- 9 months ago
Scott Schoifet, MD: Medical Director Of Musculoskeletal Services, Virtua Orthopedics And Spine
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00:00hello everybody i'm andrew salchunas 97.5 the fanatic you can hear me on the midday show
00:04from 10 a.m to 2 o'clock and i'm really excited i was bummed out last month i actually did not
00:09be able to do this i had some other obligations going on so i was bummed out but today i'm back
00:15and i get to talk to another great person from the virtual health team and this one's great
00:20because the longer the title like the more excited i get so i'm joined today by dr scott
00:25showfit medical director of musculoskeletal services at virtual orthopedics and spine joint
00:31replacement surgeon virtual reconstructive orthopedics virtual health i love it the longer
00:36the better right that means you're an incredible doctor god i appreciate you joining us today
00:41no i'm very excited to be here very excited so we're going to talk about msk musculoskeletal services
00:48pain all that kind of stuff because if you think about it nobody's 100 healthy right like i would
00:53like to say that i'm in good shape but every once in a while i move and i go that hurt a little bit
00:57so what is musculoskeletal care how does orthopedics fit with it right that's a great question so
01:04musculoskeletal care is care of our muscles our bones our tendons all the parts of the human body
01:11keep us moving orthopedic surgery is it really encompasses all that there are subsets in musculoskeletal
01:18care such as uh non-operative orthopedic doctors we have podiatry which specializes in feet there's
01:27non-operative sports doctors who take care of sports injuries they all fall under the blanket of
01:32musculoskeletal care what most people are familiar with are orthopedic surgeons such as myself that's
01:38really who you're going to interact with and we cover all aspects of musculoskeletal even the
01:43non-operative parts and the way i look at it with orthopedic surgery and musculoskeletal and what
01:50really attracted me to it is we're not just surgeons right we're orthopedic surgeons but we actually are
01:55orthopedic primary care physicians as well most people have a primary care doctor they're internists
02:01who they go to for their medical problems and when they have a problem they go to a surgeon
02:04we see ourselves as primary care doctors for all of musculoskeletal medicine
02:09i mean we we treat a lot of things non-operatively injuries that attendance and we have relationships
02:16we have office hours we see people we never operate on and then i think we have the honor of actually
02:21doing surgery on people who then come to us with a broken bone or a joint that needs replaced or a
02:27tendon that needs repair and we get to do that as well and so that's what i find is most exciting about
02:33it and how we treat all parts of the musculoskeletal care and if we were to have musculoskeletal pain
02:40what should we do so that's a great question because the number one thing people think about
02:46when they get hurt is do do i need to go to see a doctor is you know what's happening to me and what's
02:51going on and the human body has a tremendous ability to heal itself and we do see people occasionally
02:58who'll make an appointment wait and come in and do you see a doctor and then they'll come in and say
03:01i don't hurt anymore right so obviously they probably didn't need to see a doctor and that
03:05gives you a hint on what the first thing to do is is wait right if if you're able to walk if the
03:10problem is relatively minor in that you hurt but you can still function then your first instinct should
03:16be let's give my body a chance to heal itself right so you might want to stop what you're doing
03:21you would do the usual first aid which is what we call rice which is rest ice compression and
03:28elevation just simple things take some uh anti-inflammatories like advil or aleve or
03:34tylenol and wait you know you want to wait does it get better tomorrow the next day and does it
03:39disappear and then you know it's fairly minor does it get worse does it linger does it persist
03:45and generally the rule is you know if you're still having symptoms after a week to two weeks
03:49they haven't abated and you're still struggling that's a reason to call doctor make an appointment
03:55to come in if you can't function you can't walk you can't do what you need to do we actually have
04:02a virtual urgent care walk-in both for orthopedics and for you know medical problems as well and you
04:08can get a more emergent checkup you should not have to go to emergency room emergency rooms are really
04:14for real true emergencies you know you you broke your bone and you know something like that but for
04:20these these gradual aches you want to utilize the non-emergency services and leave them available
04:25for other people with the real emergencies and that's why we have those walk-in clinics
04:29now hopefully some of you watching this aren't feeling any pain whatsoever that would be great
04:33good good for you if you're feeling no pain whatsoever that means we can hopefully prevent it
04:38what are some ways that we can prevent pain in our joints so the pain is your body telling you
04:45you overdid it all right so you know it's an important signal it's it's not something bad it's
04:50really our our alert and and knowing that you overdid it is gonna you know lead you to to what
04:57you can do to try to prevent it or or to try to treat it now sometimes when you overdo it and something
05:03breaks you know it's pretty obvious you have to do something right away but usually if you have an
05:10injury or you start to get ache or you're playing a sport and your knee starts to hurt or your shoulder
05:14starts to hurt or your elbow starts to hurt which is pretty common you know the first thing is to do
05:19is to is really to stop doing it right you want to you know cut back what you're doing and then start
05:26thinking about what you can do after that right so if you stop what you're doing and you're just going
05:31to go back and do it again you may get a repeat so you know you want to start to look at things you
05:36could do to prevent the injuries or prevent the recurrence something like what we call repetitive
05:42use injury that's the most common now my mom told me there's no such thing as stupid questions
05:47and i would hope that you know when you're feeling pain in your body or anything in your body there is
05:52no such thing as a stupid question because a lot of people like myself sometimes like to keep it on
05:56the inside and not tell people what's bothering us so what are some of the most common questions you
06:01do here just so that people feel comfortable going to you doc and saying all right i'm dealing with
06:05this not really sure if this is something i should be worried about but what are some of the most
06:08common questions you hear so so for me so i'm a joint replacement surgeon right so uh that's my
06:16specialty and in orthopedics we you know we do five years of training in general orthopedics and then we
06:21do an extra year of what we call fellowship where we specialize and so we all in orthopedics at this
06:26point pretty much are sub-specialized in something and me it's joint replacement other people is sports
06:31medicine spine etc so i get a lot of questions related to my subspecialty and it's a very common
06:39one and it has to do with arthritis is basically you know how do i prevent arthritis right and that's
06:46and you're going to hear that from a lot of people probably the number one question and to really
06:51understand that you have to really understand what arthritis is right arthritis is the loss of
06:57cartilage cushion between your joints typically a knee or a hip and the cartilage cushion is the
07:02tread of that joint right so you're thinking of this is like wearing the tread off the tire of a car
07:07if we were a human you know our knees would be our front tires or hips or be our back tires we're a human
07:13car and so that's what arthritis is is the wearing of the tread and so if you're going to drive that car
07:20for a really long time which we think as a human we're going to drive our cars for 80 years or so
07:25you're eventually going to wear the tread out not everybody but some people and it's very difficult
07:31to prevent if you're going to drive a tire around to not wear the tread out so unfortunately i tell
07:38people you can't prevent it you know if you were born with the tires a little bit out of alignment a
07:42little bit knock need a little bit bow leg when you hit 60 70 that's why we see so much arthritis
07:46and it's difficult to prevent it but you can manage it and that's the key how do you prevent the pain
07:53from arthritis right that's the big question right because you can't prevent it from occurring if you
07:58have it but you can prevent the symptoms and the way i explain that to my patients is i stick with
08:04what i call the car analogy so patients can really understand how this affects them right so if you
08:10were a car driving around right and you had thin tread on the tire of a car that would be like losing
08:15half the cartilage cushion between your bones since we might see that on an x-ray and if you were a car
08:21with thin tread on a tire the mechanic would tell you the tire is still good we'll keep an eye on it
08:26right car still drivable everything's good but it's wearing out right it's going to lose something
08:30and i would expect with me and a patient that comes in and i get an x-ray and there's half the
08:35cartilage left that they should probably be functioning pretty normally and then when all the
08:40tread's gone and you got a bald tire well that's when you might see what the bones are rubbing together
08:45and people say oh i have bone on bone and oh i need surgery bone on bone just means all the
08:50tread's gone doesn't mean the tire's blown out doesn't mean the tire's non-functional and when
08:54i see a patient like that i would expect them yeah they got some symptoms some problems and like a car
08:59on high speed and rainy days you may have an issue driving around then what happens next right you get
09:05a flat tire well that's getting bad right it's tough for the car to drive and of course you could be
09:10riding on the rim and those are basically the stages of arthritis that i see but what the important
09:17part of that story is the tires aren't the only thing to keep the car running right the motor of
09:23the car is really important right and so i see people that come in with just a little bit of
09:28cartilage missing in their joints and they say i can't walk at all my arthritis is horrible i need
09:34surgery i can't go upstairs and if you were a car that couldn't go up a hill or drive around the
09:40block and you had thin tread in the tire and you were the mechanic you'd want to check the motor of
09:44that car right you wouldn't be looking at the tire and that's the muscles right the muscles are the
09:50motor of our car and when people get arthritis they get less active they stop going upstairs they stop
09:56walking long distance it hurts to walk i don't walk anymore here's to go upstairs i use the other leg
10:01and they get weaker right and then they show up to me with a dead motor and a bald tire right and of
10:08course fixing the tire on that car doesn't help right because you got to fix the motor first and
10:14then unfortunately some people start packing up the trunk of that car and that's the body weight right
10:20if you have an extra 10 pounds of your body you put 70 on the joint and so the treatment of arthritis
10:26and how you manage it is you manage the car low impact exercise the most important thing well these
10:32people they can't walk we put them on an exercise bike take the weight off of that joint bike yourself
10:38back to strength and the symptoms disappear if you lose 10 pounds during that time you take 70 pounds
10:44off the knee and then maybe we manage it with injections but eventually eventually that tire is
10:49going to go bad and that's when we'll fix it wow that's an incredible analogy so thank you for all
10:56that it makes it makes it easier to put that all together uh i loved it never thought of it that way
11:01before so thank you doc i appreciate it doc i have a question for you because i'm on the air every day
11:06and we're talking about the eagles every single day the nfl every single day and one of the big
11:10issues so far is injuries they lost a lot of players just from week one to week two and a lot
11:15of the thought is the preseason and how players don't play in the preseason anymore and so they go
11:20right into week one and they get hurt because they haven't built the calluses we'll say uh soft tissue
11:26injuries joint issues you name it is that actually real like do you have to play in a few preseason games
11:32at 80 so that you can avoid injury at 100 in week one or is that just something we kind of make up
11:38now that guys are getting hurt after not playing in the preseason that's a that's a great question
11:44and and it's multifaceted in the answer so i'll give you all the different answers that could come
11:48out of that and uh and certainly training is an important part of being ready for it so the players
11:52are training there's no question but also the the value of these players has gone we're paying a
11:58tremendous amount of money for these players so do you really want to risk that you know getting
12:02injured when the playing time doesn't count when it's just for practice and you have to weigh that
12:07against whether doing more of those is going to help them not get injured during this season
12:12and we really don't have an answer but you can see now that because of the price of these players the
12:18owners are more keeping them out of playing because of their value rather than risking it but then if
12:24they get injured such as aaron rogers on day one right then really what was the value of not having
12:29them play at all maybe that could have been prevented by the warm-up and we we don't really
12:33know how that plays out and then you have artificial turf versus grass you know where they're playing
12:38you know some people say there's more injuries on the artificial turf so where that player is going
12:44to be playing do you play them or not play them i know that they're all well well trained i know
12:50that the trainers or work as much as they can on prevention but the last part of this which is the
12:55physics part of it is the players have generally gotten bigger and faster year after year after
13:02year and when you look back at football players back when i was growing up in the 70s and certainly
13:07in the 60s i hate to say i was growing up in the 60s but i was the lineback the linemen were 240
13:13if you had a 300 pound lineman it was unheard of right they're 240 linebackers were 220 you know and now
13:19you got 280 pound linebackers you got 340 pounds and in physics mass times velocity you know it's
13:25going to give you your force right and so they're faster and they're bigger and they're getting hit
13:31with so much more force than they did before that we're seeing tremendous numbers of injuries
13:36you know and me i'm a jets fan i'm a kai beckton you know injured his he dislocated his kneecap well
13:42he's 400 pounds right yeah so there's a lot and it was going you know if you're going full speed
13:48of 400 pounds you know your bones and joints they sometimes can't take it so when i say it's
13:54multifaceted because we're adding more complications and at the same time you know we're trying to
13:59manage it and we haven't really figured it out but if i were an owner i'd be protecting my asset
14:04all right so keep them out yeah i know seriously but yeah who knows then now we say this is why
14:11they're getting hurt because they're not playing season now doc let me ask you it's such a generic
14:15term when we talk about we just throw out the term sports medicine all the time obviously there's
14:20different areas of of expertise when it comes to the medical field so when it comes to your expertise
14:25with the musculoskeletal services that you do at virtua like what is sports medicine for you what
14:32would that entail for you and your job uh so sports medicine you're absolutely right because as as we
14:38become more involved with sports that certainly become one sports you know people where we don't do 16
14:43sports we just focus on one repetitive use injuries to become very common right so you're doing the
14:49same thing over and over again with one joint you know be a tennis you know serving and volleying with
14:56the elbows and the shoulders or running or you know athletes and you know um you know um track and field
15:03and such that amount on one joint produces injuries repetitive use and and you can think of it like if you
15:11took a wire hanger and you tried to bend and break it you could pull as hard as you can it wouldn't
15:14break but you know if you bent it back and forth 20 times really fast it would snap like fatigue
15:19fractures these things happen in the human body and they need to be treated so sports medicine really is
15:25a developing field because now it's become more focused on sports it's almost a livelihood for people
15:29they're getting these injuries you know these repetitive use injuries how do we prevent them how do we
15:34prevent the anterior cruciate ligament injuries and there's a lot of training you could do
15:39to try to prevent that and that's still you know a developing field and the treatments for it right
15:45if we're going to if somebody gets one of these injuries how do you treat it because they're going
15:48to go back to that again can we can we do something to reinforce it can we make it stronger can we get
15:53them back to their sports field because that's their livelihood right you can't just tell them you
15:57can't go back and do that again they want to go back and play and so that's been a burgeoning field
16:02probably for the last 20-30 years and still is with different technologies different techniques
16:07uh prevention has become very important um and so these subsets of orthopedics and that's why orthopedics
16:14is such a vibrant field it continues to develop new things do come along such as joint replacements
16:20in sports medicine um that really keep us growing and and trying to keep us as active as possible
16:25now doc let me make this clear speaking of uh you know sports medicine you don't have to be a professional
16:31athlete right like you know i like to go play my basketball once a week and make a fool of myself
16:36on wednesdays but i know there's other stuff i i do the i mow the lawn at my house once a week and
16:41i know i feel certain pain when when i'm pushing the mower up the hill or when i'm getting down and
16:47weeding uh so sports medicine not necessarily just for athletes or for professional athletes or just for
16:53playing sports absolutely so what we were talking about is repetitive use injuries are very common and
16:59you see them of course in athletics but in everyday life and you see that a lot with with people going
17:04to see a hand surgeon carpal tunnel syndrome repetitive typing uh you know and there's now
17:10chairs ergonomic chairs we sit a lot during the day well our backs our spines aren't made for that right
17:15so if you're it's a very stressful position to sit all day long for your spine you may not know what
17:20you think i'm resting but that's something else that could be really causing issues so even though we
17:27call it a sports service or sports medicine you know we're all involved that we're all athletes
17:33at some point as we try to get through our day and certainly working at our jobs not just because
17:38you're being paid for it but we're repeating the same thing over and over again even when we're not
17:42being paid for it and and the things we're learning from sports medicine do translate down to us you
17:48know us people who are not athletes in the treatments and things and prevention uh and and how to get
17:54through our day healthy without pain every single time i speak with somebody from the virtual health
17:59team i learn so much more and i hope if you're watching this today that you're enjoying it and
18:03that you're learning a lot more dr showfit i really appreciate your time today uh i can't wait to keep on
18:09doing this every single month it's a shame that you and i are done after today but i really appreciate
18:13it the reason why your title is so long is because you know what you're talking about
18:17so thanks doc that was a lot of fun i really appreciate it thank you
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