 Hello and welcome to this episode of quality of life. I'm your host at day of Augustine today We're talking about family and sports medicine Joining us to talk about this topic is dr. Jose Armendaris. Welcome to the show dr. Armendaris Thank you for having me to start out. Could you give us a brief background of your experience in sports medicine and family medicine? yes, so I'm a purveyor primary care sports medicine physician and I take care of general medical conditions as well as sports medicine related injuries in the shabuigan and surrounding areas Okay, do you care for athletes non-athletes or? People of all ages or what's your basic practice makeup of yes right now? My practice is made up of a 50% family medicine patients as well as sports medicine patients and we we take care of athletes non-athletes and even injured Workers in industry accidents. Okay, how long has sports medicine been around or in practice? so the sports medicine as a practice is relatively new it was a subspecialty of family medicine along with other primary care fields since the 1990s Okay, how did it come about developing into its own discipline? Yeah, so as far as developing or branching as a subspecialty the the primary specialty such as pediatrics family medicine ER medicine and PM and our medicine Those have been around for a while family medicine being my specialty since the 1970s But as of the 1990s it it turned into into a subspecialty within family medicine Okay, so it has all the certifications board certified and all those is recognized as a As a discipline as well. Yes with with a sports medicine specialty This requires board certification in family medicine and an additional certificate of advanced Qualifications in the field of sports medicine. Okay, does that then require something? Do they go to medical school and then go to additional training for sports medicine or is it all rolled into one curriculum? Yes, so in addition to four years of medical school. There is a accredited residency program in family medicine in my case And then beyond that is an additional year in a fellowship program Specializing just in sports medicine. Okay, could you go into some of the differences between regular family practice medicine and sports medicine? Absolutely, so the the biggest differences is is basically the training Besides being board certified in family medicine able to take care of general medical conditions I did the additional year of training in sports medicine, which allows me to coordinate care with Athletes and non-athletes musculoskeletal injuries on and off the field Okay, why is sports medicine unique? So this is the my favorite question sports medicine is unique and In its own way, it's it gives me the ability to take care of Athletes of all types and just active people of all types Whether they're training for an event wanting to be more active or just wanting to learn more about Increased activity as it pertains to their overall health Okay, are there different approaches or different kinds of sports? for the types of sports medicine as far as sports related injuries and and The approach goes it's very specific to the type of activity As far as treatment of the injuries, it's pretty standard. You can roll your ankle playing basketball You can roll your ankle walking down flight of steps So that is in this tailored as the preventive portion of it So the the the specifics of it more or less lie in the in the prevention. Okay With sports medicine, I mean there's the care and actually physical injury that you know people may Get while playing sports. What about you know, once they have it you do your thing. What about rehabilitation or? recovery type procedures so this is this is basically the meat of what we do we We focus our attention on As quick and safe recovery as possible for the athlete or non-athlete and a quicker safe return to their activity whether it's work or or a sport Does the sports discipline also have Psychological rehabilitation, you know, if somebody who's let's say a high school or even a pro athlete, you know They have a promising career and all of a sudden they blow out their knee or something and their careers pretty much done I'm sure that's something that they have to cope with as well. Yes This is a very important question and often not as well addressed as we would like but there is a big component of behavioral health Psychological component to athletes and in in the setting of injuries a lot of these student athletes are our athletes first They're doing a Student career plan and then once that injury comes along then they're left questioning What what do I do next? How's this rehab going to impact my level of activity that I was before the injury? Okay, could you step us through, you know from a youngster to all the way through up? You know how they may be involved with sports medicine or when did somebody really get involved where it's considered dead? absolutely, so My ability to incorporate sports medicine basically in all stages of life begins with it could be something like a New-born exam on a baby that might be two hours old looking for hip clicks looking for hip dysplasia And as they develop taking care of overuse injuries as a child And and I'm even into arthritis as adults so it's full spectrum. Okay Do you see as you know, they grow older into it you take different approaches versus you know Younger's versus, you know now you're in high school or even to the pro level or is it more aggressive as you get older or? Absolutely, so everything's tailored and as far as their their Conditions go it's specific to where there are in life. Sometimes it's a growth plate type of injury sometimes it's it's a Overuse tendon type of injury and other times it's it's arthritis. So it's very tailored and level of activity whether they're high school collegiate or just a weekend Person doing Intermural sports it's all taken into consideration. Okay Is your role in sports medicine? Coordinating other resources as well say surgeons or other medical teams or do you in your? Practice or discipline perform that yourself. Yes So we do is is we coordinate care with other specialties whether it be orthopedics general surgery gastroenterology Psychiatry we coordinate care with the specialties and with the teachers the Coaches and the athletic directors along with the parents and and the athlete themselves Okay, do the care plans differ for the path of recovery in sports medicine versus let's say somebody has a Traumatic event or through emergency type Injuries yes, so the the care and they return to activity is very tailored a lot of times rehab for six weeks would mean the end of their complete season so so that has to be taken into consideration and It's no different when we treat non athletes Wanting to return to work we kind of treat them like athletes themselves nice Say for somebody let's say who's disabled, you know, and they want to play sports You know or they have some type of a condition Do you work with those type of people as well to help them create more into sports and work with them? Yes, so we always recommend health and and activity and special populations is no exception we do pre-participation physicals prior to their activity beginning and We take special considerations for for certain conditions that may require special imaging or or or other Attention, that's that's normally not a Common in in regular sports physicals okay With the different types of sports that are out there so you got football basketball Wrestling, you know, do you see different types of injuries or different types of approaches you take for those? Yes, so the the approach has more to do with the the prehab or the prevention of injuries With the regards to the sport then it does the injury itself So you can again you can break a finger you can roll an ankle doing just about any kind of sport But it's that hamstring prevention for that for the soccer player It's the skin prevention for the wrestler and things like that. That's more tailored Okay Now you speak about prevention. Is there anything that athletes can do themselves to help prevent, you know injuries when they're playing sports? yes, we Educate patients in the in the office in the training room with regards to pitch counts So that they don't overthrow and and predispose themselves to an overuse injury We talked to them about preventive or even prophylactic treatments with With antivirals for known skin conditions during their during their season, okay We also have different types of athletes those are who are really like in school sports They have their seasons and then they wind down, you know, and then they have to wait till the next year Let's say if you're a wrestler, you know, you you're all that and then you cure yourself up to You know get in shape or cut weight, you know, so to speak or whatever. So you have those types of Athletes, what do you recommend like for dietary or ways to keep in shape for these types of athletes? Absolutely. So there there is More of a push towards prevention and it could be anything from maybe visiting with a nutritionist So we talked to them about nutrition about health about stretching these athletes are growing As we speak and they predispose them to tendon strains and tears So there's a there's a maintenance that needs to happen if they really want to consider a Future in in continued sports as a student athlete, right? I know when I was in wrestling I didn't have a problem of dietitian because I was heavyweight all the time So looked at the lights a lot too, but anyway What I remember, you know getting in shape, you know, that's like you said You kind of you know lacks offer throughout the summer and fall I didn't play football so a lot of the other people in a wrestling team played football So rolling right in they were in shape where I had a kind of gear up So I mean there's a lot of aches and pains and muscles the first week or so of practice, you know to Stay in shape. So Any do's or don'ts that you can recommend on things like that? So the do's or don'ts mainly reflect back to the conditioning the two a days That takes all levels of all athletes kind of lumps them into one and pushes you through some rigorous Exercises so if if you know that that's coming which they do the important thing is is to make sure they do preventive types of Exercises whether it be stretching whether it's starting earlier on your nutrition getting things on track For the things down that are coming down the pike. Yeah, okay What advice do you have for the weekend warrior as far as you know? activities, you know Softball seasons coming up, you know as far as that goes so in baseball season things like that You know what they get out on the weekends and go and you know how that goes you're all energetic and you know Give it all out and then oh I threw out my shoulder of my arm So the weekend warriors or the anyone that wants to be more active than they actually are have other special Considerations I would ask them to consider the activity that they're wanting to do for the first time or wanting to incorporate I would also ask them to consider their current medical conditions and If they have any questions they can certainly contact their primary doctor or someone qualified in sports Injuries to make sure they do a proper assessment make sure they're not on any medications That's that are going to be counterproductive or even hurtful to their to their goal of becoming more active I would think you also have a background in emergency medicine because probably in the acute case of A lot of those types of injuries that may come first through the emergency Room and then they come to you for you know probably recovery or how to treat it. Yes, so in in in residency I worked as an ER physician as in as far as moonlighting goes I was a orthopedic technician in the army, so I'm familiar with acute injuries and That's what we do as far as sports medicine goes We take care of kids in the clinic and in addition to that on the sidelines or on the wrestling mat or on the volleyball court Absolutely, okay getting back to you know family medicine versus the sports medicine What are your driving factors of how you treat a wound versus one side or the other since you know you do both You do both disciplines, you know, how do you distinguish the two? So it's it's there's less of a blur as far as distinguishing family medicine and sports medicine the the added field has actually given me a more of an emphasis on on physical activity and improving quality of life through more than just a chemical management with a medication or or Or an analgesic so or a pain medicine. So what we do is we encourage movement And and tie that in nicely to family medicine And that would make sense because with the sports medicine It's more activity staying healthy staying active rehabilitation repetition versus like you said Okay, we take a aspirin a day for this or whatever so which then again would promote You know good health because then your weight goes down you stay healthy your heart and your cardio system and everything works better Absolutely, so What are some of the injuries that you see on a regular basis when it comes to sports type injuries? So the most common type of injury is an overuse injury So this is something that that can happen in your knees and your shoulders and your wrist from a repetitive test That you've never had before and it doesn't necessarily have to be during a sporting event You can get the same Tennis elbow from not playing tennis just at your job as you can from a match a tennis match So the most common thing is is overuse injury as far as the the injury type It's it's a lot of it season driven Depending on on what the athletes it's exposed to or what the individuals are exposed to we're coming into the spring season So I would suspect more outdoor kind of stuff happening Okay, at what point would you think that an athlete should you know say you know I've really got to get this looked at you know and distinguishing between oh It's just a kink it'll work its way out versus no I should get this checked out. Yes So I have some general rules that I tell Athletes and non-athletes number one if the pain is two out of ten and You've rested it you've iced it and it's still lingering. It's been a week or two Don't ignore that pain if that pain Modifies the way you do your activity if you're running and now you have to run in a different way And you've rested and iced it and you and you've honestly Given it a week or two and it's still the same kind of pain Or if that pain is the focus of your activity So you can't run without thinking of this knee pain. You can't run without thinking of this ankle pain those are the kinds of Warning signs that I would say you know your body is telling you to do something different and maybe have it looked at And because rest ice I be profan or Tylenol or not enough, right? And I would think you'd want to get it looked at because you know like with anything else if you get a limp And you start limping or running indifferently you can throw other things out of whack and actually cause More more harm or damage to other parts. You can't it's like a wobbly wheel on a on a car It'll start shaking other things up absolutely So okay, let's say I'm getting older, but I still have the passion to run not me Maybe but you know other people you know passion to run or be active or do whatever even to well I am a hunter. I like going in the woods, you know So I am active in the woods in the fall, you know in winter and stuff So as you get older, you know are there certain things that a person can do to you know help along Especially when the joints get over do you start, you know wearing knee braces wrapping up or how does how can somebody you know? Take preventative medicines or help around medicines, but to help with activities that they can still be fully active So that's a that's a very important question and as we age it doesn't mean that we have to move less You're absolutely right something even is as complex as hunting requires a lot more senses so the important thing is to To find out what the the limitations are as far as the activity goes see what your overall health is and then as far as Medical conditions go see if it's safe to do so a good example is having arthritis It doesn't have to slow you down It actually likes arthritis likes for you to have movement But if you have bad knee arthritis, then running wouldn't be something that would be ideal There's other things that you could do to keep you active and healthy Okay Any does Infectious diseases or other types of viruses or things, you know that especially going around this day and age You know with everything going on does that affect you know an athlete or their ability to perform there are? Skin conditions are the most common thing especially amongst wrestlers, but anything from a viral illness like infectious mononucleosis can affect the size of your spleen can affect the size of the energy level you may have and As far as activity with a fever that's something that needs to be evaluated to make sure that you're You're okay to continue doing that type of training or activity while you're sick Okay, I go the Walgreens and I look at the shelf There's all kinds of you know body enhancement things to you know the days of Mark McGuire when supposedly he had his home run Thing and he was taking supposedly a non prescription, you know enhancer or stuff any of those you know Don't stay away from them or do they help or you know should somebody stay away from them? So this is a common question that I get out all the time in the office The most common product of being something like glucose amine chondroitin for the joints and What they should do and what they should not do The evidence shows that if you try it for a good six weeks twelve weeks And it shows effect and you can continue a supplement like this for your joints if it does nothing then I tell them, you know save your money don't take don't buy anymore and and let's let's talk about other options whether they be gel injections for the knees or or some other Functional rehab for that for that knee pain But there are a ton of supplements and the most important thing is to bring them into the office Have us take a look at it and make sure that not only are you getting the right amounts of these supplements But they're appropriate for the activity or the purpose that you want them for okay So is there certain lab tests that you do to keep you know a track of a Person's health or an athlete's health, you know that you do either from blood draws or whatever there are Recommended lab tests and they mainly center around The patient's ages they center around the patient's medications if they're on certain high-risk medications for electrolyte imbalances and those things are checked Cholesterol is an important one to check. They all have their their Times that we begin to monitor these things and it's they're not routine, but they're more Specific for the patient and their conditions okay along with that dietary Requirements, let's say for an athlete is there different dietary requirements that they should follow You know like you see like you have the rocky show or rocky bell bull and all those big class of eggs Do you know is that really do anything with the protein or is that just a movie stunt or whatever? I guess what should an athlete's diet really be composed of that is a well That is a good source of protein eating rye's although. It's not tolerable to a lot of people As far as the diet for the athlete. It's a it's athlete specific wrestlers have different requirements football players have different requirements Bodybuilders have different requirements and even long-distance runners So this is all tailored and and and discuss that there at the patient's visits I know it always is important to stay hydrated as well You know you see him Gatorade was always the big drink on you know You see him on the sidelines and everything at the football games and such Is that really an important factor and what's the best way that an athlete can stay hydrated? Is it just good old-fashioned water or is like a drink like Gatorade or better or something else that puts the vitamins back in quicker? Yes, so hydration is always important, especially when you're doing a lot of sports that that end up with a lot of electrolyte loss Gatorade and and these sports drinks are good for replenishing electrolytes So those are important to use and in that time up before the most part water does a great job as far as hydration goes Okay What are some of the other physicians that you work with as far as their disciplines on a common basis? So the physicians I work with cover all disciplines and that could be anything from surgeons of all type to other primary care specialties such as pediatrics internal medicine and and Psychiatrists, but it covers all all specialties and nutrition as well In an athlete's training program, I mean like some of them you see they're lifting weights or they're running or To get cardiovascular. What mix do you say? They should follow versus, you know, cardiovascular versus, you know weights or restriction type exercises So those are those are good questions and they come up very often as far as aerobic exercise for somebody That's an athlete. It's it's pretty much dictated by their their coaching staff and their strength and conditioning folks the everyday person I always say 30 minutes of aerobic exercises two to three times a week and That aerobic exercise could some be something as simple as walking The exertion level of it could be fast enough to have this conversation We're having right now and the nice thing about aerobic exercise if you get 30 minutes It doesn't have to be in one straight shot You can do 15 minutes and 15 and use it as your warm-up and cool-down when you do weight training, too Importance is moderation and that's was going to follow in my next question That's like if you're lifting weights You don't have to be you know 50 pound dumbbells all the time you could start with the five and work it up as well And you know and the other thing when I did work out I was always got yelled at because I was seeing how many reputations I was doing versus doing the thing and then the slow to really get your workout as far as that goes Yes, so there's two two Functions as far as the muscles go and one's the contraction and one's the the eccentric portion of it or what some people call the negatives and they that they make the workouts as far as Aerobic or or weight training exercise is more effective when you do them both Before I go into training, let's say or I'm considering do that Should I see somebody like yourself first to get on a program or to look at or just go right into it and Go from there. Yes If there is any doubt whatsoever if there are medical conditions I would recommend that you see someone first just to assess the overall picture if you want to do a lot of heavy aerobics and you're on blood pressure medication sometimes that could Slow your heart rate down so it won't let you reach the aerobic levels that are beneficial So a good assessment if there's any questions, otherwise something slow and steady would be would be recommended with any concerns brought up to the To the patient's Primary doctor. Okay The treatment for sports medicine and injuries is that covered by most insurance plans? Yes So I'm a primary care sports medicine so I'm a family medicine and sports medicine physician and we We have no problems with injection treatments that we do with medical treatments that we do and even Some of the ultrasound Evaluations that we do So that's not a problem. Okay If somebody wants to learn more about sports medicine, where are some resources they can go to for more information? Yes, so I direct folks to the Prevea.com website This is a source of reliable information. That's printable and any further questions. You can actually Contact and schedule appointments with a specialist Otherwise, they're the primary care doctor can direct them as well What should somebody look for in a sports medicine type physician or a program to get into some of the, you know things to look for so some of the things to look for is is as far as Board certification In order to to be sports medicine certified They also have to be family medicine certified and then just a comprehensive kind of approach To the treatment of their of their concern or their their condition. Okay? Any other final thoughts as far as you know sports medicine your involvement with it and Advice to athletes or other people who just you know for general exercise. Yes, so my my advice for general folks is To keep things moving. There's always a way to make things better and if you find yourself wanting to be more active not sure how and And and need a little bit of guidance or assessment to schedule appointment and get those questions answered I always encourage folks to bring in questions that we can answer and then get things going in the right track Excellent Any other final thoughts before we wrap? Yeah, I look forward to serving the shabuigan and the shabuigan area more and bring in more and more sports medicine and Into the area as far as my specialty is concerned Okay, how long have you been in the area for practice your practice so far? I am six months old six months old Welcome to the community. Thank you as far as that goes This takes care of this episode of quality of life I'd like to thank dr. Jose Armand Ars for joining us and talking about sports medicine If you have any other questions about this show or Questions in general you can look on our website at www.wscsshabuigan.com for quality of life. I'm Dave Augustine. Thank you for watching