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Sports Medicine Physician, Dr. Kevin Elder and Orthopedic Surgeon, Dr. Eric James teamed up to explain the issues and injuries associated with overuse, treatment outcomes and recovery.
Q: With your expertise in treating athletes, weekend warriors, and exercise enthusiasts, what are some of the most common overuse injuries you treat and along with repetition, what are the common causes?
Dr. Elder: Common overuse injuries can be divided into those that occur in a younger/pediatric population versus those that occur in an adult population. Pediatric overuse injuries often involve growth plate injuries- fractures or strains/as well as areas where muscles/tendons attached to bone, and occur due to the excessive demands on these areas and very busy competitive training schedules that often do not allow for an off season. Muscle and tendon inflammation as well as bone fractures can occur of course as well.
Specific examples of common pediatric overuse injuries include Little leaguer’s shoulder (growth plate stress injury) and Little leaguer’s elbow (medial epicondyle avulsion stress fracture and/or capitellum osteochondritis dissecans) to name a few.
Dr. James: We have seen quite a lot recently with the changing exercise patterns and work habits that have come up as a result of Covid. The most common tend to be golfer’s or tennis elbow (medial or lateral epicondylitis), pain at the front of the knee (patellofemoral syndrome) and a number of areas of tendinitis around the foot and ankle (peroneal and posterior tibial tendinitis).
Frequently the cause of this pain is simple overuse, but this can mean different things to different people. Overuse may be training too hard, too frequently or not having a good variety of exercise. Sometimes overlooked, overuse symptoms can arise if our biomechanics are not correct.
Q: Dr. James, many people might want to wait it out or self-treat at home. What are some conservative “at-home” treatment options, and what are the symptoms of injuries that require medical intervention?
Dr. James: RICE – rest, ice, compression and elevation tends to work well for minor injuries and soreness following exercise. While it may not necessarily speed your recovery, it does allow for increased comfort while our body heals and attempts to adapt to the work that we ask of it. Soreness and fatigue are very common after exercise, particularly when starting a new regimen. Severe pain, pain that does not improve in 3-5 days or pain that substantially limits regular daily activity are signs that medical evaluation would be appropriate. Some injuries or overuse phenomena may take 6-8 weeks to improver fully, but I would generally not wait that long to seek evaluation. Our bodies are quite remarkable in their ability to heal but also in their ability to tell us when something is wrong. I frequently tell patients to ‘listen to their body’ and this is no exception.
Q: Dr. Elder, we know that the conservative, non-surgical treatment options are recommended when appropriate, but what different signs should patients be aware of when more invasive measures are possibly needed?
Dr. Elder: The main sign that we determine the need for more invasive treatments is that conservative treatments are not working. Often the patient has had a condition for many months; they have already tried several different conservative options and are possibly seeing a couple different doctors, or other medical providers such as their primary care doctor, other specialists, physical therapist, massage therapist, chiropractors etc. The first step is to make an appropriate diagnosis with the appropriate imaging, which may include x-ray, MSK ultrasound (done in office), or MRI. At this point based on the diagnosis and condition, including how long the patient has had the issue, a shared decision can be made based on evidence as well as the experience of the physician regarding what is the best treatment.
Many conditions that do not resolve with the usual or typical treatment may have good options to be treated with the latest sports medicine therapies including platelet rich plasma/PRP or bone marrow aspirate concentrate/BMAC ” bone marrow stem cell” treatments. These treatments are done under MSK ultrasound guidance and can be excellent tools in permanently resolving and healing some of these overuse conditions.
In the case of arthritic conditions these treatments do not “cure arthritis”. Arthritis pain may flareup with activity and is very disabling to some patients. PRP and BMAC can diminish pain, improve function, and allow patients to return to a more meaningful level of activity. In addition, these treatments may help slow down the progression of arthritis, which is also an additive benefit. Whether or not a patient is a candidate for these treatments, or if it is time for joint replacement surgery is an individual decision based on an office evaluation with appropriate imaging.
Some conditions may require surgery, including those that fail all other treatments or end-stage arthritis. The first step is to determine the actual diagnosis and then a shared discussion and decision making can occur.
Q: Dr. James, anything to add?
Dr. James: I agree with Dr. Elder on this. Occasionally, recommendation for surgical intervention may be made early on if there is an injury, deformity or finding that is not likely to improve with non-operative management, but this is quite rare. Although, I am a surgeon, my goal is to get patients to heal and return to activity with as little invasive treatments as possible.
Q: Dr. James, what are the most common different treatment options for both sports medicine and an orthopedic surgeon?
While our training backgrounds are different, much of the care that a patient would receive from a sports medicine physician and orthopedic surgeon would look quite similar. Orthopedic surgeons spend 5 years in residency and often a year of fellowship to subspecialize after completing medical school. During training, residents learn operative and non-operative management of musculoskeletal concerns throughout the body. One of my mentors often said that the mark of a good orthopedic surgeon was not only knowing how to operate, but also knowing when to operate.
Q: Dr. Elder, what are your thought on this?
Dr. Elder: I agree with Dr. James and that’s why our team is always communicating to decide what’s best for our patients. Sports medicine physicians are nonsurgical in training, therefore the treatments offered will be nonsurgical in nature. Orthopedic surgeons offer surgical options for those patients who have failed other treatments or have conditions that may require surgery such as end-stage knee replacement or a torn ACL in a young athlete for example.
Eric R. James, M.D.
Dr. Eric James is board certified in orthopedic surgery, specializing in foot and ankle. He earned his Doctor of Medicine from the University of Pittsburgh in Pittsburgh, Pennsylvania. He furthered his medical education by completing an orthopedic surgery residency at Orlando Health in Orlando, Florida. Dr. James then completed a fellowship in foot and ankle surgery from the Foundation for Orthopedic Athletic and Reconstructive Research in Houston, Texas. Dr. James specializes in reconstructive foot and ankle surgery. He focuses on the non-surgical and surgical management of foot and ankle conditions. This includes specialty management of conditions requiring ankle arthroscopy, fusions and post-traumatic reconstruction. He is a candidate member of the American Academy of Orthopedic Surgery and the American Orthopedic Foot and Ankle Society.
Kevin Elder, M.D.
Kevin Elder is a trusted and respected sports medicine specialist caring for the Tampa, Florida community. Dr. Elder attended the University of Toledo, where he received his medical degree, and completed his residency in family medicine and a fellowship in sports medicine at Bayfront Medical Center and part of BayCare Medical Group. He is board certified in family medicine and sports medicine by the American Board of Family Medicine. He speaks both English and Spanish. Patients trust Dr. Elder’s expertise because he consistently provides high quality care that leads to positive and lasting health outcomes. He has trained extensively in Musculoskeletal Ultrasound and Regenerative Medicine and has performed numerous Platelet Rich Plasma (PRP) injections for a variety of musculoskeletal conditions and is now performing stem cell (BMAC) injections as well. He is one of the most experienced doctors in the Tampa Bay area performing these types of procedures under MSK ultrasound guidance and has published articles in national journals on these topics.
BayCare Medical Group Sports Medicine
711 S. Dale Mabry Hwy., Suite 303
Tampa, FL 33609
(813) 548-7890
BayCare Medical Group Orthopedic Surgery
Friday Morning Appointments Only
711 S. Dale Mabry Hwy., Suite 303
Tampa, FL 33609
(813) 877-6748