they'll say, oh, it's, you know, I started, I got hurt six months ago or a year ago. And you ask them, like, why did it take so long for you to get it checked out? And they say, well, you know, I took some time off, I stopped doing whatever it is I do, and I thought it would get better. And one day I realized I'm not better. I can't do what I want to do. And that always amazes me that people will wait so long hoping it gets better with, you know, so that they don't have to, you know, potentially have surgery or whatever.

They don't even get it checked out. That always amazes me. Yeah. What do you think the, I don't know, I don't know if I've ever asked any patients, like, what made you think that resting it and stopping all activity and not getting looked at would be the correct thing right now? Right. I mean, it's crazy. I mean, I mean, it makes sense for a few days, but when you're, when you, these people tell you six months or a year, like, that's hard to imagine that they would give up. You know, I haven't been able to lift weights or they can't do some of the exercises or I can't run up hills because it causes this vague, achy discomfort in my knees.

I can run on flat surfaces, but can't run on hills. Like, why wouldn't you get that checked out? Like, that always surprises me. Yeah, there's, there's definitely, uh, like there's, there was actually a lady this week that her husband, uh, he had a knee condition and, um, she wanted me to talk to him about it and so on. And, but it was, it was really hard to even get, uh, in contact with him because she said his response was, I don't like to be seen by doctors and I don't get it. Well, I think because I hear that a lot, uh, not even necessarily me specifically, but people that reach out to me through my website.

I do think that at least with orthopedic surgeons and maybe rightly so, there is a real fear of one of two things. One, that they're going to be told they need surgery and they really don't want surgery. Or, and it may be both, they hear, or they feel like they're going to hear, you have to stop doing whatever it is. You have to stop running. You have to stop playing soccer, whatever it is. And they're terrified of being shut down. But, you know, you know, this, the vast majority of the time we don't tell people that one, you need surgery. That's probably maybe 10% of all the patients we see end up needing surgery.

But the vast majority of the time, we're trying to help you get back to your sport or get back to your exercise and not shut you down. So I think that, especially if you come in and get it taken care of relatively early before it becomes a chronic problem, we're not going to be shutting you down and you're going to get back to that as quickly as you could. Yeah, I completely agree. I mean, I don't, I don't remember the last time, but there's, I mean, there's a handful of cases like types where I would say, look, we have to stop for X amount of time, but majority of the time that, that isn't the case, you know, but obviously if you have like a fracture going on or some type of instability or like you had a, you know, ACL blown, I mean, there's, there's going to be a period of time that we need to take off, you know?

Yeah. So. Yeah. Interesting. I think it's fascinating, honestly. Yeah. The, the human psychology. So everybody, I want to have a Dr. Guyer on mainly because he, he's an interesting type of orthopedic surgeon in regards that he's, he's actually putting a lot of great content out there. He's got a podcast. A lot of the questions that, uh, or the stuff we were talking about, like right there, like I heard, I was binge listening to your podcast actually the past couple of days. I really liked when he answered all the patient's questions like randomly through there. Um, but you could put great content out.

So I thought you'd be a good person to have on to talk about. Um, I know you got the book out there that it's got, or that's got to hurt. So we went through some ACL, some ulnar collateral ligaments, even concussions in there, right? Yeah, absolutely. And, uh, I love talking about this stuff and if it helps people that just love to play sports and exercise, uh, that's what I love to do is, is explain this stuff for them. Well, so let's go through first then. Um, I know, uh, so tell us about ACL injuries and, um, cause I know that is a large, large money generator in the medical profession in regards to surgical, um, and they're extremely common, but tell us about, you know, like what they typically feel like as well as like some preventative models.

Yeah, absolutely. I mean, it's one of the most devastating injuries in sports because, uh, you know, almost always occurs in athletes that are in a competitive sport. Uh, I mean, you can get it exercising, I suppose, but it's generally like, you know, a competitive sport athlete lands awkwardly from a jump or turns awkwardly and they feel like their knee explodes this huge pop. It swells up like a basketball, like an enormous, uh, swollen knee, uh, very, very painful. Now that eventually starts to come down. The swelling goes down. Uh, if you give it a few weeks, the knee motion comes back, the strength comes back, the pain starts getting better.

But as you know, the, the problem with an ACL tear is not pain or stiffness or things like that. It's that the knee's not stable anymore. So the vast majority of, of ACL injuries end up needing surgery to restore stability of the knee. If you have an unstable knee, you, it's really hard to play soccer or basketball or football because your knee might buckle or give out when you go to do, you know, those movements. And so, uh, to prevent future meniscus tears and cartilage injuries from your knee buckling, we do a surgery. That's great. But that also means not just the surgery, but nine to 12 months out of sport, uh, sports.

And that's why you mentioned injury prevention, uh, those injury prevention programs for ACL injuries are so important because if we can prevent even a just small number of ACL injuries, that's a good thing, uh, for the people that play these sports. So, uh, we'll come back to injury prevention one second here. Um, in, in regards to like what type of people get ACL injuries typically, are there more people to get more, uh, or injuries more often? What type of sports? What's the demographics? I think generally in the studies show different numbers, but I think the big group you think of are female athletes, you know, between the ages of say, uh, 12, 13, you know, really into the thirties.

Um, and there's a lot of reasons we can talk about that. And I'm sure, you know, a lot of that, but female athletes are anywhere between twice as likely to suffer ACL tears to some studies have it as high as eight to 10 times more likely than male athletes, uh, related to landing mechanics and muscle firing patterns and alignment of the lower extremity. Um, but that's a group that we really need to do a lot of work to try to prevent these injuries. Um, so if you're a parent of a, of a, you know, have a young girl that plays basketball, volleyball, soccer, those types of sports, you might look, you know, to your local sports medicine groups and your athletic trainers and your physical therapists to, you know, look into these, uh, ACL injury prevention programs.

So I'll just play devil's advocate here for a second. Cause I know this, this probably question probably comes up a lot. Uh, so ACL injuries are common in my family. What, what is there? Is there any validity to that? I know that they'll probably bring that type of thing up or they'll say, well, she's a girl. So should we just suffer with it? How can we prevent something that's gender specific? Yeah, there is, with respect to the family link, there are, and I don't know the numbers off the top of my head, but there is a family link that if you have a family member, an immediate family member that's had an ACL tear, I want to say it's like you're 50% more likely to suffer an ACL injury than some similar person, similar age group, similar sport thing like, uh, something like that, but the 50% number may be wrong, but it is higher in first degree relative.

So there is some genetic link. Um, I think, um, as far as, uh, what, why the injury prevention programs are so important, we know, and I'll try not to get real technical here, but we know, and I actually found that this out, uh, researching for my book. I talked to a lot of experts in the injury prevention world, um, about this. If you look at, at boys and girls before puberty, the injury rate for ACL tears is about the same, but when basically they go through puberty, the boys stay at about the same rate where the girls, uh, their injuries start to skyrocket, start to go up significantly. And it's related to how their bodies change.

And all of a sudden they become more quad dominant in respect to their hamstrings. And they start landing with their knees more extended and, and planning their foot to turn with their knees more extended. And, um, they don't have the muscle strength to really stabilize the knee in the right way to take stress off the ACL when they land. So the key with those injury prevention programs, teaching girls how to land, teaching them how to turn with their, their knees bent and land with their knees bent. If you can really get that, um, into the youth sports at the eight, nine, 10 years old girls, uh, you could make a dramatic difference.

Some of these injury prevention programs, the experts say we can drop the rate of ACL injuries 40%. Some say as high as 70%. I mean, that would be a game changing shift if we can really, uh, increase the utilization of these programs. Yeah. That's interesting. Actually, they, uh, that it had, that there, is it that their geometry changes is, is there hormones? Like, why is it during that timeframe that, that, that they become more quad dominant and just can't use their legs and pelvis and core anymore? Yeah, that's a good question. And I, I think again, it's something about neuromuscular firing patterns, uh, and something about, you know, as they get taller, that, that valgus alignment at their knee, the knock knee appearance changes.

I think that they get to where, uh, the forces across their knee are increasing, but they still don't have the hip, uh, strength and the hip control, uh, when they land things like that. I think a lot of different factors occur. When I talked to Tim Hewitt up at the Mayo Clinic, uh, he compared it to, he gives it a car engine analogy and basically, um, they've, you know, they've now girls develop, uh, you know, their, their ligament is, is about the same size, uh, and boys go from having like a Toyota Prius engine to a Cadillac engine, but the girls stay with the Toyota Prius engine despite now having a body that's that much bigger and needs a bigger, needs more muscle strength essentially and control to protect that knee.

I don't do that justice in explaining it to him the way he explains it, but that's what's going on is that they don't adapt as they go through puberty. And so that there's just more stress on the ACL when they land. Yeah, that's, it's, it's really interesting. I feel like, uh, at this point in time has, there is, is there enough, there's, is there enough research to kind of say like, we know it, we know what's going on with ACL injuries. We know how to prevent them. Or is there, is there more that they're kind of searching for that you've seen? Um, I mean, I don't know that I have an absolute answer to that.

I do think that we're trying to learn more and we're, we're figuring it out a little bit, but I think that it's challenging. I mean, there are studies, you know, the, they do these meta analyses and, uh, where you combine studies from multiple different, uh, you know, studies on ACL injury prevention programs that don't show a benefit. And so a lot of people are opposed to this, but there's so many variables and ACL injuries are one of those things that's hard to really predict. You know, you may study, you know, three teams of soccer players. Maybe you have one ACL tear over a couple of years.

So it's really hard to collect the size of the numbers of kids that you need to really get in one place and study, uh, to get good information. There's probably a hormonal link. You know, that we've heard about these studies where if you put, uh, female sports teams on oral contraceptives, birth control pills, that lowers their rate of ACL injuries. But we don't know what the, the hormonal effect is because you need blood tests on young athletes every single day, just to know what phase of their menstrual cycle they're in when they tear it. That's not possible to do. We can't draw blood on every female athlete every single day.

So they're that variable. We're never really going to understand. So that's why it makes the, all of this is really, really complex. Yeah. That would be a really complex study. Yeah. And it'd be great. Cause I mean, I think that we would love to be able to say, all right, you know, if we knew it was the luteal phase of the menstrual cycle, then yeah, maybe it's oral contraceptives or maybe it's, or hormone targeting. I mean, where they get really fancy, fancy cellular, uh, medicines that they take or injections. I mean, there's the, the possibilities are, are fascinating, but yeah, we got a long way to go to figure out exactly what's going on.

Yeah. I would, I would imagine that, I mean, all of, you know, that is stuff that we don't completely understand yet. The, I feel like the neuromuscular aspect is, I think we, I think we kind of got it down at least to the point where you said we can decrease it by 40 to 70%. Um, implementation of that though. I heard you do a podcast. I think it was like 50 episodes ago, by the way, everyone, he has like 300 episodes. How do you do so many? I have done them once a week since 2011. So, uh, yeah, um, it's, it's, uh, I, I, in a million years, never would have, if you had told me I got up to 300, I wouldn't believe you.

I thought for sure after about 30, I would, I would flame out and just, but no, I really enjoy it. You know, I don't have an enormous audience, but I get a lot of feedback. People will, will text me on a Monday morning and they've already listened to that week's show and it makes it gratifying. So I can live even with the, you know, the few hours each time it takes to do it and, and, uh, you know, only getting four or 500 people listening each week. But if I get comments about it and it really helps a lot of people, I'll take it. Yeah. It's, I, I'm curious now to go back and find your episode one or two to see, cause you're well, you're well spoken right now.

I'm sure they got better. Yeah, they were, they were, um, uh, you can already tell that I will one question and I can speak on it and give a 60 second night. I just talk and talk and talk. They, they really went on and on, uh, the first early. I've really gotten them shorter, uh, um, as I went, people don't want to hear, you know, 30 minutes on any topic. I mean, you know, sometimes they, they want five, 10 minutes, at least my audience. So I've gotten a lot better in that sense. Yeah, that makes sense. Like, I feel like when you're watching, say like TV or the news, like they don't spend more than like maybe a couple of minutes on one topic and they jump to a different one.

Um, I would imagine cause everyone has lower retention or, uh, attention spans now. Um, yeah, it's, it's unbelievable. I've been doing these radio interviews, uh, to promote, uh, my book and literally the interviews will be 10, 15 minutes, but each we move on like topic to topic, like every 30 seconds, it's just bang, bang, bang. And I, I think that, uh, that's how society is today. So yeah, my podcasts in that sense, I've gone to shorter, sweeter sort of bite-sized chunks of information, but you know, there's no right way to do it. You do a great job cause you do interviews. And at some point I may get into the interview thing, uh, for my podcast.

I haven't done that just because I, the time side, you know, trying to work out a schedule. But, uh, um, I think if you do interviews and it's a back and forth, you can do one topic for a lot longer. If it's just one person talking, you can't really do that. Oh yeah. They're really hard. Uh, I don't know. I don't think you probably didn't hear the one I did on a hip mechanics or anatomy and knee anatomy. Oh my gosh. That is a boy. I've gotten feedback. I started, I started with the bones and ligaments and like, uh, tendons around the knee, say in the knee one. And then I think it was about 20 minutes and finally I went into like some mechanics and I got some feedback from people and they said, you should have flipped that order because we were bored out of our mind.

Yeah. It's hard to, when you're trying to discuss something like you and I do, that's, uh, medical and it can be sort of complex. I learned this early on is that you can't really get in the weeds. Even if your audience probably knows what you're talking about, if it gets too technical, people just won't do it. Um, and so I think, I don't know, it's a tricky thing, uh, um, with podcasts in the healthcare world, uh, because it's such a niche audience, uh, you know, how, how in depth do you go? It's really, uh, I'm always curious to see how other people do it. Yeah. I, I actually don't even know what my demographics are of people listening.

Cause I know iTunes will give you a ton of information, but, um, like I would imagine that people like, say they have a knee injury, they might tune into this one and we're listening, they're talking about the ACL, but they, they would probably not even listen to a shoulder podcast. So the re probably the retention on one type of podcast or one, one person anyways, is probably really low, but you never know. Yeah. Uh, we'll, you will have to, you know, keep in touch about, uh, podcasting cause I think you and I can learn a lot about it. Uh, I will tell you though, and I'm really happy that people like you, people like me and other people are doing it in the first place.

Even, you know, if your goal is to educate the public or your goal is to educate other physical therapists or athletic trainers or whoever coaches, parents, whatever it is, I'm just glad people are doing it. I think that there is so much value in sharing. We've worked really hard to learn all this, but we all learn from each other and we have a sort of a mission to sort of help people. And this is just a, honestly, I think a better way or at least a, a different way to educate people. Yeah. I think it's awesome. And I know we'll come back to ACL prevention in one second, but this is a good route we're taking here.

Sorry, we got off on tangents there. No, it's good. I mean, you think about it, like the, like you listen to radio shows in the morning, they used to have, or I think they still have morning shows, but I mean, they, they, it's for the most part, there's, I would say over 50% is entertainment easily, probably 75 and the rest is information. And we just have to be able to, you know, give them tidbits of information here and there and entertain them a little bit along the way to keep their attention, you know? Yeah, absolutely. But yeah, so we were talking about before the podcast then that, so the reason why, like you were talking about the reason why you started podcasting and like giving information this way, period at all.

Can you tell everyone about that? Yeah. Well, so I had started my website about a year before I started the podcast and really was expecting to be talking, and you sort of are, anybody that's written, you know, does a blog or something, you're sort of at first talking to an empty room, but pretty quickly I was getting, you know, comments and people that would respond on Twitter and things like that. And it was really, I was really encouraged by it. So I started, you know, writing articles once or twice a week and very quickly realized that, you know, I wanted to do something more than, you know, 400, 500 word article.

I wanted to be able to have more of a discussion and that sort of led to this idea of doing a podcast. And I grew up, you know, loving the radio, listening to various talk radio shows, mainly sports talk shows. And I was like, you know, I think this podcasting thing, it was sort of in its infancy in 2010, 2011, but I was like, you know, I think there's something to this. I'd like to give it a try. So I spent about, I don't know, two months taking a course on podcasting and really kind of getting it ready, spent probably more money than I should have on equipment and stuff like that. And I went all in and I used to spend, I mean, I'd prepare, I mean, each show has taken me like six hours to kind of script out with the topics and sort of prepare and then edit on the backend and do the tweets and all this kind of stuff. I've cut that way down since then, but I was just really passionate about it. And, and I still am obviously now I've got sort of a little bit of momentum and I've gotten a lot more efficient, but there was something about talking that's just different than writing. It's different than 140 character tweets. It's different than what you can post on Instagram and Facebook. And I've, I've just really enjoyed it.

Yeah. Yeah. It's, you don't, you don't see it very often. Like you said, there's not too many awesome and ongoing 300 episode podcasts on medical out there. So I'm really, I really enjoy yours, uh, often, but I, like I said, I'm going to dig back to that number one and two. I want to hear it. All right. Fair enough. So, so coming back to ACL prevention, uh, one of the podcasts to listen to on yours was it, it was that something about resistance of resistance of some coaches to implement. Yeah. Can you, can you tell us a little bit more about that? Absolutely. And, uh, this is another one that when I reached out and when I keep saying I reached out to these experts, you know, in my book, I write a chapter about Brandy Chastain and the U S women's national team. And I talk about ACL injuries and female athletes and why they're so common.

And I talk about the injury prevention programs. So I talked to Holly Silvers, a physical therapist in Santa Monica, California. I talked to Tim Hewitt up at Mayo Clinic, a physical therapist at UConn, a physical therapist that only rehabs ACL injuries in Minneapolis. Uh, some of the really leading experts in this and almost exclusively, they said that one of the big challenges with getting the ACL injury prevention programs adopted by sports teams are that the coaches just are reluctant to do it. They gave me a few reasons. One, they said that, Hey, look, we only, the coaches only feel like we've got two hours a day, three days a week. That's all I have with my team. I'm not going to spend any of that with an injury prevention program. If they want to do it before practice, fine, but they're not going to do it in my two hours. Cause I need all that time to coach or it's that they're worried that that's going to increase their risk of an injury during clinic because their knees and their legs are going to be tired.

Um, or they just don't, you know, they just don't believe in it. They, they just don't see the value in it. And, um, that's really a worrisome thing. And Holly even told me that when, and she and Burt Mandelbaum tried to get the pep program, uh, get every college soccer team in the country in to a study to test how effective they were in college solid soccer players. Only 14% of the college soccer coaches would agree to have their teams do it. So I think that's a real challenge. Um, you know, if I'm a parent, uh, that would worry me, I would talk to my coach, but you may get some, some resistance. And so then you got to figure out other ways to have your son or daughter's team doing them. Yeah. The, so this is, this is also happened. Like you're, there's almost no one who implements them at, you said the eight, nine, 10 year old level too, right? Right. No, I mean, it's really typically done in my experience at the high school and college level, but maybe we need to figure out ways to get them in the youth sports. Yeah. I feel like the, if, um, I mean my, my, my mindset, with a lot of like injury prevention, at least like bare bones stuff is that if, if we can get it like optimally programmed, it should take 10 to 15 minutes and it becomes part of their warmup.

And, and I would imagine that, you know, if, if I don't, did you put actually, do you play sport? I didn't ask you. I don't now I lift weights every day and do high intensity interval training, but I played a travel soccer growing up. Uh, actually I was in the age that you play a different sport every season, but once I specialized, it was soccer, but not anymore. I, I, I would love to play rec league. So I just don't have the time. Uh, and I wouldn't think that'd be fair. If I'm always having to cancel, I wouldn't be fair on my teammate, uh, teammates. So I have elected not to. Well, I was, I was curious if you had like a certain warmup that you did. And I know that I have a certain warmup that, that I kind of do before I play baseball. And it's something that we, I just kind of had for, you know, 15, 20 years now. It didn't really change. Um, but I would imagine if we implement somehow into like youth sports, then they would carry it on hopefully to the college level, you know? Well, I think that's, that's a great point actually. And that's true with a lot of stuff, uh, these, uh, exercise maintenance programs. But I think if we can get the young kids to do it and it becomes normal, sort of the idea of NBA players don't stop shooting free throws, they keep practicing free throws their whole career. If we can get kids at a young age doing these as part of their warmups, it just becomes normal. And I think that that then, yeah, they, in college, they're not even thinking about it. They're just spending their 10 minutes warming up with these exercises. I think that would be so key. Um, you know, and I, it's probably a good selling point too. So have you've talked to, you've talked to some coaches that have implemented programs, right? Oh yeah. And when I was a director of a sports medicine program, uh, here in Charleston, uh, we, our program would, would do them with, uh, some of our high school teams. So, so for any coach listening right here, uh, give them your 32nd pitch because we can maybe, maybe get a few hand more, uh, people doing it. Yeah. Here's what I would say to a coach. I, I think that this is really minimal effort. You're basically taking warmups that they already have to do and replacing them with a different set of exercises. So the only thing you're really substituting is that now maybe the warmup exercises are kind of boring, but it's no increase in time. But if you can look at your bench at the end of a season and have everybody healthy and able to play rather than three of your athletes, three of your players with knee braces and on crutches, that's a good thing. If you have a full team because you prevented a few injuries, that's absolutely what you want to do.

Yeah. Some, you said that reminded me of, uh, the section of the book I read on with, uh, uh, in a, uh, ulnar collateral ligament injuries or the Tommy John one is that, so you wrote something about, I wrote it down to make sure I remember. So, uh, athletic ability at some point overcomes technical flaws. So if you have a star soccer player who plays well, his knee doesn't complain of hurting coaches might say, well, there's nothing, nothing wrong. He, why would I change a thing? Yeah. I mean, the problem is, so I, I, I agree with that to, or, or agree with the idea of it, but I think the challenge with that is I don't know that that many coaches can really identify, um, awkward landing mechanics that would put you at risk for ACL injuries. I think you can teach that.

And, and a lot of these, these kids that do these ACL injury prevention programs for a few months can recognize their teammates with bad mechanics, but I don't think just an uneducated coach could look at a girl running or jumping and know what to look for. Um, you would hope with the ulnar collateral ligament injuries that they know bad pitching mechanics that kind of gets into a whole other discussion of making sure we correct bad mechanics at an early age. Uh, but I, I would worry that this idea of, well, if they're good enough or they're strong enough, it doesn't really matter, you know, how their technique or mechanics are. Yeah. I just, I don't know that I trust a coach to make that decision. Yeah. And I totally agree with you on that. I mean, there's, there's, there's definitely people that spend all day doing that and have been doing it for years that will probably be better. But I mean, yeah, we wouldn't pretend to coach. We'd be terrible at it.

Yeah. No, I mean, it's the whole thing. It kind of gets to the debate that, that we have sometimes as doctors working with coaches and they, they want to know why it's taking so long for a player to get back, you know, from an injury. And, and the, the response that I love is, Hey, look coach, you know, I don't tell you if you should pass on third and one, don't tell me when somebody's cleared to play. I do. Do they laugh at that one? Oh yeah. Yeah. The coaches, coaches don't really want to make that decision. I mean, sure that they would love a player back, but I think if you play it that way, cause the last thing they want is your flack about the call they made, you know, like, why did we, um, you know, play conservatively up one, nothing in a soccer game or something.

Uh, so yeah, no, I think if you kind of frame, Hey, this is my role on a pro sports team or youth sports team, this is your role. No, the coaches are good about it. That's awesome. I, and I love that there's, there's good communication all around cause that's going to be what's best for the athlete. Now you may hear, you may get a bunch of your listeners saying, Hey, that is not how it is with our coaches. I'm not saying every coach is like that, but I think if, if you have an open relationship, you guys talk and you know, then everybody's kind of on the same page. Generally that if you know, you frame it that way, it does, you don't have that many issues.

Yeah. Cool. So let's, let's move on to another, the other three liter acronym, which is the, the UCL or Tommy John surgery. Uh, tell us a little bit about that. Cause you do have a section on your book on it. Yeah, I think that this is, it's fascinating for a lot of the same reasons we just talked about with the ACL. I mean, this is an injury that, um, honestly it's been around since the 1920s. It was first diagnosed in javelin throwers of all things, but it obviously gets its, its fame from baseball pitchers. Tommy John was a pitcher for the Dodgers through a pitch in a game in 1974, felt a pop in his elbow. Uh, and his surgeon, the team doctor for the Dodgers, Frank Jobe said, Hey, look, you have no shot of ever pitching again, unless you try this surgery.

Rest wasn't helping him and that kind of thing. And that surgery had never been done before. It was truly experimental that he gave him a one in a hundred shot of ever pitching again. But sure enough, Tommy John did make it back to pitch and actually pitched for over a decade after that surgery. Now what that surgery involves is basically taking a tendon from the wrist and moving it into the elbow to rebuild that ligament. Um, and it works well. 83% of, of athletes get back to pitch at the same level of play, but that's still 17% of, of kids that don't, or our pitchers that don't get back. And it's like we said, with ACL injuries, you're looking at about a year out of baseball and a very, very long, difficult recovery. My worry about it is, and, and we'll stop and I'll let you kind of, when there's a lot to get into here, but the thing with the Tommy John injuries that I think it's created a mentality at the youth level of, Hey, I can throw as hard as I want. And as often as I want, heck, I'll just have surgery if I get hurt and I'll be good as new. And that mentality has led to an explosion of these injuries at the youth level. So all the good we've done at the major league level, uh, at the pro level, I think in some ways we've made the problem worse with our kids.

Yeah. I'm glad you said that. Cause I was going to say something about it, but I didn't know how I was going to word it because there's been a couple like young kids that I've seen who have had like medial elbow pain and they seem to know about the surgery already and they don't seem to care. Like they, they weren't in the need of it yet, but it's almost like a badge of pride. And I remember seeing a, there was a, there was a, uh, a picture I saw on the internet where it was an ulnar colateral ligament insertion and it made it into a tattoo. It was like, but it was the seams of a baseball. So it was almost like, yeah, I got it done. Wow. So yeah, there is, there is a mentality among kids and, and, uh, coaches and parents to a certain extent that, um, they feel like one, it's not a big deal. They'll just pop a new ligament in and you're good as new. But then there's this perverse idea that you're actually stronger after surgery, which is crazy. Uh, and we, we can talk about why, uh, that's not true. But, um, I mean, these are 13, 14 year old kids.

We don't want kids at that age to have surgery, any surgery, elbow surgery or any other body part. So if you can prevent that, I don't know why in the world you would look at surgery as a good thing. Yeah. And I think that's one of the only injuries that I've ever seen or heard or surgeries that I've ever seen or heard where people don't seem to mind that it's going to happen. Like it's, it's just, it's, it's like, I'll just pop a new one in. Like you said, um, is, I mean, how young do these kids get it now? What's the youngest you've ever seen? Yeah. I mean, I've probably, I guess the ones I've heard about, I've really, the youngest would be about eighth grade. So that's what 13 year, maybe 14 years old. Uh, I'm sure there are reports and as somebody emailed me on my website a few weeks ago, their son was 10 and had that injury. That's pretty rare.

Um, but yeah, I think the eighth, ninth grade is it's getting into high schools for sure. I mentored a kid at a magnet school here in the Charleston area and he did his thesis at his high school on Tommy John injuries. And I was like, that's an interesting topic. Why'd you pick it? And he rolls up his sleeve and he's a baseball pitcher with the Tommy John, uh, surgical scar. And so, yeah, you're just a stunned, you know, and it's, you know, it worries me. You talk about that mentality, this pop a new ligament in, you know, baseball pitchers at the major league level have every day to rehab. They have a physical therapist they can work with for four or five, six hours a day. High school kids have to go to school and they're out of baseball. So they're not around their teammates. It's really hard for a high school kid to recover like a pro. It's just a different animal. And so, and they don't, they're not as tough emotionally. I mean, that's, it's a lot to ask. If I'm a parent, I wouldn't wish that on my son for anything. Yeah. It's it. And, uh, I think the reason I'm just going to theorize. So I actually wrote a huge article on rotator cuff tears and I actually bumped into some stuff on ulnar collateral ligaments, which I just kind of dropped in there just a little bit. It was just like a paragraph, but there was a stat and I don't know if it's a, uh, uh, I haven't looked at the resource in a while, but they're saying as, as rotator cuff injuries went down, ulnar collateral ligaments went up, um, in major league baseball, I think it was of 2014. But the reason why I wrote the rotator cuff article in the first place was because if you have a full cuff tear, like, I mean, what's the chances of you ever pitching again? Yeah. You know, versus an ulnar collateral ligament where it's like, Oh, just don't throw again. We need about a year.

Yeah. Fine. Yeah. I don't know the current statistics on rotator cuff tears in major league baseball, but back when Jimmy Andrews and Chris Mazzoway wrote that paper in the early 2000, like 2006, I think it was two out of 16 pro pitchers got back after a rotator cuff tear rotator cuff repair. I mean, that's abysmal. Uh, you know, so yeah, you definitely don't want that. It's true. At least with a Tommy John surgery, you have a reasonably good, I mean, what? 83% chance of getting back at the same level. So there's clearly good of that surgery. Don't get me wrong. It's just, uh, uh, I'm just worried about it at the youth level. Yeah, no, I agree. Um, so prevention of it, uh, you talked about a couple things in your book. What are ways that we can prevent that?

Well, I mean, I think the biggest thing is, uh, we've got to somehow limit the overuse on people's elbows. Uh, and that is not really necessary. People immediately think like pitch or inning counts and that's part of it, but this is a wear and tear problem over years. Uh, so I think the real challenge, uh, it starts at the youth level, not letting kids pitch all year long, you know, give them three or four months in a row off from pitching, play a different sport if you want to stay active, but don't pitch. I think it's not playing for more than one team at the same time, not, uh, pitching in these showcase events when your arm's tired from, you know, pitching and playing in games all week, uh, not pitching through fatigue or pain.

I think if you limit those things really from the time a kid gets into little league baseball, you stick with those sort of rules of thumb and in high school, even going into college, we can gradually, or we can, I can't give you a number, but we would probably cut way more than half of those injuries if we just followed those simple guidelines. So you brought up a good point. What's your, what's your thought on club baseball, year round baseball? I am not at all a fan of it. And I live somewhere that is warm enough where people can play year round and kids do pitch year round. Uh, I just, I, I don't think these kids have the muscle strength to take the stress off the shoulders and off the elbows. Um, and so, you know, yeah, you can withstand that elbow stress for a few months or maybe even a year, but over time that stress is going to build up and you're going to get hurt. There are reasons major league baseball pitchers don't pitch year round. So if we don't have our pros doing it, why would we want 10 year olds doing it?

Yeah. And I, I know that the parents and the kids always have like the, like the thought process of, well, he might lose his spot. You know, I got invited to this team. They're having a showcase, but, um, I mean, at some point they just have to just realize that they got to shut it down a little bit and just do some real strength training or rehab or preventative approach, kind of how they do the majors, you know? Absolutely. I mean, when I was in, uh, my fellowship, I worked with the doctors that took care of the St. Louis Cardinals and, you know, I would just, I loved baseball at the time. I would hang out in the training room, uh, all the time. And, uh, I would talk to the pitchers and none of them were just pitchers growing up. A lot of them played other sports other than baseball, but even more of them played sport or played positions other than pitcher. They were shortstops or they were center fielders or something. And then they got moved to being a pitcher in high school when they realized they were really athletically gifted. Those guys used to tell me either you're a good pitcher or not pitching a ton at seven and eight years old is not going to make you a good pitcher. And so they, they thought it was a bad idea. And obviously they made the major leagues as pitchers not pitching year round at a young age. Yeah. You're bringing up a lot of good points here. I really hope there's some coaches listening in on this one. Um, actually I went to a strength conditioning conference one time and I forget who was speaking, but they made a really good point and they were talking about, um, you know, diversity of sports, at least growing up and overall athleticism. And they said that there, we got a real problem in America. If you're a star quarterback, can't kick a soccer ball, just the overall, they're just, they're so specialized at a young age that they just don't, they're not athletes, you know, like when you think about someone like Antonio Gates, who just plays baseball and says, or a basketball and says, Oh, you know what? I'm going to play football and he's really good, you know? Yeah. So, yeah, I mean, we, I don't know why people are afraid of that. Parents and coaches are afraid of that. If anything, and Brandy Chastain makes that point. She told me that every single member of that 99 us women's national team, every one of them played different sports growing up. None of them just played soccer. Brandy played, if I remember, she played basketball, soccer, and I want to say either baseball or softball, whichever was available to her. And she used to say that, um, it made her better. She learned movements and she learned skills and strategy and techniques and different ways to interact with different types of teams that made her better at soccer. And I think that that's, uh, it's immensely valuable. There's a reason that 88% of the, the athletes drafted in this year's NFL draft, 88% of them were multi-sport athletes in high school. That's a good thing. Uh, and why we're discouraging that is beyond me. Yeah. Yeah. I think everyone needs to play multiple sports and especially those, those unilateral athletes like baseball pitchers. I mean, unless you throw with both hands and, or at least switch it, I mean, you're going to be loading one side for a very long time by the time you hit the majors. I've never even thought of that. That, that is a good point. When you're a dominant on one side, you know, at least do a sport that involves your legs or something. Yeah. That's a great point. Yeah. I, I, I don't remember where I got this fact from, but it can't, I think it came from a colleague, uh, who then read something and I'm, I'm, uh, I guess I'm just going off his word because he's a really smart guy. He was saying that baseball hitters who are switch hitters actually can generate more power than single-sided because they're more balanced. Um, I don't know where he got that, but I do believe it. And one day I'll probably search the reference, but you know, that's really interesting. I've never heard that, but I understand the theory behind it for sure. Um, I, I actually know somebody that's sort of a, uh, an expert in biomechanics, uh, and studies does all the video analysis of a lot of the major league baseball players. I may run that by him cause, uh, that makes a lot of sense. I've never seen that study, uh, or seen numbers on it, but boy, if that was true, uh, you could make a compelling case to sort of change how we develop young baseball players. Yeah. I'll have to really, I'll have to really look at it. And I know that, uh, like one of the major league strength coaches I was talking with, with, uh, I was asking about what do you, what do you do for power training or rotational power during the year for some of the players? And, and, well, we don't, she's like, well, we don't do any during the year for rotation in the same direction. We might do the opposite direction, you know, but you usually don't add on to that, you know, that unilateral dominance, you know? Yeah. I've heard that same type of thing though. That actually makes sense. I've heard that same argument with, uh, dry land training, uh, essentially weights, uh, for swimmers, for competitive swimmers. Like you don't necessarily want to replicate the exact things you do in the pool. You want to develop other parts of the body. Uh, that makes a lot of sense. Yeah. I like how you had dry land because I was, I talked to, there was a, there's a couple of swimmers I know where they're like, they're saying, well, we're doing dry land today. I'm like, you just, you know, I want you to say land workout, you know, why do you have to say dry? That's a good point. Yeah. The swimmers are great. I love the swimmers. Uh, they are an intense breed, uh, in a different way. Uh, you talk about people though, that, that are, that probably could benefit from playing some other sports. Can you get them on anything that involves their legs running or landing? And they, a lot of them are a mess. Um, because all they've done is, is basically training a pool. Yeah. They're, they're all like just open chain with, I mean, I would imagine just feeling the ground just to walk to their bedroom is, is odd how many hours they've been in the pool, you know? Yeah. Um, so, okay. So actually before we move on from ulnar collateral, is there anything that you want to add? I know we diverted a little bit there.

Yeah. It seems to be our norm on this interview, which is great. It's a lot of fun. The, uh, you know, I think the big thing is just, and I'm not going to hit on it cause I tend to preach on youth sports and injury prevention, but I think that parents and coaches, and we need to do this as healthcare providers. We've got to get people educated on this, you know, because these are preventable elbow injuries, preventable shoulder injuries. These kids are suffering and, um, somehow we've got to change our approach to developing young athletes because we're not doing any favors for these kids. Yeah. And so everyone, that's why you should listen to the Dr. David Geier show. We'll put a show notes or as his link on the show notes for everyone to find it too. Um, okay. Something I needed to hear from you because I heard in a couple of the podcasts, I heard there was such a passion behind the, the theory of football and should we continue it and the reasons why or why not? Yeah, I tell you, I have evolved a lot in the last few years on this. Uh, and I, and I'll preface this by saying, I love watching football. I never played it. Uh, I had a lot of friends that were on my, the high school football team, but I didn't play personally, but I have loved it as a fan. And I have always up until a few years ago, been resistant to the idea that, Hey, we need to make major changes because of the concussions and the CTE.

But I tell you, I've, I've interviewed a number of the Boston, uh, brain experts that are studying these, uh, former NFL players that commit suicide or they've died for various things. And they are convinced that it's not so much the outright concussions, but those repetitive blows to the head, the collisions between linemen and the tackles that that is the buildup of those microscopic blows to the brain that really leads to the long-term brain damage over years and years and years. And I tell you, I've gotten more and more concerned now about the risks of tackle football among kids, you know, that basically under the age of 14, who, you know, their brains are still developing. I don't know if that's necessarily what we should be exposing our kids to. So I'm starting to lean more and more towards flag football, passing league football, at least, uh, for our young kids. Yeah. Yeah. It's a, I think it's a tough thing because I I'm right there with you. I love seeing grown men beat up on each other, but you know, it's one of my, actually it is growing up playing baseball. I used to love to watch baseball, but now I cannot name hardly like any of the players in the league anymore after Ken Griffey Jr. left the Mariners, but I love watching football and it's, it's just so, it's so exciting. And then you can, they stop real quick and you can go to the bathroom and you come right back. It's, it's great, but I don't think I would want my kids playing it either.

Yeah. It's, uh, I mean, what other types of injuries actually? So actually, but let's go on to the, the whole concussion thing with kids in high school. Cause I know they screen them sometimes. Yeah. Uh, do kids fake their concussion screenings? You know, I've heard that, you know, I, uh, when our program, when I was, I don't do this anymore, but I was the director of a sports medicine program at a, an academic program here in Charleston. And, uh, we used to do the, the baseline screenings for a lot of the high schools. And you would hear that sometimes that kids would try to bomb them so that when they did suffer an injury, the follow-up test would be bad as well. And, uh, then they'd be quote unquote cleared. I have heard that. I don't know how often that actually happens. Supposedly those tests are sophisticated enough to catch that. But I kind of look at those, those screening neurocognitive tests as one piece of a big puzzle. You have to look at symptoms. You have to look at testing them physically, like having them run on a treadmill and seeing if that reproduces symptoms. I mean, there's a lot of things that are involved in clearing an athlete for concussion. So, I mean, I think that I guess it's possible, but I don't know if it's as big of a, it's certainly not a reason I wouldn't offer the test. I guess I'd put it that way.

So if there's parents listening to this and I know they blame a lot of the, uh, you know, like my kid's moody and like, he's just going through puberty and so on. Like, are there certain signs that they should be looking for? Like out of the norm that, that might may indicate that their, their son has had a possible concussion or at least. Yeah. That's a, that's a great point. I don't think that this gets enough attention when, uh, and I, I can't tell you too much more about it than this. Cause we had a whole, uh, concussion team of neurologists and neurosurgeons that sort of did our concussion evaluation. But we did have an athlete one time that, uh, they caught that, uh, supposedly was contemplating suicide, but you know, they, you know, somebody recognized something and got them, uh, evaluated and turned out he had just had multiple concussions that changed his personality. So for parents out there, I would look for things that are different. Yeah. Anger would be one if your child's not normally angry, but the reverse can be true. It could be somebody that's normally very volatile and very intense that all of a sudden now has sort of a flat affect and doesn't seem interested in things or doesn't seem to be eating normally or interested in school, some sort of behavioral change, uh, that just doesn't seem natural for your child. I think then it would be worth getting it checked out and talk to your kids. This is where open communication is a big deal, not just, Hey, you know, you know, beating them down about winning and statistics, but asking them if they're having fun in their sport, what, what happened on any given day. Hopefully they start to open up and trust you over time so that they could tell you, Hey, you know, something's not right here. And then you decide to go get it checked out.

So where would they go to get it? Like is, can their general practitioner do that? Do they have to go to a special clinic to, to have a concussion test? Well, I think the first place you start if you're at the high school level, at least hopefully your school has an athletic trainer. So you would go, you know, say, you know, talk to the athletic trainer and see what they've noticed. And then they usually have a connection with a sports medicine program that covers that school. And then you go from there, but if you don't have access to that, then I think you, you first place to start is maybe go to your family doctor, you know, the child's pediatrician or family medicine doctor, and then see what they think. And maybe they know a neurologist that does this type of thing. Even your team doctor, if it's an orthopedic surgeon, you know, just ask people that they'll know people that can evaluate you for this kind of thing. But get somebody involved. Yeah, perfect. Yeah. So definitely, definitely parents start talking to your kids. That is probably a big thing. Yeah. I don't have any kids, but I would imagine like around like 15, 16, they'll start saying, yeah, whatever, dad, like they just don't want to talk to you anymore. Yeah. Oh, yeah. No, it probably starts earlier than that. But I will tell you that you got to do everything you can, at least as it pertains to sports, to keep the open communication there. And again, it doesn't have to be intense conversations when you're driving home from practice or driving home from a game, just simple stuff, but developing the, that open communication, because you read these stories of high school athletes or college athletes that commit suicide, you know, either from burnout from sports or multiple concussions or something. And, and the sort of underlying theme with all of those is they just didn't know that anything was going on. And I think communication goes a long way, uh, to helping with that. At least maybe they should start making movies kind of like, you know, uh, actually, are you, you're like 40, right? Yeah. Um, little, just, uh, just past 40, just past 40. So did you go up with like the movie varsity blues and like, remember the Titans? They, they never talked about concussions in those. They should just do an all on concussions, how it gets depressed. They found out it's a concussion. Yeah. I mean, maybe that'll come. Yeah. It wouldn't be quite as funny or as, as, uh, uh, enjoyable maybe as varsity blues or, uh, remember the Titans, but I, yeah, I mean, concussion is out there. Uh, the movie with Will Smith and I think there is awareness of it, but, uh, yeah, we've got to quit glorifying the huge blows and that kind of stuff. And even movies like remember the Titans really sort of glorify the contact and the physicality of football. And, um, maybe that's part of the problem. I don't know. Yeah, it could be. Um, so as we're, we're, we're almost at an hour here. Um, I want to make sure that everyone knows how to reach you or if there's anything else you want to add to this actually. Uh, I mean, shoot, you and I can probably talk for another six hours, so I'm not going to, I won't do that to the listeners, but, uh, yeah, I mean, I'm happy to, I love talking this kind of stuff. I love talking sports injuries and injury treatments and prevention, exercise and health for active people. So, you know, obviously you do a great job with what you do.

Uh, anybody's welcome to check out my podcast. Uh, you can go to, uh, it's on iTunes, the Dr. David Geier show, go to my website, drdavidgeier.com. It's just not just the podcast, but I do YouTube videos. I do, um, uh, written articles. I have a newspaper column you can check out there. And then obviously my book, if you're interested in this kind of thing, I just got a book out that came out, uh, recently that's got to hurt the injuries that changed sports forever. We talked about a number of the dilemmas and things that, uh, in pro sports and the issues with youth sports that came of it. If you're interested in this kind of thing, definitely check that out as well. Yeah. Perfect. I saw on the YouTube channel, I imagine you, you said you're, you're lifting weights all the time. You ever do those selfie videos of you lifting weights?

I don't. And the funny thing about that is one of my best friends is a physical therapist and his Instagram feed is literally, in fact, two of my good friends, they're both physical therapists. Their Instagram field feed is constantly them lifting weights, showing some exercise and it drives me bananas. So you will never see me do that. I mean, there's probably a good reason for that. And they get tons of likes doing it, but I've almost unfollowed two of my best friends because it just drives me bananas. So you will not get that from me. Yeah. Good. I, I don't, I definitely don't believe in, uh, selfies or, uh, I call them lonelies. So lonely videos are probably the worst of all of them.

Um, but I understand, I understand why they're doing it all. So it's, it's probably all, I'll just get people excited. Yeah, I guess I don't get it. I've never really understood social media as an effort to talk about yourself per se. I always look at it as what can I help people with? What can I teach? So I've never really understood taking pictures of food, never understood showing yourself working out, unless you're teaching an exercise like for injury prevention or something, that's a different story, but yeah, I don't get it. Um, so yeah, and I don't do too much of that. So if anybody listening does do those kinds of videos, more power to you, but I am not in that camp.

I, I, I have a, there, I had a friend do an interview on this as well. He's a, uh, uh, he's a, he's a, he's a triathlete and he was saying that it starts, it starts at your gym and ends on your Facebook. Yeah, I guess. Uh, I don't know. I don't get it. I will tell you that I go to a gym that people work out, they take it pretty seriously. So I have not seen many people, uh, just, uh, shooting videos of themselves. I think, uh, the, the big strong guys, I am not one of these meathead muscle guys by any means, but I think those guys would beat the snot out of people shooting videos of themselves working out. Um, it's just the type of gym it is, but Hey, more power to you. Hey, if you're working out, I at least admire you for that. We need more people working out. If taking selfies of us, what gets you to do it? I guess I shouldn't complain. Yeah. I should probably let everyone know that on your Skype, your Skype profile picture here is just a big bicep girl. So that wouldn't be funny. Wouldn't it? I, the, um, that, oh gosh, that would be, uh, uh, he is kidding about that. It is not, that would be funny. Yeah. Yeah. That'd be amazing. If I, if I could just change that around for you, somehow hack it and then make it so you can't change it.

So you talk to everybody and there's just a big bicep or the email picture, the picture that shows up in your email. Um, you know, so that when you open somebody's email, that's the picture that they get. That would be funny. The, uh, I don't know. Yeah. Who knows? I, it's kind of the same thing. And I, I will say, uh, for a lot of reasons, uh, once in a blue moon, I'll actually record a YouTube video talking about some kind of injury or something, and I'll be wearing scrubs, but it kind of would, the, the, the workout videos, uh, on Instagram sort of rubbed me the way of the people that go to the gym or go to the grocery store in scrubs. I'm like, come on, you really didn't have time to change clothes. Like, come on. I, I, I've heard stories of what kind of stuff is on the shoes that you wear in your scrubs. And that's probably true. I have a different pair of shoes that I wear in the OR and they stay in my locker there, but that's probably true. I actually though think that it's a bunch of people that, that probably did not come straight from the hospital. They just want to be seen in scrubs. Um, who knows? It's just one of my pet peeve rants that I have. It's just a weird thing for me. I feel like I'm going to stop the next person I see in scrubs in the grocery store and just, I'm going to just talk, talk to him for 20 minutes about their work and see how much they'll wear scrubs ever again. Yeah. Yeah. Start asking them medical questions. Hey, yeah. Yeah. See, maybe they'll stop. Uh, I bet you're going to find out though, that I don't know. I shouldn't say cause that's some of my friends do it, but, uh, I've never understood it. Um, anyway, I don't know how we got off on that tangent. Yeah. Okay. So, uh, actually just, just stay on, stay on. Let me close the podcast real fast and we'll talk for minutes after. Okay, everyone. That was Dr. David Geier. I know we didn't say how to spell his name. So that's G E I E R is the Geier, uh, dot com. So go over there and listen to his podcast. And again, we have all the links on the show notes. You can find that at P2 sports care.com slash podcast. And if you have a question and kind of how we talked about on this week, I guess we can't give real, real specific medical advice, but we can definitely brainstorm what's going on. So if you have a question, there is a voicemail button on the P2 sports care site. Just leave your, leave your case, leave your story. And, uh, it'll probably provide really good, uh, insight to a topic we can talk about. And I know that you, if you have this condition or if you've had a condition, a lot of other people do. So you're going to help more than just one person. So, uh, again, if you have not listened to this on iTunes, go through the website to iTunes to subscribe there, please review it because it helps get this to the forefront. So everyone can listen to the same content you are. So, uh, thanks for listening and thanks for, uh, subscribing. Talk to you guys soon.