Podcast Transcripts

So we were like, yes, we have to do it. Let me set it up real quick before we bring in Dr. Garcia. I'm going to admit, I have a fantasy football team. And I get this notification this morning, saying Deshaun Watson out for the season being selfish. First and foremost, I go, Oh man, I'm out of a quarterback.

What am I going to do? Right. That's the first and foremost. I know you fancy football players out there fans. They know exactly what I'm talking about But more importantly it was about this injury and then dr. Garcia chimes in so dr Garcia when you heard about Deshaun Watson's [00:01:00] injury And the fact that he's out for the year the star quarterback player for the Cleveland Browns that they spent a lot of money Draft picks to get what was your first initial thoughts before we talk about the injury

Dr. Grant Garcia: itself?

I mean, obviously going out for the season is a big deal and his contract was a big deal. I mean a significantly guaranteed contract after kind of a lot of dilemmas that he went through you're kind of expecting only the best. But we know how it works in the NFL, especially with high pay contracts, but you know that, and then getting injured now for the season.

I mean. You know, this is not looking like a good for the Cleveland Browns with their trade. So this is, this is pretty frustrating if you were a Browns fan. And then not to mention the uniqueness of this injury.

Will Sanchez:Yeah. And I, and I can't wait to get your take on this injury. Especially how common or.

Maybe not so common of an injury it is just so just to give the audience some context. Deshaun Watson was playing against the Baltimore Ravens had a fantastic game and [00:02:00] actually came back and won the game and beat the favorite Baltimore Ravens in that game. He injured as we found out now after an MRI on Monday.

And then make an announcement on Wednesday that watch Watson sustained a shoulder fracture during the first half of the game and continue to play before we get into the injury by him. Continue to play with that injury in the first half. Does it have any bearing on how severe it became or it didn't matter?

And before you answer that, why don't you tell the audience what exactly, actually the injury that he sustained?

Dr. Grant Garcia:The only clarification I want to ask before I answer this is this is his throwing shoulder or non throwing shoulder? This is his throwing shoulder. Yeah. First off, I am shocked that he played through the rest of the game with this injury.

So to kind of go over it with the audience, and the reason I want to talk about this is something called a glenoid fracture. There's also another name for it, which is a bony [00:03:00] Bankart fracture based off of the description by Dr. Bankart. But when you dislocate your shoulder, Or have a direct blow to it.

You can dislocate the shoulder where the ball comes out of the socket. We hear about that all the time in the NFL. And those players come back in a few weeks. You know, usually they get rehabbed or something like that. And they get a labral tear. So, usually that will heal. And maybe that goes on to mean something surgical, but not always right away what he must have done.

And again, I don't know, don't obviously know the x rays or the, any type of other imaging he had done, but he may have partially dislocated his shoulder. He may have had a previous injury that we don't know about, and he broke off a piece of the golf tee. So imagine you've got your socket, which is the golf tee, and then you've got your ball.

That's the humerus. And when you break off the golf tee, that's really bad. For a number of reasons, one, it makes your shoulder incredibly unstable. And to be honest with you, this is one of the few times I've heard about someone able to keep playing through. So he may not have had as [00:04:00] big of a fracture as I was thinking initially.

But then the fact that piece of bone broke off with it, that if you miss that. And that he goes on to keep playing for another couple weeks. This is a big problem because the shoulder has such good healing potential that basically what'll happen is if you break off a piece of the golf tee and it falls down, you can't get it back up once it heals.

Because it'll heal and turn into it in the wrong spot. That's called a malunion. So even if he is stable but the golf tee's gone, then he's at a much higher risk of re injury.

Will Sanchez:So he mentioned that you know, he quote unquote said the whole second half that he was throwing, it was extremely painful to throw the football.

And and just talked about, you know, the severity of the playing. By the way, he completed all 14 of his passes in the second half and led them to a winning field goal to beat Baltimore 33 31. If you, just in case. So, I, like you said, I can't imagine. Having the injury, let [00:05:00] alone with my throwing arm and for any football fans out there, the amount of velocity that you have to put into that ball so it doesn't get intercepted or knocked down or however far that ball travels I can't imagine what are your initial thoughts about with him playing?

I know you mentioned that maybe the fracture wasn't as severe, but still having a fracture in your throwing shoulder to compete at the NFL level, let alone, I don't know if he got hit. took any sacks, ran with the ball, hit the ground, or anything like that. What are your thoughts on just, you know, we talk about these superhumans all the time.

What's your

Dr. Grant Garcia: thought? This is a perfect example of superhuman. I don't care if it was even a small fracture. I mean, that's, this is, most of the patients that I see with this injury, there's absolutely no fracture. I mean, the last two patients I've seen with that have been almost many back in to the area.

They come in with their arm completely locked at their sides. And this is not a, this is not an injury that you see someone come in and you're finding it [00:06:00] randomly. You know, again, If it was a very small shell of piece of bone but usually they don't say this is definitely has to have surgery. So it probably was a pretty decent injury.

And he, what happened is it may have worsened from him playing, right? It could have been a small fracture that hadn't moved. And then he played through it and then it broke off more as he played through it. And that's very well could have happened with the type of forces that he's putting on his shoulder.

So yes, I mean, he's a superhuman, right? He's incredibly good athlete. And you know, be it what it may, you can think about him whatever way you want. But his ability to play through this is, just shows his level of you know, athleticism, his pain tolerance. I mean, this is, this is incredible that he's able to go on to win The game with the, with this injury.

And then, you know, we can always, I love to go into sort of the injury itself. So the, so the, my patients and people listening will understand it a little bit better because it is, it's a little different animal. But again, we talked about the golf key, but the problem is, is not the injury. [00:07:00] The problem is not that he played through it.

It's the problem is that the surgery, so this is one of the hardest things to fix. And the issue with this type of injury is we see labral tears all the time. We can talk about, I'm sure we have a laundry list of players that have torn their labrum and had it fixed. That is a technically not very challenging surgery.

You know, it's still a surgery. We take it seriously, but that's not a technically challenging surgery. When you fracture a piece of bone, that's where things go awry and in a lot of groups There's usually like one or two people even that even know how to fix this thing and even that that that's still tough You know, I've seen these types of surgeries take three four hours now again We've got newer techniques and I'll go over some stuff that we're doing now Yeah But the older version of this was to do a big open incision to find it and put screws in it The problem you have is a really small piece of bone.

It doesn't work And sometimes you damage things and a lot of people still do it that way and they struggle. And this is one of the, one of the hardest shoulder injuries [00:08:00] to fix. And so the fact is that he got this is not ideal. And then with newer techniques, we're much faster. And in the last few patients I've done of this have done quite well, but it's a bad injury.

And the number one thing I'm worried about in him is this. Again, I've had lots of wrong predictions on these players because they're superhuman, but he's going to have to have the bone fixed and the labrum, imagine like it's all going to have to be rebuilt. And I'm assuming he's going to get a surgeon that can do it arthroscopically because that's really the way to go.

I mean, doing this open, the results are just, they're not the same. You know, my patients, now I do it all arthroscopically through scopes. It's a lot more technical. But I can do it more efficiently and I get good results and keep that bone up, but I just don't know how he's going to get it done. And I'm assuming he's going to go to someone incredibly good surgeon because he's obviously getting opinions about this, but the problem is stiffness.

And a stiff shoulder in a thrower is a career ender. So I don't know if that's going to be the case. Again, I [00:09:00] don't know how bad this was. But this is really concerning because I worry a lot about a thrower when I have to do a labral repair like this. Okay,

Will Sanchez: so let's go back to what you said, right? So...

I'll start with the last thing you said. Stiff shoulder. Now are we talking about just stiff shoulder after the after the surgery? Or are we talking about something that can stay with that person, athlete, whoever it is, to have a stiff shoulder and not regain the mobility that they had in that shoulder at one point?

Dr. Grant Garcia: That is a hundred percent correct. So it's, the answer is it's not, it's, this could be more of a permanent situation. This bone heals very well. I mean, it'll heal in the wrong zip code. I've never seen one of these not heal, whether it's healed inappropriately and they come to see me at two or three months or whether, you know, once, if you wait six weeks or more on this, the person doesn't get a repair anymore.

They have to get another procedure where we actually move a piece of bone to the front of the shoulder. So it tells you how quickly you need to act on this type of [00:10:00] injury. And then at that point, if you fix them, there is a chance cause you have to, you have to take tissue and fix it back up. You can stiffen the shoulder up.

And one of my number one concerns with this injury is the stiff shoulder. A regular labral repair is different, but generally if you have to do something urgently. surgery urgently. That's never ideal in a situation with any knee or, or shoulder, right? If we have ACL tears, we usually want to wait. There's a lot of data that shows we should wait between eight and 11 weeks after an ACL tear because of the fact the knee is really stiff, unless it's an emergency, like a piece of meniscus is stuck or something else, but those patients are at much higher risk of getting a stiff knee.

This is the same way with the shoulder. And on top of that. You have a massive healing response because the bone in the shoulder is so well, so much blood supply and it's a really high risk of instability, a really high risk of your shoulder getting stiff. The good news is This type of injuries, patients have a much lower chance of re dislocating their shoulder [00:11:00] or re injuring it.

But the stiffness is much more of a concern with a guy that's, you know, what is it, 230 million contract? Yeah. So I'm pretty concerned about that.

Will Sanchez: So, some, just some, the cliff note version is this is gonna heal real fast for the most part because of the location, the blood flow. The biggest concern besides the...

is where it heals in that placement, right? And, and if it heals, starts healing in the wrong place, is that something that if it doesn't heal correctly, you have to go back in and then do a different procedure to try to put it back where it belongs?

Dr. Grant Garcia: Yes, but that's usually if you don't fix it, like the surgeon that he's going to have to do it will likely fix it back to the right spot and keep it in there, and now it doesn't always hold perfectly because these are really tough.

I mean, imagine you're trying to hold, imagine you have the side of a deck, I'll try my best, and there's a, you have a little tiny post on that deck, but it's really loose, and you can only fix it with a few little, you can't fix it [00:12:00] with a screw. You can't fix it with a big mount. You can only fix it with a few toothpicks, and that's essentially what you're doing here.

You've got to fix it the most delicate way possible so you don't break the piece of bone because it's so thin, but you want to get it to hold up in the pedestal. So we have new technology using Arthrex technology and other technology that we actually use that we now can fix it without using any, any screws or anything like that.

So I can do this all minimally invasive. I'll give you a picture of one of my One of these patients, you'd never know they did surgery on them because everything is hidden. It's all these really minimally invasive, really low profile, brand new sort of anchor constructs, but it's still the concern is the stiffness that we talked about.

Will Sanchez: What is something that a surgeon would have to look for when you're putting, let's say, these suture anchors in if, most likely doing orthoscopic? Is it the amount of tightness, or putting it in the right place, or am I just kind of overthinking this at this

Dr. Grant Garcia: point? You are not overthinking, but the hardest part is just getting this piece fixed back.[00:13:00]

Because this is gonna, it moves around, it's very challenging. You know, this is one of those ones that we if... The listeners want to check out the website. I just posted a brand new video on actually how to fix this Which is why I was so interested in talking about this Yeah, because I was just talking about this topic and showing some people the new technique we use But you know you want to see how you fix one of these arthroscopic glenoid fractures I will when we do this post I will post about my website link so you could take a look at it but it's just a really interesting injury pattern because it's also, it's really uncommon.

You know, I see a very high volume of shoulders instability. Maybe I see over 100 to 150 patients that have unstable shoulders a year and probably have to operate on 75 of them a year, 80 of them. I see probably two or three of these a year and I have to get referrals from them from all around the area.

So if you imagine how uncommon this is in comparison to regular injuries, it's pretty low. Some surgeons who, you know, a lot of my patients come for second opinions for these and when they see another surgeon, [00:14:00] some surgeons that, some of these surgeons say, I haven't seen one of these in three or four years.

So if it just shows you how uncommon, how difficult, it's kind of a, It's kind of a nasty combo. Now again, if you know what you're doing, you can get good results. So I don't think that Deshaun Watson is going to have a poor result. I hope he doesn't. But nonetheless, it's something that people should be aware of because this is not just a standard injury.

Will Sanchez: What's normally the injury or... The action that the patient is involved in when you normally see these type of injuries in the shoulders is something that's like, if you do this, this is a common injury for that, whether it's a sport or falling on your shoulder, skiing or what, is there anything that's common or it's just kind of random because it is a random injury as, as it is.

Well

Dr. Grant Garcia: this injury usually comes with a shoulder dislocation. So the person arms outstretched all the way back, like a cocky motion, like a throwing motion. And that's when it could come out. The last two though, randomly I had one guy was in the middle of a. Was in the middle of a park, got his [00:15:00] arm caught on a bush, 10 miles out, and had to, had to limp home and drive for 4 hours into my office.

Oh my lord. So that just gives you an example of, and that gives you an example of it just comes randomly. You know, I had one person that fell on their bike, one person got hit by a Amazon delivery truck. So, you know, I, there, the, the, the, the the injuries are different all over.

Will Sanchez: I'm sorry, I'm sorry for laughing.

Dr. Grant Garcia: They're doing fine. They're all doing fine. But nonetheless, for just for the, for the listeners, really just to understand the injury and the differences in it. And again, maybe we'll look back in a year and Deshaun Watson will go on to win the MVP next year. And I'll be wrong again. But even though it heals fast, we're still looking at a solid five, six month recovery for him.

So this is not something that is going to be quick fix. And he's gonna be back. I mean, hopefully next season but we'll see throwing shoulder is not ideal.

Will Sanchez: : If everything goes right, is there still any concern, right, I'm thinking about a quarterback here, and throwing a football, of a range of motion, is there any [00:16:00] concern, or because it's in the throwing shoulder, it automatically becomes a concern, no matter what the results of the surgery is?

Dr. Grant Garcia: : I would be very concerned if I were the Cleveland Browns, because of the range of motion. I mean, that's the only thing I'm concerned about, like we had mentioned before, when you fix labrums labral tears, just the one he probably has, he has a labral tear and a piece of bone that broke off. They come together, kind of stuck together.

So just the labrum repair it alone, even throwers do well, but those are still concerning. This is a piece of bone and that, and it's at a much higher risk, it's got to get fixed so quickly. It's not like he tried to play through the season. It's not like he got his motion back. I mean, we're talking about this.

He's probably getting surgery in the next week and if he's not, I'm surprised. But once they made the announcement, I'll be getting surgery in the next week. I mean, you want to fix these within the first two to three weeks.

Will Sanchez: : Yeah. If you can. You know, I, I think about football players and I think about football pads working out, throwing a ball, getting hit by 300 pound men, [00:17:00] multiple 300 pound men.

Are we, is there concern with continuous pain with a, with an injury like this, or if everything heals right, it's just going to be the normal pain of getting hit by a 300 pound man?

Dr. Grant Garcia: :Yeah. So the there's not a lot of good long term data on an injury like this because there's so uncommon, but what we could tell you is at any time you break that joint surface, your knee like a fracture of the knee or a fracture of the elbow or a fracture of the wrist.

You, no matter how good the surgeon is, they don't always put it back exactly right. And hopefully they do. And even if you get it perfect, they're still damaged the cartilage and the cartilage doesn't like to be damaged. It doesn't like to be separated, beaten up, pulled back. It just doesn't like it. So his risk of arthritis in that shoulder is significantly higher as a result of this injury.

He won't feel that pain for a long time. And he may not ever feel it, but nonetheless, that is what his risk is. Short term pain [00:18:00] with this, it tends to be very minimal. You know, my, my patients are happy with the result, but my patients aren't Deshaun Watson. Yeah. When, with this injury, I mean, I don't, can't think of the last athlete I've had with an injury.

I've had football players with a small bony bank cart. But if he took off a bigger piece of bone, that is concerning. But again, I wasn't there. I don't have the x rays that are on the CT scan. Yeah. But I think it's good for the, for the listeners to hear the different levels of this injury and what this means.

But the, you can imagine, this went from like, Oh, we don't know. This is okay. He played through the thing. Now he gets surgery. It's done. You know, there's not even a question,

Will Sanchez: :man. Obviously we know he's going to rehab the hell out of it because they're just programmed to just kind of work all the time.

That's usually that, you know, we've had these discussions on many shows that that's the main component after you've, you know, rebuilt and fixed the patient. And we had the discussion with our physical therapist that the next step is the rehab just [00:19:00] to kind of give. Some context, if it was just kind of like a regular, you know, John Doe walking into your office and they had this type of surgery.

What is a similar kind of rehab or exercises that you're now looking to do to fix the shoulder, stabilize the shoulder, strengthen the shoulder, and trying to get back to some normality?

Dr. Grant Garcia: : Yeah, so the, the problem with this injury is if you have a regular labral repair, you can move someone pretty quickly.

Yeah. You know. Sling for a week or two come out of it really quickly get motion back and we're getting more and more aggressive the better Technology we have they've got to fix a piece of bone and the bone takes about six weeks to heal So if you imagine he doesn't want to overstress his shoulder so quickly Yeah, but you want to get the motion back?

But if you get the motion back too quickly, you can pull that piece of bone and break the entire fix It's a catch 22 and so, you know, he may get repeated x rays, he may get CT scans and check and make sure he's not moving it. I don't know what level of overkill [00:20:00] they're going to do to check them. Or they may say, Hey, listen, we'll get it good enough.

Even if it moves a little bit, you're going to be stable. You're not going to have pain. So I'd rather you not get too tight and you can throw again. So I don't know what they're thinking. Per se, if I was, if I was taking care of him, I'd probably give him a little bit more accelerated protocol than my regular patients.

He's also really, he's still a young man, so he's going to heal really fast. I mean, I would tell you half these injuries are, are usually in patients over 30 years old and so they tend not to heal as fast. They still heal well, but they're not as fast. He's younger. And he's a super athlete. And so, probably better to get him going sooner.

Is it enter risk is this place pulling off and not healing and having further issues is a pretty low risk him getting stiff is a pretty high risk. So if you're thinking about how we determine what someone should do for their rehab, we try to, yeah, well, that's the way it works in life. You know, not all my surgeries are, they're, they're custom approaches.

You can't just, every person's [00:21:00] different. And so he's going to hopefully get a custom approach. You know, so he's going to start strengthening at six weeks. Like, our goal is hopefully that four, you know, five to six month mark, but he may get, he may start throwing sooner. Who knows? I mean, there's no way to do an internal brace in him, but who knows if they'll try it.

You know, for just to make you happy. Well but the but nonetheless, you know, we've seen freak and we've already seen freak recoveries with Aaron Rodgers thrown out of the field. So maybe he'll prove me wrong.

Will Sanchez: Everyone should get an internal brace. I'm just saying it's everyone, you get an internal brace and you get an internal brace is like Oprah, like just giving out internal braces everywhere.

Looking ahead. Right. And obviously there's no way for you to determine, because obviously you're not, you're not going to be with Deshaun Watson with their team. You haven't seen you know whether it's. MRI results and going forward because pretty much you're telling me they're going to get in there, they're going to fix it, try to do a great job and then monitor and then try to maybe fast track it without injuring it so we could, you know, be aware of stiffness, try to get some mobility and [00:22:00] then work your way up.

So there's, this seems like there's all these different levels. And the only way to do that is to monitor the situation constantly, which obviously they're going to have the best doctors and try to. Tech, their monstrous investment of a player going forward, but training cap, it's in seven months. I know this is crazy.

I know we're in football season right now. We're kind of holidays are coming along and everything else, you know, you're throwing the ball, you know, June is one of the things we saw Daniel Jones get injured and how long he's going to be out seven months from now, throwing an NFL ball, is it? There's, is it really no way to determine what the result's going to be and, or I guess maybe the better question is, what would be a concern for you if in, let's say, four months from now, Deshaun Watson is not doing what?

And then that might determine whether they're going to be ready for the next season or not.

Dr. Grant Garcia: I just [00:23:00] think if he's not throwing the ball yet, I mean, you, the thing is he's going to probably have to wait. I mean, it's, this is, a thrower is different than any other athlete we deal with. This is the hardest of all the things we do when it comes to a shoulder injury.

For me, my hardest thing in the, in my office is dealing with a pitcher or a quarterback that injures their shoulder with a labral injury. So this is the hardest thing in terms of surgical outcome. Because you just don't know what they're going to do. And we've seen better and better results. And our, our results are getting better.

Our data is getting better. But you just don't know. And so I, you know, I'd like to see him consider start throwing at four months and hopefully that seven month mark he's rocking it and whipping it and accuracy is there and everything else. Yeah. But if you're five months out and you're not seeing him try any throwing, you should be really concerned because they're clearly trying to figure something out now again.

I don't know. We'll see how it goes and maybe he'll be on the field throwing balls at two months and everyone will say, Dr. Garcia has no idea what he's talking about, but we'll see. [00:24:00]

Will Sanchez: Hey, we say that already jokingly. lIsten, everybody get an internal brace. Ask, ask Santa for it and put in your stocking stuffer, whoever you're asking for.

Everybody stuffers. It's just going to make life a lot easier. Anything else as we wrap it up, br>
Dr. Grant Garcia: Dr. Garcia? Now I just want to make sure the listeners learned about this injury. It's very interesting and really when you see that you're saying Oh, what the heck happened? He broke his shoulder, but the good news is it's not as bad as what we a lot of other injuries We see people that fall off ladders, etc Yeah but it's a unique injury to an athlete such as this and people should know what the outcome is and the surgery and this is Not gonna be a chip shot.

So they get him back next year on the field Kudos to those

Will Sanchez:surgeons remind everyone to check us out at sportsdoctalk. com. We've got some great content there. And we always remind our listeners, there's transcripts of our shows. So if you don't want to listen to, to us, then please read up [00:25:00] on us. We've got some great information.

Remember we're talking all sports, all orthopedics, all the time. I'm Will Sanchez and Dr. Grant. Garcia that gets extremely excited sending me text messages when people get hurt. Only, only Dr. Garcia can love you a certain way. So Dr. Garcia, thank you so much for your time and everybody out there. Thank you for listening.

Dr. Grant Garcia:Thank you guys.Audio Transcript

Will Sanchez: Grant Garcia, our orthopedic surgeon and sports medicine specialist. And just a reminder, check us out at sports. talk. com. Dr. Garcia. How are you this, this beautiful fall as we get ready for the holidays. Is everyone excited? I know you got some little ones running around the house. Are they starting to get the excitement of the holidays coming around or is this a little too, still too soon?
Dr. Grant Garcia: They're excited. You know, the. It's my daughter's birthday before the holidays, so she's, she's way more into that than the holidays yet. So once that passes in early December, then the holiday rush will come. Once the, you know, once we get the tree up [00:01:00] and everything else, people tend to get, the kids tend to get more excited.

Dr. Grant Garcia: But we're good. Yeah, no. End of the year is crazy though for orthopedics, so it's hard to Get super excited about the holidays. Yes.

Will Sanchez: Now, I'm going off topic right now for what we're about to talk about. But do you tend to see some of that uptick, one, because people are starting to do activities that they haven't done since maybe last winter?

Will Sanchez: Or two, they're trying to get some things done, you know, whether it's insurances or trying to get certain things at the end of the year. Or is it a combination? What has been the pattern for you that you've noticed with patients coming in?

Dr. Grant Garcia: So some patients may know this, but basically the worst time to get surgery by North Peak Surgery is in December because it's the busiest because everyone has their ductible.

Dr. Grant Garcia: And so they meet their ductible and then they decide to like, okay, I'm going to get my knee done. I've been waiting two months and waiting six months and waiting a year. So December is the busiest time of the year for pretty much all my partners, um, right before the holidays and up to basically patients will be, you know, they'll be asking for [00:02:00] surgery all the way till I've done surgeries as New Year's Eve.

Dr. Grant Garcia: Oh my God. I want to get done before the end of the year. So the yeah, the end of the year is a big deal. As a sports surgeon, unfortunately, as we know, ski season's coming up and so that's a. That's a different level of busyness, but the end of the year is always the busiest time of the year. You know, we all prepare and staff prepare for a higher amount of cases.

Dr. Grant Garcia: It's just busier. All right, so let's all

Will Sanchez: insurance related. Yeah, you know, it sounds like it and I know personally for myself I used to snowboard a lot and you know, I've been far enough removed where I'm going Yeah, you're starting to get a little too old for that. Not so much getting too old for that But the fact that I've haven't Snowboard in over a decade and now I'm just like I feel like I'm gonna go out there.

Will Sanchez: Something's gonna happen utilizing muscles and I'm not used to doing and used to carving and things like that, but Like I said, we're getting way off topic about what we're going to talk about today, because what we're going to talk about today is really an underlying [00:03:00] theme that's been around for a long time, and it finally seems to be at a heightened state, especially the last year in football, and that's been the argument between turf and grass, and that's the topic that we're going to get into today.

Will Sanchez: We're going to talk about the differences of the turf, Turf, grass, and maybe what kind of roles it plays when it comes to injuries, non contact injuries, and so on, so on and so forth when it comes to that. So, real quick, Dr. Garcia, what are your thoughts for someone that is an orthopedic surgeon that has been a part of professional teams and high school teams and seeing all these different, from the professional player field to just, you know, the high school field.

Will Sanchez: What are your thoughts initially when you hear the topic of turf versus

Dr. Grant Garcia: grass? I mean, the first, the first thing you're thinking of with this is, you know, this is [00:04:00] a, this is one of those ones where this is a open box and it's, it's kind of, it's an underlying theme, obviously, I think in football, if you look at it, because It's really the debate is grass versus turf, but it's also players versus owners And there's a huge cost factor in here that I am not saying is related to why the decision is to do grass versus turf but we're preparing for this episode.

Dr. Grant Garcia: I mean it really opened my eyes to sort of the differences and You know, what what are these sort of conundrums and you know, you hear the players, right? Someone gets hurt on the field, a non contact injury. You know, Odell Beckham Jr., a couple years ago, you've got, you know, there's just a plethora of players that have gotten hurt, and they all say it's a result of the turf, right?

Dr. Grant Garcia: And the Players Union is talking about that. But then you have some studies that show, you know, there's maybe no difference, and maybe those were earlier studies. And you always have to be careful in like, who's the bias here? And understand all these different things. But I think the audience is going to just enjoy hearing about...

Dr. Grant Garcia: You know, what goes on with that debate and then the [00:05:00] preparation, right? Because, you know, I didn't even know anything about that there was, there was, they were looking at the quality of the turf and they have to have a certain criteria in order to meet that in order for the game to be allowed to be played.

Dr. Grant Garcia: And the same thing with grass. So, you know, this is a really interesting topic and it's, you know, we're not going to solve it today, but hopefully we get more information. And there may be a little bit of bias opinion here, but again, I'm also somebody who doesn't, as much as I, as much as I make my living off of injuries I have no interest in people having more injuries.

Dr. Grant Garcia: And so I do think it's important for people to understand the differences.

Will Sanchez: 100%. Just to give context, there are 32 NFL teams in the NFL which means that there's 30 stadiums, two teams share. the stadium. You know, we're fans of the Giants. They share the stadium with the Jets and the Chargers and the Rams share their stadium in L. A. So there's 30 NFL stadiums and right down the middle, 15 of them [00:06:00] use grass fields.

Will Sanchez: The other 15 use some kind of synthetic turf. And last year, the NFL P. A. president, J. C. Tretter, called for a ban on specific turfs, especially what's called slit film turf. It's citing safety concerns. And this type of turf has statistically have had higher in game injury rates compared to other surfaces for each of the following, right?

Will Sanchez: The non contact, missed time, lower extremities, foot and ankle injuries. So let's start right there. When it comes to non contact injuries, that is something that As a surgeon, that piques your interest right away, right, because those usually tend to be, and correct me if I'm wrong, the more serious type of injuries that you can sustain.

Dr. Grant Garcia: I think it probably depends on what you're thinking of, but I think that yes, I mean, you see those non contact injuries, you know ankle sprains. You know, ACL tears, I mean, there was [00:07:00] a number of times when you see a player run on the field, usually wide receiver someone open field, you know, it's pretty hard to get a non contact injury if you're kind of in the center of the line and you'll see them twist and grab their knee.

Dr. Grant Garcia: So it's a kind of a, it's kind of a combination of those things, you know, the, the contact injuries like Nick Chubb suffered. You know, that was pretty gruesome and that's a totally different animal. So you know, they tend to be just a different, they just a different look to them. They're just more worrisome to me because.

Dr. Grant Garcia: You're trying to figure out what happened, right? You're just, you know, when you see someone just get clobbered and then he goes in another direction, or their hip goes a different direction, or their arm goes a different direction, or whatever, we don't want to, you know, go into too many details, you know, you kind of know what happened.

Dr. Grant Garcia: But when someone just tweaks, runs on the field, twists, and then all of a sudden go down, you're trying to figure out, you know, that's a, that's a, that's kind of a conundrum. You're trying to go, immediately go look into what's going on.

Will Sanchez: This might be a stretch here, but... Have you noticed or in your profession, a higher tick of [00:08:00] injuries from turf to grass, or it's just, is that just too hard to really kind of realize or, you know, having asked that question with your patient From what you've seen from, you know, players coming in, whether it's soccer, football, lacrosse, you know, because especially I guess at the high school age, they're probably going to play more on turf fields because of the cost savings for these stadiums compared to maybe some of the other fields that are happening, you know, at the You know, the city park or something like that,

Dr. Grant Garcia: I think that's important point.

Dr. Grant Garcia: So, you know, I'm not asking him. Unfortunately, when you're in the office, you know, did you plan grass or into yourself on turf? But it makes more sense to me, right? The idea of grass more give, right? It can rip apart, it can pull, and if you have these thick cleats on, you're still going to kind of make some turns.

Dr. Grant Garcia: The turf, as much as we always try to have the word synthetic and more natural, it's not going to rip. It's supposed to be [00:09:00] longevity. I mean, you can't design, grass is not high longevity. But turf is, that's why it looks so good all year round, no matter how much they try to make it and put, you know, tire chunks in it and all other fancy stuff.

Dr. Grant Garcia: And again, I don't even know all the different types of turf, I'm not a turf expert, but, you know, it makes sense to me that there would be more injuries on it. And especially injuries that require very, you know, precise movements or these sort of small tweaks. I mean, we've seen this already in the sense that more recently there are, they are a higher number of foot and ankle injuries found.

Dr. Grant Garcia: And there's been a couple of studies which we'll talk about but with I think the point you brought up That's really important for everybody to understand and say, you know, why does this matter? Why is this not being fixed? Well, the word cost is real. Yeah I mean I was hearing about this and I think it's well, I mean we may talk about this or not But you're talking about you know turf field to maintain to put in It's moderately expensive, but it's not very hard to maintain.

Dr. Grant Garcia: The grass can be, you know, upwards of two to 3 [00:10:00] million. And, you know, you have these owners who don't want to spend more money and would rather have the money be profits versus using all grass. But what the interesting statement is when we were doing some research on this is that the grass now and all the technology grass can be done at any level.

Dr. Grant Garcia: Right. And I think, I think a few of the places like green Bay, who you'd imagine would not be able to handle grass or places like. Miami or whatever that can't have grass because of the heat, they both maintain them. So the weather is not a factor anymore. And so there's really, really the reason I think is because it's harder to maintain and more expensive.

Dr. Grant Garcia: But then again, you're, this is my own opinion.

Will Sanchez: No, let's keep it real. That's exactly what it is. I mean, let me, let me, let me grab a quote from Tiki Barber. He he mentioned this on his his radio show about two weeks ago. And this is his quote. He said, Whatever the cost is, isn't that worth the maybe 500 million of salary on your team?

Will Sanchez:[00:11:00] You are putting that investment in each player at risk every time they play on this terrible surface. Barbara explained on that Monday, every single week, I feel like someone is getting hurt on this turf. If the giants and the jets are serious about player safety and the NFL, they have to change that turf to grass.

Will Sanchez: : I don't care how much it costs. It's worth it in the last player's salaries, paying guys to be on injured reserve and just. For the non football fan out there, Tiki Barber is a former running back, great from the New York Giants. He has affiliations with the Giants, he works with the Giants, he works on their flagship store, he has relationships with the owner, John Mara.

Will Sanchez: So he is really kind of putting himself out there, this is not coming out of left field from someone that's not, that... It doesn't have insight. So this seems really, really personal and, and kind of a reach out there to the owner [00:12:00] to say, Hey, you have to get this done no matter what the cost, because the cost of losing these franchise players are going to cost you more.

Will Sanchez: What do you think about when you hear that quote from Tiki Barber?

Dr. Grant Garcia: I think that's an incredibly good point. And it also makes the question, you know, why have we not done this? And I know that. The problem you have and we've talked about studies on this. This this show and how they can be really, you know, challenging and they're always a little bit biased one direction or the other.

Dr. Grant Garcia: And there's statistics we have to look at, you know, if you have the same study being done multiple times, which we can talk about that 1 we were mentioning previously, you know, recently showing a significant uptick in foot and ankle injuries with artificial turf. They're not lying. And you have players arguing for it and you're absolutely right.

Dr. Grant Garcia:: I mean, we all talk about this, you know, why do I do certain treatments on a professional player? That's different than I do on a regular natural athlete there. Unfortunately they are paid more [00:13:00] money. And so as a result, even if they miss getting back one game earlier, it's worth the more expensive treatment or the out of pocket expense.

Dr. Grant Garcia:Because I want to get them back. But if I get back one week earlier, or you get back one week earlier to your, you know, our day jobs, it's not the same financial difference. And so, you know, these, these guys being out and being paid on injury reserve. You're absolutely right. It's not that expensive to put grass in and maintain it compared to one of your best players or a combination of players.

Dr. Grant Garcia: I mean, even one or two players that are making two to three million dollars a year, which is probably, it's considered low for the NFL. You know, if they are an injured reserve, that already pays for the grass. And so it's, it's, it's kind of a silly thing. It's almost at this point now, an ego thing, I think.

Dr. Grant Garcia: And just sort of like, that's the way it's been done. Right. And these, and obviously it makes it easier for them. It is a lot of hassle. They have to change it over all the time. But at the same point, it's not like there's only one or two teams doing it. Half the teams already have graphs. And so I, I, and I, I think that his [00:14:00] quote is excellent.

Dr. Grant Garcia: He's got good insight. Again, he's not a statistician, he's not a grass master, he's not a turf master but nonetheless you know, he's done this enough that I would really trust his opinion and he cares for his players, but he also cares for the Giants. So for him to say that, it's a, that's a big

Will Sanchez: deal.

Will Sanchez: yeAh. And we're talking about a player, like I said, for, for the, the listeners that don't know who he is. He retired at... The height of his football career, he led the NFL or was the second leading rush in the NFL when he retired and he retired because of the fatigue that he felt that, you know, it's getting beaten, beaten up on Sundays by players, but also landing on turf and for anyone that's ever played right now, I'm not just saying football, soccer, anything.

Will Sanchez: When you fall down, we look at, we look at them, they fall, they get up. Yeah. That hurts. Those fields, those turf fields hurt. It's like it's [00:15:00] just falling down on something hard, and it's just it makes a big, big difference. I want to put in context because. If you're looking on a grand scale around the world, the biggest game around the world is soccer.

Will Sanchez: And the biggest league is the Premier League. And just to give you context, their football, they call them football pitches, you know, as far as their field. And stadiums opt for a high quality, hybrid, grass. system in that hybrid grass system, which the NFL does have for their grass fields, especially in Arizona, right?

Will Sanchez: We go back to these weather you know, hot weathered states or cold weather states. They using this hybrid grass. They use about 95 percent of this hybrid grass with then it's reinforced with like this artificial turf fibers like the other 5 to 10 percent depending on the quality of grass. So if you If the premier league, [00:16:00] which is at, like I said, at the highest level with the biggest sport in the world, this is what they're doing for their players because they pay them a lot of money.

Will Sanchez: Maybe the NFL should take a page out of that. and put that into their stadiums because these players have been asking for grass fields for quite a long time. Dr. Garcia, when it comes to high schoolers playing that have no choice and they're playing on turf fields, what are some of the concerns or have you noticed concerns besides injuries?

Will Sanchez: Is there uptake in concussion or anything like that from hitting these hard turfs? Or once again, is this something that You know, if you don't ask the turf when you have the communication with the patient, it's hard for you to really know.

Dr. Grant Garcia:I mean, I think this is a challenging and sort of loaded question, but I'm used to it on this show.

Will Sanchez: Yeah, yeah, yeah. I know, I know.

Dr. Grant Garcia: My bad, my bad. No, it's okay. [00:17:00] So basically, you know, we're talking about costs again. So you did Premier League and the NFL. These are where money's no matter, and the word multiple millions of dollars get thrown around like it's just candy. Yep. Right? This is different than the high school team.

Dr. Grant Garcia:And you know, again, I take care of Marshall High School. We have, you know, reasonable funding, but we do not have NFL level funding. And so to have a grass field, especially in Seattle, would be a disaster. And so the artificial turf is nice because even if it rains, it doesn't, it's not very slick. Yeah. But I do worry.

Dr. Grant Garcia:I mean... There's, we know there's an uptick in concussions. We know there's an uptick in injuries in general because players are getting faster and you have these mismatches, especially in high school. I mean, it's almost more of a risk, right? Because the, some kids haven't gone through full puberty yet, et cetera.

Dr. Grant Garcia: But I do think that, you know, when I see those players hit those the turf. Field, it looks harder. It looks more comfortable. You know, I myself have played on fields like this before. And it feels different. Now again, it [00:18:00] depends on the weather, whether you like it or not. But, you know, it's but again, in the lower levels, there's no choice.

Dr. Grant Garcia: It's just, it's just without a doubt, the upkeep. The ability to keep it good quality, because again, we're talking about good maintained grass, but we're not talking about poorly maintained grass versus turf, because I imagine a poorly maintained grass is probably a much higher injury rate than turf.

Will Sanchez: Yeah, and some of these turf fields are as you say, not in great shape.

Will Sanchez: They're kind of coming off at the seams. I know Magnuson Park, which is in Seattle, it's a big park out here. They have a couple of fields. One of them is in excellent shape. They changed it about two years ago. And they have another one where I've seen rugby games being played. It's coming apart, and I think they finally closed it up.

Will Sanchez: So I'm assuming that they're going to start working on it. So even some of the turf fields, it makes it even worse if they're not in great conditions, but you know, like you said, those are the situations. There's only but so many fields out here and [00:19:00] you know, you just kind of wish that you know, things could be a little bit better, but it is what it is.

Will Sanchez: As we wrap up the turf versus grass conversation, I'm going to be a little cynical here, but I'm feeling kind of that way. I'm, this is the week I'm kind of having. So I'm going to go, I'm going to go a little cynical here and say that. I think also you take it with a grain of salt when I think about these owners, maybe being hesitant to change right away and give the players what they want.

Will Sanchez: I start to think about negotiations and give a little and take a little and we'll give you this, but we want that. And you know, we got 17 weeks. We will love 18 weeks and we can do this if you could do that. Like I said, I have no idea, no justification, but we know. This is a business and businesses with owners and players is a give and take type of situation.

Will Sanchez: So I'm not saying that that's what the case is, but there's always that little voice in the back of my [00:20:00] head because I'm playing cynical this week that that possibility may be there.

Dr. Grant Garcia: I think that's an excellent point. I I think you I think you may find out sooner or later you may be more correct than you think.

Dr. Grant Garcia: Well,

Will Sanchez: I'm hoping nobody comes knocking on my door. I'm not that, you know, let's, let's make sure we don't have Goodell's goons coming after

Dr. Grant Garcia: me. Well, you, you know, you've hit it, you know, you've hit it big on the podcast start knocking on

Will Sanchez:your door. Alright, let's, let's make sure we don't hashtag the NFL when we release this.

Will Sanchez: All right, let's go to a great story. I was really excited about this. I saw this a few months ago, and then I'm watching Sunday Night Football, and there it is. There's a commercial by AT& T, and I was like, this is amazing. I was talking with Dr. Garcia about this. We said, next show, we're going to talk about it.

Will Sanchez: Sure enough, commercial on Sunday Night Football, and this is their AT& T 5G helmet with which is, which has been AT& T logo. Used this year on October 7th at [00:21:00] the Gallaudet University, This school is for the deaf. And they have a football team. AT& T created this helmet that they can utilize and it has a screen in front of their helmet, a clear screen, where the coach can put this information, the play call, the quarterback can see it, and the rest of the players, and they know exactly what's going on.

Will Sanchez: So this is really a game changer. Before we get into all that, what are your initial thoughts on this type of technology that's out there and how do you think that can benefit you?

Will Sanchez: Because we always talk about technology in your field and what can you see as a next level for this type of technology?

Dr. Grant Garcia: Well, in the interest of time, I won't get too excited about this, but... They know this when I saw this and you showed it to me. This is a this is pretty impressive technology I think it's good for the audience to hear about it I mean the ability for these deaf players to be able to see the heads up display screen And see it in [00:22:00] action plus the idea of the 5g helmet having all the communication signals I mean remember the old shows when people were trying to tap on their helmet because they couldn't hear the play call Yeah, it sounds like this is completely new technology And so this is really interesting to see because we always talk about concussions and helmets But not really what else that can be brought into them and the ability of this to sort of run new plays or especially for some of these players that go you know even in the nfl level but college, you know high school when you're learning the place To have one of these heads up displays, especially for some of the wide receivers, et cetera especially if you, you know, you just started on the team and you haven't been able to chance to learn them all.

Dr. Grant Garcia: That's pretty awesome. You know, a lot of times we use, you know, in our high school, we use signs and things like that to show them, but to have this sort of technology with this helmet built in I think it'd be a game changer in terms of just being able to do more plethora of things and keeping everybody organized.

Dr. Grant Garcia: : For my work, we already do some of this stuff, and this is pretty awesome. You know, this heads up technology slash virtual reality is kind of a coalescence together. You know, when I do some of my surgical [00:23:00] videos, I have some of this, I have this 4D or 4K head camera that I wear, and I actually have a heads up display in my eye when I'm operating, and I can see what I'm doing, so I know whether the picture is going to be good quality.

Dr. Grant Garcia: So I already do some of this stuff. And the new features we're talking about are You know, you get 3D mapping of the patient for shoulder replacement, and then you can actually see if you put the implant in and you can actually virtually put it in with your hands. Now, again, that technology is limited and there's different things, and this is going to be, I think, one of the next generations of technology for surgeons, because what we could do is get an MRI or a 3D, a 3D CT scan, so what it is is like a CAT scan.

Dr. Grant Garcia: And then it can, and then it basically will show someone's bones or anything in three dimensions, and you can spin it around in your helmet, essentially like having a computer right there that's sterile. And then it can also have part of your surgical plan. So as you're putting things in, it will show you if you're doing the right orientation.

Dr. Grant Garcia: They already do a lot of this guidance, sort of 3D modeling and spine surgery. And we're doing it in a [00:24:00] lot of other places because we've noticed that the precision that we can do things is even better. So you have a highly trained, skilled surgeon. With incredibly high technology, it's just gonna, it's gonna make your surgeries better, more precise and faster.

Dr. Grant Garcia: And the less time you're under surgery, the better you do. It's just, there's no doubt about it. You do a good surgery, but you're also efficient. That is the best case. And I've seen in surgeries when I have really efficient surgeries over time as I've gotten better and better, I've seen that my patients are doing better and better.

Dr. Grant Garcia: And I'm doing maybe the same surgery, you know, the exact same thing from the year or two before that. But as you get more efficient and you have less time under anesthesia, it just makes more sense. And so, you know, this, all this technology is only going to help patients, which is pretty awesome. And yeah.

Dr. Grant Garcia: I think that you see technology in the higher level for the for football.

Will Sanchez: How do you see this as a teaching tool? Let's say Dr. Garcia, you know you know, a few years from now where maybe he's now teaching the young bucks, the young men and women of the [00:25:00] future surgeons, and you. sitting there as a proud papa and having some kind of technology like this that you can sit there almost kind of like a coach and guide them through something like this or maybe something beyond even our thought process.

Will Sanchez: You know, this is stuff I think about. I'm like, just besides what you're doing right now, but how can you use this as a guidance or a teaching tool going forward? What are your thoughts on something like that?

Dr. Grant Garcia: Well, I hate to tell you that there's actually more reality than you know right now. So, you know, I do some of this stuff, again, we used to do it with the avail system we had talked about previously, where the camera system was in there, we went live and I'd done a few of these from my operating room, where I would teach people how I'd do something and show them it.

Dr. Grant Garcia: And there are certain companies that if you need to learn a new procedure, the surgeon will actually bring in, you'll have a camera come in and do a sort of video live for you so you can, they can help you walk through or you can watch them in the operating room through this type of situation. But the newer technology, which is really not there yet, it's hard.

Dr. Grant Garcia:Even the camera system I use is quite [00:26:00] technically challenging and it's not the best system out there. It's just pretty good. There's just nothing like it. Yeah. But really the next step I think is. You have a head camera on it's a great camera. It's really you don't really have to think about it Because you don't want to have distractions in the operating room.

Dr. Grant Garcia: That's never a good thing but you have the ability to have this camera on and watch you It's guided by your head, so it sees your bird's eye perspective, which is really, that's the part that people can't see usually in the operating room, right? There's, in certain cases, there's only one person, even though there's a few people operating that can actually see exactly what's going on, that's usually me, the surgeon.

Dr. Grant Garcia: And so then I can do that huddled together with this, or a heads up display to see what I'm showing them, and then they can actually ask questions and you can teach. And so the answer is yes, this is a very early market for this type of technology, and this is going to be a game changer. Even in the last few years since, you know, residency fellowship and now surgery and then starting to build, you know, build a repertoire teaching other surgeons about certain techniques that we do in the complex [00:27:00] stuff that we do over here in Seattle now.

Dr. Grant Garcia: You know, this technology like this is incredibly helpful. It also saves a lot of time. I mean, it's a lot of effort for me to fly out to someplace to teach where I could teach directly from my operating room where I normally work anyways. Yeah. And so it's, it's really, it's better for all parties involved, lower costs too, because you're not paying for someone to fly out in hotels, et cetera.

Dr. Grant Garcia: It's just, it's overall better quality for everybody. And so that's really what's important. But you're also utilizing technology. It's like Zoom. But for surgeons,

Will Sanchez: which is pretty cool. You think besides whether it's the cameras or the technology getting better, but outfitting the operating rooms, whether it's having, , 25 mini cameras from different angles

Dr. Grant Garcia: It will. And it's also the push. It's the push for the companies who want to teach. It's the push for the surgeons who want to have that better perspective. I mean, hospital social surgery, where I trained, we had cameras, we had one camera and the lights. And so you could bring it over to right where you want it to be.

Dr. Grant Garcia: And so we have so many people that would come from all over the world to watch our surgeons operate because obviously it's one of the best hospitals in the world for orthopedics. Yeah. And we had so many visitors all the time from international that they would sit in the back and they could watch the whole surgery and ask the surgeon questions.

Dr. Grant Garcia: So you know that and that's that's what a lot of these new operating rooms and technologists do. We're more of a private practice so it's a different teaching facility but a lot of facilities nowadays they're starting to do more outfitting that right because you want to be able to see and people want to come in if they're going to shadow you.

Dr. Grant Garcia: : And watch, they don't want to see someone turned around talking and kind of mumbling. They want to be able to see the whole thing, you know. It makes the experience better, and [00:29:00] as we all know, you know, what you hear, you hear about 20%. But when you see it, it's a whole other animal. You're like, that makes perfect sense to me.

Will Sanchez: It's funny. I was thinking of like some old movie where the surgeon turns around and looks at, you know, the young surgeons that are coming up , , all dressed in white, I am now going to do this and, you know, turn back around. They've got a little you know, pencil and notepad and taking notes and things like that so thanks for that, that visual.

Will Sanchez: What do you think about the university and the football players? This university for education for the deaf

Dr. Grant Garcia: I Saw a video when they introduced the helmet, they introduced the technology. To them saying this is going to be available to you and said, man, I'm really happy for the kids that are going to college and playing football and, and having something like this. And I'm looking forward to the technology that's going to keep expanding and who knows where this kind of goes.

Will Sanchez: What are your [00:30:00] last thoughts on on this technology and just, you know, this 5G helmet that Gallaudet was able to use?

Dr. Grant Garcia: Well, I'm just really excited. You know, hopefully we can do another episode like this in a year or two and talk about, Hey, remember that episode we had on the 5G helmet from the, from the prestigious university in DC?

Dr. Grant Garcia: Yeah. Now look at it being used more. You know, these, we get, it's so fun that we've done this for so long now. You know, with the new rebranding of the show, but even our old episodes, you know, we've done this for almost what now? Three years? And we can now look back on episodes and be like, Oh, look how wrong we were, but also every once in a while we can say, look at all the cool technology we're talking about.

Dr. Grant Garcia: Look what it is now. I think this is going to be a good segue to the next few episodes, which hopefully our listeners will enjoy. The next episode, we have an excellent entrepreneur we're going to talk about. Talk about some new technology and napkin to reality, which everyone will really enjoy that.

Dr. Grant Garcia: It was extremely hot on our podcast. And then the end of the year episode, which I know Will and I are really excited about is [00:31:00] I talk and we'll talk about a lot of fancy things that we do in orthopedics and sports. But you know, I talk about like, Hey, check this new thing out. We're going to be doing, but that thing we talk about doing is only six months old.

Dr. Grant Garcia: Well, now it's been about a year or two. So where are we at? What were you right about? What were you wrong about? And, you know, hopefully we get more rights than wrongs, and, you know, we're pretty happy with the new technology, but I think that the listeners want to hear about it. This is the most cutting edge stuff, and there's some new things, too.

Dr. Grant Garcia: And again, I tell everyone in my patients that if you come back to my office or my PAs, if you come to my office in a year or two and I'm doing exactly what I did before, then I'm not getting better. And that's something you should be worried about. And so every year we're advancing. And so I'm really excited to have listeners here about all this new technology that I can offer them, and how we continue to push the envelope in the future.

Dr. Grant Garcia: So that'll be our sort of Christmas episode. So we're excited. Thank you all for listening and follow us on our all the platforms we've talked about. And Will, [00:32:00] I hope you feel better. And obviously, you know, many thanks for coming on tonight. I know you weren't feeling up to it, but I think that...

Dr. Grant Garcia: I think that the listeners will be really happy to hear our turf discussion and our 5g helmet. So

Will Sanchez: Before we go You know, I got some trivia for you.

Will Sanchez: You're trying to sneak on out of here. You were like, all right people, thanks for coming. Good night, y'all. No, no, no, no. Hold on a second. Hold on a second. All right. We were talking about the 5G helmets and all these wonderful deaf and blind athletes. Well, it's a deaf and blind school. So that's why I mentioned the deaf and blind athletes, but they're deaf athletes.

Will Sanchez: So, and I think you got this here. All right, so Some of the hearing, you know, impaired players was Bonnie Sloan and Larry Brown and Kenny Walker and even Flozel Adams, he played with Pittsburgh and the Cowboys, some really well known kind of players if you're a football fan, right? But the first [00:33:00] legally deaf person in the NFL, do you know who that player was?

Dr. Grant Garcia: Oh my gosh, no, I have no idea.

Will Sanchez: He was a Super Bowl champ and he played for the Seattle Seahawks.

Dr. Grant Garcia: Not Jim, not Jim Zorn, no he's not deaf. Who,

Will Sanchez: no, who is it? Derrick Coleman. Derrick Coleman was on the football team really with the Legion of Boom. He he won the Super Bowl with them. He was, he is recognized as the first legally deaf person. The other players I mentioned before. They had some hearing issues and loss of hearing, and I think some of the loss of hearing is probably getting smacked upside the head by Too Tall Jones and some other players, but that's a whole other story.

Will Sanchez: But the first legally deaf person in the NFL was Derek Coleman from the Seattle Seahawks, and he won himself a Super Bowl. So just tying all of that [00:34:00] there together. So imagine how difficult it was for him to play in the NFL. NFL at the NFL speed and still be able to be a player. And he was, he was a player five, six years, at least, you know, I don't have the numbers in front of me, but he played and he made it.

Will Sanchez: So kudos to Derek and everyone else out there that are playing and doing their things, whatever the challenges are just a little information. And, you know, I know Dr. Garcia was trying to get out of here before we got to the trivia. So we just want to thank everyone. Thank you for listening to SportsDocTalk.

Will Sanchez: Check us out at SportsDocTalk. com. We've got our shows. We've got transcripts of the shows, right? We're talking about you know, this is a great episode, right, for Deaf, right? We, we're, we're there. We, we have this information on our website. You can read. All the mumble jumble that I'm talking about right now.

Will Sanchez: You can read it in our scripts and our transcripts. So please check out the website. There's a lot of great information. Dr. Garcia [00:35:00] always has some really cool stuff and talk about cool toys and all the other stuff that we talk about. So please check it out. Dr. Garcia, before we go, any last words? No,

Dr. Grant Garcia: thanks to all those listeners.

Dr. Grant Garcia: Always fun. Thanks Will. And I'm looking forward to the next episode. All

Will Sanchez: right. Thank you everyone. Thank you, Dr. Garcia. Take care.

Dr. Grant Garcia: Take care.Audio Transcript

Will Sanchez: So we are just so excited about it. We have a great guest today, but before we get to that guest, Dr. Garcia, can you confirm, are you giving out miniature ponies for our 1000 listeners ?
Dr. Grant Garcia: Oh, yeah. I, I wish I had a thousand miniature ponies, so I can't confirm that, but it's a, it is a good idea.

Will Sanchez: Listen, we're really excited about today.

Will Sanchez: We have a big component of what you talk about, seems like every single show, and that is the work that you do, getting to the patient, repairing them, um, getting them [00:01:00] back to where they need to go. But really the next step is your handoff to someone that really does the work as far as physical therapy.

Will Sanchez: putting in all the work that has to go into recovery so they could get back to normality. And we have an exciting guest today, Dr. Garcia, please introduce our guests. And before you do, please explain a little bit more why it's so important to have a physical therapist to get you on your road to recovery.

Dr. Grant Garcia: So you know, we thought about this show and you guys all hear the fancy stuff that we do. We're cutting edge procedures. We do, you know how we're trying to push the envelope. Yeah, that's all well and good. But, you know, my, my surgery is hopefully anywhere between an hour to two hours worth of work, you know, there's some pre discussion, but really that's it, you know, most of that's handoff and the handoff is to physical therapists.

Dr. Grant Garcia: And if you don't have a good team, you'll see pretty quickly. That despite how good a surgery you do or whatever you do in the operating room, it really doesn't matter if you don't have a good team. And [00:02:00] so, you know, being now in Seattle for a little while and getting to meet a lot of good physical therapists, there's just some really high quality places, um, that I think Really will help things and also when you those difficult situations where you need to have second opinions second opinions for physical therapy Because the things not going the way you want, you know, I've got my go to's Tonight, I'm really excited to introduce Zach this is he's one of the co owners of high death And you've really been instrumental in helping me take care of my patients.

Dr. Grant Garcia: I know I've sent Plenty of patients his way, um, even for second opinions on top of my standard surgical patients. So some of my patients will drive an extra distance just to see him and his team. Um, and they take care of anything. You know, there's, there's sometimes you have in physical therapy, the procedures that we do are unique.

Dr. Grant Garcia: And they're not commonly done. So you see a meniscus transplant, you see a Carlos transplant, um, and that can, that can make people nervous as they rehab, but this team does not falter and I've never had any issues before and they've taken care of plenty of those patients of mine. So, [00:03:00] um, it's a pleasure to have them on.

Dr. Grant Garcia: And I really want to talk about. What cutting edge stuff that they're doing to help our patients get ahead and with our better outcomes, because again, all these athletes are seen online, Aaron Rodgers, Nick Chubbs, you name it. Lonzo Ball is going to come back from his Carlos transplant. Most of that work is being done by amazing physical therapists.

Dr. Grant Garcia: So thank you Zach for being on here and love to

Zach Smith: hear more about your stuff you're doing. Well, thanks for having me on and I appreciate you guys taking the time, uh, to bring me on here and, and I've had nothing but positive experiences with you and your team and, and never hesitate to send people over. I know you guys are the best in the business over there.

Zach Smith: So we've enjoyed being able to be on the cutting edge of. of medicine with you and bringing some of the passion that we have for sports medicine and recovery of some of these complex surgeries. And so it's been a, it's been a really fun thing to work with you and your team. I was actually just online yesterday watching a bunch of your surgeries that you're doing.

Zach Smith: So I've been, I've been loving what you've been doing with taping the surgeries. Sometimes I'll [00:04:00] be at parties and I'll be watching your surgeries and people will look over at me and they'll see that I'm on a phone looking at surgeries and they're like, what are you doing? And I'm like, Hey, come over here.

Zach Smith: You got to see this. This is what This is Dr. Garcia. He's got these surgeries that he records and it's really well explained. And so, yeah, I'm even bringing some of the people that are not in the medical field into the fold on some of the stuff that you're doing. And so, so, uh, thank you so much for having me on and, you know, I'm looking forward to it.

Will Sanchez: Awesome. It sounds like Zach's hanging out with a bunch of guys like myself, just kind of randomly looking at these, uh, surgeries, these internal braces, you know, that's my thing right there. So Zach, I can relate Zach Smith. He's a physical therapist and co owner. Sure. Like. Garcia mentioned at hi-def pt, that's H i d E F p t.com.

Will Sanchez: So you could check out, check him out and check more information out there, at his website, uh, de Garcia, uh, please, can you continue?

Dr. Grant Garcia: So, I mean, I think. I want to know more and I kind of talked to Zach about this and [00:05:00] I'd like to know more about like, what do you guys do? How do you guys do it? You know, I've told everyone kind of my backflow and my secrets to sort of how I try to stay on top.

Dr. Grant Garcia: But you know, I'm not, I'm not as experienced in the PT world. I know I send them to you. You do an awesome job and the patients come back looking really good. But what does it take? You know, what does it take for you guys to stay on top? And, uh, you kind of explain your methods and what you're doing that's new.

Zach Smith: Yeah, I mean, the first thing is, I think what it takes is consistent team effort on education and keeping up with the latest in what's going on with surgical techniques with rehab and performance and all of that. So I think in the Pacific Northwest, like you said, there's so many great clinics and so we're just happy to be a part of, of the community of PT here up in the Pacific Northwest because there are so many good physical therapists up here.

Zach Smith: And, and really what, what I think is, has led to us being one of the leaders in sports rehab and performance, um, has just been our, our attention to education. So, like [00:06:00] this upcoming week, we're, we're bringing in a course, um, from a guy named Tim Gavitt, which is all about load management. Um, you know, he's a, he's a legend in the, in the field coming out from Australia.

Zach Smith: We host a lot of courses on a, on a variety of different topics. And then on top of that, our team stays up to date by. Um, a bi monthly full company wide meetings where we review, uh, journal articles relating to new stuff that's coming out, maybe some old stuff as well. We go through case studies and case reviews, so some of these, uh, more difficult surgical procedures, uh, some of the harder rehabs and the more complex patients, what we'll do is someone will present that case at our, at our bi monthly meeting, and, uh, and we'll get weigh in from, from all 11 of our physical therapists, um, and plus, you know, we bring people in.

Zach Smith: Like yourself, uh, to help educate our physical therapists on these procedures and help make sure that, you know, we do right by the patients because, you know, there, there are the simple straightforward procedures like, you know, metastatic needs, total knee replacement, [00:07:00] total hip. Like some of those are kind of, you know, like they're, they're fairly simple, they're fairly routine.

Zach Smith: We kind of know what to expect unless we get a curve ball, um, with some of the healing processes, but with things like, uh, you know, complex, even like a simple ACL, that's a complex rehab. And if you don't know how to test and make sure that you're loading the knee correctly through that rehab process, there could be a lot left on the table as far as like return to sport timelines.

Zach Smith: And you're seeing guys like Jordan Brooks returning to practice at six or seven months, um, returning to, I think, full play at eight months and. I think a lot of that, that type of faster return to sport, not that it's always advised early on like that early, right. But a lot of that is, is because of dedication and time spent and diligence with physical therapy, not just on our side, though, from the physical therapy and clinic side, but also helping to make sure that our patients are also ACL,[00:08:00]

Zach Smith: you know, That takes a lot of effort, right? That's, you know, I've got, I've got patients who are professional athletes where it's their full time job is now an ACL recovery. And so when we have patients that take that sports mindset that like they attack the recovery, we see really good results. And so we really try to bring that level of energy and effort into the clinic.

Zach Smith: And everyone who comes through our doors is treated like an athlete and that mindset. helps us to propel these people forward. You know, they're in three of our four locations are inside of gyms. One of them is is a standalone but looks like a gym. And when people come in, they don't necessarily feel like they're in a medical center.

Zach Smith: They feel like they're in a training facility, which for a lot of these injuries, right? We don't want to push people too early. We're always safe. We make sure we respect all the protocols and and all of that. But when the time comes to load and make sure we have adequate load for adaptation, um, You've just got to really understand how to do that and how to do that safely.

Dr. Grant Garcia: I [00:09:00] think that's a great point. I mean, I think we made a number of excellent points. You know, I think the one thing is education is really important. And I find that you have groups that are maybe not as up to date and you have some groups that are. I mean, the reason you guys will get a weird, you know, they'll get a Bay Area ACL, or you'll get a meniscus transplant, or you'll get a Carlos transplant, you'll get an NPFL, or you'll get a revision ACL of mine.

Dr. Grant Garcia: And there's really not many questions. You can follow the protocols and you do your education. And I think that's really nice. Like, you know, I love that. I love being able to teach those sort of more complex things, but it is nice to, when there's some breadth of knowledge, you know, even the fact you're joking about the videos, you clearly care enough to watch them, to learn about it.

Dr. Grant Garcia: And so that's really important. I, I think for me when I'm handing off my patients, you know, I want to know I, you, we've all heard the stories before. I have them plenty of patients come back and said that the person they worked with didn't have any idea what type of surgery they had done. Um, even though we had sent them with operative notes and you know, it's not to knock anybody.

Dr. Grant Garcia: It's just that that that's hard for me when I do a lot of work and I'm spending a lot of difficult, uh, you know, time [00:10:00] doing this. And so it's good for me to know people that Really care about the education. It's good for the patients. You know that too. You know, we you know this there is a difference between good PT and bad PT And if your therapist on board if you care about it, you read literature, you understand how things are adapting That's good.

Dr. Grant Garcia: And so, you know, you know me like I'm okay with feedback to you're like you listen, you know, dr Garcia, you're not really there's some newer things that we're doing like have you thought about this and that's really good idea Thank you, right? Like I can't read every paper I just like you can't read every paper.

Dr. Grant Garcia: So we're here as a team. Um, and I think we drop our egos cause all we care about is the patients. Um, so that's really important. And the ACL thing is like, you're dead on on that. I mean, there's patients that don't get the athletic mindset early on and it's a long recovery. And when you have that athletic mindset, you know, you can do big things.

Dr. Grant Garcia: You know, the one thing, you know, you probably heard me ask the patients before, it's like, how is your testing? And they'll be like, what are you talking about? You know, and if I get them from someplace like yours, You know, they got their testing with them as a sheet, you know, they've had everything done and they know they're ready or they know they're not ready and that's really important [00:11:00] too.

Dr. Grant Garcia: And so that's just the basics of just ACL in general, so I don't mean to interrupt

Zach Smith: you too much, but yeah, that's important. No, no, that's, that's perfect. And really that, that points to like one of, one of the things that we try to stay on top of, which is, you know, you mentioned the testing and when we talk about testing, we talk about the main one for, for ACL is quad.

Zach Smith: Testing with dynamometry, isokinetic strength, um, isometric strength. So we test at 60 degrees and we try to take more of a criterion based measurement of progress, right? There's, there's constraints from, from, from, uh, the physiological healing side. And then there's constraints from a strength and Performance side.

Zach Smith: And so what we try to do is try to marry both of those concepts and make sure that, hey, we're not stressing the graph too much in certain ways or like a meniscus repair, right? We can't load it in certain ways. But we want to make sure that if we can load something that we're not just fearful of, hey, we can't load, you know, anything, right?

Zach Smith: So someone that [00:12:00] comes in with a meniscus injury and they've got a brace locked There's no reason they can't do hip and core work. There's no reason they can't do upper body strength work. All of that helps to simulate their body and keep them from, from astro sitting elsewhere. So one of our big focuses on is on hitting other areas, right?

Zach Smith: So they come in with a knee injury. We could still potentially work ankle, definitely hip. Definitely core, um, and upper body. And so that's one of the things we work on. And then with the, with the testing, we've also got a very, uh, stringent return to sport testing that we utilize. So there's, you know, there's a lot of testing out there.

Zach Smith: They have sport court tests, which test basically muscle, uh, endurance and strength. Um, we'll do some, some one on one numbers, but there's really, and some single hops and double hop numbers, but really the big one is like you said, it's. The strength number, right? So there's certain things that we want to hit.

Zach Smith: And if someone doesn't hit those numbers, it's going to be really hard to progress them in their program. You know, if someone comes in and they want to start running [00:13:00] at 12 weeks, but they only have a 50 percent limb symmetry on quad strength, that's going to be very difficult from my perspective. But, but very easy to explain to the patient also.

Zach Smith: And most people understand that because we set these goals and expectations up front. Hey, this is what I would like you to be at eight weeks. I'd like you to hit 70%. Limb symmetry with your quad. And so this is the stuff that's going to take to get there. And if you don't do it, it's like a math test, right?

Zach Smith: You come in, we know that you haven't really done the work or we haven't helped to guide you in that work to get you to that 70 percent or there's something else going on and we need to reevaluate our approach as a physical therapist and a physical therapy clinic of why we're, you know, we're sitting at 50%.

Zach Smith: Um. At eight weeks, and you know, maybe there's a pain issue that we need to deal with, you know, maybe there's some manual therapies or something else we can do, or maybe we need to do some more blood flow restriction therapy to help boost that strength in the early phases, and so all of [00:14:00] that we try to take into account with the testing, but the testing really guides us and tells us, because there's been a lot of cases, you know, on both sides where I get someone, and I test, and I anticipate that they're going to be very strong, and then we test them, and And they're not strong.

Zach Smith: And then we have to look and say, Hey, why is this happening? Hey, we need to refocus. And sometimes it's a little bit of a reality check for patients, but in a good way, it helps them refocus. Because if I wouldn't have had those objective tests that can't, that just cannot, those numbers don't lie. And, and if I didn't have that test, I could have gone through six months of rehab, not knowing that, Hey, the quad actually is not getting stronger.

Zach Smith: We're just working on, you know, compensation methods through the hip and through, through the calf. And so there's a lot of things that we could do to help to, to guide them in the right direction. But we have to know these problems are happening. Um, and so like, obviously the easiest stuff is like range of motion measurements, everyone takes that.

Zach Smith: But really this, like most phases of the rehab, the [00:15:00] strength and the ability to accept and, and, uh, load eccentrically, that's going to be the most important piece of, of this rehab process.

Will Sanchez: Hey, Zach, is this something that you're measuring day one? So let's say, you know, someone like Dr. Garcia sends you a patient, they walk in through the door and you're doing this, you know, whatever it is, dyno meters kind of measurement, you know, that you're measuring the force and the power and what's.

Will Sanchez: the muscular strength. , are you doing that day one? And then how often, I guess, depending on the injury, how often are you going back to this test to see what the measurements are for the patient as for you to figure out you and your team to figure out that they're progressing in the right direction or you have to change course?

Zach Smith: Yeah, for something simple like a meniscus, uh, uh, Like a metastectomy where we don't, where Dr. Garcia doesn't go in and repair the meniscus. So we're not worried about tensile load on that meniscus. We can test them a lot earlier on, depending on the patient, usually like second or third visit. Um, for [00:16:00] ACL, we really don't want to test it.

Zach Smith: There's really no reason to test until about eight weeks. And so there's this period of time where we have to really motivate these patients within this early phase of rehab, because we're not even going to do that test. The knee is already, it's swollen. It's inflamed. The quad probably isn't even activating.

Zach Smith: The quad muscle isn't activating for the first few weeks very well. So we're using a lot of electrical stimulation and blood flow restriction therapy to try to maintain size of the quad. And so there's really not a whole lot of benefit to testing it that early on for us, as far as like the numbers that we see, because a lot of it's going to be inhibited by pain and fear.

Zach Smith: And so at about eight weeks, if we've worked them out correctly, we can get a very good, accurate number. Um, I've seen numbers as early as six weeks, uh, on an ACL and it's all going to depend on the, on the protocol, right? So like a, a meniscus repair or a root repair, and Dr. Garcia, you might be able to speak a little bit more on this.

Zach Smith: Um, we're not going to test those nearly as early because we can't load them into flexion. [00:17:00] And so it's going to be a lot more difficult for that. And so there's other metrics that we can take though, quad, quad girth. Like making sure that they're not getting so much actually in the quad that, you know, we know that muscle cross sectional area is directly related to strength.

Zach Smith: And so we know if we have those metrics, uh, you know, we've got some idea of what's going on. Um, and then after we take the initial test, it's every two to four weeks and we're doing a serial testing, right? Because strength testing can go up and down by anywhere, you know, like on a max effort day. Plus or minus 20%.

Zach Smith: And so sometimes we'll test somebody and then test them two weeks later and they're actually down a little bit or we test them in four weeks and then they've had a good restful night's sleep the day before and they haven't taxed their sexual nervous system. And then all of a sudden they've got a massive improvement.

Zach Smith: So we try to take regular tests throughout the process so we just can track it a little bit more Uh, like a linear progression and we can really see what's going on, like every few weeks, but really like every week, we [00:18:00] probably wouldn't get that much result with testing it week to week for the time, uh, sacrifice of it just because adaptation of strength takes a while to gain, um, especially in the later stages of rehab, but earlier, definitely closer together helps us gain some valuable information.

Zach Smith: Um,

Dr. Grant Garcia: yeah, I mean, that's a, those are important points you brought up, you know, the dynamometry is important. You'd be surprised some people don't do that, and, uh, I don't really get it. That's how I get the best test for me in terms of how people are doing. You know, cause they complain, they'll say, I've got some anterior knee pain, you know, I feel weak.

Dr. Grant Garcia: And I'm like, what's your dynometry? And they just don't know cause they haven't been tested for it. So it's really important. And I'm obviously not, I don't get that from your group, but that's an important thing to be part of. I think for Will, if he's heard this, he brought up this, this term a few times called blood flow restriction.

Dr. Grant Garcia: Oh baby. This is a really hot topic. And, uh, this might be the internal brace of, physical therapy. So if you don't want to listen up, but tell him a little bit about what your blood flow restrictions like. What do you guys like to use it for? You know, [00:19:00] it's a, it's a kind of sometimes controversial topic.

Dr. Grant Garcia: I'm obsessed with it. I love it. I would do it for all my patients if I can. Um, I do think it makes a difference. I tried it myself a few times. Uh, but maybe tell the listeners and, uh, maybe do, uh, help Will out too so he can do his prescription for blood flow now.

Zach Smith: Yeah. Yeah. Uh, so blood flow restriction therapy is basically, um, it's, it's a class of tourniquet, but unlike in surgery where we fully occlude the blood flow to the extremity, um, we occlude a certain amount.

Zach Smith: So basically how it's done is there's a cuff that's placed up at the Very top of the thigh right by the kind of in the groin area, um, and it wraps around the thigh and the, the customer we have are very smart. They have a built in Doppler and they have a built in pump. And so they're completely wireless and they run the Bluetooth to our phones.

Zach Smith: And what we first do is we take your what's called limb occlusion pressure. And we figure out how much pressure does it take on this cuff to include all of the blood flow in your leg. [00:20:00] And then the maximum at which we work is that 80 percent of occlusion. So we're not including full arterial, uh, blood flow, but we are including most of the venous, uh, flow.

Zach Smith: And so there's not a lot of return of blood from the limb. And so the science behind this is now very good. It's been mostly done in ACL cases. And we've shown that we can, um, we can really slow down the rate, and if not even pause the rate of atrophy, if done early. In rehab for post op cases such as knee, post op ankle, post op foot, we usually use it.

Zach Smith: Our clinic is mostly using it in the lower extremity. We use it a bunch in the upper extremity though to elbow, hand, wrist. Um, there's even some good, some good literature that shows that even though the cuff on the arm is placed at the armpit, it still has some effect. Because of the backflowing of the arterial system into the rotator cuff.

Zach Smith: And so basically what this does is it tricks your body [00:21:00] into a muscle hypertrophy. So there's three different ways that our muscles grow in size and grow a muscle growing in size is called muscle hypertrophy. And basically there's three different ways. One way is by eccentric loading. So that's the slow lowering on a squat or a bench press.

Zach Smith: So we overload that phase of exercise and we under load the concentric phase or the up phase. That's one way. Uh, another way is progressive overload. This is like the standard way that. Weightlifters get strong and big. They just progressively increase the weight at which they lift over time, right? Today, I lift 200 pounds on bench press.

Zach Smith: In six months, I lift 250. I will gain size and muscle by doing that. The third way is what's called metabolic overload. And that's basically where the muscle produces a byproduct during exercise. Usually it's, it's hydrogen ions and lactate and, and those are a signaling mechanism for your body to [00:22:00] increase muscle mass because your body is under stress.

Zach Smith: And so what these BFR cuffs do, the blood flow restriction is they block the blood flow from going back up into the body. And so it pulls those hydrogen ions and lactate and all of the other metabolic byproducts in. Muscle activation and physical exercise. And so it stimulates this massive response where your body thinks you're doing a lot more exercise than you are, which helps you to maintain and activate your mTOR pathway, which is the pathway for increasing muscle size and strength.

Zach Smith: And so. This is the basic mechanism. There's a lot of ways to do it. Um, there's some rules around it, right? There's some contraindications. There's certain people that can't do it, uh, because of like things like, you know, uh, having a blood clotting disorder, being on blood thinners, things like that. There's, there's a few things that, you know, would preclude you from being able to do this, but most, most healthy people can do blood flow restriction.

Zach Smith: Um, there's really not a whole [00:23:00] lot of downside. There are some, um, cases of, of a few injuries that have occurred with, with probably improper use and non high tech cuffs. But the cuffs that we use are, are very, are very high tech, very easy to operate and they're, they're, they're fairly user friendly and are very user friendly.

Zach Smith: And so, um, some of the protocols that we do for blood flow restriction therapy is we do a little bit higher reps and lower weights. So some of the studies are showing. That at about 30 to 40 percent of your one repetition max. So the maximum amount of weight you can lift you with BFR, you can get the same amount of muscle hypertrophy at early phase rehab, as if you're lifting.

Zach Smith: 80 percent of your one repetition max and about 80 percent of your one repetition max. And so the good thing is, is for things like ACL with like people that have anterior knee pain, uh, people who have had a meniscus transplant or a cartilage surgery that can't take a lot of Mechanical load [00:24:00] or a lot of weight load.

Zach Smith: We could do exercises with much less weight and get similar result in maintaining, uh, muscle hypertrophy. And so that's been a huge piece of our postoperative rehab for both the upper extremity and lower extremity. Unfortunately, you can't do it for like core injuries and back injuries, things like that.

Zach Smith: Although I did have an interesting case of a guy who had a, a, uh, radiculopathy, an injury to the nerve that came from his lower back, and he had almost no calf strength, and we did BFR for six months, and he was able to produce, uh, body weight strength of that calf. By the end of six months, which was very cool because, because previous to that, uh, he just couldn't physically load his calf enough because of the lack of nerve, uh, reception to the calf.

Zach Smith: So, um, we've seen really good results with it and it's just, you know, another tool in our bag that we use early on, especially in post op cases to help people get back to a hundred percent. [00:25:00] Hey,
v Will Sanchez: Zach. Um, yeah, I know. I love it. Yeah. Are there any restrictions? I, you, you mentioned certain restrictions when it comes to maybe the type of medicine you're on and blood thinners, things like that.

Will Sanchez: And, and, uh, I know Dr. Garcia and I talked about, , B F R before and, , and kind of going back to this KATSU training. , but. Is there an age restriction? Is this for all ages or is there a ideal age group that this would benefit?

Zach Smith: No, that's, that's a great question. Um, it really could benefit from people from all ages.

Zach Smith: So I've, I've used it up to people age 75. Uh, you know, obviously, and unfortunately, as, as we age, people, people tend to gain comorbidities and they tend to have You know, things like elevated blood pressure, they're on statin drugs, they're, uh, maybe they've had a stroke in their history or TIA, and they start to gather these, these, these contraindications to blood flow restriction.

Zach Smith:[00:26:00] So I think, you know, like, as the population ages, you become a little bit less of a candidate for blood flow restriction therapy, but you're not necessarily precluded because of age. The younger ages, that's kind of an interesting topic right now going around and I talked to a couple surgeons recently who say, you know, Hey, as long as someone, um, is, you know, 12, 13 years old, basically hitting puberty.

Zach Smith: I've got absolutely no problem with them doing blood flow restriction therapy. Um, It's all about tolerance though, right? Cause these cuffs at 80 percent occlusion of your, of your lower extremity. Um, we usually don't start at 80. We start to get them comfortable at 60. Then we worked up to 80 percent at 80%.

Zach Smith: Those cuffs are tight and maybe, you know, Dr. Garcia, I'm sure you felt this too. It's not the most comfortable thing in the world when pressurized or around your thigh and squeezing. And so, you know, some younger kids [00:27:00] don't have as. wouldn't have as good of tolerance to it. And some people in general don't have as good of tolerance to it.

Zach Smith: But I'm always surprised when I'm like, Hey, you know, I warn people, I say, Hey, this is uncomfortable. Let me know if it bothers you too much. It's not a hundred percent essential to your care, but it will definitely help you. And most people are able to just, Hey, I got used to it and now I love it. And we have a lot of patients that actually end up buying the cuffs for themselves to continue to do their workouts.

Zach Smith: Uh, Because, you know, they love, they love the results so much. And that's

Dr. Grant Garcia: a, that's a big thing, Will. The people do that all the time. I hear that they come in, they say, I bought my own because I was so happy with the results. Yeah. It's a big deal. And for me, it's one of the, you know, if I've got go to PT's, I really want to make sure blood flow restriction is an option, uh, for the patients.

Dr. Grant Garcia: You know, especially with some of those patients, you know, they're four months out, you know, Zach, and they're, Quads don't look great and they're ACL and you're like, are you doing blood flow? And they said no, I never tried it before and to me that's a concern, right? I'm also concerned if they say they are doing it and they look they look [00:28:00] weak But that's I don't tend to see that as often again Antidotal one surgeon, but I think it's important and it's a real thing I have a couple videos of me doing it and there's a burn Well, you you feel like you you feel very weak within a couple within a couple sessions

Zach Smith: And I actually do it a lot myself.

Zach Smith: Yeah, I do it a lot myself. I've had, I've had knee surgery on both my, uh, on both my knees. I've had, uh, posterior patellar surface cartilage injuries, osteochondral defects. Um, and so, so like injury to the cartilage behind my kneecap. And, uh, one of my, one of my training tools. When I'm doing knee load to maintain quad size, especially of my right knee is, is blood flow restriction and, uh, and, and yeah, even just bicycling, cycling for 15 minutes with blood flow restriction cuffs on is even on light resistance, it is a massive feel of workout.

Zach Smith: Like you're, you're like, you're on fire by the end of it. [00:29:00] And, uh, and the great thing is you don't have to load the knee. So my knee never hurts after I do BFR. But my muscles are always sore, and that's a sign to me of something that I need to be doing for my own personal need. And I know that a lot of my patients experience the same thing where they say, Hey, yeah, my knee didn't bother me at all.

Zach Smith: But my glutes and my, and my quads and my hamstrings are really sore, but like in a, in a good muscle way that I haven't gotten to feel for a while.

Will Sanchez: Yeah, it sounds amazing. I mean, , it sounds like we should do an experiment, but, , that'll be a conversation for another day. For my birthday, my buddy, , sent me a,

Will Sanchez: I'm looking at it right now. MetaQuest 2, uh, VR,, you know, going into, 2023 and beyond, right? We're seeing Apple jumping on it. We, you know, obviously we know about MetaQuest and I know that virtual reality is something that, uh, you're dabbling in. Can you explain a little bit about that?

Will Sanchez: Because virtual reality is just, you know, it's the future and it's here and I can't imagine where it's going to be [00:30:00] 5, years from now.

Zach Smith: Yeah, so we're using, using, uh, via, uh, VR and, um, kind of in a way that you probably wouldn't expect. So I think there, there's a lot of cool applications. Um, some of the stuff that we don't do, which, which I think we, we will now that we actually have a, uh, someone who's specializes in working with amputees is, is working on limb reintegration of like sensory stuff.

Zach Smith: So, you know, like phantom limb pains that people have. There's, there's some stuff coming out with via VR technology and. And using VR to reduce those phantom limb sensations. What we like to use it for right now currently is what we call sensory reweighting. And so basically when you get one of these lower extremity surgeries, like an ankle, uh, an ankle surgery, a knee surgery, hip surgery.

Zach Smith: You lose something called proprioception, or you diminish your proprioception, you don't lose it fully. But what happens is, because you've had some disruption to the [00:31:00] mechanoreceptors, or the things that recept, uh, information from your leg, like sensation, um, that's disrupted, you start to re weight. your sensation or your, your balance system to the other two systems.

Zach Smith: So there's three ways that we maintain our balance. There's your vestibular system or your inner ear, which basically helps you to a sense the, the, the horizon. And so, you know, some people get vertigo, they have a disruption of their vestibular system. You've got your, uh, proprioceptive system and your proprioceptive system basically senses.

Zach Smith: where your position is in space, right? So you've got, you've got your feet on the ground, your skin is in contact with the ground, you know your foot is flat because you can feel that. Your knee knows that it's slightly bent because you've got mechanoreceptors in your knee. And then the last system is visual.

Zach Smith: And the visual system is obviously like, if anyone's ever tried to balance and close their eyes, it automatically becomes harder because you've removed one system of [00:32:00] balance. And so what we do is we put people on hard surface, with a barefoot and we start to try to reweight the system back to the proprioceptive system.

Zach Smith: So after you've gotten one of these injuries or surgeries, your body is relying heavily on your vision and on your vestibular system. And so, uh, especially, you know, like for older adults who have vestibular dysfunction, but even like in dark situations, you'll notice that people are more likely to fall and get injured in the dark because.

Zach Smith: They don't have good proprioception and now it's dark. So they've eliminated their vestibular or their visual system. And then maybe they're turning their head. So their vestibular system has changed and they're more likely to get injured. And so what we want to do is we want to try to start to get that sensation back into the proprioception so that person can sense what position their knee, their foot and their ankle are in, in relative to themselves so that their injuries are less likely.

Zach Smith: So what we do is we. We put someone in a VR headset, and we have them do [00:33:00] things like riding roller coasters, or we have them do, um, like, like mazes and courses, or we'll have, uh, you know, like, they'll be watching gymnastics, and people will be flipping, so, basically, we're removing the visual system, or the actual visual feedback that's happening, and then, that change in movement from the, uh, roller coaster also helps to disorient the vestibular system, and it makes them rely very heavily on the sensory.

Zach Smith: Okay. On the proprioceptive system and what type of feedback they're getting from the floor through their foot, through their ankle, through their knee, through their hip. And so that's a lot of what we're doing right now, as far as balance training in VR. And it's incredibly difficult. I've ridden a lot of roller coasters now with a VR headset on, uh, standing on one leg.

Zach Smith: And, and it's incredible how much of a deficit you will pick up in someone like, like my right knee versus my left knee because of my surgeries. My right knee when I first started this, uh, was incredibly [00:34:00] diminished with proprioception, which led me to understand that, hey, my quad strength. And my lack of proprioception is leading to continuous injuries in this leg.

Zach Smith: And so if I want to try to prevent continuous injuries in my knee and my ankle on my right side, I gotta make sure that my proprioception is, is up to, up to par, and that I re weight a lot of my balance from my visual and my vestibular system. And so there's a lot of ways to do that without having VR.

Zach Smith: It's just a really cool and fun and engaging way to do balance, rather than just having someone stand on there. foot eyes closed and turn their head, right? So it becomes a lot more, um, engaging and fun for patients to gain back their proprioception. That's a great point. I hadn't

Dr. Grant Garcia:heard that before. I know a lot of stuff you're talking about, but that technology sounds incredible and it's a nice option.

Dr. Grant Garcia: And I, I, you know, I've been injured before too. And I've noticed that when my eyes closed, one of my legs is not as strong as the other in terms of balance. And Uh, I might have to [00:35:00] watch some more roller coasters to get stronger now that I hear this.

Will Sanchez: It sounds like a trip to Busch Gardens. Let's just go and do it for real. Anyway, , I know you've got a lot of stuff going on, with PT and you have some other technology, you've partnered with, , Theracentric, , and it seems like this is, an app for exercising for patients at home. If you want to talk about that a little bit and describe kind of like what, what is the benefits of patients having access to something that they can do at home?

Will Sanchez: Yeah.

Zach Smith: Yeah. I mean. Like Dr Garcia said about his surgeries of like, you know, two hours to three hours of work when he's doing surgery with physical therapy. The maximum amount that I'm going to have somebody in is three times a week, you know, for 45 to 60 minutes depending. But the typical person is really only going to be able to make time for one or two appointments.

Zach Smith: And so out of your entire [00:36:00] week and the amount of workouts that you have, one to two times a week is just not enough. And so if you really want to get the results and you have a high level goal, right? Like you have an activity goal. Hey, I want to be able to, I want to be able to hike up, um, poopoo point on tiger mountain, or I want to be able to jog a 5k, or I want to be, go back to basketball or tennis.

Zach Smith: Then, you know, you've got to, you've got to work outside of the clinic. It's not just about what you do inside the clinic, because if you rely on just what you do inside the clinic, you're definitely not going to achieve the result. And so we have partnered with several physical therapy exercise apps in the past, and this one is probably, is definitely the best that we've had.

Zach Smith: Um, and it's great. It gives access to patients, um, anywhere they go. Everyone takes their phone, right? Like if you give someone a printout. Or even yet, like, you know, some, some PT clinics are still drawing stick figures, um, which is fine, right? Like if that gets the job, if it actually gets the job done, that's fine.

Zach Smith: But the nice thing is with our [00:37:00] app, you've got videos of every, every exercise. It'll time your rest breaks. It'll help you count your sets and reps. Um, it's very smart how it'll guide you through. It'll help you motivate gamifies. You know, streaks of getting into physical therapy, exercise in your home exercises.

Zach Smith: Um, and so all of that combined helps people be more successful. And the cool thing is that I love about this exercise is that I can on the spot. With HIPAA compliance. So I can, I can be compliant with the medical laws. I can shoot a video of you doing your exercises and put them into your own exercise app, and so you could see me or you could see yourself doing your actual exercise.

Zach Smith: Um, so instead of a patient. Taking these videos on their phone and then trying to figure out how many reps and sets we can actually integrate these videos right into the app where they see the reps and the sets and the rest breaks and all that. And then when they pull up the video at the video of them inside of our clinic, doing that very specific exercise.

Zach Smith: And so that's the great thing is like, if we come up with a unique, very, um, [00:38:00] customized exercise for somebody, then we could say, Hey, this is like. This is exactly how you do it and when I voice over the, the, the video as I'm, as I'm shooting the video, they get the very specific instructions. So every time they're at home, they hear me coaching them through the exercise or they can hear me coach them through the exercise that they want and we found that our compliance rate with home exercise program has, has over doubled.

Zach Smith: Since we switched to this, to this technology based, um, home exercise program with higher tech, uh, app. And so like, if I can get somebody at 70%, 80 percent compliance with home exercises, um, we know we can do a great job versus industry average of 30%. It's just, it's really not enough load to get the adaptation that people are going to go for, especially, um, if you're trying to get back to an activity.

Dr. Grant Garcia: No, and I think that's a good point. Go ahead. I think it's a good point that the, you know, the on the number of patients I see that, you know, they kind of forgot about the home [00:39:00] stuff and then just do the PT at home, PT. And then as you know, as your insurance starts to run out toward the end of the year or by the end of your surgery recovery, you know, the home stuff is really important.

Dr. Grant Garcia: So I think it's good for listeners to hear that. There's a better option out there than just stick figures or print offs. I mean, I've seen the same thing, you know, my family members have gone to other PT places just cause it was closer. Um, not that they shouldn't have gone to high def, you know, uh, but nonetheless, when they go there, we get printouts and they're going to lose those things.

Dr. Grant Garcia: I mean, I, first time my mother in law brought home printouts, they were lost within 24 hours. And so the, the, the, the online ability, don't

Will Sanchez: get yourself in trouble. Dr. Garcia.

Dr. Grant Garcia: They may be listening. I'm not getting myself in trouble. Okay. I'm not getting myself in trouble. I'm good. I'm always in trouble though.

Dr. Grant Garcia: Let's be honest. So the, uh, so, but it's important. It's important. And that's a really good thing for the patients to know that there's a high quality app out there that'll make their lives easier and get them back faster, which is again, that's the whole point of our show. That's the whole point of what we do.

Dr. Grant Garcia: That's the whole point of what you do [00:40:00] and what I do. We try to find a way to get our patients back faster, be more compliant, do well and look good. Because honestly, if they do their homework, it's going to make you look good. And it's going to make me look good. And let's be honest, those are all important things.

Dr. Grant Garcia: So the key here is all patient compliance is important.

Zach Smith: Yeah. And there's like one more thing on that printout thing. The thing that always got me with those printouts is that you have a picture of the start and you have a picture of the finish, but you miss everything in between those two pictures. And that's really where the money is, is, is in execution of the exercise and knowing that you are, Executing it correctly and people also feel more confident when they can see the exercise and they also hear the Explanation of the exercise and we go.

Zach Smith: Oh, yeah. I remember when he said that to me in clinic This makes all the sense in the world versus back back You know four or five years ago when I was giving out printouts people come in and they'd like yeah They're doing this right the whole time and I'd recheck it and it's just completely off And, [00:41:00] and not that there's not variation to exercise, but it's like some of this stuff would be completely, uh, you know, like this wasn't even close.

Zach Smith: Um, and so that's really what, what, what I've loved. And then also on our end, we get to see when patients log in, how many exercises they've done, how many sets they've done, and I can see how many minutes they've spent in the app. And so I can really help to hold people accountable, which is kind of. The way that I think physical therapy should be going is into not just rehab and the clinic, but health coaching somebody through their entire journey of physical therapy and helping them to stay motivated because, because I know I like to work out and I like to get in the gym, but I always train better.

Zach Smith: When I've got a coach or someone looking out for me, or I've got a workout buddy. And so that's what I think that this helps us to bring is, is the accountability side and people feeling like, Hey, this person's in it with me versus, you know, Hey, I see this person once a week. And then when I'm not in there, it's kind of out of [00:42:00] sight, out of mind.

Zach Smith: Exactly.

Will Sanchez: This is Zach Smith, physical therapist and co owner of HiDefPT. Check him out at H I D E F P T dot com. Zach said it earlier in the show. If you go to his Instagram and check everything out that he's posted, some really cool stuff. But he mentioned in the beginning. It's walking into a gym.

Will Sanchez: It looks like a gym. It feels like a gym and they're getting to work like a gym. Zach, thank you for your time. We really appreciate everything and please check out his website. Reach out to him. We need to get into a bunch of other stuff and dry needling and God knows we could have gone on and on but please check out his website.

Will Sanchez: Reach out to Zach and his team. They've got a lot of great benefits. Obviously, Dr. Garcia loves dealing with him, sending his patients over there because they know they're in great care. Zach, thank you so much for your time. Thank you for being with us today.

Zach Smith: Will, Dr. Garcia, thank you guys [00:43:00] so much. I appreciate you having me on.

Zach Smith: It was a fun conversation. We'll have to run it back again. I've got some questions, uh, for Dr. Garcia. Um, and so I think we could jump into some cool stuff. I appreciate you guys though. Thank you.

Dr. Grant Garcia: Awesome. Yeah, no, thank you. I know we always, every time we do this, Zach, we always have like a million things afterwards, a question.

Dr. Grant Garcia: So let's do

Zach Smith: it again for sure. Yeah. Yeah. Let's

Will Sanchez: do it. Okay. Take care, Zach. Dr. Garcia, great show. , most important thing that I want to kind of, you know, relate to the audience and you talk about it, Zach's talked about it, is the physical therapy part of what it is. we need to do, right? When I had, I tore my Achilles, I've had injuries, I've had surgeries.

Will Sanchez: The only reason I've gotten back is because I went to physical therapy and I was diligent about it, right? And I went home and did my homework that was put out there for me. And now, like, my left leg that I had Achilles, my [00:44:00] Achilles injury, my rupture is stronger than my right leg because I worked so hard at it and I did ladder drills and, and did balancing acts.

Will Sanchez: and single leg, , exercise and all these other things. So I just want to reiterate to everyone out there, you get what you put into it. And if you put the work in post surgery, you're going to have great results. Dr. Garcia, as we wrap it up, last thoughts, , on this show.

Dr. Grant Garcia: Well, it was just, it's incredible to hear all the technology coming out there.

Dr. Grant Garcia: And again, I completely second and third what Zach and you said. about compliance. It's really important. It's good for our patients to hear. Listen, there are if you have something that you're dealing with some problem or either non surgical surgical, um, and you're feeling like you're not getting what you need.

Dr. Grant Garcia: You know, there are places out there that can do it for you. Or if you are certain things that you're missing, there might be, you know, pay people or we know our bodies and it's important understand that there's technology out [00:45:00] there. That's why I do all the marketing. Um, for myself, because patients don't understand what's out there.

Dr. Grant Garcia: I mean, I've saw multiple patients even today that had, that we had technology we've been doing for the last few years and they had no idea they could have saved their knee with this, this opportunity. So it's just more information gathering for patients to teach them. So they're not, they're learning better and they're understanding what gets them back in the game.

Dr. Grant Garcia: And in the end, like we've said before. Patients first, getting them back to things they love, because when that patient comes back and they say they're back to everything, that smile on their face, it's worth everything. For Will

Will Sanchez: Sanchez and Dr. Garcia, special thanks to Zach out there, and I promise Dr.

Will Sanchez: Garcia is going to work on getting that miniature pony out there for our listeners, don't blame me, blame Dr. Garcia. We appreciate you listening. Thank you for listening to Sports Doc Talk. Dr. Garcia, have a great night.

Dr. Grant Garcia: Take care.Audio Transcript

But we'll get into all of that. Unfortunately, we've got some really bad news and we know how difficult, how beautiful the sport of football is, but at the same time, how difficult it is. Nick Chubb had an injury tonight and we're doing the show Monday night, Dr. Garcia, when you saw the injury, you heard about what happened to Nick Chubb, what was the first thing that you thought about and let's get [00:01:00] into what type of injury this is.

Dr. Grant Garcia: So I'm, you know, I had my usual friend group and I saw this and get texts blowing up saying, you know, do you see what happened? You see what happened? And looking at the injury footage and then hearing from most people, I mean, it's only been injured for less than an hour. And I've heard from about six people asking what happened.

So obviously this is a pretty hot topic and people want to know because he's a very high profile player with a pretty bad injury. So basically had a knee dislocation and in isolation, this is really not a good thing. You know, for me as a sports surgeon that is the last thing I want to see on the field.

You know, there's obviously severe neck injury with paralysis. We don't want to see that or, you know, the Demir Hamlin injury, but those are really rare. This one's not as rare, but fairly rare. We've seen a few players with it, but having knee dislocation is just awful. It's one of the worst things we can think of.

And there's been a few players that have had this, but unfortunately for Nick Chubb, this is actually the second injury of knee dislocation on that same knee, which just makes this a whole [00:02:00] other level of. But basically if you look at it, and again, I'm not there examining under MRI, but if you see it in slow motion, it's pretty obvious what happened.

You can see he tears his MCL, which is the ligament on the outside. Almost definitely tears his PCL, which is the ligament on the inside. That's the one you hear about less, probably tore his ACL. His posterior corner, or LCL, which he had reconstructed in Georgia in 2015, may be okay, but this is considered a grade 3 or 3 ligament dislocation, and the other concerning thing is an injury to his artery, which I know there was a Bears player, or one of the players, about last year, that had to get rushed emergently to the operating room because he had an injury to his artery, so this is This is a bad combination of things and we'll obviously see how it unfolds and I just hope that this obviously is not the end of his career, but also that he can, you know, there's no major arterial damage and they can protect him and they will again with NFL.

We've seen them. They can do things that most places if you got injured on a field, you wouldn't be able to do. So I do have faith [00:03:00] that they're going to get that done.

Will Sanchez: All right, I have a question here. So just kind of going back to let the listeners know you mentioned in 2015 as a sophomore when he was still attending University of Georgia, he dislocated his knee toward the MCL PCL LCL in the same left knee that he had the injury tonight.

If you're in a physician, if you're running out in the field to treat him what is the one of the first things that you need to do? Because obviously there's Some besides the the physical trauma what's happening emotionally because it's such a serious injury So you have a team go out there What are the some some of the first things that you have to concern yourself with the player and the injury at the same time?

Dr. Grant Garcia: Well, let's assume they saw the footage before they went out there or they saw them the injury itself And they might not have and they ran out right because he goes down Says he's injured and then now you're seeing the game footage on the screen or on ESPN P. N. But that was the zoomed in one. Let's say they saw the footage.

The first [00:04:00] thing I'm worried about is his state of his leg. Because you know, I've seen in residency and things like that, injuries like this where they go on attended and you have a major problem because you've lost arterial or a supply of the blood to the leg. So the first thing I'm running out there doing is obviously making sure that it's relocated so that it needs an appropriate position.

But the other important thing is making sure that there's a pulse in the leg and you see that people check their pulse in their neck, their arm, you know but you can also check in your feet and that doesn't give you the whole story of whether this is a real injury. There's some other tests you have to do, but just checking for that initially is something that's important and making sure that the foot looks like it's got some normal perfusion and not like all of a sudden it's becoming, you know, pink or a different color.

And again, really quickly it just happened. So it might not have happened at that moment. Yeah, but that's the first thing I'm checking and then I'm getting him off the field as soon as possible.

Will Sanchez: When it comes down to this type of traumatic injury, right, and whether it's the femur, the tibia, whatever that's no longer connected to the knee, and it's, [00:05:00] for lack of a better word, it's not funny, but it's one of those words that is used, dislocated knee.

It doesn't sound bad, but then obviously when you describe what the injury is, it's really bad. What is the concern and how do you check for possible nerve damage in that immediate situation? Or is that something that you have to do when you get back to the locker room? What's what's that concern like and how do you recognize it immediately?

Dr. Grant Garcia: So damage to the nerve is usually on the outside of the knee, there's a nerve. You can have damage to the other nerve on the inside of the knee, but that's a lot less common. Okay. But damage to the outside of the nerve was with someone, you've probably seen someone that wears a brace called a, it's like an AFO or something where it keeps the foot from slapping.

So the nerve, the nerve that lets your foot lift up can be injured in this type of injury. Probably, Nick Chubb probably didn't have it at the initial time, because obviously he wouldn't be the level he is right now. But that can happen and that's a big deal. I've seen that before a number of times.

With these massive meatus locations, so you can have a nerve injury and you can have an artery injury. The [00:06:00] nerve injury is A bigger problem in the long run, right? Because sometimes it doesn't come back. But the artery injury, the nerve injury, if it happens and you notice it, there's nothing you can do at that moment.

As long as you've relocated the knee. The biggest thing is to get the patient's knee, or to get the player's knee in alignment, and get them checked out to make sure it's not an injury to the artery. That's the number one thing to do right now.

Will Sanchez: All right. And the last thing before we move on just because I'm just fascinated by this type of injury and I just, I can't imagine going through something like that.

How do you deal with the dislocation? Is that something that you're going to deal with before you go to the hospital that you have to pop it back in place or move it into place? I'm not, I'm probably not saying it correctly as far as you saying the word. Those are good questions. But you know, how do you deal with that?

Because this knee is. out of place, and I'm assuming that this is extremely painful.

Dr. Grant Garcia: So, the answer to that last question is yes. [00:07:00] But the the problem is this is the second knee dislocation, right? Yeah. Because when you tear three ligaments, usually the whole knee dislocates. Now, this is quite bad. It went backwards.

You could see it just completely go in a different orientation. Ugh. And bend in a way it's not supposed to go. And so he's gone through this before. And this may be one of the reasons that dislocated like this, because the ligaments you make in theory, they're stronger, but they're always a little bit higher risk.

And once you got damaged to your ligaments and things like that, you're at a higher risk. Now, again. He hasn't gotten injured or had significant injury like this since 2015, so he's done fairly well since his Georgia injury. So that's impressive, and I didn't realize he had dislocated his knee before until this happened.

Because you wouldn't expect a player of that caliber with this injury. So he's already proven he can do it, but revision surgery, we've seen with Odell Beckham Jr. with an isolated ACL revision. much longer recovery. And this is a bad, bad one. I mean, this is the second injury of this caliber. I don't, we have to probably look it up.

But I don't know of anybody that had a second one in the same [00:08:00] knee and made it back. But again, I have to do my research, but this is not the one that I would wish upon anybody. And again, we don't have the actual, you know, maybe his ACL is okay. Maybe it's his PCL but to dislocate your knee that far back, usually you have to take advantage of a number of ligaments.

And it's going to be also tricky, I think, again, this is, we don't want to get this podcast too long for the listeners. Too late. But the other problem you have to think about, yes, too late. So, well, this is complicated, but this is super interesting, people that want to know about it. It is. So basically, this is a whole nother level of injury, if you want to talk about complex, like the guy getting this injury right now, and I don't know if they're in the Cleveland Brown Stadium, if they are because a few of my friends are actually

Will Sanchez: team docs.

No, they're at the Steelers. facility, in fact, the fans did a good job and cheered for him, so it was nice.

Dr. Grant Garcia: Yeah, so there's some really good surgeons there at University of Pittsburgh, and I imagine that the surgeons for Cleveland are there also for the game, and so they're both going to go right now to figure out what we need to do for him.

He won't operate on everything right away, because you don't want to do that, because there's a lot of... This is a whole [00:09:00] nother lecture we could do and talk on this. We may want to add this as a talk later on. But basically they want to stabilize him. The same thing as trauma. This is like a trauma to the knee.

It's like a car accident, right? Like you're not going to fix everything right away. Yeah. You're going to figure out, like, let's calm everything down and do the big stuff later. So let's not worry about the major stuff. But the problem you have is he's had reconstructions already of his PCL. Probably his LCL and probably his MCL.

So he already has new tissue either used from his own knee or from cadaver, but probably a combination of both. And so now where are you going to get it from? So he can't use his own tissue because a lot of it's been taken already. And maybe from the other leg, but do you want to do that in a running back like him?

Yeah. And will he, can he, can a cadaver ligaments hold up in an NFL player? Don't know. So, you know, this is a, and now he's got tunnels and probably hardware in there. So this is not like, this is a straight up simple, let's go reconstruct everything. They're going to have to figure out things to avoid.

Because he's took him, he's done some wear and tear on these ligaments over time. And it's not the same as your own natural ligaments. So this is going to be and there are some really good [00:10:00] surgeons at both those places. And he's probably going to get some second opinions very quickly. But this one is going to be this

Will Sanchez: is going to be a dizzy.

All right, I'm apologize right now because I have another follow up question, and I'm really sorry, but this is I've got so many thoughts on this Will they consult the original surgeon? I don't know who it was right from Georgia or whoever they wherever he had a surgery When it comes down to something like this that they're going back in to Refix something that was already broken and fixed would they make a phone call or hey?

You know like consult at all or go back and look at some of the old film To, to see what they're dealing with, you know, before they jump in.

Dr. Grant Garcia: This is a great question. This is a revision question. So I do a lot of revision ACLs and revisions such as this level. I mean, this is a pretty unusual injury. But whenever you're doing a revision, you want to get data from before, right?

Because let's say they use something that's metal. You don't know how to take it out. Right. It's there's hundreds of metal implants out there, and they're all required different [00:11:00] screwdrivers and different removal devices. So if he's got a bunch of metal in his knee, and I don't know, I've never seen the inside, but he's got multiple screws that are different sizes.

It's like you go into a car and you don't read the instruction manual. How do you take out the engine appropriately? If you don't have all the right, the right ratchets and the right wrenches, et cetera. So if this is something where it has that, this could be a whole nother level. Again, these guys are good.

This is not something, you know, you're used to going into the operating room, and if you have to kind of audible things, you will but they're definitely going to consult previous notes. I don't know if calling the surgeon is something that they would always do, because, you know, how are they going to remember from 2015?

Obviously, he's a big deal, so maybe they do remember that surgery. But overall, you know, it's But you, we all use somewhat similar techniques. We have different variations, but you know, there's some, there's good ways to do an a c l. There's good ways to do a posterial corner. There's good ways to do an MCL l.

Yeah. So if you do it relatively a good way, you know, kind of what's going on. And a guy like him who was checked out a number of times during the draft and each time he's gotten through physicals. Yeah. You know, his knee was checked out for quality. And so, you know, I don't, I'm not super worried about that [00:12:00] part.

But yeah, they're gonna do some homework tonight for sure. This is gonna be an all night event. At least preparing if they have to do anything for him. So this is behind the scenes. This is a whole nother animal. We had a lot of these giants players that had these severe urgent injuries and not even this level.

And it was, you know, this is going to go into the wee hours, probably. Man,

Will Sanchez: that wow. All right, we're gonna move on. I, I, I'm telling you, I could, I could ask a bunch of other things. And, you know, we, we've done so many shows with new tech and everything else, and we're 2023, and this, this procedure happened in 2015, so I could imagine the changes from Then to now and going back and you know, whether they have to, like you said, finding the right screws and you see him, I, whatever I'm going down to rabbit hole.

Let me, let me move on. He's going

Dr. Grant Garcia: to have a few internal braces. If I have to make a comment

Will Sanchez: about that. Oh man. You know, you just, you, you just like, you just like saying the term brace because it gets, it gives me a hype, man. I get so high. Let's, let's get right into it. You know, Aaron Rogers, man, traded to the jets on April [00:13:00] 24th, 2023.

I mean, Every JET fan, and I have a lot of friends that are JET fans, they ran out and they got, they bought tickets. In fact, my buddy's going with, with his son and his grandkids to the JETS Kansas City game. They got tickets because it was the kid, the kid's birthday and everyone's excited. And HBO is like, we're going to put them on hard knocks.

And the NFL is like, well, opening night, we're going to have them play Buffalo Bills division rivals. on September 11th. And that night, you know, it's packed stadium. Aaron Rogers comes out by himself running out of the tunnel with the American flag and it's waving and the crowd is just rambunctious and just Absolutely rock star atmosphere.

The place is jumping. The savior is here. We're finally going to win a Super Bowl after 54 years, going back to 1969 and Willie Joe, name it. And four [00:14:00] plays later, Aaron Rodgers gets sacked. He stands up and he sits back down. And something is wrong before we get into a real quick when you heard about what had happened when I heard about when I saw it was unbelievable.

I couldn't believe it. But when you heard about what had happened, what was the first thought? Because you're a Giants fan. You're a football fan as a fan. What was your thought

Dr. Grant Garcia: as a fan? It was horrible. You know, that's the last thing you want to do for a team that really needs the motivational boost. And, you know.

You think about what you, what you want about Aaron Rodgers and other things he's done, etc. But you know that what he's brought to the team and what he's brought to the fans in New York Jets, you know, and the fact that this happened so quickly after the first game. I mean, it's just, it's just frustrating as a fan of any team and just you feel badly for those, the Jets fans, you know, and you feel badly [00:15:00] for him.

Too because this is not an easy injury to recover for and I think you'll get back but That's not why we're doing this show is because whether or not we think you'll get back. We're doing it for the The innovative tech that he was supposedly given.

Will Sanchez: Yeah, get into this orthopedic surgeon that had performed this surgery.

He has a history of working on athletes and some notable ones, so can you talk a little bit about this specific doctor and the type of work that, and the type of players that he's already done some of these surgeries on? Yeah,

Dr. Grant Garcia: so I think the more important part of this talk is the behind the scenes. because this

Dr. Grant Garcia: is, this is no cakewalk to take care of Aaron Rodgers. And you probably heard that he texted the doctor right after he got injured, you know, telling him, get ready. I'm getting operated on tomorrow type of thing. So this is a guy with a speed dial to professional athletes at that level.

Wow. So this is Dr. Neil Elitrosh. He's the team physician for the Los Angeles Rams. He is the Grand Master of Curl and Jobe, which is a extremely prestigious [00:16:00] LA fellowship. I actually had the pleasure of interviewing with him. He's a really nice guy and obviously, you know, really well known. You know, my most memorable post I saw of him was him with having operatable Sylvester Stallone and Arnold Schwarzenegger in the same day.

So this is the type of guy that we're talking about. He's on Saquon Barkley, you know, Joe Burrows, Tom Brady you know, and he's, he always is pushing the envelope too. You can see, you know, he mentioned the word internal brace a lot, you know, with he talks about Tom Brady, how he internally braces MCL to get him back when he had that MCL injury.

And he does a lot of behind the scenes celebrities as well. But, you know, if you look up at so many professional athletes and he's. He's always been a high level player in terms of you know, one of the cutting edge leaders, one of the leaders for the celebrities and for the athletes. But over the last like five to six years, he's really taken off and, you know, he's really good friends with the CEO of Arthrex.

And so he's done a lot of innovative things through Arthrex. Obviously that's, we've talked about them as an innovator. And so he's, he's well known throughout the world. You know, he's the Tommy John guy. He's [00:17:00] the now knee guy. He's the shoulder guy, you know For Jacksonville, he's the one that did the eight anchors on the quarterback for, he's the one that said that was the worst tear I've ever done and, you know, ended up putting, you know, eight anchors in the shoulder of a normal human being is a lot.

So, you know, he's a, he's, he's done every one you name. I mean, if you look up his type of injuries he's done extremely prestigious. So, Dr. Neal Eltrage is the physician, and you'll probably, you know, he may get consulted on this one. You know McGregor?

Will Sanchez: Yeah. McGregor went down. Conor McGregor from

Dr. Grant Garcia: UFC.

Yeah, look him up. So my friend did the, my friend is a trauma surgeon at UCLA, did the surgery, but Neil Alatrosh was, was required to be in the operating room to do it as well. So Neil Alatrosh, I'm not sure he is an expert at tibial shaft fractures, but he was in the surgery because he's a celebrity surgeon.

Yeah. So that gives you an example of how big a deal he is that McGregor wants you in the operating room.

Will Sanchez: All right, let's talk about this procedure, right? And you know, I, I was excited not about the injury, but the fact that they did this internal brace and [00:18:00] I went to look at it because I'm just, I'm fascinated.

You know, I'm, I'm dying to do it on, on a patient and we got to find a way. I might have to go to a different country to get away with it, but they showed where they, they drilled in and placed internal brace and how they pulled it. The Achilles together to hold it in place. So just talk about that procedure.

And I don't know, what are they calling this? The speed bridge for this torn Achilles? Yes.

Dr. Grant Garcia: So I will burst the bubble a little bit that this is not new. This has been around for a little while. Yep. The idea, the word internal brace, which we've talked about, and please listen to our previous episodes about internal brace, internal brace is where you do a bone to bone.

So in this situation, he technically wasn't internally braced, but everyone loves that idea. And so now everyone's using it for anything. It's now a catchphrase. It should be your catchphrase, but nonetheless... I'm gonna get a

Will Sanchez: t shirt that says, I love internal brace.

Dr. Grant Garcia: I'll get you one. I need to get you one.

There you go. So the so basically he wasn't [00:19:00] technically internally braced because remember the word brace is to sort of make it rigid. And you don't want to make the Achilles rigid because the Achilles has to stretch so far. Yeah, you need that flexion, right? Yep. Yeah, and again, you don't internally brace tendons, you internally brace ligaments.

So ligament is the UCL. A ligament could be the A C L that you internally brace. The M C L is a ligament, but the a achilles is a tendon, and so by bracing the tendon that would be very bad. So he technically wasn't internally braced. So the procedure that he had is called a speed bridge. We do it in the shoulder as well.

I've done this in the Achilles before. It's a really slick way of doing it, and the thought process is that when you tear your Achilles, You split it mid substance. Initially, the older way of doing it was to do it open and then they came up with percutaneous techniques where you can do it through a small little incision, maybe like, you know, a little bit longer than your thumb.

And then you can connect them together and sew them. Well, the third way of doing it is the way that Aaron Rodgers had it, where you kind of say the bottom [00:20:00] part's like pretty good, so you maybe put a stitch in that, but the top part's where the big part of the Achilles is. And so you sew that directly into the bone, so the fixation is much more rigid and you can move people faster, and there's a lower chance that they're gonna tear out.

So they dumped it into his heel bone, which is what you probably saw. And the speed bridges, that means it's a lot faster with no knots or anything, because the knots can cause injuries. Because one of the biggest complications of Achilles is to get an infection. And so that's why these percutaneous techniques have been invented, because Achilles were known for having problems with having wound infections.

With these new percutaneous techniques, it's extremely low, and now you have this newer technique, the speed bridge technique, which fixes it into the bone, so it's much more rigid fixation. You never want to really be repairing tendon to tendon together, that's why this newer technique is so impressive.

Will Sanchez: Your tendon snaps, right? So, there's a part of it that's up and there's a part of it that's low and they're not connected. So, when they did this procedure and they're bringing them close together, are they just bringing it close [00:21:00] together and letting the body heal itself because now they're next to each other?

Or do they have to, at that point kind of connect them?

Dr. Grant Garcia: So that's, that's the best question you could, you've asked tonight and you've asked some good ones. So that one is the trick that people do that. Even when I was learning this and we learned about this, it doesn't make any sense. So it's a lot of people can be treated without surgery with an Achilles injury.

If you keep the person in the elevation, eventually the tendon will grow back together in some cases. So there is some data that you can do non operative treatment, especially in patients as they get older. So the idea is that it doesn't have to be in the same, the same zip code, right? Or maybe this is the same household.

And so. We used to tie them together either with a big open incision or this percutaneous technique. But what I was saying before is they really don't care about that bottom tendon, and they just pull the thing down as close as possible and keep it rigid. And then the idea is that by keeping that part rigid and stretched out, you don't have a likely chance it's going to pull off.

You can start moving faster, and the little leftover tendon We'll heal back there [00:22:00] and eventually it'll be fine. And the first couple of times I did this, it was really weird because you're used to like repairing everything back together. Like you want to make things look perfect, right? Yeah. I'm an OCD perfectionist and you have to tell them, no, don't worry about it.

It's not a big deal. It'll be fine. And that's what these newer surgeries, you have to kind of come to the comfort level. And it's always these. Really big innovators that cutting edge that understand this and learn this and teach this and invent these techniques understand ahead of time, and then you slowly pick up on them, but that's exactly the point.

So this is it is a partial repair, but really, it's just basically putting in the same household and then the body will heal it because it's not moving, right? Because it's been braced down to the ground.

Will Sanchez: Are you, are you doing anything or are you adding anything to that area to speed up the healing process besides, I'm, I'm assuming that they're going to put them in a boot, but is there anything else that they can do to kind of, yeah, we're in the same neighborhood, but we want you guys to be a little bit friendlier, quicker, and not just kind of you know, bumpy to each other in the street, [00:23:00] you'd be like, hey, no, you're, we're, we're putting you in the same in the same place.

Dr. Grant Garcia: So they're probably using, you know, they may have used. And again, the data is kind of mixed and whether any of those type of biologics help them, but it's Aaron Rogers. So why not throw everything at him, right? The other thing is you don't want to give him too much stuff in there and then causing infection, right?

Cause you give him too much things. You're not really, you're kind of experimenting with and trying new things. You want to be careful, right? It's just a fine balance. Now, if you're in Dr. Neal Alatrosh doing this. You're not super worried about your reputation because you've got such a big deal. So you want to try something that's going to get them back faster, that's going to look better, right?

Yeah. And then they're going to use that special dressing I think they had talked about that's an antimicrobial because again, we don't want an infection because the most common place to get an infection is right here where you had it. Now again, probably had it done percutaneously if Dr. Neal Eltrash did it.

Yeah. But nonetheless, you know, that's something to be aware of as well. So. They're, they're attacking the healing process from rigid, solid, incredibly good fixation so you can start moving early, because remember we've talked about [00:24:00] this, the faster you can move our patients, the better they're going to get back to, that's why internal brace works so well, because you can move them faster and test the ligament faster.

That's the whole, that's the whole reason why it's so effective. And things don't stretch out. Two, you know, you want to make sure you don't get an infection. So you have a special dressing and three potentially biologics. So you've done everything right in the body to make it go better. And I think this is be a great topic at some point for one of our, our show is to kind of say.

What makes things better, right? And this is this, this device, this technique has made better. And, you know, where it came from, Arthrex, which we talked about before. So this is, this is a combination of, and you could see they jumped right on. I mean, there have been multiple Arthrex posts about this new technique in the speed bridge and really bringing light to it because it's done a little less frequently than the side to side repair.

And it's just surgeon preference, but I've done it before and I've been extremely happy and that's sort of the way I now fix these because of the fixations are rigid in the bone. But also I'm a proponent of rigid fixation as it is. I'm an internal brace guy. You know that. Oh baby. [00:25:00]

Will Sanchez: And also having a smaller incision also helps with the healing process, right?

I mean, I had my Achilles done years ago and you know, I have a. Six inch scar right down my Achilles compared to the, you know, the small incisions that Aaron Rodgers had for

Dr. Grant Garcia: this procedure. Yeah, and that's 100%. I mean, that's why we started doing it. It was helping with healing because the other thing is when you get your whole Achilles opened up and I don't want to gross out the viewers but there's, there's a tendon sheet around that that has blood supply into it and that can get damaged as you open it up and try to repair it.

So, you know, I think we go for smaller and smaller decisions, not because the idea of it's sexy that you can do minimally invasive, but it's actually better for the patients and the less trauma that your body has, the faster it can heal. Okay. And so that's why minimally invasive works if obviously there's certain areas where we can't be minimally invasive if you shatter your heel.

You know, you're not getting a minimally invasive repair because you have to open it up and get all the pieces back together and etc. But we are getting better and better at [00:26:00] minimally invasive surgery and this is one of the reasons why so we can get you back faster.

Will Sanchez: Okay, he's talking about recovery and getting back by the end of the season he's 39 years old.

He just had this procedure. He wants to get out there by the time you know, playoff start, which I don't think the Jets will be in the playoffs, but that's a whole other conversation. We're just talking about the timeline. If you had to, if you were a gambling man for 39 year old, after this procedure for him to get back on a professional football field with 300 pound men chasing after you, What would the odds be of that?

Dr. Grant Garcia: So we've been wrong on gambling many times on this show. I will tell you absolutely not. But I will tell you absolutely not. This is, this is ludicrous that he was told he was four months. But you know what? Everybody's talking about it. We hit ESPN. I saw a big huge article on ESPN talking about he's going to get back in four months.[00:27:00]

But again... You know, my primary surgeries that I do are, you know, shoulder, knee, and elbow. I do do Achilles, and I do the innovative technique, but four and a half months seems is just a little, it's a little bit too. But again, it's Aaron Rodgers. He loves to get people excited about things he says. He also was talking about things he does with, listens to dolphin noises to get his healing better.

So we have to talk about, there's, there's different things that, that he said that we don't know the credibility of. But listen. More power to him if he's motivated to get back, and he will get back, and like I said before at the very beginning of the conversation, I think he'll be back, but he's not coming back this year.

Will Sanchez: Anything that works, if it puts you in a great mental space for you to deal with your injury and think that you're recovering faster by listening to Dolphins, then I'm all for it, right? Whatever gets us to our happy spot. Dr. Garcia, you know, this was supposed to be a 10 minute show, and then we started yippity yapping, and I've got, you know, 85 questions, so let's wrap it [00:28:00] up.

I just want to remind everybody, please check us out at sports. talk. com. Our shows are there, transcripts are there, just cool information. Dr. Garcia has tons of stuff on the website, so please check us out. Dr. Grant Garcia, orthopedic surgeon and sports medicine specialist. If you haven't figured it out, he knows what the hell he's talking about.

Dr. Garcia. We didn't even get a chance to talk about our boy getting hurt. Our, our Saquon Barkley with that ankle sprain, which is probably going to be out three, four, maybe longer weeks. Very concerning, but Hey, this is a tough sport. Thank you for your time tonight. And let's do it again.

Dr. Grant Garcia: And again, yeah, thank you so much for having me on.

And again, hope both these athletes recover quickly. Check us out on our website. And again, also, you know, on our website, we have posts. You can post questions. We are happy to go through a show where we answer questions from our listeners. You know, again, it's, it's always nice to hear the questions from Will, but you know, the listeners as well [00:29:00] would be great.

Will Sanchez: So. Yeah. Less of me and more of you. That should be the motto. That's another t shirt. Take care, Dr. Garcia. Thank you for your time.

Dr. Grant Garcia: Thank you very much. Bye.Audio Transcript

Will Sanchez: And we once again have our favorite orthopedic surgeon and sports medicine specialist, Dr. Grant Garcia. Dr. Garcia, it's football season. Welcome to the show. It's so good to talk with you once again.

Dr. Grant Garcia: Yeah, it's good to be back. I've had a little summer hiatus, but I'm extremely excited. We have the first Giants game coming up, got a brand new looking team, faster [00:01:00] team and so far healthy team.

Dr. Grant Garcia: So this is really exciting. And I'm excited about the show today because it's football season and everyone loves to talk about football.

Will Sanchez: Oh, yeah, once again, man, it's football season for those fans that haven't listened to our previous shows I'm from new york now in seattle. We have dr. Garcia here in seattle We're both giants fans.

Will Sanchez: So that is the common thread. This is how we we meet and conclude in the middle of this beautiful relationship friendship partnership It's the New York Giants that have tied us all together. So that's where our allegiance lies. How excited are you for this Giants season? After a 10 8 1 season last year, Coach Brian Dable, Coach of the Year, led the Giants to the playoffs.

Will Sanchez: They demolished Minnesota and finally get knocked out by the Eagles. How excited are you for this upcoming season as a Giants fan?

Dr. Grant Garcia: I'm extremely excited. I [00:02:00] mean, we have a lot of speed. I was just reading recently. It's going to now the fat or the fastest teams as opposed to one of the slowest teams, which is just, you know, speed kills now in the NFL.

Dr. Grant Garcia: Darren Waller, what can I say? I am really excited about watching him play. I hope he stays healthy. And I think that it's going to be good for Dan Jones to no longer have the criticism of. Getting new contract, et cetera. And you can just play as hard out and feeling more comfortable with Dave Hall.

Dr. Grant Garcia: So, I mean, there's, there's a lot to look forward to. I'm only, the only thing I'm worried about is, you know, the, the giants worked best last year of being an underdog and now they're no longer a secret. So, you know, how is that going to affect them? I don't want them to turn into a cowboy, as you know, or have lots of high expectations that doesn't

Will Sanchez: perform.

Will Sanchez: Yeah. I'm not, I'm not worried about the expectations. I'm worried about the Philadelphia Eagles and the rest of the division and the NFC conference. But as we get ready to kick off the 20 23 season. It's a perfect segue to talk about the kickoff rule change on concussions, right? So there's a paper there [00:03:00] that you had sent to me.

Will Sanchez: It's the effect of the 2018 NCAA kickoff rule change on concussion rates in college football. And in fact, the investigation performed was at the University of Washington here in Seattle, Washington. Let's talk about that. When you read the paper, what was your findings and what was really interesting about this paper that you could share with the audience?

Dr. Grant Garcia: Well, I think what's interesting is, you know, again, we're shifting now to college versus NFL. But, you know, you always keep hearing, and I think people sometimes, you know, people complain about football and they're saying they change the rules to protect the players, right? Yeah. And that's always the goal.

Dr. Grant Garcia: Change the rules, protect the players. We don't want to see concussions. We don't want to see players having traumatic brain injuries or whatever else. If we talked about Dr. David Smith from the Q caller telling us it's not concussions. We're talking about looking for more traumatic injuries in terms of the definition.

Dr. Grant Garcia: But basically by changing this college rule, they try to change it. So you no longer have kickoffs. You do fair catches and touchbacks [00:04:00] and trading trading when you start on this, it's automatic, no longer kickoffs. Or a significant decrease in that. And the thought process is by having less, this high impact, because this is the most high impact of all the, of all you're doing, right?

Dr. Grant Garcia: You have full speed, almost the entire field, coming at another player from the other side. You don't, you don't get to wind up like that in the other option, other than, you know, a kickoff or a punt return or something else. So, what they found was the thought process was, is going to reduce concussions by fixing the rule.

Dr. Grant Garcia: And what's interesting is it made no difference. And the overall amount of concussions was stable. The only thing you always want to, you know, question with these papers is how are they determining that? You know, whether the test, as we know, the tests are not always great. But nonetheless, it's interesting to bring up because we always think about real changes.

Dr. Grant Garcia: We're talking about another real change or another change in the NFL. And whether that led to improvements or decreased injury rates. But, you know, we keep talking about these interventions that are going on. And we're saying, Hey, I hope this is going to make it better. I hope this is going to be better for the [00:05:00] players.

Dr. Grant Garcia: And right now we're not seeing that. So, you know, I think people are worried. Are they going to start getting rid of touchbacks or can you start getting rid of kickoffs for the NFL? And at this point it doesn't show to be a big difference. And so maybe they're going to keep it the same. But it's interesting to have that data because I think a lot of people don't understand that, don't think that.

Dr. Grant Garcia: They're thinking, okay, a lot of these real changes, clearly there's data to show it's effective. In this case it

Will Sanchez: wasn't. Yeah. It's really interesting. And, and this is a very debatable topic, right? Because there's an aspect of it that I'm not sure if the paper. concludes is the amount of kickoffs that are not being returned.

Will Sanchez: So if you had a thousand kickoffs and now because you have a touchback rule that automatically puts the ball at the 25 and they decide not to run it back. So instead of a thousand returns, you only have 700 returns and the concussion number. Are, or the percentages are still the same. Are we still getting a decrease because we have less returns?

Will Sanchez: So, [00:06:00] I think that's where it becomes an interesting conversation because the amount of plays that are being used compared to the amount of plays that are no longer being played. So, it's an interesting dynamic in how that plays a part with these conversations.

Dr. Grant Garcia: Will, are you sure you're not an MD?

Dr. Grant Garcia: You have so much knowledge of these papers, I love it.

Dr. Grant Garcia: So funny. Anyhow, well, this is a great, it's great to know, you know, we talk about sports all the time, but we never talk about data. So it's just interesting to show this, you know, I don't want to bog the audience down with the data, but you know, the fact that people know, like, this is where NFL and, you know, us as team positions, we see this stuff, you know, this is important to us.

Dr. Grant Garcia: Right. When you're coming up with plays or working with the NFL Players Association or you're, you know, there were definitely, there were definitely neurologists and neurosurgeons and stuff probably involved in the rule change. And so they want to show, is this worth it? Right. Cause it's changing things.

Dr. Grant Garcia: I mean, the excitement decreases when you have touchbacks, right? Is there going to be a run back today? Is there going to be a [00:07:00] touchdown, you know? And so is it worth it? And maybe it's not, who knows? We still have more things to do, but your percentage information. The top, the, what you brought up is really, really an important point.

Dr. Grant Garcia: And again, it's always good to kind of criticize the paper and look at it in detail. Yeah. But I thought the audience would like to at least know that, so.

Will Sanchez: Yeah, it's, it's really interesting and it's concerning also because the numbers can be swayed different ways, right? And then do we take into consideration And we've discussed this, right?

Will Sanchez: We, we talk about the, you know, and, and the most lovingly way that we can say it, the freak athlete, right? And we'll probably touch upon some of these incredible athletes, these specimens throughout this show, especially when it comes to recovery. But then we talk about the size and the speed. I remember the joke was, well, you know, the smaller guy was the fast guy.

Will Sanchez: The bigger guy was just the bulkier guy. But now you've got guys that are 230, 240 pounds running a four or five. And you put them on a kickoff line and they're running down flying at you, you know, [00:08:00] those are also considerations thinking about how big these players are getting as the faster that they get.

Will Sanchez: And these fields are still staying the same, right? You know, CFL, right? The field's a little bit bigger, it's a little bit different. So there's so much that goes into it. And like I said, we can go on and on with this. So, you know, for For the purpose of the show, we'll kind of move on, but this is really just kind of tidbits and things for people to think about, you know, when we start to see some of these datas.

Will Sanchez: Totally agree. You know we talk about concussions, right? And this is the way we kind of kicked off this show with the kickoff rule and the change on concussion rates for, for college football. But one of the players that was most recognizable for concussions, and there were many concussions last year, but normally the quarterback gets the most attention, right?

Will Sanchez: And for Tua Tagovaiola, the Miami quarterback, I mean the spotlight couldn't have been brighter. He suffered numerous concussions last year, including one that was as [00:09:00] serious as can be when he played the Cincinnati Bengals and got flung to the ground and his head hit the ground and bounced off the ground and laid there pretty much motionless.

Will Sanchez: with his his hands in that cramped position. First off, before I move on with my question, can you once again say what was happening to that player when his extremities were tightening up that way?

Dr. Grant Garcia: Well, it was, remember, we and by the way, guys, look back on our Sports Talk podcast. We had a sort of...

Dr. Grant Garcia: Full section on that. So it'll be good if the audience is interested in refreshing the entire episode and that can be found on all of our different podcast areas. But nonetheless, it's called fencing. And it was likely from a second hit. So he had. You know, again, I don't know how the testing was done then, but there was a lot of staff changes after that, but basically not probably fully recovered from the first concussion, got the second concussion, essentially a second hit syndrome, which is not good.

Dr. Grant Garcia: And this caused a severe reaction that you see in traumatic brain injuries [00:10:00] where you can have this sort of position, it's actually kind of an innate neonatal or sort of infant response that people have. And when they fall, they kind of do this whole thing where they lift their arms up and that's exactly what he had, if I remember correctly, so not ideal.

Dr. Grant Garcia: So, I mean, it's really important with a guy like this that he's healthy, obviously with ESPN recently showing them making it potentially to the finals. Or the championships, you know, it's important that we have him at top condition, so.

Will Sanchez: Yeah, and it's going to as you said, be impactful for the team, for the league, because I think as a fan, I'm pretty sure as an owner, as a coach, as a player, and, you know, the league itself, they have to be really concerned that Tua doesn't get, You know, hit and have something like that happen to him again, because not only, most importantly, it can be so detrimental to the player and what his long term outcome is, people are already scared [00:11:00] about what happens in the NFL and what, you know, what can possibly happen.

Will Sanchez: It is something that I'm pretty sure the league have already discussed with the Miami Dolphins. I am... just guessing here, but I'm pretty sure that that was the case that they would have reached out and said something. So there's a lot of concern. And one of the things that they said he's doing is Brazilian jujitsu training to learn how to fall.

Will Sanchez: I'm not sure how that helps when a 300 pound man is flinging you, but you know, we'll, we'll see how that all works out. But you know, you mentioned at the top of the show, Dr. David Smith and his biomedical engineering and develop developing design the Q collar which is supposed to mitigate the absorption of slosh or sloshing energy by the soft tissue of the brain.

Will Sanchez: And he described so eloquently. the the inspiration of looking at a woodpecker and how the tongue wraps around the cranium and protects the brain and that's where kind of that thought process, the beginning of that thought [00:12:00] process was for the Q collar. Why aren't players, and I know, you know, there's still discussions about the Q collar even though it's already FDA approved, why are players maybe hesitant to use something like the Q collar, or is it, is it something just uncomfortableness, or just lack of information, or just going based on what maybe medical doctors are telling them?

Dr. Grant Garcia: So, I, I think you know, it's always hard to see with new tech for lots of people. Yeah. I think it's interesting the way, the point you brought up, so, Yeah, it's probably the device of medical physicians who say, Hey, I don't read the data on this. I've never heard of something that can prevent it because we know about how this works.

Dr. Grant Garcia: There was just a post about a helmet that reduces concussion rate by 25 percent in the NFL. And there are a number of comments, even on LinkedIn, people saying that's not true. You know, the helmets have not shown that just like Dr. David Smith said. And so, you know, you've got to be careful that people are always judging, like, how good is this, right?

Dr. Grant Garcia: Because this is a very, if you find the [00:13:00] holy grail to reduce concussions, I mean, that's, you're not working ever again. Yeah. You know what I mean? Yeah. So, you know, we've got to be careful with the right thing. If I was finding this, like, huge... Area that we're looking for this huge need. And so him being hesitant to use it, it makes perfect sense.

Dr. Grant Garcia: It also seems almost too simple to work, but we've heard Dr. David Smith and we've seen, you know, since we've been working with him, we've seen a lot more information from professional athletes that are using it. I would actually say the flip side that at freshman athletes tend to be more likely to use the new tech.

Dr. Grant Garcia: This situation is different. Okay, because they're always looking for get to the edge, right? Like I, I don't consider myself a professional athlete, but I try to keep myself on the edge in terms of trying new technology, innovation, etc. And I'm more willing to try some new things based off the sort of patient population I have and what I'm looking for in the Seattle area and these athletes are always looking to find an edge.

Dr. Grant Garcia: How can they? Be a little better. How can they up their game? And they're lucky enough in their situation to have unlimited funds and to have the NFL, you know, their teams back in there, I mean, you [00:14:00] see, there's all this new biotech and we can jump into one topic, you know, you want to talk about but there's always, there's always new tech.

Dr. Grant Garcia: They're always trying new things. I mean, it's interesting because most of these companies use the NFL and professional teams as a marketing tool, right? So if they get, they get into the NFL or they get into Sounders locker room, they say, Hey, listen, the Sounders use them. But it's funny because it's actually easier to get into professional teams than it is to get into like a regular doctor's office.

Dr. Grant Garcia: Because professional teams are like, Hey, we'd love to use this. This is brand new. It's not going to hurt our players. It's like a, it's a. peptide evaluator or a blood tester or a massage gun or something really kind of minute. And so they're always willing to try it because they're looking for the edge.

Dr. Grant Garcia: I mean, we're always trying to beat the next person in the NFL and it's a huge multi million, probably billion dollar industry. And so if you can find a way to give your players a day faster or 10 days faster, you know, it makes a big difference. And so you'll see like when you go in the locker rooms, they have tech all over the place and they're always trying something new.

Dr. Grant Garcia: You know, they're trying these. Yeah, we the copper or the, or the the armbands for [00:15:00] the players, you know, if they're overthrowing, you know, there's, we talked about the tech on the, these players wear all the time. So it's interesting that there is certain hesitancy with some things, but again, the other concern is constraint, right?

Dr. Grant Garcia: Like, is the cue call going to constrain him that he can't focus even though it's a very light amount of pressure? And so you don't see a lot of players with braces or other things to protect their... Our body part is easily because if it does slow them down and they lose speed, right? So you want tech, but you don't want to be lost.

Dr. Grant Garcia: You, the tech should only improve you. And if it slows you down at all, they're not going to use it. Right. Cause they don't want to get caught or they don't want to get injured or they don't want to get taken off the field. You know, the NFL is very competitive.

Will Sanchez: Yeah, that's really interesting. And for the people that are listening, there are numerous NFL players using this Q collar right now.

Will Sanchez: I know right off the top of my head starting running back for the Dallas Cowboys, Pollard, he's, he's always using the Q collar. He's using it for protection. And some of the things that Dr. Garcia just mentioned, so I just want to elaborate on that. It's, it's a pressure that's, it [00:16:00] goes on the back of the neck.

Will Sanchez: It causes a slight... increase of blood volume in the head and it helps reduce the brain's movement when there's impact. So the extra infusion of blood creates kind of, you know, using, you know, Dr. Smith's words, an airbag effect that restrains the ability to move inside the cranial fluid and that's where the thought of the woodpecker or the ram becomes that inspiration because when you You know, let's say if you were to take an x-ray, you would see this protection that's happening around their brain to reduce the movement.

Will Sanchez: And maybe if you've seen the movie concussion or something like that, you, you see, there's a part in the movie where you see that the brain is shifting back and forth and rattling inside the cranium, which is causing this concussion. I don't know if I described that as well. Dr. Garcia, please help out if I didn't do it as

Dr. Grant Garcia: well.

Dr. Grant Garcia: I told you, you need to get your M. D. You're an expert.

Will Sanchez: So... Just to give everyone an idea what [00:17:00] this sloshing of the soft tissue of the brain and what this Q collar is. So it's just, once again, we just want to bring stuff up. Also, it ties into some of our other shows. In fact, that show was on June 27th.

Will Sanchez: So, it is an incredible show with Dr. Smith talking about the Q collar and the biomedical engineering that kind of went into all of this and is part of our tech and football kickoff. So, Dr. Garcia got jokes. You know, he's taking a shot at me a little bit earlier talking about getting into this biotech and what I really want to talk about.

Will Sanchez: So just to give everyone some insight, I'm reading this article and it's on the Jacksonville Jaguars, right? So I'm like, all right, cool. And oh, they got this new biotech. And it's in the urinals and I'm like, Oh, this, I got to read this. Right. So I send a picture to Dr. Garcia and I said, Hey, they have sensors in the urinals.

Will Sanchez: And when the players use the urinals, the sensors will turn either green, yellow, or red based on the [00:18:00] player's hydration levels. And I was like, This is really cool. This is biotech. I don't know, Dr. Garcino's like, okay, we're talking about urinals. I said, I'm gonna bring it up for the show. We get this biotech.

Will Sanchez: So, listen, even though it's hysterical, but it tells, the fact that it can tell the player how, how well you're staying hydrated. There has to be some benefit to that, right?

Dr. Grant Garcia: Listen, I think that the thing is, you've seen, you know, on Instagram, they have the glucose monitors and you have It's all about knowing your body.

Dr. Grant Garcia: And we've, we've talked about this extensively on the show. And our last episode, you look back on, you know, what athletes do to get the edge or get better and the tech they're using, you know, we have smartwatches tells us when to sleep, tells us our blood pressure, tells us. EKG tells us heart rate then you have, you know, this thing tells you whether you're hydrated or not.

Dr. Grant Garcia: If you're telling your glucose levels, we just want to know everything about our bodies so we can be more in tune. You know, am I feeling crummy because I'm tired? Am I feeling crummy because my [00:19:00] blood sugar is low? Am I feeling crummy because I'm dehydrated? Is my, is my urinal hydration system showing green, yellow, or red?

Dr. Grant Garcia: You know, I think. It's important for us to understand that all this tech is important, and it's just another way for them to be aware of it, right? You know, these guys, they're super athletes. A lot of times they're not even thinking about their athleticism. They're not thinking about hydrating the body. I mean, you've seen all the movies and shows where they go out to dinner, and I've seen them back and...

Dr. Grant Garcia: You know, working in the locker rooms with these professional athletes, they have huge meals. They're not talking about very healthy food they're eating, you know, they're not really watching some of the things they're doing because they're just these super athletes constantly exercising, working out all the time.

Dr. Grant Garcia: But there are certain ones that take their, their health really seriously. And I think this is a, this is an important point that they're saying, you listen, I mean, Jacksonville is not cold right now, you know, so it's important to figure out a way to stay hydrated. It is super hot in Florida. Players.

Dr. Grant Garcia: Yeah. We've seen full players that have gotten really injured over the last bit. So while I can laugh all I want on your, at [00:20:00] your urinal center post you sent to me or you text you sent to me it is important and especially for Jacksonville. You know, I don't know if the Seattle Seahawks right now are worried about hydration, when it's like 64 degrees outside.

Dr. Grant Garcia: But in Jacksonville, I could see the reason

Will Sanchez: for it. Listen, if they they, they're one of these teams that there's a lot of expectations. They expect them to get to the playoffs and, you know, possibly win the South. And, and go kind of far away, you know, far into the playoffs. So, they want to make sure that if they have any playoff games in Jacksonville.

Will Sanchez: That everyone's nice and hydrated, so these urinal sensors, you know, they might get a Super Bowl trophy at the end. They'll put like a little star next to the urinal, so who knows where this is all gonna go. So, I think we've gone awry, but listen, we hope that you're getting some information on it because the reality is...

Will Sanchez: If you listen to our shows, Dr. Garcia is always talking about tech, right? This is, you know, he loves it. You know, lovingly I say, he's a nerd about it, right? [00:21:00] And it's great for us, the patients, because he's always staying on top of technology and innovation. And this is... Even though it's, it's a little bit of a funny topic, but it just shows that the biotech is such an important part of everything that we do, whether you're a doctor or you're a patient or you're an athlete.

Will Sanchez: So having these biotechs be a part of our lives. is so important, and to see where it may go, and I'm kind of teasing a future show as we talk about future tech, as we see where we're eventually going to go, it should be really exciting to everyone.

Dr. Grant Garcia: I couldn't agree more. I don't want to change your topic, but I definitely think you guys are going to see in the up and coming months, we've got a lot of good shows planned for you, and I think one of them will be, sort of, what are the new cutting innovations, you know.

Dr. Grant Garcia: Last year's old news. Yeah. Let's figure about the new year. What are we, what are we doing? How did we do last year? How did, how was our, how was this stuff I talked to you about from the [00:22:00] new innovative procedures or how is it new at the N F L? You know, there's been rule changes even in the N F L or things that have changed.

Dr. Grant Garcia: N F L, like how did that affect him? You know, we talked about recently on major League Baseball. Yeah. With the change in the pitch timing. You know, we don't know anything yet about how it's gonna cause injury, but I know we talked on the episode a few years ago with our old podcast. That's been molded now into this new one the game of numbers.

Dr. Grant Garcia: And I think you remember, I remember it was a while ago that we brought it up and how does the expansion of the NFL game time increase injury rates? And we said, there's, there's no way it doesn't hurt, it increased injuries. But yeah. You know, I sent you that recent paper. I don't know if you want to tell everyone about kind of what you thought.

Dr. Grant Garcia: I don't mean to segue, but it's actually super interesting topic. But I know that was a huge, that was a huge discussion in the NFL, whether we should add it, you know, we know why the NFL players, the NFL owners want to do it. There's a lot of money involved in any other game in the NFL. Right. But for the players, are they going to get injured?

Dr. Grant Garcia: Because we don't want that.

Will Sanchez: Yeah. No, it's a perfect segue [00:23:00] because that's where I was leading because the Jacksonville Jaguars are, are going to play in London twice this year. And for your Seattle Seahawks fans, by the way, you guys lead the league in total mileage for this upcoming season. And I believe you led the league last year, this upcoming season, they will travel almost 32, 000 miles over 36.

Will Sanchez: Time zones. In one NFL season, by far and away the most, San Francisco 49ers are next on that. So this segues right into this this paper that you're talking about is the Association of Injury Rates Among Players in the NFL with Playoff qualification, travel distance, the timing of the game, and the addition of another game.

Will Sanchez: So, Dr. Garcia, talk a little bit more about the findings that they had, this investigation that was performed at Northwestern University.

Dr. Grant Garcia: So, it's really interesting. So, basically, they, and [00:24:00] again, a lot of these Articles that use like NFL player data or a lot of there's a lot of Major League Baseball because there's a lot of good player data out there.

Dr. Grant Garcia: Yeah. That I've done actually my own papers on using the Major League Baseball database. So this one's really interesting. So basically it looked at five NFL seasons 2017 to 2018 and then through 2021, 2022. Yeah. And when they expanded to the from the 16 game to 17 game schedule, they looked at whether or not, There were more injuries during that time, and then they also looked at they looked at whether or not they're more likely to make the playoffs and all those other things, injury rates for based off distance and what's really interesting.

Dr. Grant Garcia: And again, this is one paper, but they're looking at a lot of accumulative data. And again, you. You can only look at so many injuries, right? You're looking at basically news, like if someone tweaks their toe and it's not listed as an injury report, you're not going to ever see that in the NFL data. So it's just something for people to understand.

Dr. Grant Garcia: What's interesting is they found no difference in the injury rate or the number of injuries by adding another game, [00:25:00] which I find kind of fascinating. And it's kind of hard to wrap my My brain around that. But it's interesting that people saying for these kind of argument for the players associate or not fair session, the owners that this new increase did not increase rates.

Dr. Grant Garcia: It gave the players potentially more options to work for something or get to the playoffs and also to showcase their talents. And hopefully there was some bump in, in income as a result of it for the players. But you know, it sounds like this was a good, this was still a good thing. It's we, everyone loves more NFL.

Dr. Grant Garcia: If I have to, you know, I'd love to see the Giants play an extra regular season game. So I'm not complaining about it. But it's important to see that. But what's interesting, this is actually super, this makes the most sense is that the play, the teams that are the least likely to qualify at the playoffs had the highest injury rate and the highest amount of players on injured reserve.

Dr. Grant Garcia: Which makes perfect sense, right? Like we didn't know when your team starts getting decimated with injuries. Your team's success drops significantly, but this actually makes this is actually documented now and this paper is helpful for that So, I don't know if you have anything else to take away from [00:26:00] that, but I thought that was really interesting I know our listeners were gonna love that because they don't have access to these papers and I'm sending you Yeah, so it's nice that we're able to get that information out to the public No

Will Sanchez: I think it was a great paper and just kind of reiterate, you know The purpose of the paper was to determine whether they're higher Cumulative travel distances or, you know, overseas played, like when I mentioned Jacksonville going up, played at London twice.

Will Sanchez: In fact, I think they're gonna stay there both weeks. I think they're gonna do back to back you know, early season, bye week. Right. And for me, as a fan, that always stood out. It's like, oh man, the, the, the bye week. This week is week four. And then they have, you know 13 more games to play without a bi-week.

Will Sanchez: So as a fan, you're concerned for your team like they getting in that bi-week early. They added an extra game. I've always thought that they should add a second bye week, but you know, this paper is now saying that it's not, you know, it's not making much of a difference, right? Because the conclusion over the five NFL seasons, with the distance, the play, the bye week timing, the added, like, was not associated with [00:27:00] increased injury rates in NFL players.

Will Sanchez: So, it'll be interesting to see, I would love to see this paper five years from now, right, and to see if that stays consistent, because there will be so many other variables, once again, like, kind of, we mentioned, right, the size, the speed, the biotech, right, you know, from 2017.

Dr. Grant Garcia: Well, and more international games.

Dr. Grant Garcia: More and more

Will Sanchez: international games, but it's, it's, it's going to happen, right? And how do they handle that? How do they talk to the doctors? Maybe, maybe that's a conversation that you can you know, help with, you know, when they talk about travel and especially as, you know, we decide to play more games overseas.

Will Sanchez: Do they talk to, do they consult with the doctors, or do they just consult with, you know, the, the banks, you know, bank stub here saying, hey, we just made extra money, when it comes to, hey, this is the best way to take care of our athletes, you know, if we're gonna go overseas, this is the way we should do [00:28:00] it, I, I know people like Richard C. Oh my God, what's this guy, anyway, the player from Thursday Night Football complained about Thursday Night Football saying, you know, about the injuries, you know, going up on Thursday Night Football, shorter weeks, you know, what, what is all of that data? So I think there's still some added data that needs to be inputted into you know, some of these papers.

Dr. Grant Garcia: And again, you know, we don't usually drop papers on our show, but these were two super interesting topics that I thought people would like to say, and this one especially when I sent it to you. And, you know, I immediately thought of making sure that the audience heard this. And again, remember, most people listening to the show, You know, not like Will Sanchez that has an MD from his podcast but the but understanding the epidemiology and understand how these papers are done.

Dr. Grant Garcia: You got to take it as a grain of salt, right? Like this is important. This information is interesting. It's a topic. And if anything, it's great for your, it's great. It's great for parties, party conversation. You know, I mean, people talk about the NFL all the time and be like, Hey, that's your game. Do that cause more injuries? [00:29:00]

Dr. Grant Garcia: Well, no, I heard about this, this situation where it didn't but what's, I think more important about it is it just gives some more food for thought and saying, okay, maybe our, maybe our indications or maybe our concerns about this were not perfect or not correct and, and, or how can we make this topic better or more intro, how can we look more into this and find ways to really think about this better because it doesn't really make sense, right?

Dr. Grant Garcia: Shouldn't there be more injuries? So maybe there's something we're missing. Okay. Yeah, I

Will Sanchez: agree. And if that 100%, which you should always do, right? And by the way, that was Richard Sherman that was drawn a blank on, I was like, I can see his face, and I can't say his name, and I was thinking about it, I was like, oh, it's Richard Sherman.

Will Sanchez: Because obviously he's talked about it, and it's funny, he complained about Thursday Night Football, but now he works for Thursday Night Football. But I digress, let's kind of move on. Let's talk about some key injuries for some players, let's make some predictions sure to go wrong. As we get ready to wrap up our 2023 NFL kickoff season if you're a Cincinnati Bengals fan, you know, one of the most exciting quarterbacks in the league, you know, [00:30:00] arguably the tops, you know, top two, top three quarterbacks, you know, in NFL, Joe Burrow has his calf injury.

Will Sanchez: Obviously the show is before week one. Commences this weekend what are your concerns for an injury, that calf injury for Joe Burrow? Do you have any concerns? Has there been enough time or are there any concerns starting week one and hopefully playing the entire season? So that's 18 weeks of football after this injury.

Dr. Grant Garcia: I think you've heard this before, but this is one of my least favorite injuries to deal with. You know, these are so nagging. I think Aaron Rodgers had this a while ago. There's been a couple other players with this. But these calf injuries, they come with two muscles, the soleus and the gastrocs muscles.

Dr. Grant Garcia: And when you get these tears, usually it's a tear of the muscle, not an Achilles tear. That's a different animal. And I know you you know, we've heard of players that had the calf injuries and then got Achilles injuries. I don't think that's what he's going to turn into. But they can nag. And then you come back and I've had plenty of, [00:31:00] you know, athletes, non athletes come back with these and you know, they're better for six weeks and all of a sudden they re injured again.

Dr. Grant Garcia: Now you can sure as heck know he's done everything possible to get ready for week one and he's, you know, he's doing PRP, he's doing other stem cell options, he's probably doing anything else and things I haven't even heard about yet to get him back because he's very important for the team. But watch out, you know, I do worry, is he going to get it re injured?

Dr. Grant Garcia: And so, you know, that's just, it's just a stressful injury to deal with because it's just so you really can't fix it, right? You just got to let it time be and you got to give it treatment. And so that's hard, especially when you're a big surgeon and you're trying to get an athlete back faster.

Will Sanchez: Is there any benefit for them saying, you know what, the first two weeks, three weeks, four weeks of the NFL season, we're just going to rest you, or is this just too hard to answer because you really don't know the severity of that calf injury for Joe Burrow?

Dr. Grant Garcia: You know what, say that to, say that to the Mahomes and the Kansas City Chiefs. Now again, it was a Super Bowl. Yeah. But you know, this is the NFL, you know, you had, you had all this time to, [00:32:00] to rest up And you lose two or three games at the beginning and you're iced, you know, it's really hard to come back.

Dr. Grant Garcia: We've seen the statistics. If you're 0 3, your playoff chances drop significantly. Especially

Will Sanchez: in the AFC this year. Correct, yes. Yeah, yeah, absolutely right. And then hopefully hopefully Joe Burrow will stay healthy. Hopefully you know, maybe he's not taking off running, you know, as he's done before and kind of says, hey, you know, I can only push it, which I doubt because when you get out there, you're such a competitor, you're still going to do it.

Will Sanchez: And then the last thing that we want to see... is kind of, and you kind of alluded to it, was kind of like the Kevin Durant injury where he had a calf injury and then obviously in the playoffs you know, we saw that pop and that was the Achilles. Well, on that happy note, we'll move on because there's just no way to do it and as a football fan you just kind of want to see everybody out there.

Will Sanchez: He's one of those more, you know, exciting players that you love to see play week in and week out. So hopefully... That calf injury has healed up nicely. [00:33:00] Staying in the leg, Cooper Cupp, wide receiver for the Rams, has had a nagging hamstring injury. Apparently he flew to Minnesota to talk to a specialist.

Will Sanchez: Who knows? Do you know that specialist in Minnesota? What are the concerns when you have a wide receiver, like Cooper Cupp, that's had some injuries in the past? And at a speed position, when you're having a hamstring injury, what are the, I guess, the varieties of injuries that are most concerning, or least concerning to most concerning?

Will Sanchez: Well,

Dr. Grant Garcia: you touched on my two least favorite injuries now. I'm on number two. So these hamstring muscle injuries are a pain in the butt. I mean, you've seen them. I think when Oda Beckham Jr. first started with the Giants, he had this injury, and it was just waiting for him to give his debut. And these are, again, The calf injury is a muscle injury.

Dr. Grant Garcia: This is a muscle injury usually. And what it is, is you get a little muscle tear. You want it to heal as quickly as possible, it doesn't heal as fast as you want, then you re injure it. So, he's probably going to a specialist, [00:34:00] I don't know who he's going to over there in Minnesota. But nonetheless, probably going to one of the Vikings team physicians up there, those guys are really good.

Dr. Grant Garcia: But regardless, the, you know, he's probably considering treatment options, maybe even considering surgery. But probably not, you know, I would imagine you wouldn't want to do it, but he's also probably getting different opinions to see whether fixing this is going to get him back if they don't think he can get back on his own.

Dr. Grant Garcia: So I'm sure he's talking to a bunch of people. When you're flying out to see a specialist there is definitely a thought of surgery on the plate, in my

Will Sanchez: opinion. So that's the red flag. When you see, hey, he flew out to see a specialist, that's one of the things that cross your mind saying, okay, this is maybe a little bit more severe there than, you know, just a slight pull and there might be surgery, you know, that's on the board because of the severity of this injury.

Dr. Grant Garcia: And also, I mean, again, the NFL players. Are different, you know, usually a normal person wouldn't go fly out if it was a non operative treatment. Like, if they're like, oh, I want to, I just, I might tell you this can be treated with three weeks or four weeks of rest. Yeah. Most people aren't going to fly and see another person. [00:35:00]

Dr. Grant Garcia: to double check on that outcome, right? If I tell you, you need a massive big surgery, or you need a surgery that's going to cut away half your season or your entire season, you might be like, whoa, I want to get another check. You see that all the time. So, you know, to me, that's a red flag for how bad this is.

Dr. Grant Garcia: But again, I'm not in the, I'm not in the clubhouse. I don't know what's going on so I can't actually see the injury itself, but I get a little bit worried when I hear that.

Will Sanchez: Yeah, by the way, he's already been ruled out for week one. They, you know, they had it on the table. There you go. He may or may not play, but he's, he's been ruled out already.

Will Sanchez: So we'll see how that kind of goes. And then You know, we talk about these, and this is kind of why I'm using these guys right here which I think would have been the offensive rookie of the year Brees Hall tore his ACL meniscus in week seven. One of our favorites Sterling Shepard had a very, You know, bad injury himself when we hear about a c l and meniscus and the type of injuries that [00:36:00] both these players have had and the fact that they are ready to go week one of 2023 season, first off, the type of injury and also the recovery in the work that has to go into it and for, in order for you to get ready to, to be able to play at this high level for week one.

Dr. Grant Garcia: So first off, I think the hard part of this is that. It's not that it's impressive that they're getting back, but it's what it shows. And you know, as a, as a surgeon, and I do a lot of ACL injuries, you know, players, my, my patients, athletes, et cetera, that aren't professional athletes come in and they see this and they say, Hey, why can't I get back in seven months?

Dr. Grant Garcia: Why can't I get back in eight months? You know, every, these players are doing it. I should be able to do it too. Well, the average return to playing is between nine to 10 months and maybe even longer than that. If you look at the data. That's in general in all commerce. Now, again, these aren't professional athletes.

Dr. Grant Garcia: But I think you get this sort of warped perception of what normal return is. We always talk about the Adrian Peterson ACL, where he came back [00:37:00] stronger, had an amazing year, ran for over 2, 000 yards, if I remember correctly. Yeah, he's not human. Everyone talks about that. He's not human. No, he's not human. I totally get it.

Dr. Grant Garcia: We've talked about that before as well, but nonetheless, you know, it's a lot of work. They're doing, like I said before, they're using tons of biotech. They're using rehab tricks that we haven't even heard of. They're flying around to get treatments. They're working six days a week, things that we can't do with normal jobs.

Dr. Grant Garcia: I mean, their job is to get better and play football. And so they have to do that all the time. They're putting in five hours. I mean, you hear their, you hear their workout regimens, like five hours of exercise a day. I mean, well, we wouldn't be sleeping if we had five hours, five hours of exercise a day with our jobs.

Dr. Grant Garcia: So, you know, at this point they can get, they can do things we can't do in our normal life. So that's why they're able to get back a lot of times. And they're also, they're still fairly young. I mean, these players are still young. They consider them old at 31 years old. You know, so it's, it's, they have young bodies and they're adapted to this.

Dr. Grant Garcia: And also. These players play through different things. I mean, we have patients that recover [00:38:00] from ACLs. They say their knee feels some stiffness at six months, or they have a little bit of discomfort. You know, these guys are feeling the same thing, but they don't. They don't really care, right? These are players.

Dr. Grant Garcia: They're used to getting hit, they're used to getting damaged, they're used to getting beaten up. You know, they play with pain. We could talk about that topic as a whole other section. But, you know, I could tell you if you asked 90% of the NFL players on the field if they have any pain, most of them would say yes.

Dr. Grant Garcia: Yeah.

Will Sanchez: Yeah, you know, it's funny, you know, now, now that we know some some more information and some of the technology, and we think about Adrian Peterson and how fast he came back from his injury, and he didn't even use an internal brace. I mean, come on now. I mean, that's, that's absolutely ridiculous. By the way, check out our show on Internal Brace.

Will Sanchez: It's a great show. I think, I think we mentioned it every show because it's my favorite. I'm going to perform it. I'm not sure. I'm going to walk in. I got to steal some credentials and I'm going to work on, or maybe I shouldn't shout myself out like that. We'll just move on. Let's wrap up the show. Let's wrap up this show here and let's let's get some predictions sure to go [00:39:00] wrong.

Will Sanchez: Who, who are you liking to come out of the AFC to be the representative in the Super Bowl for this 2023 into the 24 season?

Dr. Grant Garcia: I'm thinking, I don't know. It's hard to, it's hard to decide. I think the Chiefs, man, I'm still

Will Sanchez: thinking. You think the Chiefs are still the team to beat?

Dr. Grant Garcia: They're just, they're, they just always surprise me.

Dr. Grant Garcia: And they still got Patrick Mahomes. Yeah. And that's the big thing. So I, I'm, I think that there, I think there's still, there's still the team to beat.

Will Sanchez: I like it. I'm gonna go with a wild card just to be different. I was thinking Jacksonville. I'm gonna go with the Ravens. Lamar Jackson, if he could stay healthy.

Will Sanchez: You know, they have a new offensive coordinator. It's something different. And if that happens, that means that, you know, Joe Burrow didn't get through the season unscathed because that's the same division of the Bengals. So, you know, I hope I'm not putting the [00:40:00] kibosh on Joe Burrow. All right, the NFC, who do you like to be the representative in the NFC?

Will Sanchez: There's you know, there's some interesting teams there. I don't

Dr. Grant Garcia: know. I mean, I think the Eagles are still so strong. But I mean, it's not a very strong. Division right now with a lot of the teams. I don't think the giants are going to be close. No, I think giants can be close behind. I mean, if they don't get injured, if Darren Waller stays healthy, the giants have a close back.

Will Sanchez: Yeah, it'll be interesting. I think the Eagles are just head and shoulders above everyone else. But to be different I'm sorry Seahawks fans. I, I will, I'm going to go with the 49ers to represent. I think the 49ers could get the Eagles with a healthy quarterback. They just gave Nick Bosa about a billion dollars.

Will Sanchez: With his new five year contract I'm pretty sure they're gonna be like, hey, you know, remember last year when you whooped on us [00:41:00] and we had no quarterback playing? Revenge is sweet. So I would love that. That would be ideal. I would love to see that matchup to send one of those teams into the Super Bowl.

Will Sanchez: So that would be fantastic. So, ladies and gentlemen, these are our predictions, surely to go wrong. Let's wrap it up as we always do. I like to bust your chops. So we're going to have a little trivia. We're going to send it right down your lane as a Giants fan. By the way, the Giants were they've been around since 1925.

Will Sanchez: So in two seasons, it would be a hundred years. They're one of the first of one of five teams when they first started the NFL. And I don't even think it was called the NFL at the time, but then when they started the football league. So Saquon Barkley is fifth on the rushing list with 4, 249 yards. If he stays healthy and gets another thousand yards, he's gonna pass Joe Morris and be in that third spot.

Will Sanchez: Can you name the running [00:42:00] back that has the franchise's rushing record?

Will Sanchez: Is it Tiki Barber? Tiki Barber has 10, 449 yards and maybe one day will be in the Hall of Fame. That is the correct answer. Tiki Barber. I never get those. This is awesome. Number 21 in your program, ladies and gentlemen. This has been great. It's a great show. This is always a lot of fun. It's always good to talk some sports and talk a little tech and talk urinal sensors.

Will Sanchez: So, that really made my day. So, just want to remind everybody, check us out, sportsdoctalk. com. We're talking sports, we're talking orthopedics, and we're talking all the time, obviously, because I'm still rambling on. I'm Will Sanchez, Dr. Grant Garcia. Dr. Garcia, thank you so much for your time. Any last thoughts as we wrap up the show?

Dr. Grant Garcia: Well, first off, thanks again for this show is always fun and I'm [00:43:00] glad that we talked about all those various topics and I think the listeners will enjoy it. And we want to mix it up a little bit. We've had a lot of guests on recently and we're gonna have some guests in the future. I think we're going to start hitting on maybe some of these non surgical options like rehab.

Dr. Grant Garcia: We have some great rehab facilities that we work with and I'm sure you'll love to hear about their cutting edge technology they're using. And then we're going to have a great episode coming up, which I'm really excited about. And so stay tuned for it in the next few months. It's going to be sort of.

Dr. Grant Garcia: Things we predicted in terms of new surgery that we were doing, and how we're being, how we're pushing the envelope even more, and how our previous sort of new tech that's now old tech is doing. And so it'll be really interesting to talk about some things and If Will's lucky, I'll even add some more internal brace stuff for

Will Sanchez: him.

Will Sanchez: Oh, baby. Woo! Sweet music to my ears. Don't tease me like that. I'm getting excited. It's just kickoff time. Dr. Garcia, thank you so much for your time. You have a great evening. I'd like to thank everyone out there, the listeners. We love you guys. Please check out our website. Feel free to email us. We'd love to hear some of the [00:44:00] topics that you want to get some more information or just hear us ramble them on.

Will Sanchez: So, but listen, we cannot do a whole show on urinals, so please stay away from that. Once again, thank you very much. Thank you, Dr. Garcia.

Dr. Grant Garcia: Have a good night, guys. Thank you all.Audio Transcript

Will Sanchez: He's recognized as Seattle's Top Doctors and one of the our own Seattle's top doctors. Dr. Grant Garcia is with us. Dr. Garcia. Welcome. How excited are you about our guest today?

Dr. Grant Garcia: I'm very excited. I was excited to invite him. You know, Dr. Uh, Weill is a fantastic hand surgeon, does lots of sports, uh, hand surgeries, and it's as one of my partners, I get to see him do them every day and be impressed by the technology that he is using.

Dr. Grant Garcia: Uh, you know, he takes, helps me with Mercer Island, uh, teams that we take care of and does all the hand stuff for us. Uh, you know, he's a [00:01:00] fantastic, uh, partner and friend. Uh, in addition, you know, you may have seen our segments recently on the dual surgeon approach, and we just posted another one, episode five of 10.

Dr. Grant Garcia: Uh, and so for these really complex elbow cases I tell you about, he's really the my go-to and it's been really helpful for that. So I'm really excited to have him on the show. Hopefully we can pick his brain and, uh, hear more about sort of the cutting edge tools. And really it's nice to have one of the top, uh, hand and, uh, elbow surgeons in the, uh, Washington state with me.

Dr. Grant Garcia: So it's really excellent. So thank you Dr. Wel for being on here.

Dr. Wayne Weil: Uh, pleasure to be here with you guys today. Really excited. So I

Dr. Grant Garcia: think, you know, we can go in all, we can go so many different topics today, but the one we always hear about, and I know you, we see it pretty much always in the news or ESPN, is the sort of gamekeeper skier thumb.

Dr. Grant Garcia: Will you tell us a little bit about this, sort of, the treatments you're doing for it and maybe some athletes you can think of, you know, off the top of your head that, uh, have been treated

Dr. Wayne Weil: with this? Yeah, uh, I think that's a great place to start. Uh, Gamekeeper's [00:02:00] thumb or skier's thumb, it's a super common injury, uh, at the, um, thumb metacarpal phlange joint, which is kind of that big knuckle on your thumb.

Dr. Wayne Weil: And, uh, basically, uh, you can think of that, uh, ligament as the a c l. You know, you have all heard about the a c l on the knee. Uh, this is the. Uh, basically the ACL of the thumb and, and, uh, so it's a common injury in ball sports, uh, or in any sport, uh, where the, uh, hand is outstretched a and people are falling.

Dr. Wayne Weil: So, mountain biking, skiing, skateboarding, um, and again, uh, ball sports, uh, especially basketball. And, uh, then, uh, baseball as well. So, And basically what happens is, um, let's say in baseball, um, couple of, uh, this is probably now [00:03:00] five or six years ago, Bryce Harper sliding into third base, uh, and, uh, his thumb got caught on the base and, uh, wrenched his thumb back and, and tore the ulnar collateral ligament.

Dr. Wayne Weil: Uh, Basically what happens with that is you lose the stability in the thumb for power, pitch and grip. And obviously, uh, somebody who's, uh, holding a baseball bat, uh, uh, needs that power pitch and grip. Or, uh, somebody who's, uh, riding a mountain bike or holding a ski pole. Or even our, our weekend warriors who are, uh, just, uh, you know, trying to hold a golf club or, or, or somebody in the kitchen trying to open up the pickle jar if, uh, if you've torn your ulnar collateral ligament.

Dr. Wayne Weil: Really affects your, your power pinch and your grip. Uh, and so in athletes, uh, this, uh, typically, uh, was a, uh, fairly [00:04:00] debilitating injury in that, uh, it would, uh, oftentimes be a season ending injury. Uh, Um, because after, uh, a repair of the owner collateral ligament, typically I, uh, we'd need to put you in a cast for six to eight weeks.

Dr. Wayne Weil: Then there'd be a long rehab time afterwards. And so the full recovery was roughly six months, which was, was basically a season ending injury. And over the last, uh, really about the last five, six years. Uh, hand certains, uh, we've borrowed a bit from the foot and ankle docs and, and from the knee docs. And, and I've started, uh, using a technique called an internal brace.

Dr. Wayne Weil: Uh, and with that internal brace, we can, uh, augment our ligament repairs and then, uh, instead of a six month recovery, We can get folks, [00:05:00] uh, especially pro athletes, uh, back to sport in about six weeks. Wow. Uh, and it's, it's been really gratifying to, to treat our athletes, uh, and even our weekend warriors, uh, with this technique cuz we can get people back to doing the things they love doing in, in, in such a, a faster fashion.

Dr. Grant Garcia: That's awesome. Well, thank you for that update. I know that Will is very excited. This is probably the internal brace is probably his favorite topic ever. So we've gone through the round of internal braces all over the body and now you know we have another reason for Will to get excited. You can do internal braces.

Dr. Grant Garcia: The thumb. Oh, I love it. On the ucl. I, I love it.

Will Sanchez: Yeah, I think it's absolutely incredible the, the internal brace and, and hearing about the recovery from, athletes and just everyone in general. Just, uh, just a quick follow up. You mentioned golf. Um, you know, we think about the, the golf grip. How many injuries do you see from golfers?

Will Sanchez: You know, I, I'm not a great golfer, so [00:06:00] sometimes I take a swing and I'm slamming right into the grass, and all of a sudden I'm, I'm feeling that reverberation kind of shooting through my hand and my wrist. So what kind of injuries are you seeing when it comes to, golfers? Because believe it or not, one is seven Americans play golf, in 2022.

Will Sanchez: And a follow up to that is, Is there a grip that may prevent less injuries? , open or closed grip?

Dr. Wayne Weil: Yeah, that's a great question. Uh, you know, in terms of the actual grip itself, uh, not really aware of any one, uh, being better than the other. I think really it's all about, you know, uh, the mechanics of the ball striking and really I think a lot of the injuries are, are coming from.

Dr. Wayne Weil: Essentially what, what you described earlier is, is, is sort of those swings that, uh, uh, don't end up being as sweet as, uh, we'd like 'em to be. And, uh, you know, you take a shot really fat and you [00:07:00] hit the ground really hard and that can cause a, a number of different, uh, injuries. Um, you know, number one, uh, wrist injuries, uh, there's a area of the wrist.

Dr. Wayne Weil: Kinda, uh, but on the pinky side of the wrist, uh, called the t f ccc, it's one of the ligaments of the wrist that helps stabilize the, what we call the ulnar side of the wrist. Mm-hmm. Or the pinky side. And, and that acts, uh, kind of like a meniscus in a knee. It's a bit of a shock absorber. And, and that can be, uh, torn, uh, with a pretty violent, uh, impact into the ground.

Dr. Wayne Weil: Uh, other things that, uh, can happen is, uh, you can, uh, have, uh, it's a rare fracture, but it's a, uh, somewhat common fracture in golfers and actually baseball players as well. It's called a handmaid fracture, a hook of the handmaid. Um, and then, uh, other [00:08:00] injuries. Uh, Or, uh, can be a lot more of a chronic nature.

Dr. Wayne Weil: People can develop a golfer elbow, which is, uh, similar to tennis elbow, but golfer's elbow happens on the inside of your elbow as opposed to the outside of your elbow. I think will

Dr. Grant Garcia: you, you got a perfect segue for your Mike Trout

Dr. Wayne Weil: question. Well, I, Will Sanchez: yeah, I didn't want to jump in here, but I mean, you, you mentioned the Hammed bone and um Yeah.

Will Sanchez: You know, for all you baseball fans out there, uh, the loss of superstar Mike Trout, he suffered that fractured, um, and. I mean, correct me if I'm wrong, first off, if you could describe the Hammed bone injury. Uh, they're saying that he's gonna be out four to eight weeks. He has a cast from his hand up to his elbow.

Will Sanchez: So that seems like a pretty serious injury. But is that injury common or uncommon? And then following up, what does that mean? The fact that his hand all the way up to his elbow is ha is donning the cast.

Dr. Wayne Weil: Yeah. [00:09:00] So, you know, it is one of those injuries that, that, that I like to call uncommon, but common for me, uh, as a hands, um, and in, in the general population, fairly rare, um, in, in my practice, you know, seeing a lot of baseball players, a lot of golfers, Um, I see it fairly often.

Dr. Wayne Weil: It's often, uh, misdiagnosed and, and, and missed in general. But, uh, essentially the hammock bone, if, if you're looking at your hand a and you push on the, uh, pinky side of the heel of your hand, you can feel a little tiny protuberances in there. Mm-hmm. And, and. That is what we call the hook and the handmaid.

Dr. Wayne Weil: And, and the hook and the handmaid is important in that it acts as almost like a pulley or a lever so that [00:10:00] your, uh, flexor tendons to the ring and the small fingers, which are, will give you your, your power grip strength. They, they key right off of the hook of the handmaid and so. If you have a fracture, uh, off of the hook of the handmade, those jagged edges of bone can, um, cause the tendons to tear as the tendons ride o back and forth over that, uh, fractured area.

Dr. Wayne Weil: And the other big problem with the hook of the hand. It has a pretty poor blood supply, so it's a tricky, uh, bone to, to, to get, to heal. And so the reason Mike Trout is now in a giant cast for this tiny little bone, which is less smaller than the size of a peanut, it that the, the goal is to just completely immobilize everything in the.

Dr. Wayne Weil: Uh, hand [00:11:00] and the way to do that is with this giant cast that goes above his elbow. Cause you need the cast to go above the elbow to prevent rotation of the wrist. So, um, moving your palm from the palm up to the palm down position. As well as just the, the flexion and extension of the wrist. Um, and there, you know, they're, the doctors treating him are, are really trying to keep him outta the operating room cuz the next step if the bone doesn't heal, is an operation.

Dr. Wayne Weil: Hmm. Alright. So,

Dr. Grant Garcia: Talking about more of the sort of hand bones, et cetera, but also kind of moving on different topic. I've seen some sort of crazy stuff you're doing now with, uh, you know, as we, as we know, as we get older or people do a lot of pinch grip, you get a lot of, you get some arthritis in sort of the base of your thumb.

Dr. Grant Garcia: We call it cmc. Yeah. And you're doing some things now. You know, we used to see, remove it, put extensor [00:12:00] tendons. In there. And I think you probably still do that, but there's some other ways you're trying to, you basically are doing the similar stuff that I'm doing in the knee, sort of cartilage restoration, uh, and other options for people that are younger.

Dr. Grant Garcia: Cuz those procedures aren't really as good if the other older procedures aren't really as good for young patients. So what are you doing that sort of more innovative in that area? And are you doing arthroscopy? Are you any other implants you're using?

Dr. Wayne Weil: Tell us about that. Yeah, that's a great question. You.

Dr. Wayne Weil: Uh, it is a, it is a big interest of mine in, in terms of, um, solving this problem of a base of the thumb joint arthritis. And, and traditionally the, the operation of, of choice, uh, was to remove the arthritic bone called the trapezium, and then, Uh, put in a spacer, uh, typically a portion of, uh, one of the forearm flexor tendons or, or one of the thumb extensor, uh, tendons.

Dr. Wayne Weil: Um, and, and this operation works [00:13:00] really well if you're 70 years old. Um, but in somebody who's maybe in their mid forties or fifties who has kind of early onset of this problem, Um, it's been a big, uh, uh, problem for us to solve in terms of, well, what do we do for these folks? And like I mentioned with kind of with the internal brace that we sort of stole the, the idea from the foot and ankle docs, um, for basally thumb arthritis, we're, we're, we're sort of borrowing from our, our, our knee colleagues in terms of, um, Uh, techniques like arthroscopy.

Dr. Wayne Weil: Uh, so now we can do, uh, now that the cameras and the, the instruments from the knees have been miniaturized, uh, we can now, uh, work in the smaller joints and the wrist and the hand, and, and so arthroscopic surgery, the base of the thumb is something that I enjoy doing and [00:14:00] oftentimes in, in young folks.

Dr. Wayne Weil: This is my, my first, uh, step in terms of treating this issue. Uh, we can, uh, debride, um, different cartilage lesions, um, and we can, uh, debride any inflammatory tissue that's in the joint and hopefully by, uh, folks, uh, uh, uh, significant amount of time before having to do any major operations. Um, and then kind of next up the line, uh, from our surgery is, is, um, surgery to try and.

Dr. Wayne Weil: Um, basically put a, a spacer in between the two, uh, bones, the trapezium and the thumb metacarpal. Uh, and by doing that, oftentimes, um, we can preserve the, the normal anatomy. Um, you know, there's a reason why that trapezium and, and that thumb metacarpal are there to [00:15:00] begin with. And, and so, uh, trying to keep them there for as long as possible just makes intuitive sense to me.

Dr. Wayne Weil: And so, um, we have different implants that we're now using, uh, that work as spacers. Uh, and then, um, Once we go beyond that, uh, there, there's also a lot of interest in, uh, um, a technique that we're using called the tightrope technique. Uh, where, um, instead of having to sacrifice, uh, some of the tendons of the forearm to recreate some ligaments that are required for thumb stability, uh, we'll use a, a tightrope uh, implant.

Dr. Wayne Weil: Uh, and again, that that's something that's been miniaturized and, and kind of stolen from our, our foot and ankle colleagues. So there's a lot of new, um, uh, surgical procedures that, that we're performing now that, uh, I think really [00:16:00] will, will, um, be incredibly beneficial to, to my younger patients, um, where we don't see that the traditional.

Dr. Wayne Weil: Surgery that we do for a 70 year old is, is gonna hold up in a, in an active 40 or 50 year old. I

Dr. Grant Garcia: think that's a great comment. I think it's important for listeners to hear this cuz I think, as Dr. Wild knows, I do a lot of knee stuff and I get a lot of patients even in their fifties that come in and they were only told the only options are replacement.

Dr. Grant Garcia: Right? Or the only option is this sort of extensor tendon, salami technique that's really for 70 year olds, right? And so it's important for the patients to know that there's other options out there and these are innovative. They're still cutting edge. They're, you know, we don't have 20 years of data on them, but they work really well.

Dr. Grant Garcia: You know, things I do did a couple surgeries today that they're only about a couple years old, but nonetheless, they work very well. And so it's important to understand that those techniques are offered and the second opinion's very important. [00:17:00] So if you've seen somebody and you're not exactly sure, you know, get another opinion.

Dr. Grant Garcia: Always good to get another opinion, especially when you're younger and you don't wanna have an end stage procedure. You know, once you get that trapezium removed, there's no going back. Right. Yeah. So it's

Dr. Wayne Weil: important to have those options and, and, and that's one of the things that I, I think is, is really important in our younger patients is, is trying to find solutions that fit.

Dr. Wayne Weil: Younger active patients. You know, an operation that's really good for a 70 or 80 year old is not necessarily good for a 30 year old. And, and really what we're trying to do here is, is tailor our treatment, uh, to, to the individual patient. And again, a 30 year old is not an 80 year old, and so we gotta have.

Dr. Wayne Weil: Uh, techniques that we can, uh, use for our, our young active patients. That's awesome.

Dr. Grant Garcia: Well, I [00:18:00] know we, uh, for, for a hand surgeon you see a lot of hand fractures. So are there any sort of and wrist fractures. So are there any sort of innovations that have come up for you

Dr. Wayne Weil: and, uh, there are ways

Dr. Grant Garcia: to make your patients do better?

Dr. Grant Garcia: You know, the old school way is you. Break something in the wrist or you break something in the hand, you're immobilize for a long time, you're stiff and you know, you complain for six months that you're getting over it. Uh, and I know there's newer things out there that you're doing. You know, your patients are not, I don't see hundreds of cast in the office when we're in clinic together.

Dr. Grant Garcia: So you're doing something different. So tell us what you're doing and, uh, tell the

Dr. Wayne Weil: audience a little bit more about that. Yeah. You know, that's also, uh, I think we're in a really exciting age in orthopedics in general, uh, over the last, uh, 20 years. Um, there's just been a huge wholesale change in how, how we think about things in general in orthopedics.

Dr. Wayne Weil: Um, and I'm lucky enough to have gained, uh, [00:19:00] in the early, um, Early two thousands. I finished med school in 99, and so I've been kind of witness to this whole transformation in orthopedics. Uh, you know, when I was a resident, uh, uh, a hip replacement, uh, patient stayed in the hospital for four or five days and now they go home after an hour and a half in the surgery center and, and similar in, in the world of hand surgery.

Dr. Wayne Weil: Um, with wrist fractures. Um, for, for many years, people were treated in, in awful casts, and then their wrists came out of the cast and they were crooked and looked horrible and, and worked even, even worse than they looked. Uh, and then, uh, there was an interest in external fixators, which, uh, Basically, uh, looked like an erector set that was pinned to your arm, and, uh, nobody like those either, and they, they worked maybe [00:20:00] marginally better than a cast.

Dr. Wayne Weil: Um, and then there was an interest in, in, instead of doing these erector sets to maybe, uh, putting in some plates and screws. Uh, and that was really began the evolution of, of how we treat wrist fractures and, and especially just the radius fractures in general, uh, to the point where now we've got, uh, Uh, what's called the voler plate, which is the voler side of the hand is the palm side of the hand, so voler plate, uh, and, and fixed angle devices, which basically means the, the, the screws lock into the plate and it creates, uh, really stable fixation of fractures.

Dr. Wayne Weil: Uh, and, and, Think of it kind of like an internal cast, uh, to the point where at this point after, uh, an internal fixation, uh, of a distal radius fracture. Uh, I don't use a cast anymore. There's no cast. Uh, it's just a soft bandage. After surgery, folks, [00:21:00] uh, start their physical therapy three to five days after surgery.

Dr. Wayne Weil: Uh, so they start their physical therapy before I even see them in the office, which I, I see them in the office at two weeks after surgery to take out stitches. But they've already had a week of physical therapy before they've even seen me postoperatively. Uh, which just basically. Uh, like any other surgery, I'm sure like all, all your operations, Dr.

Dr. Wayne Weil: Garcia, you know, as, as soon as patients hit physical therapy and, and they can get hit the ground running, it just speeds up their recovery so much faster. So they're, you know, back to work, they're back to sports, uh, back to regular life, you know, months and months, uh, ahead of where they would, if, if, if they weren't, uh, uh, engaged in that, that PT right away.

Dr. Wayne Weil: So, Um, the voler plate has been a huge advancement in, in the world of hand surgery, uh, and, and it's really gratifying to be a part of [00:22:00] that, uh, Um, kind of wholesale change in, in how we, uh, uh, treat these fractures. And these fractures represent one sixth of all fractures seen in an emergency room. So one of the most common fractures, uh, that we see in.

Dr. Wayne Weil: And I see, uh, you know, 10 or 15 a week. So, uh, it is super common and, and it's great that we have a great solution for it. Well, that's amazing to hear.

Dr. Grant Garcia: Well, I think. And I think it's excellent to hear that we have such a good, um, person to take care of those in the area. So thank you again for that information.

Dr. Grant Garcia: I think there's something, uh, I'd like you to kinda share cause I know that we've all talked about this special rehab. Uh, devices we use and things like that. I know you just recently started doing, you did a couple patients with your fractures and this new machine, the relists, which you've also had done with your elbow, uh, patients.

Dr. Grant Garcia: Again, still working on, you know, outlets for it and insurance things and everything else. Yeah. But will you tell the, the viewers, you know, they've [00:23:00] probably seen your, um, insane surgery you did on the elbow of that kid, that every, every part of their body was stuck and you've been able to find ways. To offer probably one of the only ones.

Dr. Grant Garcia: You're one of the only ones in Washington I know that's hand surgeon that has this opportunity. So it's pretty amazing to have this device. Uh, tell us little bit about your sort of experience with it and what it's, how it's helping your patients. Again,

Dr. Wayne Weil: you know, I, I'm a huge believer in motion and if we can fix

Dr. Grant Garcia: fractures and,

Dr. Wayne Weil: and.

Dr. Wayne Weil: And fixed ligaments, uh, in a way that we can get them moving as quickly as possible. Uh, then we have the opportunity, I think to, to really get outta the gates running quickly and, and, and with this new relist device, I, I think it's awesome. It is just, again, it's all about movement, moving people quicker, and the great thing about it is that, Um, because we can monitor [00:24:00] our patients remotely now, um, it just makes us be a able to really dial in people's therapy protocols basically on a personalized level.

Dr. Wayne Weil: Uh, you know, it used to be, uh, that we would, um, you know, make physical therapy prescriptions and it would be. You know, one size fits all and, and sort of like our pump surgeries, uh, that we're trying to really individualize to the patient. Um, this device allows us to individualize, uh, patient's rehab protocols right from the get go.

Dr. Wayne Weil: And, and it's, it's, it's so scalable in that there's so many, uh, variations that we can tweak with this device, whether it's, you know, just simple, um, passive range of motion. Versus active and active assist range motion, which the, uh, means, you know, just moving the, the joint versus actually [00:25:00] having the patients fire the muscles and start their strengthening protocols.

Dr. Wayne Weil: Um, and it's so adaptive. I mean, you can use it in the knee, you can use it in the elbow, you can, uh, we've used it in the wrist now. Um, so, uh, it's really, I think, again, very exciting, uh, to be an orthopedic surgeon, uh, in this day and age. Cause we have so many. Better tools that we can provide to our patients and, and we're getting such better outcomes than we did 20 years ago.

Dr. Grant Garcia: Well, and I think the important thing that the listeners need to hear is that, you know, you see, we talk about all sports, orthopedics, all sports all the time, but it's more than just the surgeries. Right. And I think Will's seen this before where there's lots of things that we are non-surgical treat, but also in the surgery is not just the surgery.

Dr. Grant Garcia: You know, that's the, that's the. That's the part that everyone finds is sort of the sexy, glamorous, technology driven, but really it's, the postoperative is very important. And as you heard from Dr. L, he does an amazing surgery, but if that patient doesn't move, [00:26:00] they don't look good. Yeah. And so he's, he's talking about ways to accelerate everything.

Dr. Wayne Weil: And so when you

Dr. Grant Garcia: do that, that's when you have patients rocking it in the office at six weeks. And so having the device plus the good surgery plus. Accelerated rehab. It's a combination and so, you know, will hears us talk about this all the time, but it's not, you know, we're orthopedic surgeons, but we also specialize in.

Dr. Grant Garcia: Orthopedic postoperative care. We specialize in preoperative evaluation. You know, it's not just doing the surgery. We love the surgery part, but I also love good outcomes. And so the key here is with seeing with Dr. Wild is same thing. It's just continuing. How can we fix it at every level? It's a supply chain, you know, kind of machine sit system we have to have, but you gotta make sure that every part's working correctly or you're not gonna

Dr. Wayne Weil: get

Dr. Grant Garcia: a good outcome.

Dr. Grant Garcia: But if you do it correctly, you get good outcomes appropriately. So. Yeah.

Will Sanchez: And it's a, it's a good reminder also, we had talked about this on one of our other shows about technology and, [00:27:00] biofeedback. And, uh, you're talking about this rebless, right? That was the, a robotics one that we talked about.

Will Sanchez: Yes. How

Dr. Grant Garcia: it please look at our previous episode to learn

Will Sanchez: about it, you know, the, the physical therapy device for both upper and lower extremities , and Dr. Weil, uh, said it perfectly, right? The elbow, the wrist, the ankle, knee joints. , so As a patient, right? As someone that's gonna come into your office, and have something done.

Will Sanchez: And knowing that, okay, that was just, that's step one. But now what's the next step to get back to having some normalcy, right? To get back to doing the things that we want to do, whether it's, you know, grabbing my coffee mug because my, my. Thumb is now fixed and I'm, you know, getting treatment or, you know, going for a run because now my knee is fixed.

Will Sanchez: So from the surgery through the rehab and having technology, that's really exciting for, for us. But I know for you guys too, cuz it's like new toys. So it's, uh, it's really exciting.

Dr. Wayne Weil: Yeah, it's, it's, it's, like I said, it's [00:28:00] really, I think the golden age of orthopedics is, is upon us and, and we are having this huge, um, uh, merger of, of, you know, high tech computer electronics and, and, and, you know, old school anatomy and surgery.

Dr. Wayne Weil: You know, my kids ask me all the time, uh, about, you know, the, you know, Bionics and the, the $6 million Man and all that. I think forget books, I mean, we're, we're, it is, it's closer than we think. Um, and it's really exciting, especially with inflation.

Dr. Grant Garcia: You may be six mile, mile man

Dr. Wayne Weil: sooner or later. Oh yeah.

Dr. Grant Garcia: Uh, I think we're gonna have to wrap up soon, but, uh, Dr.

Dr. Grant Garcia: Wahl, can you tell us anything sort of, you know, hand, wrist, what are you most excited about in the future? Anything you've heard about that you're looking forward to kind of read about? I know you're da dabbling, you know, you talked about the tightrope, you [00:29:00] talked about the, some implants you're using for the thumb.

Dr. Grant Garcia: Is there anything else you're kind of thinking about in the future that may be coming? You gotta learn a little bit more about it, uh, for the listeners. So they kinda get excited and. Maybe check you out in the future and find out if there's something you can offer for them.

Dr. Wayne Weil: Yeah, I mean, you know, from a, a sci-fi perspective, uh, a lot of interest in, in just robotics and biofeedback and, and, you know, for our severely traumatized patients, uh, one day being able to provide them with, with, uh, a real.

Dr. Wayne Weil: Uh, useful and working robotic hand as opposed to just a, a hook, but that, that's pretty far out there. Hmm. I think more, uh, closer on the horizon, uh, is, uh, the continued sort of miniaturization of, uh, our implants that we use, uh, and, and tools that we use in other body parts. Uh, the fact that, uh, we're [00:30:00] now able to get, uh, cameras that are small enough to, to fit into the small joints of the, the wrist and the hand, um, really allows us to kinda move hand surgery forward.

Dr. Wayne Weil: Uh, kind of like the knee and shoulder docs have been able to do over the last 10, 15 years. Um, we're gonna be able to do all the stuff that they do. Um, just on a much smaller scale. Uh, so that I think is quite exciting. Um, and then, um, the other, uh, one that I, I think is, is really important is, um, sort of nerve recovery and nerve regeneration.

Dr. Wayne Weil: Uh, so you slice your hand and you lose feeling into your fingers. Um, when you're taking out that avocado pit or, uh, uh, slicing the, the bagel and you slice open your hand, um, really getting nerves to regenerate quicker, uh, so we can, uh, repair your nerve and, and you [00:31:00] get sensation back into your fingers faster.

Dr. Wayne Weil: Uh, all that I think is, is really exciting.

Dr. Grant Garcia: Oh, we just opened up in another Pandora's box, so we're gonna hold off on that until the next time we have Dr. We on, but the, ive got one more question ballgame.

Will Sanchez: I got one more question before we let

Dr. Wayne Weil: him go. Yeah. We, we can talk about kitchen, uh, kitchen knife injuries, uh, next time.

Dr. Wayne Weil: Oh,

Will Sanchez: no, no. One last question before I let you go. As a, as a parent, and I know everyone on the call as a parent, we have our little ones and they fall and sometimes they're like, oh, ouchie or something like that. But is there a, Hmm. Lack of better word. A simple sign where you need to, as a parent, say, you know what?

Will Sanchez: You should go get your, uh, child checked

Dr. Wayne Weil: out as

Will Sanchez: far as a wrist. I, I had a friend that their, daughter fell. You know, they, they complained a little bit here and there, but didn't complain much because just to remind everybody, there's eight bones in the wrist and 27 to hand. Yeah. So you might have an injury that doesn't hurt that much, but something is wrong.

Will Sanchez: Is there a sign? As a parent listening that if [00:32:00] your young child that may be having a trouble communicating displays or exhibits this, you should go have them check it out.

Dr. Wayne Weil: Yeah. You know, I, I tell this to, to my patients and friends all the time, you know, kids are smarter than adults, right? Adults, you know, always are trying to play through the pain.

Dr. Wayne Weil: Whereas a kid, if something hurts, they're not gonna use it. And so if all of a sudden. No, you notice that your, your, your kid isn't, you know, grabbing stuff, with their, uh, hands normally again, or they don't wanna ride their bike or they don't wanna go out and climb trees cuz uh, you know, their wrist or their hand.

Dr. Wayne Weil: , you know, it seems to be bothering them. Those, those I think are telltale signs that, um, you know, something's wrong when there's sort of this immediate change in behavior. Mm-hmm. Um, where you, where, you know, you had a kid running around yesterday. Now they're, they're, [00:33:00] they're kind of mopey and, and, and not wanting to do, uh, the normal stuff that they, they usually do.

Will Sanchez: Great. Thank you so much, Dr. Weil, please everyone, orthopedic specialist of Seattle. Check out Dr. Wayne Weil at Seattle Hand Doc as well. I mean, you've got, you gotta read his bio, I mean, from where he is been, where he is

Dr. Wayne Weil: graduated, and

Will Sanchez: nyu, I know you're a Maryland guy. I mean, marathons, triathlons, Ironman, we ain't even get into that.

Will Sanchez: I had a whole other thing for you there, but we don't want to keep you up. Dr. Wilde, thank you so much for your time this evening.

Dr. Wayne Weil: Thank you. Thanks you guys. It was great chatting with you and hope to do this again with you. Okay, thank you. Thank you very much for being on

Will Sanchez: Dr. Garcia once again. Great. Guest, initial thoughts on what we just heard?

Dr. Grant Garcia: I just. I just love hearing innovation. You know, you guys always get to hear me talk about all the fun, fancy stuff I like to do, but you know, I only do three joints and there are a lot more in the [00:34:00] body and there are a lot of other bones and other things that we do. And I think what you're seeing is that we're in a day and age, especially in uh, Seattle practice that we have, or in a downtown city practice, you have to be super specialized.

Dr. Grant Garcia: And there's so much to keep track of. You really wanna make sure that you're getting the person that does the most of this. Yeah. And understands the most of this. So that's really what this our practice has turned into. Um, and patients expect that, you know, there, the days of going into somebody that does everything is just, it's important.

Dr. Grant Garcia: But really that subspecialist super specialist can really help out and pick up on things. You know, you, like you talked about for the hand, you're 40 years old, you're not gonna get a seven year old procedure. Yeah. You know? Now we have procedures that are set for each age limit. Um, so it's, it's really important for us to understand how this works.

Dr. Grant Garcia: It's important for patients to be informed too. You know, the number of patients that come in, they're like, I had no idea that was an option. You know, that's why we do this. Yeah. Right. We teach them about what's out there, what can be done to get them to do, uh, better. And so really it's, it's important for us to make sure that we educate the [00:35:00] patient population, you know, from the Seattle area to.

Dr. Grant Garcia: Uh, throughout the Washington State, et cetera, and or people that listen to our podcasts from elsewhere, we've got people from outside the country listen to this. Yeah. Hopefully they can have those options where they are. So that's really what our goal is, is to inform patients and just to show 'em how excited we are for n New technology.

Dr. Grant Garcia: And, you know, it'll be exciting in a year or two to update on this and find out what we heard, what happened, what didn't happen. Um, and that's the way technology works. So we wanna keep people updated. Again, all sports, all orthopedics really. Maybe all innovation would be another thing

Dr. Wayne Weil: we could add to our title at some point.

Dr. Wayne Weil: I like it.

Will Sanchez: I like it. No, definitely. It was great to, uh, kind of circle back to, uh, the technology we've talked about before with Redless. I was like, oh, atrial robotics, redless. I know exactly what you guys are talking about. So it is really exciting to hear that, uh, the different ways that all of this is being utilized.

Will Sanchez: From, you know, the knees to the wrist and you know, hands and so on and so forth. So, I,

Dr. Grant Garcia: I need to remind the listeners that despite, while everyone thinks that Will Sanchez is a doctor, he's still in [00:36:00] training. We're still working on this, but you may think he's a, a physician from this podcast. So I've been impressed.

Dr. Grant Garcia: Uh,

Will Sanchez: thank you. I'm work, I'm working on it hitting, you know, you know, secretly I'm gonna, I'm just gonna walk in with scrubs one day and say, all right, Dr. Garcia, move over. I got x I'm doing this in total bracing, you know, so that, that'll be great. Yeah. But Dr. Wild's absolutely incredible., Check out his resume, you know, from NYU Hospital and, you know, shock trauma hospitals and, you know, I, I wanted to ask him, I said, listen, you're, you're from Maryland.

Will Sanchez: Um, are you excited about your Baltimore Orioles that are playing so well? Or, you know, you've been here, what I believe 18, 19 years, something like that. You correct me if I'm wrong, is he a Marylanders fan? Yeah., so, uh, you know what, what gives

Dr. Wayne Weil: here, but I didn't wanna,

Dr. Grant Garcia: I didn't wanna start off.

Dr. Grant Garcia: I think he's a true Seattle guy now. Oh really? He's coast up, but, True Seattle guy now. Yeah. We're all, we, you, we live in Seattle. You know, you become more of a Seattle except for me. I'm, I'm a I'm still the New York guy. That's right baby. I still like giants. We know this. Yeah, but that's just you and me we're [00:37:00] different.

Will Sanchez: Uh, his Orioles are doing well this year, so I didn't know, so I wanted to ask him. But we'll save that for another time when you bump. Next time when you bump into 'em, ask them. That'll be a around the round table when you guys are hanging out and say, Hey, by the way, you still Orioles fan, or you on the Mariners

Dr. Wayne Weil: bandwagon?

Dr. Wayne Weil: But Dr.

Dr. Grant Garcia: Gar, oh, maybe I'll give you update next

Will Sanchez: talk. That'll be great. Dr. Garcia. Thank you for your time. Check us out, sports.talk.com. All sports, all orthopedics, all the time. Maul Sanchez, Dr. Grant Garcia, thank you and very much Dr. Garcia for your time today. Thank you

Dr. Grant Garcia: so much. Looking forward to it.

Dr. Grant Garcia: Check us out and uh, check out our previous guests and, uh, check out what's coming up. Audio Transcript

Will Sanchez: So we're really excited about having Dr. Smith on to talk about the Q collar. But before we get to that, let's get to our Dr, dr. Grant Garcia, Dr. Garcia, before we welcome in. Dr. Smith, how are you? Are you excited? It's almost summertime. You know, got some good plans for the summer for you.

Dr. Grant Garcia: Yes. Well, again, thanks for having me and we're really excited about having Dr.

Dr. Grant Garcia: David Smith today. You know summer's looking good and you know, we've had so many episodes with Tua and concussions and we've talked about concussions [00:01:00] before. And we've talked about the napkin to reality inventions, and we've brought up lots of examples, but we haven't had an opportunity to have someone as esteemed as him on the show.

Dr. Grant Garcia: So this will be excellent to kind of teach everybody what it takes. Well, where we came from and a really, a really challenging topic to deal with is concussions. And so we have one of the experts here, so I want to kind of take it off from there. And Dr. David Smith, if you don't mind kind of telling us a little bit about your product and people can learn about it and kind of what you got you into this and sort of what the dilemma is you're dealing with.

Dr. Grant Garcia: Yeah, sure thing.

Dr. David Smith: You know, my background, believe it or not, kind of mirrors yours, Dr. Garcia. I actually was an all-American swimmer like yourself. I went into chemistry and then came into medicine after sort of having some life-saving events as lifeguarding in swimming, and made a huge life change and decided that I.

Dr. David Smith: Had to move into medicine, but taking a chemical brain, a chemistry brain, and the logic train that goes with it all the way through to [00:02:00] Case Western Reserve in Cleveland which is sort of a detective world internal medicine is I left the case Western area after I got trained and actually acquired the assets from Pfizer's.

Dr. David Smith: A development team to make advanced wound dressings. And I ended up going out into the world and manufacturing these wound dressings and trying to make them smart and trying to invent them into something new and different that, believe it or not, led me to stand in front of the Army Research Lab, showing them how to not have our soldiers bleed out on the battlefield.

Dr. David Smith: And after I was done, the project coordinator happily walked up, put his arm around me and said, wow, really clever doc. He says, but you know, We really are struggling with traumatic brain injury here. We've got a hundred billion dollars a hundred years and we're having trouble moving the needle. Wouldn't it be great if clever people could just solve this TBI problem?

Dr. David Smith: And one of the guys in the room raises his hand and says, you know, I think if someone could figure out how [00:03:00] woodpeckers can smack their heads into a tree 80 million times and fly away. Maybe we'd have this whole thing solved. Everybody cracked up but me. But believe it or not, six months later, we did figure out how all of the creatures of the forest actually can tolerate unbelievable G-forces, like head ramming, sheep diving birds, giraffes, or headbutting animals.

Dr. David Smith: And of course, The woodpecker as well, and they utilize mechanisms to raise the volume of blood in the brain so the brain's not able to slosh around within the confines. And we all understand how important that is because if we get in a car and we put our seatbelts on and our, our pretensioners and the airbags go off, even the National Highway Transit Authority says, You reduced brain injury by 80%.

Dr. David Smith: Well, believe it or not, I did come up with about 15 years of research into this, 25 publications, 43 patents. And finally [00:04:00] last 2021, the FDA came out and authorized the first and only medical device to be able to make claims against traumatic brain injury, and that's called the Q collar. So to answer your question, it puts a slight amount of pressure on your jugular veins.

Dr. David Smith: It's a very, very tiny amount. If you reach down on the back of your hand and push on the back of one of your hand veins, that's 30 millimeters of mercury of pressure to collapse that vein. That's all we needed to divert a tiny amount of blood over into the venous capacitance vessels. And guess what?

Dr. David Smith: Your brain locks in place. It's as simple as that. Huh. Well, that's

Dr. Grant Garcia: a fascinating I think for all the listeners, you know, to hear kind of your story and how you went from, you know, this idea to the product, and I guess we can get into that in a little bit. But you know, And hearing, hearing this sort of, I hate to say simple idea, but pretty impressive, you know, looking at the way the animals [00:05:00] work and I understand, you know, how the juggler anatomy works and how you're adding that extra blood supply in the brain to try to stabilize it better.

Dr. Grant Garcia: I. For all the listeners out there, can you kind of tell, so that's important, but how does this sort of convert into the nfl? Like where, where did your path go with that? You know, again, N F NFL we've talked about before and all these sports shows, they wanna be on the cutting edge, but they obviously wanna keep their players safe.

Dr. Grant Garcia: So what's your sort of experience with that level?

Dr. David Smith: Well, we were very fortunate. We had. 350 million social media hits in 48 hours after the F D A released that press release. Hmm. So we got a lot of action out there and excitement, but unfortunately it's a medical device. We still had to get every advertisement okayed by the F D A.

Dr. David Smith: So it took almost an entire year still. And then we launched in 2022 and we now have 13,500 athletes. We have 150 professional athletes from. All across the spectrum, 45 N F L players. We had eight [00:06:00] people in the playoffs. We had one in the Super Bowl, Boston, Scott actually got a touchdown with a Q collar on.

Dr. David Smith: Mm-hmm. So we, we've really had an enormous amount of success in people that actually start using this device. It's been well received. We have over a million head impacts. Now think about that. A million, and these were studied by some of the best institutions in the world. This was not done in my garage.

Dr. David Smith: I'm really proud to tell you that just today, Cincinnati Children's Hospital got awarded the number one children's hospital in the United States by U S A today. That's where more than half of my studies were done. We also have Harvard researchers. We have university, or excuse me, Mayo Clinic, university of Toronto, West Virginia University, Chicago North Shores.

Dr. David Smith: My point being is, is this is not a cute seed device. This is literally $20 million worth of research in 15 years of my life. Yeah, trying to make sure that we [00:07:00] made sure that this was safe. And after a million head impacts, we didn't have a single unusual occurrence. None. Wow. Wow.

Will Sanchez: Yeah, and, and we're seeing that across.

Will Sanchez: That's

Dr. Grant Garcia: not a small feat. Do you know? No. Could you tell the listeners, could you tell the listeners off? I don't know if you seem to have a lot of knowledge off the top of your head, which is impressive. I like it. Do you know what the average occurrence is for normal head injuries? And is that to give them example of what the difference is from what you're telling them to the sort of the, the norm without

Dr. David Smith: your collar?

Dr. David Smith: Yeah, I'd be happy to kind of you know, one of the little pet peeves that I have from an academic is the, is most people do not understand the difference between a concussion and a traumatic. Brain injury. Yes. A concussion doesn't necessarily cause an injury, at least per most people's understanding, but repetitive head impacts are becoming the most obvious source to look for chronic traumatic encephalopathy.

Dr. David Smith: Our most recent study at Harvard actually used in animal model, and we were actually able with [00:08:00] jugular compression, which is how the device works. We demonstrated a reduction in phosphorylated tau in neurofibrillary tangles. These are the precursors to chronic traumatic encephalopathy, C T E. The dreaded thing that no one's been able to really get a handle on and what are we going to do?

Dr. David Smith: And yet there's not, I'm not saying that this is gonna block it, it's just the first study that suggested that something might actually be able to put a dent and what is happening to some of our traumatized to soldiers as well as. As, as well as athletes. I'll take this opportunity to tell you.

Dr. David Smith: We've already gotten complete acceptance by the Army. We just had the best Ranger competition down in Fort Benning, Georgia, just two weeks ago. 39th annual and every single one of the hundred and 30 Rangers had two colors on. Wow. How cool was that?

Dr. Grant Garcia: That was very cool. So for the, for the listeners, let's go back to that topic you had about the concussion [00:09:00] versus traumatic brain injury.

Dr. Grant Garcia: You know, from, sure. Like you said, for most of us, we hear the word TBI and I, you know, you think, you know, traumatic brain injury. We think, you know, a massive, you know, Massive issue where you have long term permanent damage and that's, that is a lot of times the issue and the word concussion, like, oh, I got a concussion, I have a headache.

Dr. Grant Garcia: Or if we hear from sort of the, in more layman terms, you know, football, that's considered more of a concussion thing and then otherwise it just kind of bon your head. Can you, with the cue collar, is the end, is the thought process that you're reducing concussions or you're reducing the concussions that could go onto a tbi?

Dr. Grant Garcia: Is that correct? Or what is, what's the, what's your pathway you're talking

Dr. David Smith: about? Sure. So as you're aware, in one season of, say, a sports team of say 50 50 kids, high school kids, there may be one, if not two concussions on the team over an entire season. Mm-hmm. But what we did was, and, and we can measure and we can study concussions by computer programs.

Dr. David Smith: It's an expensive, we can have that, like trainers go out there and question people. I mean, in the old [00:10:00] days they just said, Hey, what day of the week is it? Right? I mean, it's come a long way. From that, we ended up going a massively more detailed and expensive route. We used tensor mri. This is one of the most sophisticated imaging methods of looking down into the micro structure of your brain.

Dr. David Smith: We did a tensor r i at the beginning of the season, and then we did another one at the end of the season. And using digital subtraction angiography, we were able to superimpose these images onto each other. And if there was, Any change at all in those two images, then you get little red dots that appear on your picture, your image of the screen.

Dr. David Smith: And on the kids that did not wear a Q collar, I'm sad to tell you there were hundreds of these micro structural changes, but on the kids that wore the Q collar there were next to none. It's absolutely sobering to see these pictures, which I'd be honored to pass these studies on. They're published and they're available to any and all that are [00:11:00] interested When you use the word concussion, sadly it, it can come about from a lot of very subjective.

Dr. David Smith: Nebulous data that's put in. In fact, at Cincinnati Children's and other institutions and headache clinics, they can enter into a concussion protocol because the parent calls and says, I think my kid had a concussion yesterday. Okay. Now that's not quite as objective as being able to look down into the mechanics of the brain and objectively see a difference in their actual brain structure.

Dr. David Smith: So that's the frustration of using the word concussion. There aren't as many of them, and so when you power your studies, we analyze that we would have to do around 10,000 kids if the only thing endpoint that we were looking for. Was a concussion. Now it turns out our data did show a reduction in concussions, but one of the critiques that people have had with the Q collar is we didn't even try [00:12:00] to power our studies for concussion.

Dr. David Smith: Now that there's tens of thousands of people wearing these Q collars, I think you're gonna find that we are gonna be able to have the data for people, and we're gonna be able to demonstrate those reduced numbers of concussions out there on the field.

Dr. Grant Garcia: I think that's an excellent point for the, for the listeners, we just had a napkin to reality kind of talking about what you're, what you did, which is taking a product idea and turn into the big picture.

Dr. Grant Garcia: And I think we didn't talk about the clinical side of things. It's nice to have someone such as you with the academic background, you know, people don't understand that, you know, they want these clinical studies to have. Thousands or hundred thousands of people in them, but it's just not possible. It's too expensive, et cetera.

Dr. Grant Garcia: And so to hear that you know that that word power is really important for us to understand from an epidemiological standpoint is that. When we have these new products we're you can't get studies that big without multiple, multiple millions of dollars. And initially in the run of things, it's just hard to do it, as you would probably agree.

Dr. Grant Garcia: [00:13:00] But the fact that you got enough information and you were able to find a better way, and again, I've always thought the word concussion is very vague. It's like shoulder pain, right? Right. And so there's not a subjective way. I mean, we, when if Will asked me before, you know, how do you know from concussion?

Dr. Grant Garcia: You do an scat, you do a test, you ask what day of the week it is. You know, we've got some more sophisticated things, but in the high school level, we're not able to get those MRIs you have unless we have a big study on it. You know, I can't tell my high school kids, I'm gonna go send you for an MRI after they hit their head and they're walking and talking.

Dr. Grant Garcia: Normally it's just not something we can do in real life. But you know, there has to be better subjective information and it's good to, it's good that you were able to. Elicit that clearly. It's obviously your specialty. But it's good for the listeners to hear that, you know, that doesn't always mean they have concussion or the word concussion can be thrown out more easily and to the point where the doc, where the doctor gets a call or the trainer gets a called and be like, the parents said, my kid had a concussion without any real basis on what that

Dr. David Smith: means.

Dr. David Smith: Right, and they're in a concussion protocol all of a sudden. I mean, it's very frustrating. You use the word cost and, and yeah, you're right. It's [00:14:00] tough to cough up the kind of dollars that was put into this. And we didn't take any individual's money. This was privately found dollars so that we did not have to answer to anybody, whether it be the NFL or a professional out outfit or.

Dr. David Smith: Anything. We wanted to make sure that we had the best data we could have and people may somehow scrutinize the studies that were done. There were 25 of them, not one or two done by literally the most powerful, brilliant people that we could find in the planet Earth in brain injury today. So if, if it could be done better, we certainly don't know how, and I would love to hear how somebody could come up with somebody better than the list of our research partners that did the work for us.

Dr. David Smith: Now, mind you, I was on those articles, but I never touched a single subject patient or touched the data. I just helped people understand the physiology of what we were bringing to the table to help prevent these injuries. [00:15:00] And.

Dr. Grant Garcia: This session, I know we're gonna get sidetracked, but the science of, it's really interesting.

Dr. Grant Garcia: So the thought process of this jugular vein compression is you get enough, enough brain swelling to prevent it. So basically it's more sloshing and less likely to hit on the sides with this, this sort of impact, I hate to use the word concussion now that we've talked about. It's such a vague term. Is that the, is that the physiology behind it? D

r. Grant Garcia: And is there any, are there any concerns with, you know, more blood in the brain? We know in general if in blood, in the brain, in other areas is not good. But in this case that jugular blood is different, right? Or how is that different than sort of a traumatic brain injury where you get hit and then you bleed into your brain?

Dr. Grant Garcia: Obviously it's a different pressure, but I'm just curious sort of what's the difference in your ideas or your thoughts on that?

Dr. David Smith: Just an absolutely excellent question actually. So think about it. When you stand up, gravity is going to pull the fluids out of your cranial space, and in reality it's about four milliliters.

Dr. David Smith: Drop out of the cranial space and 20 milliliters drop out of your [00:16:00] spinal column, and that allows the brain to suddenly move around. Well, guess what? If you just lie back down, the volume and pressure inside your cranial space is about 20% higher than RQ color. So think about this. Wow. If you fear putting on this cue collar, for God's sakes, don't ever lie down again.

Dr. David Smith: Right. I mean, the physiological mechanism we're imparting is within the norms of what the body does every single day. Now, what the collar does in jugular compression actually mimics the actions of the omohyoid muscles in your neck. So you ready for this? Prior to our work, nobody knew what that damn little muscle did in your neck.

Dr. David Smith: Our orthopedic, and I see it, but I know

Dr. Grant Garcia: what it does.

Dr. Grant Garcia: Yeah. Well. Well, they didn't know.

Dr. David Smith: That's what's so exciting. Neurosurgeons actually cursed its name because every time they would go in to operate on [00:17:00] the neck in some way, shape and form, it took 20 minutes to dissect that muscle off the jugular vein. It wasn't close. It's literally affix. To the jugular vein, and it's that crazy woodpecker that made me realize the anatomy of that woodpecker's tongue is bizarre.

Dr. David Smith: It attaches to the top of the beak, goes up over the top of the skull, separates, goes around, attaches to both jugular veins, and then goes, forms the tongue, and goes in and out every time it blows into a tree. I mean, seriously. That's crazy stuff. Well, you have to have a

Dr. Grant Garcia: comment on this.

Will Sanchez: Oh, yeah. I mean, we've, we've covered a lot of topics.

Will Sanchez: I, I think Dr. Smith just a question. You know, how could you Make this even better is that putting more information or some kind of chip in the Q collar so you can have some kind of readings of you know, what the activity is before, during, throughout the entire process, whether it's soccer or [00:18:00] whether the army or football, anything like that.

Will Sanchez: Is there, like, what's the next step now to kind of keep pushing this forward and even gathering more information?

Dr. David Smith: So the, the you know, I've gotta give you a distinction. I do not own nor did I invest into the q 30 company that's actually out there commercializing. I'm the inventor. I created the patents.

Dr. David Smith: Yeah. I do get a royalty back, but I, I cannot speak to exactly what they're going to do. I do know from the last discussion with the team that they are putting monitoring devices, they'll be able to measure concussive forces and rotational impartation. And the thing that you guys probably know, sometimes you don't know where the impact is coming from.

Dr. David Smith: Yeah. Whether it's on a football field or if you're out there in the military and. Bomb goes off. You don't know if it's in the front, the back, the right, the left. You could impart a linear force into your brain or what's even more devastating, a rotational force into your brain, and it can come at any time.[00:19:00]

Dr. David Smith: That's the beauty of the cue collar. We mimic a yawn. So did you know that We now know why we all yawn. We didn't know that before we started down this path. When you yawn, you have actually four places in your jugular veins that completely collapse. Now you can, again, not believe me, Cincinnati Children's Hospitals, radiology and neuroradiology department demonstrated that and demonstrated that there's a back filling of the venous structures called the venous capacitance vessels.

Dr. David Smith: Big word, but it just simply means that the bubble wrap. Expands ever so slightly, only 5% per vessel. But all of a sudden, brain can't move around and it's just like bubble wrap. It's just like a, a airbag in your car. That's what you're gonna wanna pack around any package that you're gonna send across the country and you want it to get there safely.

Dr. David Smith: You don't put it in a steel container that's empty, you put it in a [00:20:00] cardboard box and you stuff bubble wrap all the way around it. Nature's been doing this for 20 million years, guys. All we did was mimic it.

Dr. Grant Garcia: Got it. On a, on a topic like that, you know, I, we all talk about, is there any role you think in sort of a collaborative effort, you have this now, this collar, And again, I think you made a great point for these people to understand this sort of conceptual idea.

Dr. Grant Garcia: You take an idea, you get a patent, and a lot of times you eventually sell the patent to the company and then the company runs with it. And it doesn't, you know, it doesn't mean you're fully involved with the company itself, which is what you mentioned. It's important for the people to understand how that process works too.

Dr. Grant Garcia: Cuz if people are always asking you like how you take an idea, bring it to reality, just like what you did and be wildly successful. But the question I have for you is, You know, they said, you know, these, they have these new expensive helmets. You know, my, my high school has like two or three of 'em.

Dr. Grant Garcia: They're like $2,000 a pump. And the NFL has 'em. You've seen these crazy looking helmets. Is there any role in the, in looking at, you know, a lot of times these studies, you wanna start with baseline, right? Like [00:21:00] regular helmet and versus the Q collar. But are there ideas in the future of like, how about more advanced helmets, more advanced technology with the Q collar?

Dr. Grant Garcia: Because the idea, and what I'm, what I'm thinking of is, is there any way that we can get these even better? Right. You've clearly shown a reduction from your studies, but can the collaborative effort be a combination of things, right? Because this is probably not gonna be a one size fits all or one answer to everything.

Dr. Grant Garcia: So is there any thoughts on that or what's the plan?

Dr. David Smith: Sure. Well, I, I hope you're not inferring that I don't think helmets are necessary. I mean, they do Exactly. No, no, no. They're design, I'm not inferring that. Yeah, they, they will stop you from getting a skull fracture. They will stop you from getting your eye gouged out.

Dr. David Smith: You must wear a helmet. But unfortunately helmets are not able to stop the movement of the brain from within the confines of its skull. Most traumatic brain injury researchers are now acknowledging that that is actually the true pathophysiology of an injury. You have to absorb the energy that's [00:22:00] coming, and I'm afraid that if you.

Dr. David Smith: Just make better, better and stronger helmets, you're just not changing the amount of movement of the brain within the skull confines. So you know, there's a lot of helmets that come and go. They've continued to make these improvements and there's not. Been any change in brain injury. So from my research and Dr.

Dr. David Smith: Julian Bales, who is one of the colleagues that worked with me, you are hard pressed to find a one, two, or 3% reduction in brain injury on any study. We blocked 83% of brain injury in the studies that we submitted to the FDA 83.

Dr. Grant Garcia: You know, I, I think that's an important point. You know, you, you have me, I follow this stuff pretty well, and that's still kind of, you know, I know that the helmets have had trouble with really producing the results, but it's also the idea similar to what we have in orthopedics and will understand this.

Dr. Grant Garcia: Essentially you are. You internally? It's an internal, I don't wanna get well too excited, but it's an internal [00:23:00] brace of the, of the of the the brain versus this external device and the word externally. When we do things externally and try to do external fixtures or things like that, they just don't have the.

Dr. Grant Garcia: It's also that torque and moment arm, and when you internally are able to kind of cushion the brain, it seems like that would be more powerful. So it all makes sense to me. And you know, unfortunately, as we know with the NFL or any of these concussion things, it's a multimillion dollar business. And so these helmets are always trying to one up each other and find what the best option is.

Dr. Grant Garcia: You know, they got the sensors as you know, you know, my, my high school and the teams I've taken care of, you know, they have the thing go off and it shows who got hit harder. It doesn't always mean anything and a lot of times it can do some malfunctions, but nonetheless, you know, it's interesting to hear your thoughts on that and that point is really important.

Dr. Grant Garcia: Cause I think that there is this misconception that that is the reason to stop concussions and it's for other reasons. And it, you know, again, we want players to be safe and we don't wanna give misnomers that homeless are not effective. But it's important to hear that there's still a lot more room that needs

Dr. David Smith: to be done.

Dr. David Smith: Well, in 2016, one of the lead articles in the [00:24:00] San Francisco Chronicle was that helmets protect skulls. They do not protect brains, and that's a powerful statement all by itself. But then when you find out who made the statement, that was a joint statement by the chairman and chairwoman of the Federal Trade Commission.

Dr. David Smith: US safety protective services. One of those, I can't remember which one it was, but at the end of the day they pointed out that you cannot make a claim that helmets reduced concussions and brain injury and that. That statement in 2016 came out right before they took every single helmet off the shelf worldwide that made the claim that they were anticon concussive because there's just no data showing that we have 25 articles by the best researchers in the world showing not a reduction in justice, nebulous term of concussion, but also actual physical.

Dr. David Smith: Damage to the brain structures, and that's what I think is, has just [00:25:00] got to be heard by most people. Yes. We didn't really go after that name in word concussion. We went 10 levels higher than that to try to help people demonstrate that we really were able to do statistical analysis. We were able to do all of these unbelievable methods in prospective studies.

Dr. David Smith: Best studies you can possibly do to demonstrate that this product is safe and effective.

Dr. Grant Garcia: Yeah, and for the listeners prospective is best option because basically you're not, you're not looking back at things where people can say, oh, I think I had it. I think I didn't. Cause if they get a concussion, they're gonna wanna remember one thing versus the other.

Dr. Grant Garcia: Prospective is like, you ready? You set it all up ahead of time and they don't know what's gonna happen. And so it's a lot less likely to be biased

Dr. David Smith: for the listeners. Yes, you gotta remove variables. You make sure that the. Two study groups are identical in absolutely every way except that that you can, except that one of the group has a collar on and one does not.

Dr. David Smith: And if you go backwards retrospectively in [00:26:00] time, you don't really know if the situations were identical. And so, yeah, you're right from a scientific standpoint, you just cannot provide more pristine and more powerful data that we did than what we did without sacrificing our subjects, which of course, were high school students and we're not gonna do that.

Dr. David Smith: Right, and so yeah, this is incredible levels of data I, you can probably hear in my voice. I'm really excited about it and very proud to literally be with some of the brightest researchers in the world and then have this kind of result pop out. Unbelievable.

Will Sanchez: Dr. Smith. Will, do you, yeah, yeah. I just have a, a question here.

Will Sanchez: You mentioned Dr. Julian Bales. And real quick, for those that don't know who Dr. Bales is, if you saw the movie Concussion about Dr. Omalu Dr. Ben Omalu, Julian Bales was the team physician or team doc, head team doctor for the Pittsburgh Steelers in that movie. So [00:27:00] having someone like him, Being a part of this discovery, this, this, this journey that you're embarking on when it comes to the invention of the Q collar, what kind of credence did that lead and what kind of, conversations allowed, you to have to say, Hey, this is something we are on the right path here when it comes to this.

Dr. David Smith: Well, you're absolutely right. I mean, he opened so many doors I can't even begin to tell you. And I think you'll find that Bennett O'Malley attributes Julian, for having an open mind. Yeah. When he came with the idea and concepts of what was happening to our football players and to be Quite blunt, I had just as big of a hurdle to get over with him.

Dr. David Smith: So not many people have the physics in the background to understand the, the impact levels that are involved. And I'll tell you what, it wasn't easy getting past his secretary when I had to teller that I wanted to talk to the chief of neurosurgery about woodpeckers. It really put me in a bad [00:28:00] way, guys.

Dr. David Smith: It was not a pretty sight, but at the end of the day, I'm really proud to tell you that I actually had three of my visual props in that movie. Concussion. I actually had to sign away a release because they used woodpeckers in there. Mm. They used Newton's cradle, if you remember. Yes. Those steel ball balls that are descended from twine and you lift the one out and drop it and it crashes into the middle balls.

Dr. David Smith: Yep. But nothing happens in the middle balls. The energy impact goes all the way through them, and then out the other side goes the other ball. That's what our device does. Yeah. It creates what are called elastic collisions, which means no energy gets transferred into the brain, and you're gonna love this.

Dr. David Smith: I actually was able to convince my team to spend $400,000 on a hearing study where we actually impact with an I E D level blast wave into little tiny laboratory animals. Half of them had jugular compression collars on, and [00:29:00] half did not. We preserved 93% of the hair cells of their hearing apparatus.

Dr. David Smith: When the Q call is on we block. Hearing damage on the battlefield, I shoot regularly. I get ringing in my ears every time, even though I have an ear muff and an earplug in. You put the cue collar on, the energy of that blast goes right through you and is not absorbed. It's so cool. So that's

Dr. Grant Garcia: essentially like the idea what people think of electricity.

Dr. Grant Garcia: If you can kind of pass it through without having it go into you too, you know, it's sort of like, or a ground or sort of like a grounding thing. So it kind of

Dr. David Smith: avoids it. You're you're quite right. I mean, and, and that's exactly what Newton's cradle ball depicts is those center balls. The energy doesn't, if you took that center ball, that steel ball and put a soft, gushy, pliable, grape, In there, all the energy of the impact will go right into that middle ball and that grape explodes.

Dr. David Smith: And if you have room [00:30:00] inside your brain, and I have tons of visuals I mean, I hate to give you, you know, to sit here and chill my websites and whatnot, but if you go to David Smith md.com, we have visuals, what we'll actually show you where we took eggs and put them into these unbelievable antique paint shakers.

Dr. David Smith: And they were in these mason jars partially filled with water and fully. Filled with water and within the partially filled mason jar with a fresh egg at the bottom, within five seconds, that becomes meringue. It just explodes the egg. But on the other side where there is a completely filled mason jar, meaning your skull, that that egg never breaks, doesn't matter how long you leave the machine on, it never breaks.

Dr. David Smith: The energy does not absorb by that egg. Awesome. It's actually relatively straightforward physics, but physics isn't easy for people to conceptualize, which is why I made all these visuals for people to get an idea. Yeah. Of what. [00:31:00] Amazing science is actually going on when you put that simple color on.

Dr. David Smith: That's

Will Sanchez: awesome. Before we wrap it up here yeah cuz I feel like we could talk about this forever and this is, this is perfect because we should be talking about this cuz it's really exciting, especially for every parent, every coach every person that has experienced this. And that kind of leads to my question is what's been I.

Will Sanchez: I don't know the greatest comment or compliment that you've gotten from someone. You've had players. If, if you look it up, there's N F L players wearing it now you can see every Sunday you could see the Q collar on soccer players like you, like you say. You mentioned the, the military. What is the one thing that stands out that, when you heard that you went home and you were like, man,

Will Sanchez: I feel really good about this. This really kind of made my day,

Dr. David Smith: well. I was here in Cincinnati, Ohio when we were playing the New England Revolution Revelation, and Omar Gonzalez was wearing his cue collar and a buddy of mine grabbed [00:32:00] my collar, went running towards the field, held it up in the air, and.

Dr. David Smith: Omar Gonzalez sees the cue caller and he points at it and he puts a thumbs up in the air and my buddy yells, Hey, the inventor's up here wanna meet him? He ran all the way through. All the fan came up to me, hugged me, and said, doc, I will never take this caller off. I'm a completely different player. I have a spatial awareness and reaction.

Dr. David Smith: Time is improved. And remember, We mimic a yawn. So physiologically we're identical to a yawn. And guess what? A yawn does it actually. Activates your attentional network. You're more aware when you yawn. So we've patented it for this. Oh, by the way, we just got another patent a couple weeks ago. We prevent vibrational forces from entering into your brain.

Dr. David Smith: Well, guess how cool that is for people going over the, in the what do you call it? The Play [00:33:00] field for many of the NASCAR that are rumbling down the field and you've got a cobblestone down in Atlanta, Georgia, and they're just exhausted after, you know, playing or running one or two or five laps around that.

Dr. David Smith: We block all of that. They, these, these racers just cannot believe how little energy is being absorbed into their brain. And you're right, the, the, the one thing that you can say about Dr. Dave, I hope to God it's on my tombstone, is that I was clever. Anyone can get these letters after their name. I've got letters after my name that go on and on.

Dr. David Smith: But you know what? You just cannot teach clever. And this technology is just clever. It's just standing on the shoulders of nature. Nature figured out how to do this and protect its little creatures. We are finally giving that same protection to mankind, and it's working in spades.

Will Sanchez: Awesome. Absolutely.

Will Sanchez: [00:34:00] Great. Dr. Smith, thank you so much. Please check out his book When Heads come together. You know, his tagline is Nature's My Mentor. So it was perfect that he ends this show on talking about nature and what it's meant to him and the inspiration to all of this. Please check out the Q Collar, the first and only device.

Will Sanchez: Authorized by the FDA for claims of prevention against T B I, which is traumatic brain injury. There, there's so much information. Thank you so much. Dr. Garcia, last words as we say goodbye to Dr. David Smith.

Dr. Grant Garcia: Well, I have to correct you will. You said we weren't gonna be talking about sports, but that's all we've been talking about is how we're protecting these athletes.

Dr. Grant Garcia: Yeah,

Will Sanchez: It's my trick to, to get you onboard. See, this is all my grand scheme as we get ready for the NFL season where I saw someone post, there's 12 Sundays before N F L starts, so it was extremely a, his. Hysterical. When I, when I read that there was like, it's 12 Sunday. It was on father's day. 12 Sundays.[00:35:00]

Will Sanchez: That's wonderful. To the start of the nfl. So what a way to kind of bring this in, and I'm so glad that Dr. Smith was able to be with us. Dr. Garcia, last words.

Dr. Grant Garcia: Well, Dr. David Smith, thank you so much for being on this show. This has been excellent. And you know, honestly I love to hear stuff like this in innovation.

Dr. Grant Garcia: I love to hear success and the future advances and that's what we're all about here. And I'm looking forward to telling my colleagues about this. This is really fun information and I really appreciate your time and your excellent speaker. And I think that all of our listeners are really gonna enjoy hearing this.

Dr. Grant Garcia: And thank

Dr. David Smith: you again. Well, I would like to make a personal offer to you, sir. If you'd like give me an email, I would be more than honored. I have a 20 minute full presentation of the science and everybody I've given it to, I've actually given it to the number two in the chain of command for the US Army, and she.

Dr. David Smith: Aid it up, and so I would be more than honored to give that talk to you or anyone in your department division or otherwise, just to help people understand just exactly what science went into all [00:36:00] of this.

Dr. Grant Garcia: Awesome. We'll likely take you up on that. Thank you

Dr. David Smith: so much, and thank you.

Will Sanchez: Thank you,

Will Sanchez: Dr. Smith. Audio Transcript

Will Sanchez: Garcia. I know you have a lot on your plate right now. You've got moving going on, family, friends, everything else going on. But first and foremost, how are you? And like always, it's great to speak with you.

Dr. Grant Garcia: I am good. Thanks for having me and I'm really excited about this episode. I think, you know, we spend so much time talking about knee, shoulder, and elbow stuff that I specialize in and we've been really waiting to have, you know, top notch foot and ankle surgeon on this show to talk about the ankle sports stuff cuz [00:01:00] it's so hot right now.

Dr. Grant Garcia: I mean, every article you see about. You know, we talked about Mahomes with the high ankle sprain and you know, there's other recent athletes that have shown getting back with some crazy surgeries, and I know we're gonna talk about your favorite topic, internal bracing. Oh, baby. And I thought, what better?

Dr. Grant Garcia: What better way to have it than the one of the, one of the Seattle experts, Dr. Anthony Yi. So we're really excited about that. I'm doing well, it's keeping busy, but I'm really excited about this show tonight. This will be our very first guest for sports doc talk. You can check us out at, you know, all the different platforms and this will be posted hopefully in the next few days so people can hear it and enjoy it.

Will Sanchez: Well, let's get right to it. We have Dr. Anthony Yi, he's with the orthopedic specialist of Seattle, and as you mentioned, he is a foot and ankle specialist. And listen, Dr. Yi, first off, we're really happy that you're here. You have all these accolades and all this training and university of Washington and Harvard and us.

Will Sanchez: And all of these experiences and awards, Dr. David, I mean David Award for best original [00:02:00] research paper and your dean's list and all this stuff. But listen, let's get past all of that. What I wanna know is if the Dr. Garcia and I come over the house because you say that you enjoy cooking, if we're coming over to Dr.

Will Sanchez: Yi's House, what are you making us?

Dr. Anthony Yi: Well, first of all, thanks for having me. I'm super excited to be here as well. Some of the cooking that I've been into recently, if you've heard of Doug Pearlman, she has an awesome little book called Smitten Kitchen. Some fairly simple stuff that can make a average guy like me make some pretty, really good dishes.

Dr. Anthony Yi: So I'd probably have you choose something from there and we could probably whip something. Sounds

Will Sanchez: good. Dr. Garcia. I know there's a lot to talk about. Why don't you just jump in right here?

Dr. Grant Garcia: Well Dr. Yi, you know, we're really excited to have you. I think one of the biggest things I keep seeing, and, you know, I, full [00:03:00] disclosure, I work with Dr.

Dr. Grant Garcia: Yi, I get to see is amazing results. And he's taking care of my family members. So this is a, this is a really special episode for me. But, you know, ankle fractures, You know, we think of ankle fractures. We used to think of 'em as sort of like, Yiah, it's a trauma injury. You know, you lots of motor vehicle accidents or people doing silly things, but high level athletes get this too.

Dr. Grant Garcia: And you know, we saw it with the Giants and other plaYirs when I was over in New York and some of these wide receivers getting in. We've seen 'em on football fields, but there's been a lot of press about some of the newer technology with these ankle fractures. And I've seen you do some of this newer stuff that I honestly, and I'm not that old in practice, had never seen before.

Dr. Grant Garcia: So will you tell us a little bit about what's going on with ankle fractures and what you're doing for

Dr. Anthony Yi: these athletes? Yiah, absolutely. So as you mentioned, you know, ankle fractures are common and we're seeing them a lot in high level athletes as well. And and. The key to treating these high level athletes is, you know, making sure you have a good solid plan for them.

Dr. Anthony Yi: You're taking good care of them, but also [00:04:00] balancing that with a timeline. Often in terms of getting them back to rehab, getting them back to the field, and sometimes maybe they may have an important. Playoff game coming up. So oftentimes there's that added pressure of a timeline and, but of course, making sure that first and foremost, you know, giving them sound care and, and proper rehab.

Dr. Anthony Yi: But one of the new tools in our toolbox is sort of a play borrowed out of another playbook that we use elsewhere in the body. And it's a, it's a nail. That we used to fix, fix def, fibula or one of the bones that make up the ankle joint. And so this is not necessarily a new concept. If you look into how we treat, for example, hip fractures or other long bone fractures like femurs or tibia, we often use nails.

Dr. Anthony Yi: And some smart people thought, why not? Let's try that for, [00:05:00] for the, for the ankle. And that has emerged as a newer method of, of treating ankle fractures. That has been great. In terms of some of the benefits of doing this oftentimes it means that we're making a much smaller incision instead of making a really big incision to fit a plate and screw along it.

Dr. Anthony Yi: Instead, this nail basically goes in through the very end or tip of the fibula bone and goes up the canal or the center of the bone and holds it in place. So one major advantage is, for example, that smaller incision that I mentioned not worrying as much about things like wound complications or infections.

Dr. Anthony Yi: Which is always on our mind as surgeons. And then the other major benefit of this is that you can get people starting to weight bear very quickly. It really depends on your comfort level in terms of how fast [00:06:00] you want patients to start walking on this. Some patients you can get going right out the gate.

Dr. Anthony Yi: Some patients you may want to wait till their wound heals up, which on average 10 takes, you know, about two weeks or so before you're comfortable enough to take sutures or stitches out. Mm-hmm. And let them get going. And this is, you know, that's a pretty signi still thing of difference for, for.

Dr. Anthony Yi: Professional athletes or high level athletes that have a timeline getting them going almost immediately, if not immediately, with, with their

Dr. Grant Garcia: rehab. And that's awesome. You know, we and will's here. You know, I remember even, you know, before Dr. Yi came to our practice, I would do a lot of ankle fractures and I always learned, and we used to do a wire with Dr.

Dr. Grant Garcia: Dean Lurch, and it was kind of crazy. We started doing these things and seeing that they would do it for the fib. Heads and fibular fractures. But most of the stuff is plating and people have other issues with, you know, problems in the back of their ankle and bigger incisions. And when I saw, I saw a few [00:07:00] of my friends get a fibular nail like a Yiar or two ago, and I seen it before.

Dr. Grant Garcia: And then Dr. Yi start. You know, I really don't do it anymore. Cause I have Dr. Ne so good at it, so I don't, I don't need to worry about that, which is nice. Will when we have a practice and we all do some super specialist work. But you fbri is, is really impressive. Have an example of a recent so brief,

Dr. Anthony Yi: briefly.

Dr. Anthony Yi: Yiah. So there was an NHL plaYir Alex killorn that. Recently had an ankle fracture. He was in the midst of the, the layoffs, I believe, and trying to get back as soon as.

Dr. Anthony Yi: Happened because of, because they got eliminated, well, I believe, but but basically, you know, he was, he had a fibula fracture. It was one that may not have necessarily required surgery if he was not on a [00:08:00] timeline, but in order to stabilize it and to try to get 'em back onto the ice. He made the decision with his surgeons to go ahead and have a flock placed.

Dr. Anthony Yi: And he was back practicing pretty quickly. But, but again I think, you know, he, he Didn't and ultimately get back into the games, but, you know, sort of a testament to how much, how fast you can get back at a high level.

Dr. Grant Garcia: Well, and you think, you know, I mean this technology, will, we talk about technology, these professional athletes treated differently, right?

Dr. Grant Garcia: You know, everything's different with

Will Sanchez: them. Yiah. One, 100%. Yiah. You know, and, and just kind of go back to what Alex Killorn, I, I remember the plaYir he plaYid with the 2021 Tampa Lightning that Yiar. They wind up winning the Stanley Cup and he got hurt game once. So imagine as a defender this plaYir is taking a slap shot.

Will Sanchez: And, and you know, any, anyone that's a hockey fan, especially the Seattle [00:09:00] Kraken craze that's happening right now, slap shot. His, you know, high nineties, you know, maybe up to a hundred miles per hour. And he got in front of this shot and it hit his leg, and that's how he broke his leg in two places.

Will Sanchez: And as Dr. Yi mentioned, he did his best to get back. He couldn't get back in time, but the beautiful part about it was he was on the ice. In skate when they won the Stanley Cup and he was able to hoist that trophy right then and there. So he didn't, he wasn't able to get back on the ice in time to compete, but he was there in time to be there with his teammates and to participate in the trophy ceremony.

Will Sanchez: Lift up that, you know, that trophy's about 35 pounds to be on ice skates, to do all those things, just games after that fracture had happened. Is incredibly impressive to think about what this fibular nail or this fac that they used for this. Dr. [00:10:00] Yi, just before we move on I know they use a radiolucent targeting guide.

Will Sanchez: What does that mean and how does that help you as a surgeon when it comes to you know, putting this fib fibular nail into a patient?

Dr. Anthony Yi: Yiah, so great question. So what that is is basically it's a device that attaches to the end of the nail. So as you're inserting the nail there there are screws that you put in at the very bottom.

Dr. Anthony Yi: And this adds sort of rotational control the nail so that it doesn't spin. And so there's a targeting guide that attaches to it so that you can accurately. Insert these screws without, and then that takes the guesswork out of it. And the other thing that I didn't mention about it is that they also have.

Dr. Anthony Yi: Holes or screw holes in the nail towards the bottom. Okay. That were engineered to be able to put in [00:11:00] another device such as a screw or something called a tight rope, which I think we'll probably touch on a little bit later. To address any additional injuries on top of the fibula fracture such as.

Dr. Anthony Yi: The assmosis injury or what we talk about as a high ankle sprain. And that can be all done through this, this targeting jig or guide that you mentioned.

Dr. Grant Garcia: Thank you. Well, Anthony, I wanted that segways right into, and we're not gonna get too excited with Will here, but Will's gonna have to control himself.

Dr. Grant Garcia: But it's time, I think, to talk about some of the intern, some of the you know, the ligament repairs and the tight ropes and the internal braces. But talk about this in this sort of repair, you're talking about this tight rope fixation because when I started. We were, you know, I started doing some of this stuff early on but obviously not nearly as advanced as you, but really avoiding that screws, you know, we used to put screws across the synosis and they could break people had hardware issues and then we had these sort of [00:12:00] invent of this sort of tightrope fixation to tighten it down.

Dr. Grant Garcia: Everyone's trying to copy you know, different technology out there, but now you can have a updated, you can get a flock nail. Where it's minimally invasive. You've got nothing on the outside really. And then you have this tight rope that can go to the middle, which you've showed me a few of your patients in, in the office.

Dr. Grant Garcia: And that doesn't need to be removed. And it's much more right. It's, it's, it's more freedom to movement. So it's more natural. Isn't that, isn't that correct? And it's also lower profile.

Dr. Anthony Yi: Will you give us a little information on that? Yiah, I agree completely. So in terms of the, you know, the sysm, there's, there're a series of ligaments that connect the tibia to the fibula together.

Dr. Anthony Yi: And that can tear if the energy is high enough or the injury is bad enough at the same time that there's a fibular fracture. And when it's unstable, those are situations where we repair it or fix it. And you, I'll be honest, it, it's can be quite controversial amongst surgeons, what the best way to fix this is.

Dr. Anthony Yi: Hmm. But I'm, I'm, you know, I'm with you Grant. [00:13:00] Dr. Garcia, you know, tend to lean towards using this device called Tight Rope, which is, Basically, if you imagine two metal buttons and a very, very strong suture in between, and basically what this is used to do is to cinch down the space between the tibia and def fibula so that they're in the correct alignment and to offer some stability to hold those two bones together in the correct position relative to one another.

Dr. Anthony Yi: And what Dr. Garcia mentioned is absolutely correct. You know, there is supposed to be some level of. Normal or what we call physiologic motion between the two bugs in our bodies. So traditionally we've, we use screws that pass through the tibia and, excuse me, th through the fibula and into the tibia and to, to hold those two bones in the correct [00:14:00] position while, while they heal together.

Dr. Anthony Yi: But that does. Eliminate motion, which we originally have some degree of motion in that. So you know, just from a, sort of a conceptual or philosophical standpoint, I, I completely agree with Dr. Garcia. I, I love the idea of putting in what we call flexible fixation. With this tightrope that adds enough stability to let things heal correctly, but also at the same time allows for some motion.

Dr. Anthony Yi: And I think, you know, the. Literature studies also support this in, in showing that we do a better job at getting the alignment of the fibula and the tibia or the sysm when we use the tightrope device. Yiah, and also there can be less complications with it as well. Much less likely to have to take it out than a screw.

Dr. Anthony Yi: For example, Dr. Garcia mentioned screw's breaking. That can happen just because another [00:15:00] testament to the fact that there is supposed to be some motion in between those two bonds. And what if that motion gets if is restricted with a screw, then the stress goes through that screw and it can break.

Dr. Anthony Yi: So, you know, there's a higher chance of need to take screws out. So Yiah, that's, those are my general thoughts with regards to the type of device which, which I heavily lean, encourage using my patients.

Dr. Grant Garcia: And then for the, and for the viewers this is a device that we use a lot in the acl. And for a lot of other ligaments that we do, there's sort of, it's a self-locking device, so as you pull it, it pulls it up and it locks it in there.

Dr. Grant Garcia: But then you can adjust it, which is really nice. So if you fix one side on like an ACL l you can tighten the other side and you can titrate things up and we can go over the implants another time on the ACL side of things for the tightrope. But nonetheless, this is just another, another great piece of advice that

Dr. Anthony Yi: sort of was, it's,

Dr. Grant Garcia: it's the same technology, but it's another way of using it.

Dr. Grant Garcia: Which is always great, especially, you know, this is another there's different type of proprietary places that make this, but this device is [00:16:00] pretty impressive. So, on this topic, obviously high ankle sprains are a huge discussion topic and we're gonna skip a little bit ahead, but I kind of wanna keep on with this tight rope synosis.

Dr. Grant Garcia: So the viewers can understand it cuz the idea of the sym is confusing to people. And everyone hears high ankle sprains are here. Listen, that's the one you don't want. You wanna have a regular ankle sprain. And for, you know, layman hearing this, you know, we've heard of, you know, you have a couple big athletes that have this, obviously one didn't have surgery with Mahomes.

Dr. Grant Garcia: But you know what happens These, through these patients

Dr. Anthony Yi: with high ankles sprains, they're a lot different than a regular ankle sprain, right? Yiah, absolutely. So that's a great question. So you can, you know, think of it at one area of the sprain being a high ankle sprain, another area being a low ankle sprain.

Dr. Anthony Yi: No, a low ankle sprain is that classic twist of the ankle. And you know, by and large, people don't necessarily need surgery for it. You know, take it easy for a few days up to a few weeks, and largely starting to ease back into the swing of things [00:17:00] thereafter. And that's, That's lower down. So at the tip of the fibula bone, that bump on the outside part of your ankle on the pinky to side so that there's a ligament that runs right along that region.

Dr. Anthony Yi: And that ligament can get injured or there can be a partial tear, which is, which is the lower ankle sprain. And then the high ankle sprain is more of the injury that I mentioned. Before, so there's a series of several ligaments that attach between the tibia and the fibula and hold those two bones in the correct position.

Dr. Anthony Yi: And this is often due to a pretty violent, twisting type injury with the energy sort of traveling all the way up through that space between the tibia and fibula. And there can be a lot of different variations in terms of which li, which of those ligaments are injured and how severely those ligaments are injured.

Dr. Anthony Yi: And so the, the key to treating this [00:18:00] and determining if a patient might need surgery or not, is to determine if it's a stable injury, meaning that there's not abnormal motion that the relationship between the bones are, is, is, is still preserved or. Is it an unstable injury? Meaning is there too much motion going on between those two bones now and which which is gonna lead to problems in terms of pain, not being able to use that ankle as well as you'd like to be.

Dr. Anthony Yi: And also, Concerns in the long term about developing arthritis or wearing away the cartilage in the, in, in the long term. And so, you know, some famous athletes, for example, in the nfl like Tua and you know, Tony Pilar had recently had unstable high ankle sprains for which they underwent surgery.

Dr. Anthony Yi: And, and for these, you can use that same device that I mentioned, the, the tightrope to basically [00:19:00] restore the relationship between those two bones and to restore the stability between those get those, get those, and get that high ankle strain to, to heal properly. And again, this is a little,

Dr. Grant Garcia: you know, is a better alternative, right to the old school screws in doing them.

Dr. Grant Garcia: And then, you know, sometimes, right, you add, you can add more than one if you really need to, which is nice. You can it without having to add more screws or other

Dr. Anthony Yi: fixations. Is that correct? Absolutely. So oftentimes, you know, again, this can vary from surgeon to to surgeon, but in the case of, you know, an isolated high ankle sprain you know, there's a lot of different variations of injuries that this can happen in.

Dr. Anthony Yi: But oftentimes I'm, I'm using two. Two of these devices to have to have enough stability between those two bones and to get those, get, if you heal properly.

Dr. Grant Garcia: I, I know Will's thinking this, but would you ever consider this in a high level [00:20:00] athlete that's in the playoffs that wants to get back?

Dr. Grant Garcia: Or what is the timeline? You know, someone's on the fence like ma, like Mahomes, he pushed through this. Right? But let's say you can't push through it. Would you ever consider doing this? Like unless they first round the playoffs knowing I'm gonna get em ready for the Super Bowl? Or is that not

Dr. Anthony Yi: realistic?

Dr. Anthony Yi: It, it can happen. So I mean, I might, no one's

Dr. Grant Garcia: gonna, no one's gonna hold you to, no one's gonna hold you to this. I'm

Dr. Anthony Yi: just curious. It's, it's certainly possible, I think in, in that timeline. So I may be wrong about this, but I believe Terrell Owens actually had this injury. And came back.

Dr. Anthony Yi: He, I think it happened in the playoffs and he was able to get back for their run.

Will Sanchez: Yiah, that's why he plaYid with the Philadelphia Eagles. Wikipedia. Yiah. He plaYid he plaYid in the Super Bowl with that injury with the Philadelphia Eagles, in fact plaYid really, really well. I have a quick question here.

Will Sanchez: Is this something that, this procedure, since you're, you're pretty much, you know, [00:21:00] Putting, putting a hold through the fibula to the tibia with that, you know, with this tightrope cord and you're using your suture. And first off, just for the listening audience, a couple questions. One, is this a quick procedure?

Will Sanchez: So we'll start there.

Dr. Anthony Yi: In, in terms of the actual insertion of the tightrope, actually very quick. Yiah. So basically I use an x-ray machine in the operating room at the same time to make sure that I'm happy with exactly where I'm putting this device. And then I, I, I drill across, Yip. Using a, a appropriate drill bit, and then I put the D device across and sync it down.

Dr. Anthony Yi: It's, it's very quick. Very

Will Sanchez: quick. And then is this something that you can Do you have to connect to another piece of equipment? Like let's say if you had a metal piece on the fibula side or something like that, or is this something that you can attach to the fibula to the tibia at the same [00:22:00] time?

Will Sanchez: Or does this require another piece of equipment to hold it in place?

Dr. Anthony Yi: Great question. You can use this device in isolation. Okay. Or you can use it for example, with through a plate so that button can sit directly on bone or you know, there are different plates that can accommodate that.

Dr. Anthony Yi: That button as well, so it fits nicely in a hole on the plate as well. So, for example, if you're fixing a fracture with a plate and screws and you, you leave one of those screw holes open to be able to put this tightrope through it, you can do that as well. Yiah.

Dr. Grant Garcia: So, I'm gonna segue you cuz this is a great talk, but I will not be missing Will's favorite topic here.

Dr. Grant Garcia: So we are going to, I want to talk to you about something that probably, I think that I, I think all of us see this more than anybody. I mean, you all have a friend that [00:23:00] sprained their ankle. We've all seen ankle sprains. We talked about high ankle sprain. But the low ankle sprains, I think are a lot more common.

Dr. Grant Garcia: You know, any, if you, if you don't have any friends, if you don't know a single person here that's had an ankle spraining. So it's really important for us to learn about this cuz we see tons of these, but you know, we've, we've heard about Bross and Bristow and others sort of ways to sort of fix this in brostrom procedures, et cetera.

Dr. Grant Garcia: But there's this newer procedure, which I love talking about and I know Will does too with internal brace. And really, you know, we do a lot. We talked about this in the knee, we talked about this in the elbow, but, so how does the internal brace help with instability? And is how is this a game changer for you in your practice?

Dr. Grant Garcia: Anthony, especially with athletes and young kids. And I've sent you some few patients you've done it on that were some of my Mercer Island athletes. So tell me a

Dr. Anthony Yi: little bit more. Yiah, so this absolutely is a game changer. So the internal brace, as you know is made by a specific company. No, I don't have any affiliation with them, but Arthrex.

Dr. Anthony Yi: So they [00:24:00] have come up with this awesome device that is made of a very, very heavy suture, and it's. Basically something that can augment or protect your repair of a ligament so that you can get patients going very quickly. So with the low ankle sprain or just the traditional ankle sprain, vast majority of patients will make a nice full recovery and get back to doing what they need to or want to do.

Dr. Anthony Yi: But there is a small percentage of patients. That unfortunately develop what we call chronic ankle instability, where they can't trust their ankle. They're constantly twisting and turning their pa their ankles. I just had a patient last week who a very young athlete who unfortunately even just walking on flat, even surfaces and twist their ankle because their ankle is so, so loose from having had so many ankle sprains in the [00:25:00] past.

Dr. Anthony Yi: So in patients like this I love using this internal brace because it protects the ligament repair and I can get them going very quickly. So I generally have them start walking at two weeks after surgery and starting PT right away.

Dr. Grant Garcia: So And how is that different than

Dr. Anthony Yi: before? So, Yiah, traditionally, oftentimes not, you know, keeping patients off of it for four, even six weeks.

Dr. Anthony Yi: So it's a, it's a full month. You know, earlier there was a recent study in foot and Ankle International that looked at a military population and and looked at these patients with chronic ankle and stability using the internal brace, and they found that they could get them back to activity a full month after.

Dr. Anthony Yi: And if you're talking about an in season athlete, that's a, that's a. And I think

Dr. Grant Garcia: I've heard you do this, some [00:26:00] of this with scope stuff. I mean, I've never seen someone do that before. Tell me about that and, you know, what's the, how does that add the benefit of what you can do with these sort of, these things and what other, what

Dr. Anthony Yi: things are associated with this too?

Dr. Anthony Yi: Absolutely. So one of the techniques I learned from one of my mentors, Chris Miller out in Boston was doing this procedure or was called the Brostrom procedure, which is a reconstruction. Of the lateral ligaments that are injured that can lead to this type of chronic instability. What's to do, learned how I learned how to do it through the scope.

Dr. Anthony Yi: So arthroscopy, as you know, is using small cameras through very, very small incisions to look inside an ankle joint. And you can put, use small instruments to do all sorts of things including this procedure through the scope. So oftentimes when someone has ankle instability, They're constantly turning their ankle.

Dr. Anthony Yi: There can be a lot of [00:27:00] issues in the ankle joint itself. So it's fairly standard to also do an ankle out of thoroscopy procedure at the same time to make sure that we're not missing anything like a cartilage injury that needs to be treated. And through the same incisions you can do a, a brost procedure or an arthroscopic brost procedure.

Dr. Anthony Yi: And. You know, one of the, you know, really cool Things about being able to do it this way is that avoiding a larger incision where you're worrying about the wound not healing and then it just gives you that much more confidence in getting patients going, going sooner

Dr. Grant Garcia: and, and will, I'm gonna chime in there.

Dr. Grant Garcia: You're, you know, you heard a lot of Anthony or Dr. Yi mentioned a lot of times the word incision, so you don't hear me mention that very often, and that's because I do knee, shoulder, and elbow. And those patients tend to have very little wound issues,

Dr. Anthony Yi: but, but what, what

Dr. Grant Garcia: Dr. Yi has to deal with on a daily basis is that when you have foot stuff, it doesn't heal as [00:28:00] well and it's a much higher risk of not healing.

Dr. Grant Garcia: So everything they're doing is not only can I get the athlete back faster, can I get my standard recreational back faster? Can I do it more minimally invasive? It's can I make the incisions as small as possible so I have the highest chance of them healing perfectly? Would you agree with

Dr. Anthony Yi: that, Dr. Yi? Yiah, absolutely.

Dr. Anthony Yi: You know, I. You know, the foot and ankle surgeons have somewhat of a disa disadvantage in terms of the fact that, you know, the foot and ankle is the furthest thing away from the heart. So we, you know, blood flow. Tho those are all very real considerations. We need good blood flow to be able to heal.

Dr. Anthony Yi: Wounds to prevent infections. So definitely, definitely a very, very important thing to consider.

Will Sanchez: Dr. Yuri. Is there any determining factors where you say, you know, this individual is maybe too young, or there's a certain situation there where you're, you have to make a determination that at this moment this course of action is [00:29:00] not appropriate for this patient.

Will Sanchez: Is there anything. Along those lines that you can

Dr. Anthony Yi: speak to? Yiah, absolutely. That's a great question. So in terms of age, one of the things that we always keep in mind is, Orthopedic surgeons is we, we have something called skeletal maturity. Each of our bones in the body have a different time at which they start, you know, developing and when they ossify and when they, when they mature.

Dr. Anthony Yi: And so we have growth plates at the ends of bones usually. And one consideration is if that growth plate is still open, or if it's closed, if it's still open, you know, we generally do not want to try to disturb that growth plate or do a procedure that might injure it because it can prematurely injure it or shut it down, which can cause things like.

Dr. Anthony Yi: Slowing of the growth of that bone or [00:30:00] even complete stopping of the growth of that bone, which can lead to, you know, discrepancies in the length of different bones or even what we call angular deformities. Where, for example, down, down by the ankle there's both the tibia or the shin bone and that side skinny bone and def fibula.

Dr. Anthony Yi: And let's say that the fibula bone growth plate got injured and the tibia wasn't. Mm-hmm. And the tibia continues growing. You can have this. Unnatural angle or, or turn to your ankle. So Yiah, absolutely. So these are all, all considerations. In terms of, you know, so you may want, you may need to alter your technique or consider a different procedure or just as you mentioned, holding off on a procedure if, if in certain situations.

Dr. Grant Garcia: Great. Great. Well, Dr. Yi, in essence of time, I wanna ask you one more thing. I know Will wants to chime in a few more. But what do you see sort of as the sort of [00:31:00] future for foot and ankle? I mean, we've already heard about some things you're doing that are really unique to the area and that, you know, you're bringing arthroscopy in more levels of the foot and ankle in the level that I've never seen before, which is awesome.

Dr. Grant Garcia: And you're treating arthroscopy with ankle fractures and. With, you know, ankle sprains now and other different levels of arthroscopy and minimally invasive procedures. But so what's on the, what do you kind of see as the future? What is the sort of the couple main things you're, that you're looking forward to seeing in the future for our audience and they can

Dr. Anthony Yi: hear about it?

Dr. Anthony Yi: So, I think one of the really exciting things I'm passionate about and things I'm really excited about in terms of foot ankle surgery is seeing how far we can take this concept of minimally invasive surgery. So far I feel like we're just at the tip of the iceberg. So, you know, as you know, the concept of minimally invasive surgery is performing, you know, safe, effective surgery through incisions that are as small as possible.

Dr. Anthony Yi: So whether that means for, you know, the ankle fractures we talked about, using [00:32:00] that. Then figure their nail through smaller incisions or doing the bro procedure through the scope or fixing a bunion through tiny incisions that, you know, just need a single one or two stitches using a spec special burr or, you know, repairing an Achilles through a very small.

Dr. Anthony Yi: One and a half or to two centimeter incision so that we can really, really try to minimize complications like wound complications or infections, decreased pain, and get athletes and or for all patients for that matter back on their feet as soon as possible. That, that's one thing that I'm personally really excited about in terms of the future.

Dr. Anthony Yi: And then some, some another area within foot and ankle that I'm also looking forward to seeing developments in cartilage restoration. So I briefly mentioned, you know, cartilage injuries earlier. You know, we have some [00:33:00] techniques in our toolbox that have worked fairly well so far, but I think there are some other techniques.

Dr. Anthony Yi: I know Dr. Garcia is, is our you know, expert here in Seattle on, on doing the Macy procedure. And, and that's been very successful around an knee. And that's starting to become a tool in our toolbox for the ankle as well. It has not Yit been approved by the fda, specifically for the ankle, but my thoughts are that it probably will in the very near future based on, you know, the studies that I see and then also colleagues that do this a lot.

Dr. Anthony Yi: For example, I have a colleague in the, in the Army who they have less restrictions when it comes to, you know, getting things approved that are difficult to get approved through you know, private, private or civilian insurance. So, you know, you know it's one of the other areas that I'm, I'm, I'm very looking very much [00:34:00] forward to seeing our develop.

Dr. Grant Garcia: Awesome. Well, thank you so much Dr. Yi. This is, I'm looking forward to seeing more of your cartilage stuff. As you know, I do a lot of it for the knee, but there's just less. Of it approved for the ankle. And so it's good you're pushing the envelope and I know you're working with Macy team to try to figure out ways to do more of that and other cartilage things.

Dr. Grant Garcia: So hopefully our patients, well I know our patients are gonna benefit, benefit already from your minimum invasive impressive techniques. So thank you for joining us and I'm sure Will has a few more things to add, but this has been fantastic and I think all the patients Seattle are happy to have you here.

Dr. Grant Garcia: So, and I know I am, so thank you.

Dr. Anthony Yi: Well, thanks for having me. Yiah,

Will Sanchez: I'll wrap it up. I know we're going a little bit long. I, I couldn't agree more. As far as, you know, hearing a doctor saying that we want to have smaller incisions and less invasive and things like that, so those are all key words that every patient wants to hear, right?

Will Sanchez: Because we want you to, Have, do less [00:35:00] to our body, but fix us faster and get us up and going. So these are all key things that people want to hear from our side of the of the table. So that's a great thing. And before I let you go, Dr. Yi, just to remind everybody, Dr. Yi he's the orthopedic surgeon, foot ankle specialist.

Will Sanchez: Out of orthopedic specialists of Seattle. So please look him up. There's, you can check him out on his website. He has a great LinkedIn page. And I know if I'm having foot and ankle issues, I definitely want to reach out to Dr. Yi before we let you go. I know I have a Harvard man on one end and a Penn man on the other.

Will Sanchez: So let's just get right to it and just have a little fun here. Dr. Yi, do you know who won the football game this past season between the two of you

Dr. Anthony Yi: guys? Oh man.

Dr. Grant Garcia: This is not good. This is not good. I would, I would,

Dr. Anthony Yi: I would assume Harvard, I would assume Harvard. [00:36:00]

Will Sanchez: Harvard won 37 to 14 ruin Penn's chances at a Ivy League.

Will Sanchez: Title at the end of the Yiar. That is my gift to you, Dr. Yi, for spending some time with us. Thank you very much. We really appreciate it. Dr. Garcia, I apologize for that. You know, we will find a way for you to take a shot at me somewhere else. I'm still waiting for, for me to perform internal brace. Maybe Dr.

Will Sanchez: Yi let me come in and, and and take care of that. So, Once again, Dr. Yi, we really appreciate your time. We appreciate your knowledge on all the subject matters that we talked about today. You have a great night.

Dr. Anthony Yi: Hey, thank you so much. I really appreciate it. Had a lot of fun tonight. Thank you. Take care.

Dr. Anthony Yi: Dr.

Will Sanchez: Garcia, man. Awesome. That, that was a lot of fun. It was great to have Dr. Yi on. What are your last thoughts on the evening as we wrap up our show and just having someone like Dr. Yi on?

Dr. Grant Garcia: Well, I'm just excited that we have this [00:37:00] platform now that patients can. Get more of what they ask for. You know, it is more sports, but now we can expand it.

Dr. Grant Garcia: You know, we have so much more we're gonna be doing with this show. We're getting requests, we're getting people messaging me. I'm hearing from my own patients that they love hearing the type of topics we're talking about. And again, if you have any patient, if any patients have any requests, anybody has any requests, let us know.

Dr. Grant Garcia: We're, I mean, we have a lot of things in store. We have a lot more guests. We're gonna have company stuff. We may even get a chance to have some of the arthrex and other company teams on here to learn more stuff. And I know Will's gonna ask a lot of good questions, as he always does. So I'm really excited about it.

Dr. Grant Garcia: Subscribe to us. We have another special guest coming up in a few months, a few weeks with some potential NFL ties. So I think it'll be really exciting and there's a lot more in store. We're not even, we haven't even touched the tip of the iceberg with this show, so we're really excited.

Will Sanchez: Yiah, it was a great show.

Will Sanchez: I mean, the fact that we were able to talk about the Fibular nail and obviously minimally invasive and the targeting guide and the push lock. Anchors and how that has you know, [00:38:00] resulted on you know, different athletes and different people. And obviously my favorite internal brace and just kinda speeding up the process and getting you out there and rehabbing four weeks earlier and, you know, and just kind of dealing with all that stuff.

Will Sanchez: We talked about the tight rope and how it's affected high profile athletes and, you know, the, the. The cool kind of part of that from drilling a hole through your fibula to the tibia. And it's great information for us, right, because we can talk about this, but the patients are the ones that are gonna benefit from the new technology, everything that that's kind of happening.

Will Sanchez: So as we wrap it up, My little question to you is, who has more Ivy League titles when it comes to football? Is it Penn or Harvard? Dr. Garcia?

Dr. Grant Garcia: I think it's Penn, actually. Penn needs to be really good at football, if I remember correctly. Maybe I'm wrong though, mostly.

Will Sanchez: Harvard has 17 Ivy League championships.

Will Sanchez: Penn has 18, 18 Ivy [00:39:00] League championships. So see, look. Oh, finally got one. Right. There you go, baby. Okay, so just because you lost this this past winter, don't worry about it. You can still hold. Hold over Dr. Yi's. Had the extra championship. Let's go Penn. Let's go Quakers. And once again, remind everybody, check out Dr.

Will Sanchez: Grant Garcia. He's. Our orthopedic surgeon is sports medicine specialist. Check us out at sportsdoctalk.com. Email us sports doc talk podcast gmail.com. You can find all that stuff on our website. Just go to sports.talk.com. You'll find all that stuff. Dr. Garcia, it's always a pleasure. Thank you for taking some time to be with us this evening to lend great information for bringing Dr.

Will Sanchez: Yi on. I had a great time. Me too. Thanks

Dr. Grant Garcia: so much. It's always fun. Audio Transcript

Will Sanchez: Before we get into that, Dr. Garcia, welcome to the show and really you presented this show because someone came up to you. And requested it. Tell us a little bit more about that.

Dr. Grant Garcia: So you know, we also have the ww sportsdoctalk dot com as well, so you can, there's a whole link you can add in what you wanna talk to Doctor or will about and as well add to your episode.

Dr. Grant Garcia: So it's a pretty easy interface. And so Gmail or that interface works out great. We actually have another request, which eventually we're gonna get [00:01:00] to. But this topic is a good friend of mine Nina Thatcher. I wanna give her a big shout out. But so she is a former Iron Man, or Iron Woman, you could say.

Dr. Grant Garcia: And she is an extremely athletic individual, a great person. One of my good friends and she had heard the podcast and seen some of my posts on LinkedIn, et cetera, and was asking, you know, what can we. Do. As you know, as we get older and as we age to keep doing the things that we want to do, and we've talked about this a little bit for professional athletes, but not in the respect of sort of a recreational athlete.

Dr. Grant Garcia: And so this brought up a good topic of not only Ironman event. And a lot of her friends are iron ironmen contenders or qualifiers or finishers. But really how do we keep athletes going? How do we keep the aging athlete at the level we want them to be? And, you know, there's certain tricks that I've talked about in my surgical aspects, but there's a whole nother gamut of technology.

Dr. Grant Garcia: And we're gonna try to do our best to get into that today. So,[00:02:00]

Will Sanchez: Real quick for our listening audience, if you don't know what this event is, this Ironman event no disrespect, but you have to be a little bit of a lunatic to do this stuff. It's a 2.4 mile swim, 112 mile bike ride, and then you have a 26.2 mile run.

Will Sanchez: So you're running a marathon and then you have to. Complete it within the 17 hours and there's cutoff times for each leg. So if you've taken too long on the swim or the bike ride, you don't even get to compete on the mile run. So there's all of these different obstacles. I remember I did a. AIDS ride event from New York up to Boston and that first day I rode 120 miles.

Will Sanchez: I stopped about four or five times to go into the medic tent to get my back check. I swear I'm not even joking. And this is Young Will Sanchez feeling groovy and training and I couldn't even move. I got there, it was pitch black dark [00:03:00] at our first leg, 120 miles later, and I just felt. Awful. I was like, I would never do this again.

Will Sanchez: It was a great cause raising money for aids, but what I did to my body, I don't, I still don't think I've recovered. Dr. Garcia, when you think of something this enormous, what's the first thing that goes through your head?

Dr. Grant Garcia: Pain. Lots of pain and per perseverance. But you know what, you know these, you know my friend people I know that do this, it's a different mindset.

Dr. Grant Garcia: They're different. They're different level. Of sort of both mental and physical. I mean, these are the people that are in the water swimming at six in the morning consistently, even as they're in their twenties, thirties, et cetera. You know, they don't give up when they were done in college. Like they just keep going.

Dr. Grant Garcia: Or some people find their new passion. You know, you hear all these stories of somebody that goes and starts doing these in their late thirties to forties. And it. And being a former athlete, taking care of athletes, taking care of Ironman, taking care of professional athletes, you name it, [00:04:00] you know they, there's a mental aspect to it that is unteachable and you either have or you don't, or you develop and you don't.

Dr. Grant Garcia: But it's really hard to tell someone to have that mindset. But my job and our job obviously today is to talk about the things that you can't, that you can help with. What are the additives to help with this, you know, the standard injuries you have with Ironman athletes, you have the standard sort of tendonitis.

Dr. Grant Garcia: You have stress fractures a lot of times of defeat. And we know a lot of iron men that have gotten these injuries plantar fasciitis. And we're gonna be hopefully in for a treat next month with my partner, Dr. Anthony. Ye's. Gonna talk a little bit about some of these lower extremity injuries. But these overuse injuries are really important to understand.

Dr. Grant Garcia: And how can we as. Physicians or as the population better understand the treatments available and what is the future. Because really we're, we're on this cutting edge of regenerative medicine, and I think that's really important for us to understand like what's the next step. And obviously be careful because.

Dr. Grant Garcia: You know, [00:05:00] there's, there's different levels and the word regenerative is always something you gotta be cautious of. But how can we have this aging athlete? How can we can keep them going? And that's really important.

Will Sanchez: You know, when we talk about the aging athlete for you, you know, sports fans out there, we know a couple right off the top of the hits, right?

Will Sanchez: LeBron James at 38 years old, it is a specimen, right? Tom Brady just retired. We'll figure out if he's gonna stay retired, but he's an amazing specimen. But a lot of these athletes that are performing at a high level that have been in the pro, in the pros for so long, usually have some kind of routine that's helping them along with that.

Will Sanchez: Right? So for LeBron, it's the weight training, the yoga, the Pilates. He has the. The, his core workout is this, is all of this effort to keep that, that body fine tuned and ready. Right? Tom Brady talks about, you know, he has a pre-workout [00:06:00] pliability then he has functional strength conditioning, then he goes back to pliability.

Will Sanchez: So there's all of these things that we are, we're learning more more and more each day that we need to do certain things to kind of, Give our body a chance to even perform. As you get older, what are some of the things that you think about that as you get older, some of the things that we should be keying in not only to perform and to, whether it's, you know, play tennis or doing anything else and just kind of enjoy life, but to really kind of keep the body going and be functional in your day in and day out activities.

Dr. Grant Garcia: I think you hit on it a few times. I mean, you brought it up with every athlete you just mentioned. It's adaptability. They were doing different things at the end of their careers than they were at the beginning, but they're performing at the same level. They've adapted to their age, they've adapted to their athleticism.

Dr. Grant Garcia: They've adapted the level, you know, You [00:07:00] can't be fif, you know, you've seen these videos on Instagram or other things. People lifting it appropriately and injuring themselves and they're like in their young, you know, early fif, early teens, late twenties, you know, those guys aren't doing that. You know, they're not just going up and lifting as much weight as possible.

Dr. Grant Garcia: They're doing everything in their possibility to try to maximize their athletic ability, but in a different way. You know, we've seen the evolution of fitness, right? It was before it used to be sort of all a, you know, constantly lift, lift, lift, lift, lift. Heavy weights, protein, protein, creatine, you name it, to the point now where it's like lean muscle mass, high intensity training.

Dr. Grant Garcia: Plyometrics with a combination of yoga, flexibility, aquatics training, you know, those things are all really important and constantly keeping your body, you know, you want, the things that are in, are in bad shape to get a break and you want the things that are in good shape to take the brunt and be able to get back you know, be able to get more exercise in those areas.

Dr. Grant Garcia: And so I think that's really important for these athletes and that's really [00:08:00] the major thing. And then, you know, I think it's time for us to kind of jump into the next topics. You know, I think we've talked about this before and you guys can see on our previous podcast earlier on, you know, the aging athlete, at least from that standpoint, from the professional athletes, important.

Dr. Grant Garcia: But what about the recreation athletes? What about the technology coming out? You know, this is really important. I think one of the biggest. Advances is regenerative medicine. I don't know if you have any comments on this and what you've heard. Cause it's always good to hear, you know, both sides of the story as to what's sort of the, the next thing up there because regenerative medicine is a hot topic and that everyone is talking about it.

Will Sanchez: Well, I do have a question because I'm hoping that. This is something that's going to help me in the future because I've had issues in the past and I, knock on wood, it hasn't been as bad the last year, but I was getting these, this injury about every. Two to three to four months. And that was with my perforance.

Will Sanchez: And I went to a doctor and at the time he was like, yep, man, you've got some arthritis, [00:09:00] you've got some injuries. You know, things had piled up over the years. I, you know, I played this, that, and everything else. And he was, and at the time he was like, we just, we gotta get to a point where we could get some stem cells and do some things and, you know, maybe we can help your, help the way you're feeling.

Will Sanchez: Well, I have still not had that treatment yet. You know, so when it comes to something like that, will that be beneficial to me or apply? And if so, what is the timeline that that can happen? Because I'm gonna make an appointment tomorrow.

Dr. Grant Garcia: So, you know, I think obviously we get into a broad spectrum. So regenerative medicine is the idea.

Dr. Grant Garcia: Can we find a way with medical technology to regenerate parts of the body? Or to protect the body. Yeah. And from an orthopedic standpoint, it's really important. You know, we're looking for the holy grill. We've talked about this before. You know, we are starting to, to try different stem cells for tr treatments of, you know, early arthritic [00:10:00] changes.

Dr. Grant Garcia: But we don't have a lot of data yet. You know, do we use, there's fat stem cells, we have stem cells from synovial joints, we have stem cells from amniotic fluid again. We're not selling these things right now as an orthopedic group. Yeah. Cause we're still on the verge of trying to figure them out. They're still in sort of testing phases.

Dr. Grant Garcia: Obviously you gotta be careful when people are selling stem cells at, you know, five, $10,000 a pop telling you it's gonna change your life. And so we gotta be careful about that. But there are other fields where it's, they're testing it. I mean there multiple sclerosis is a big one. ALS brain injuries.

Dr. Grant Garcia: Yeah. A big one for us is orthopedics is spinal cord injuries. And they're trying to look at ways that we can find a way to regenerate stem cells to get people back to what they're doing. And can we do that with a combination of other medicines? You know, you've seen these impressive gene splicing options.

Dr. Grant Garcia: You know, I just was reading about Dechen Muscular Dystrophy, which is a really horrible disease Yeah. Where you heard about sickle cell and they've spliced genes to get people better again. I mean, they're treating all sorts of genes with this sort of [00:11:00] regenerative medicine. Awesome. And looking at aging, I mean, Not only are we treating diseases or treating injuries, but can we reduce or turn around aging with these things called tel.

Dr. Grant Garcia: It's sort of the end of your chromosomes. That's sort of as the longer you have that maybe you have more time in this planet or not. And finding ways to reduce ways to have those be damaged. And so, You know, I think we're, we're not there yet. But that idea of regenerative medicine is a very hot topic.

Dr. Grant Garcia: And I think that this plus AI in the next 10 years is gonna be one of the, you know, the cutting edge fields to treat diseases that are really bad and to treat diseases that are not as bad. You know, no offense to your hip arthritis, but obviously it's very important. They wanna treat that, but can we also save people's lives?

Dr. Grant Garcia: And I think that we're gonna see that this, this stem cell thing, it may not be what we think it is now. You know, we think of stem cells as like you take some juice outta your body, just mix it around and get the new stem cells or something that we have to develop in the lab, you know, with other techniques.

Dr. Grant Garcia: Or is there gonna be an epiphany where it's designed by computers and computers [00:12:00] figured out? We're, we're, we're getting there and we're confident. It's one of the hottest fields. Everyone wants it happen. We all want a magic shot. I have patients all the time that ask for this, and we're getting closer each day, but it's just gonna take more time and unfortunately Will, there's no appointment for you at this point?

Dr. Grant Garcia: Oh darn. As soon as there is, you know, I'll be, you know, I'll be telling you right away. Yeah. I mean,

Will Sanchez: because really the, the paraform is pain. I thought it was in my hip and everything that was going on, and then I had some tests done and really it's coming from my spine, so I'm getting this. Arthritis in, when it gets inflamed in my spine and it's making me feel like I'm having the pain and the perforance and I'm stretching, I'm doing all this stuff, which obviously is, is beneficial, but when this flares up, I mean, I can't move.

Will Sanchez: I pretty much amusing my hands. To lift up my thigh. To swing my leg around. Right. And I'm not the only one. Everyone's kind of going through it. You, you mentioned sickle cell. My niece and nephew were born with sickle cell and they've gone through, as little kids have gone through, just, [00:13:00] you know, the worst as if, you know, if you know what sickle cell is, you know, it, it is something that is just, it's really, really difficult to deal with.

Will Sanchez: And My nephew already had to have surgery. Normally they want their surgery at five years old, but he was having so many issues that he had to have it early on. And now the, the younger sister is now showing complications from it as well. So without, you know, getting into all the. Extra details.

Will Sanchez: Really, this is something that when you say regenerative medicine and the goals and things like that for everyone, Ms. Als and everyone else, I mean, this is, this has gotta be a big one. And I, you know, the, you're on the clock, brother. You, you better go figure this out. You go everywhere and you do all these tests, so you're no pressure, but you're on the clock.

Will Sanchez: Listen, let's move on. Because it really is, it's a, it's a. Topic that we can really kind of keep on and discussing because there's so many different aspects of it. We talk about, and I'm wearing it right now. So I [00:14:00] got up this morning, I, I did some stretching, I grabbed some kettlebells, I did some, some swings, some snatches, things like that.

Will Sanchez: I did a timer and then I put in my average heart rate what was the highest heart rate. I have this information now on my wrist, so when we talk about. All of these different technologies, these wearable technologies that we've already done a show on, but how it plays a part for these athletes, especially the Asian athlete, what is something that they should particularly pay attention to if you have a, a wearable technology as far as, you know, maybe keeping themselves healthy or not, you know, trying to avoid injury.

Dr. Grant Garcia: Well, I think, you know, think about back this like 10 years ago, you wanted an heart rate monitor, you strapped it on your chest, you got very little readings. I hated those

Will Sanchez: things. Heart, by the way. Those things were so annoying. I know. And they're shaved,

Dr. Grant Garcia: they're not fun. No. So they, so now we have, [00:15:00] you know, all of these different monitors and we'll talk about a couple we didn't talk about before.

Dr. Grant Garcia: Yeah. Let's go through kind of each aspect of it, right? So you have. The simplest thing with is the Apple Watch. And I hate to say simple, but you know, it's a pretty common piece of technology. You kind of put it on your wrist and that's it, and it could do most of the stuff you want. And they keep advancing in every version, you know, soon they're just gonna tell us what we need to do.

Dr. Grant Garcia: They're like, work out harder, you know, they're gonna be able to advance all those things. Great. And so Mac now? Yes, precisely. So basically now, you know, as an athlete, You can see, you know, before when I didn't have an Apple Watch, I had no idea what my high heart rate was. Hmm. And I was like, used to say as a, as a younger person, why does that matter?

Dr. Grant Garcia: But now I know, you know, if I do a hit workout and I only get to one 30, I'm like, did I really work that hard today? If I go for a run and I get to one 60 and I feel pretty good, I'm like, I feel like I got my, my level at. But if I get to one 70 and start feeling not feeling very good, I maybe pushed it too hard and so I can adjust my workouts based off that level as someone who really likes.

Dr. Grant Garcia: I'm an analytical guy, [00:16:00] obviously we know a little dorky being a doctor, but nonetheless, you know, I find it important for me and people who, you know, these athletes, like I talked about, these ironmen. These people that are doing all the time, like they're calculating. They have all their stats. They know what they do.

Dr. Grant Garcia: You know, we talked about Verlander before, you know, he knows his, he knows each speed pitch he has, you know, they have an encyclopedia in their heads for their bodies. Yeah. And that helps him get, that's helps these, some of these players as Verlander is a great example. Of being at the top of their game for so long.

Dr. Grant Garcia: You know, I can tell you right now, I can show you. I can tell you right now, if you ask LeBron James what his top bench press was, his speed, his vertical, and everything else, and every year he would know with without a doubt. Yeah. He would've all the numbers in his head because that's what he does. And same with Tom Brady.

Dr. Grant Garcia: You know, they have all their physical stats in their head and they know they go for goals and it's personal best. Not always against everybody else. We know they're competitive, but really it's personal goals that get you to the next level. And these Apple, these watches and things like that, they can monitor those and get you to that next level or protect you because you know you're overdoing it [00:17:00] because our bodies as being competitive athletes.

Dr. Grant Garcia: You know, that you can hurt yourself. And so I think that's, I think that's an incredibly important part of the wearable technology. In addition, I don't wanna jump in too much, but into sleep as well. You know, we are so focused on the daytime activities, right. We always wanna do more. I am a terrible culprit of this.

Dr. Grant Garcia: Yeah. And honestly, until about a year and a half ago, I was really bad at sleep. Maybe even two years ago, I would, my resident, I would just work, work, work, barely try to get away without sleep, try to do two or three rounds of coffee a day. Cause I was like, I'm I gotta go. I gotta, I gotta make, do a better, I gotta get better.

Dr. Grant Garcia: I gotta keep working. Yeah. And until I got the watch and realized that I was doing a very bad job of sleeping and when I slept a lot, all of a sudden my memory came back and I felt more alert and I was actually more productive. It was, I mean, I remember falling asleep in class as a kid cause I was so tired from swimming and working and getting ready for medical school and everything else.

Dr. Grant Garcia: And I've finally taken it on my own as thankfully. The life helped a lot with that, with getting back to sleeping. Yeah. But [00:18:00] as an athlete, you and as any pet professional, sleep is essential. And if you're skipping on sleep, you might as well skip your workouts cuz you're just doing yourself a disservice.

Will Sanchez: Yeah, it's a great point because when you look at all the training, right, whether it's, you know, we talked about Brady and LeBron and, you know, even Mark Wahlberg, right? They, they all talk about, you know, the rock. I've seen his training. There's like sleep, get up early. Workout, eat, supplements, nap, workout, sleep, nap.

Will Sanchez: And so the sleep is an integral part along with it. And I'm terrible with naps and usually I don't have time for them. But it's amazing to me. And I'm a, you know, a little like I. A little angry, the fact that some people could just fall asleep really nice and easily and, and get those naps in. But sleep is a big part of any training.

Will Sanchez: Anyone out there pick your favorite, you know, personal follow or to, you know Arnold Schwarzer has you know, a new app now is doing stuff. Sleep. Everybody's talking about [00:19:00] sleeps, and as we mentioned right now, supplements. As you're getting older, what are some of the key supplements that we should.

Will Sanchez: Be utilizing because maybe our body is not creating the necessarily the same amount, or if we're staying active, we need to kind of help the body along with adding some supplements.

Dr. Grant Garcia: So, you know, the biggest one is omega-3, you know, fatty acids. A lot of times, like as us, thankfully in Seattle we have a lot of fish, salmon especially.

Dr. Grant Garcia: Yeah. So that helps to sort of improve inflammation in the joints. Improve joint health in general. And so that's a, that's a really important supplement. You know, you just gotta be careful though, at the same point. You know, supplements are a great way to add more balance to you. You can have, you know, vegetable supplementation, you can have other supplementation, you know, vitamin b12, vitamin C, et cetera.

Dr. Grant Garcia: But you also can be careful cuz it's also a huge market and it's not really FDA regulated. Yeah. Similar to other things we've seen. And so supplementation's good, but. [00:20:00] People sometimes think, okay, so the recommended daily value is this. So if I have two times more, I'll be two times better. Yeah. And that doesn't work like that.

Dr. Grant Garcia: Gotcha. And the one of other thing that's really good, especially for us in Pacific Northwest is vitamin D. We are very deficient. You know, I'm a guy that likes the sun. If I could take advantage of it and my mo you know, over the last few years I've had a couple values that have been low vitamin D despite.

Dr. Grant Garcia: Being of Latin heritage. And so it was surprising to me to see vitamin D levels and talking to, you know, even my primary care doctor, they're like, this is extremely common, you know, and, and the people in the Pacific Northwest and upper Northern Regions. Tend to have low vitamin D levels. Yeah. And especially for my patients.

Dr. Grant Garcia: I'm a bone health kind of guy cuz I see breaks and fractures all the time. You know, a lady in her fifties falls, breaks her wrist. Breaks her shoulder. That's not normal. I mean, it seems normal to us, but it's not, it shouldn't happen. It's osteoporosis or osteopenia. Yeah. And so bone health is essential. So vitamin D, calcium is good.

Dr. Grant Garcia: And it's not just women, it's men too. You know, we don't, we're not [00:21:00] above the osteopenia, osteoporosis, and no one wants a fracture. And so it's important for us to make sure we take care of our bodies. And extreme athletes can be at other risks as well. And so you wanna make sure you have right supplementation if you're gonna be doing it.

Dr. Grant Garcia: If you're doing a 2.4 mile swim and 112 mile bike ride and a 26 mile marathon, you better be properly hydrated. It's not just water. Yeah. You know, we could have the joke of Gatorade, you know, but again, it's all of those things are essential for supplementation. You have to supplement in what you're coming out.

Dr. Grant Garcia: You can't also go for being perfectly fit and just, you know, eat salad all day, either. You have to have a good combination of things.

Will Sanchez: Yeah. As men, you know, I was gonna bring it up as far as, you know, the role electrolytes plays, you know, especially if you're training and competing. And so I, I think the, the, to oversimplify it is to pretty much be aware of what you're putting out so you can recognize what you need to add back in.

Will Sanchez: Right. I mean, I think that's the, the easiest, most simplest way to kind of put it Dean Car Caris. I'm [00:22:00] pretty sure you know who this guy is. He an ultra-marathon runner. He competed in the largest, nonstop run by a human being. Back in 2005, he ran 350 miles nonstop. He's not human, all right? He's just not.

Will Sanchez: So it took him 80 hours almost 81 hours, and he's 60 years old. To this day, he's averaging about 70 to 120 miles a week, and he talked about three things. One, he talked about overbuilt running shoes. Cross-training and really the one that stands out to me, and we talk about it, we recognize it, but it's something that we really need to be aware, is he says, No sitting allowed.

Will Sanchez: It just weakens the posture when it comes to, mm-hmm. Athletes and being active. What does the role of Sitting too long or sitting too much can play on the body. And maybe that's something that you've seen with patients coming in, how it affects them

Dr. Grant Garcia: sitting [00:23:00] atrocious. It's good, bad for your back. It's, you know, I, I've had back issues before and I realize I'm thankful in my job that I rarely am allowed to sit.

Dr. Grant Garcia: Yeah, so I got lucky. But I'm also tired at the end of the day because you're constantly standing. But you know, sitting is just not good for your body and unfortunately in a tech driven market and you know, with our day and age of being on computers, we all are sitting there sitting on the couch and watching shows.

Dr. Grant Garcia: Yeah. But really, you know, being active, getting up and about, you know, the kids help. Because obviously they make you sit stand all the time. There's no sitting allow when you have children. But you know, the, the sta the stand, there's a reason your watch calculates how often you stand. Yeah. You know, it's a really important function.

Dr. Grant Garcia: And I think he's also simplifying in the sense that. Don't. Don't sit around and let life go by. You know, guys like there's a reason he looks like the way he does and there's a reason he's able to continue to train. Yeah. And he's very lucky genetically hasn't, has things he can do that. You know, we talked to us before.

Dr. Grant Garcia: Not everything is just training, not everything is effort. [00:24:00] There's a lot of genetics involved. If everyone trained like the LeBron James, Not, most of them wouldn't be, almost none of them would be with LeBron

Will Sanchez: James. I still can't dunk. I still can't dunk. Even if I trade like LeBron. I know. So go what your point is.

Dr. Grant Garcia: Yeah. Yeah. So I think, I think really what the, the, you know, the important part of this is that if you wanna be an active person and you want to be active, you just gotta go. You gotta do it. You gotta think about it. And you know what? First it's gonna be hard. If you're used to sitting 12 hours a day and you go to like eight hours a day, you know, we've seen these big push for standup desks.

Dr. Grant Garcia: You know, at my office we don't, we can't sit down because everything's a podium. So we're standing constantly. Yeah. You know, I find myself leaning a couple times cause I get a little bit tired of standing and running around between patients. You know, my staff finds it funny cuz I run between different office stores and everything else and I'm constantly moving.

Dr. Grant Garcia: But, you know, it makes me feel better. At the end of the day, you find you're sitting, you think you're resting, but it's actually worse for your body. And it slows down your metabolism and all these different things. So it's, there's, I think the hardest part, I think is the combination of activity, [00:25:00] diet.

Dr. Grant Garcia: Exercise, rest, et cetera. And people don't understand how that balance works. You have people that are on one end, they're all diet, right? Diet this, diet that. You've seen all that, and that's really important. Yeah. But that's not, there's a, it's a, it's almost sort of a, I'd say a pyramid or a square. And if you only focus on one little corner, you're not gonna be successful.

Dr. Grant Garcia: You know, these are high level athletes. They're not just eating the best foods possible all the time. Only, you know, they're focused on a lot of things, the sleep aspect. The train aspect and then the recovery aspect. And all of these are essential. And I don't wanna jump back to an old topic, but you know, the one thing I forgot to mention with the wearable technology with, in terms of sort of monitoring your body, is those new glucose monitors.

Dr. Grant Garcia: Have you seen those? No. They had so basically they're really simple and anybody can have them, and it's basically put on the side. It used to be for diabetics. Okay. Patients. But basically you can just monitor your glucose with your phone and it can, it's another way that some of our athletes are using it for training or with people who do intermittent fasting.

Dr. Grant Garcia: You can [00:26:00] identify your glucose levels and that's also part of your regimen is to see what your glucose levels are like cuz you can, you can know more information. We don't have that ability yet until this thing came out. But this new technology is pretty impressive. It's pretty painless. And it just sits on the side of your arm.

Dr. Grant Garcia: You may have seen people with these little nubs on the side of their arm and you just scan your phon and it tells you what your glucose levels are and other levels as well.

Will Sanchez: For those that don't know why it's important to explain, please.

Dr. Grant Garcia: So glucose is, is the initial sugar. There's other levels of sugars and I don't want to go into sort of the Yep.

Dr. Grant Garcia: Overall details of the way our body processes energy. But glucose is essential. And if your glucose, you don't wanna have glucose. Glucose levels can come from a lot of things, but, you know, fruits and vegetables are mainly fruits. Simple sugars are really important. And you don't wanna obviously have glucose from, you know, candy and those things.

Dr. Grant Garcia: It's a different level of, it's not the same type of stuff about the high fructose corn syrup, et cetera, but you don't wanna have your glucose levels get low cause that's when you start to get hungry, you get shaky, you don't [00:27:00] feel as well. And so I think that understanding and monitoring this, you know, you've heard the rock, he talks about having five or six meals a day.

Dr. Grant Garcia: You know, that's like really the way to go. Is you're just never really that hungry. Yeah. And so you're not engorging yourself. You know, we're so used to this. There's been an article I heard that like, you know, I talked about like the three meal regimen was invented basically by like, you know, Americans, this, this like sort of these three different things.

Dr. Grant Garcia: We have to have all the time or three meals, dessert and espresso to paint on where you are. Yeah. But really it's the keeping your, your glucose levels at a, at a moderate thing. I find if during the day I just have a little stack here or there. It, it can make it so eat less during the day and that's another good opportunity.

Dr. Grant Garcia: And obviously if you're exercising, you get a massive glucose low from your exercise, you don't want to, you know, skip a meal then, and then have an issue later on. I mean, the way your body metabolizes fat, I think it's always hard people to understand. But understanding that it's not just about, The diet.

Dr. Grant Garcia: It's about everything and it's all essential. And I think the problem is if you're, if you're hy, our bodies can only, our minds can only process [00:28:00] so much. So if we're hyper-focused on one of those, those things I call the square we're missing on the other things. You have to be kind of cognizant and you gotta sacrifice.

Dr. Grant Garcia: Okay, I'm not gonna be perfect on diet now, you know? The rock always talks about cheat days. You know, it's okay to let your body, let yourself have some not so great foods every once in a while, but it's also great. It's okay to not get perfect sleep all the time, but you just don't wanna make it a habit.

Will Sanchez: Yeah, so I guess the Rock was watching me yesterday as I had a nice margarita slice of pizza. So don't, don't tell anyone. But yeah, it was delicious. But, you know, going back to your point, I had a slice of pizza. I didn't have three or four, like, you know, which is easy to do. So in, in moderation real quick, I, I, I feel like we could do, I dunno, two hours on this thing.

Will Sanchez: So I'm just trying to move it along a little bit for anyone that's trying to say, hey, I've been outta shape. I kind of wanna get back in shape. I know personally I can't do it, and so I'm gonna go look to go somewhere, try to get some training, go to a [00:29:00] facility. I'm not sure. There's a million different ones.

Will Sanchez: Everyone's saying the same thing. Is there one thing, maybe two things to focus on. If you're going to go to a place to try to, you know, get back in shape, you know, that you should recognize and say if they do this, or if this is there a part of their training, then that's a good sign for you to go there.

Will Sanchez: Is there anything that stands out for you?

Dr. Grant Garcia: Well, I think you gotta go in and I, I hate to jump back to that, but I think you gotta go in with the regimen of, I'm gonna do my best and not hurt myself. Right? Because if you're outta shape, We saw this so much, so many times during the pandemic. People didn't work out at a gym for two months.

Dr. Grant Garcia: Two years, and they come back and they get hurt and then I see them in the office. So going in, if you've been outta shape, is to focus on the things that you can do well first, making sure you're, you know, you're stretching, you're doing all your adequate thing that's not gonna burn fat, but that's gonna protect you from getting injured.

Dr. Grant Garcia: Cuz as soon as you get injured, you're back to where you were. Yep. And. The one thing that's really people don't [00:30:00] understand is, I think if you go to these gyms, you get a lot of people lifting weights and they, the, the people that are lifting the weights are usually people that look like they lift a lot of weights, right?

Dr. Grant Garcia: And then you see the people on the cardio machines trying to burn fat. But what people don't understand is that actually weightlifting is more fat burning than cardio. Yeah. And so really the focus should be on weights, especially pay for people as they're trying to gain muscle mass. But it's, again, it's cross-training.

Dr. Grant Garcia: And that's what you had mentioned before with talking about Dean. You know, cross training is essential and so I do this workout all the time. I do, you know, hit exercises, but then I'll mix it up and do con cardio and really focus on weights to try to keep the tone and try to burn that fat cuz you know that extra effort you're doing.

Dr. Grant Garcia: So don't skip on different areas in the gym or in with a trainer. And you'll see a lot of the trainers focus mostly on the weights. And the reason being is that's where they can give you the most value. It's really not helpful to have someone tell you to run on the treadmill. You know, that doesn't really add a lot of skillset but also mix up the machines.

Dr. Grant Garcia: There's so many different options and so just constantly keep [00:31:00] the body guessing. I know that's kind of some jokes they have running and keep the body guessing, but it really is essential. And that's the same thing we're talking about with all these athletes. They're constantly keeping their body guessing.

Dr. Grant Garcia: Yeah. So when one part gets tired, they focus on something else.

Will Sanchez: And, and just to put it out there and you know, I, I, everybody kind of knows this, but the reality is it doesn't matter when you start, right? So if you're 30, 40, 50 I've worked at a local gym here with kettlebell training and I've.

Will Sanchez: Seen people come in 60 seventies and even 80. And you know, and they move a little bit of weight and they're doing you know, weight training, doing different things. And if you watch 'em for six months, you watch 'em for a year, they're moving around and it's just, it's beautiful to see. And it's inspiring.

Will Sanchez: And the reason I say it is just like, Don't get stuck like, this is what I've been doing. It doesn't matter, you know, start today, get out, go for a little walk, or whatever the case may be. Anyway, that's my spiel [00:32:00] there. Anything coming up as far as, you know, there's so much right, you know, whether it's advancing cartilage and we've talked about internal brace and things like that.

Will Sanchez: Is there anything out there out of the million things that we can discuss that stands out for you, especially with the agent athlete?

Dr. Grant Garcia: So I think from an orthopedic standpoint, you know, we talked a lot about the things that do prevent injury, but it's gonna happen and sometimes it unfortunately happens when you don't want it to.

Dr. Grant Garcia: Mm-hmm. Is to understand that there are solutions and like we've said before, get other opinions. This is the most common area I see as we get to these. Arthritis or early arthritis issues, there are less and less physicians, even orthopedic surgeon, that feel comfortable with cartilage restoration or getting athletes back at that age.

Dr. Grant Garcia: Hmm. The number of patients are surprised when I tell them I have a surgery that I'm gonna do for you and I'm not gonna restrict you afterwards because my number one goal is not to replace the joint. My number one goal is to save a joint, and so you need to make sure you shop around for the right people.

Dr. Grant Garcia: Again, it's not always the [00:33:00] right. Solution for everyone. Yep. But knowing that there are advances out there, you know, you should be given multiple options. And you're, as you're younger and things that we're willing to do are more sort of, Risque or so more cutting edge as you're younger because you're just not eligible for a near place.

Dr. Grant Garcia: I mean, especially when you're below 50, 55. So there's other things that we do now. I mean, I, like I, I said before, I just, I was at a, a big national meeting teaching newer techniques to save the acl. You know, we didn't do this a few years ago. We had no technology for it. You know, people, half the surgeons there that were learning about this were blown away that we have this technology.

Dr. Grant Garcia: Wow. And so, and just, I just basically did a, I did a course teaching about cartilage restoration and how we can save the knee. And so there's all these things that I can do as a surgeon, and there's other surgeons out there as well that have these opportunities. You just need to know this. And, and the goal of my procedures, you know, is always, patients always go well, I'm not I'm not in that much pain normally.

Dr. Grant Garcia: Okay, that's fine. But can you do the sports that you want to do? And they say, no, I'm [00:34:00] unhappy. And that's why they're in the office. And I tell them, and then will, you've probably heard me say this before, I do not do surgeries for the most part, so you can just walk down the hallway. Yeah. You know that's not why you'd spend all the time doing this.

Dr. Grant Garcia: This is so you can get back to the activities you want to do. Does that mean you're gonna get back every time? No. But does that mean that we're gonna do our best and we've had good results? Yes. I mean, you've seen it on the website, you've heard about these testimonials. You know, patients do well if done for the right reason, but it, it's important for the patients to understand that there are solutions and there are ways we can avoid knee replacement with injections, cartilage restoration, and there is cutting edge.

Dr. Grant Garcia: I mean, even the next year, I'm gonna add three more cartilage options. Probably to my repertoire with the newer technology coming out. So, you know, there's just so many different things and this is really the future. Of like you heard, a can we, can we prevent these joints from happening? And if we can't, can we get them back with surgical procedures that are less invasive or faster recovery?

Dr. Grant Garcia: You know, you've heard about the Reeb list, which we're gonna talk about next week on a [00:35:00] webinar. While we take these complex knee patients and get them back for rehab. We are, we are hitting this from all angles. The pre, the, during the post. The recovery, the rehab, the long-term man monitoring with these wearable technologies and you name it.

Dr. Grant Garcia: So our goal is to continue to keep these athletes going and if something happens to you, come right back. We'll figure out a solution. That's the key.

Will Sanchez: That is the key. And that's that's perfect. Hey, listen to your body, right. Hey, listen to your body. Get out there. Keep moving. Don't be afraid of getting injured.

Will Sanchez: You know, obviously be safe and smart, but it'll be beneficial for you in the long run to move, you know, to whether it's the, the, to hinge, to squat, to just get outta bed, right? If you don't move, you know, as you get older, those things are gonna become more difficult. Dr. Garcia, I think we're going to wrap it up.

Will Sanchez: What do you think?

Dr. Grant Garcia: I think we talk all night on this, but it's probably gonna be tiring for our listeners to lis listen for the next two hours. So here's what I'll tell everybody. If you have [00:36:00] any, if you want any of these topics in more depth, please reach out to us on the gmail sports.talk podcast gmail.com or head out the, it's a really great website@wwwsports.talk uh.com.

Dr. Grant Garcia: There's a great. Way to fill out a referral and ask about what type of episode you want or if you want more information, we're happy to jump on this and then listen to different websites and learn about this, cuz there's lots of information.

Will Sanchez: I love it. And you know, you, you're so close, Sue, wrapping up the show, but, but in honor of the Kraken making the playoffs and because of the topic.

Will Sanchez: All right. Who was the oldest hockey player to play in the N H L?

Dr. Grant Garcia: Oh my gosh. I don't even think I could get, I don't even think I can get close

Will Sanchez: Gordy. How He's not even close. He played to. 52 [00:37:00] years old, one of the greatest hockey players to ever play for the Detroit Red Wings. And he also played with the Hartford Whalers. He played 26 seasons. So if he could go out there and play 52 years years old, that's amazing.

Will Sanchez: If he could play in the NHL until from 46 to 1980, if he could play that entire time where it was, I mean, he, he didn't even have a helmet when he started. And got hit and took the punishment and kept his body in shape and did what he did, you could go out there. So that was my little trivia, honoring our hockey playoffs and also our aging show.

Will Sanchez: Dr. Garcia, thank you for playing. Appreciate it. It's good to talk to you. Check him out. Grant garcia md.com. He's our orthopedic surgeon at Sports Medicine Specialist. Good job, buddy. Thanks for having me. Hey, we'd like to thank everyone out there listening. We [00:38:00] appreciate it. Keep the questions, the comments, and the suggestions coming in.

Will Sanchez: Thank you very much. Audio Transcript

We are gonna get into that little bit, but really our show is gonna be talking about a little bit about a baseball, but pretty much some of the new rules and some of the new challenges that some of the doctors and some of these players may be facing first. And for. , Dr. Garcia. Welcome. And what kind of, fan are you?

Who's your favorite team when it comes to baseball? Well, you know, I'm, well, I live in Seattle and I know [00:01:00] that Mariners are true to heart for a lot of us. , you know, we're in New York as I know you are too, , with football, and I am. My dad grew up being a Yankees fan and my grandfather, my dad always told my sister, she said, I hope you bring home someone that's a Yankees fan.

That's what she told to her. So we are Yankees fans. , so I root for the Yankees for the most part. So how, how unusual it is that. We're both Giants fans, we're both Yankee fans. So let's go Yankees. Let's get ready to go. I've already got my ticket for one of the games when they come out here. I believe it's in May.

I think they're coming out here really early this year. Oh, okay. So, , I've got one of my tickets already, , for, for the family cuz we have to at least show up to one of the games. So we are really excited and what's really exciting about this year is that it's probably the most. Excited. I've been about a season that doesn't include wins and losses for the team I love, but for the overall game, right.

And we go back to the strike [00:02:00] season when Sosa McGuire came back and really kind of saved baseball. And I know, , when it talks about steroid use and everything else, you know, people tend to forget that these two individuals really saved baseball in the summer of baseball, which, Absolutely incredible, and I'm excited about this season on that same level because of some of the different changes, whether it's the speed of the game, , that's something that's happening now because now we have a pitch count and just to kind of, , inform our listeners if they're not baseball fans or not, know exactly what that means.

There's now a countdown, so it counts down from 30 seconds between batters. So after a batter 32nd clock comes on, starts to count. In between pit , pitches to that batter, it will be 15 seconds with nobody on in 20 seconds if there's a bass runner and then the pitcher must start its delivery before the clock expires.

The batter has to get in the in the box by a certain time. I don't wanna go through all the minutiae of these, [00:03:00] you know, all the rules, but. The, the point of context here is the game is going to speed up, right? And in the minors, they tested us and it's sped up by about 25 minutes. So they're trying to shorten the game with the, with, , the, the span of everyone's, or lack of span of, for some of the people that go to these games, it should be a little bit shorter.

So is this something that's excited for you, exciting for you with these new rules that you're looking forward to this? So, you know, as a surgeon, I've got a fairly short attention span. So for me, I'm looking forward to these shortened rules. I've always, I love baseball. I love watching baseball. , I love, you know, taking pair of baseball players.

I, I love everything about baseball, but the, the speed of the game is challenging. When you, you know, go straight from football to baseball season, , and you know, football to speed with the clock count, , or, you know, my new favorite sport is hockey since I, I'm actually a big Kraken fan now. [00:04:00] Okay. , so it's just different to watch, , the speed of those games versus baseball.

So it's nice to see a little bit of integration. I'm sure there's comments. Is people have issues all over the board with different things in terms of, you know, this is not going away from the original way the baseball was played. , but I think it's good to have sort of, it sped up in the game it is now because sometimes these games can go really long, you know, like four or five hours extra earnings, et cetera.

And having this sort of account, I think will, will change things up and make it a different strategy in the. I, I agree. And, , it, it should be really exciting and you know, we're talking about being a Yankee fan, especially the old Yankees Red Sox games. There you go. You're going four pla plus hours. And we're lucky enough that we live on the west coast, and I say if you are a sports fan and you live on the West coast, It's just absolutely beautiful because the games end early.

Mm-hmm. But on the east coast, like the national, , championship for basketball is happening and they're starting at nine [00:05:00] 20 on the East Coast. So these games really go along, especially if you're a fan, and more importantly, if you have little ones and you want to take him to the game, even if it's not that little, you know?

But they've got school the next day starting the game, so. Going home and getting home at 11, 11 30, midnight is a big deal. Anyway, we're not gonna get into all that. That could be a different show. If people want to talk sports, we're here for that because we are sports fans. But we wanted to do this show and, and the reason was was how does the pitch clock affect certain pictures?

And when I first started thinking about this, I said, we've got pictures now. They throw in the high nineties, right? They, they hit triple digits, they throw a hundred, the grom, a bunch other pitchers, right? And they had the luxury of throwing that fastball, hitting 99, a hundred, 101, and then getting the ball back, walking around the mound, you know, getting themselves ready, you know, hitter or adjust themselves, , a minute later to throw in another.[00:06:00]

You don't have that luxury now. And I was thinking, what happens to the fatigue of these pictures, especially pictures that throw hard. So just off that, just off that basis, what is something that really kind of stands out when you think about a picture that throws so hard and is really, really getting ready to throw that pitch again?

15 seconds. Well, as we know, you know, the baseball pitch is one of the most looked after, analyzed, , movements in all of sports because it's such a high torque, high acceleration, high deceleration, , force. And we see a lot of injuries as a result. You know, some of us who do care, a lot of baseball players, you know, we see so many different Tommy John injuries or shoulder.

Due to baseball, and it's because of this sort of recoil and acceleration. So to hear that, you know you're gonna have players that can go in the high nineties to. Triple digits, which happens a lot more [00:07:00] now than it used to. , you know, that is a concern in my opinion. I think that what we'll see is that there's gonna be some adaption.

You know, these pitchers who either throw this hard are not gonna be able to go as long, , and, or they're gonna have to change their pitches up. So they're gonna have to have, they can't continually throw fastballs, , or stick with a high fastball, , repertoire. , but at the same point, you know, it's gonna be interesting to see because I, I think.

Most of the things we do in baseball are based off pitch count. Yeah. And when you're younger, now again, this is major leagues, but a lot of times it's like, okay, you hit a hundred pitches and there's certain ages that we go off of, , and that the little league pitch count. And so, and players themselves have all been tracked for pitch count too.

That's what, you know, the playoffs are a little different. Yeah. And so it'll be interesting to see if this changes that number. You know, the data. We need a few years to see what happens. I do hope we don't see an increase in reconstructions or Tommy John, , u c reconstructions as a result of this, cuz it's already sort of on the rise, , with all this other stuff.

So it'll be interesting to see. [00:08:00] In the next two years, you know, hopefully we're still doing this Sports Doc Talk podcast and we can talk about this episode and go back to it and say, has there been an increase in injuries as a result of the change in the game? Cause you know, there'll be, there'll be articles on this all over the place in the next year or two if you find out that data, you know.

and it's really interesting that, that you mentioned that because. The data, right? That was the key word that you just say there, you know, how much data is there. Mm-hmm. Right. So there's data in the minor leagues, but it's different in the majors. Right. , even though we think that that's, that's the next step.

But the reality is it's multiple steps for you to be, you know, a single, a aa, triple A pitcher that then be a consistent top notch or. Everyday player, pitcher, , in the major leagues. You, you are doing something that is very different. And this is the first year that we're doing it. And we talked about the fastball, right?

Cause that was just kind of the easy thing to think about. But what about what we've talked about in previous shows with our kids or young kids, [00:09:00] and these are an adults, but they're throwing, breaking pitches. What kind of fatigue or concerns you might have when it comes to the elbow muscles or ligaments where you're doing something, you know, you're putting that strain so quickly after, you know, you've thrown a pitch.

Well, I mean, I'm, I'm worried in the majors because of how hard they throw, but these, these players have been self-selected, right? They're already the ones that didn't get injured or they got injured and they recovered. Well, they're all giant. You know, you can tell a baseball player how good they are by a pitcher.

You know, if you stand, they stand up in the office in their above your head. You know, I'm not that tall. I'm about six one. , but you know, the ones you can tell these guys are very large and strong. And so their bodies have been self-selected to be these top players. , but when younger kids are growing, it's a big difference.

I mean, again, that, that speeded , that speed, , sort of in accelerated pitch count, , information or accelerated pitch count rule. [00:10:00] Caused some more injuries, but it might not change at all. And I'm sure that MLBs done, done information on in scene in the minors that didn't change anything or they wouldn't have gone ahead with it cause it's the last thing they wanna see.

but for little kids, this is concerning to me because until your growth plates close and for an adult male can be between 16, , around 16 years old, but it can be a little bit older. If you throw too hard, you can actually change the rotation of your. Which can be something that's a little bit concerning.

You can have sort of growth plate disturbances, , and for younger kids, I mean, I see, I've seen kids now with Tommy John injuries at 13, 11, 12, and we never used to see those. , and we're seeing a lot more at 15 as a result of pitching. And so now you have a, now you have this plus a faster count. And they have to more remove more rapidly.

it does concern me, but again, with Little League, you know, they're not doing the same psych out stuff that they do in the major leagues with sort of the way they trot around and do the different things. So it's, it's part of a show as well. So it's, it's twofold, but I, I do worry that there's a chance we see with the [00:11:00] younger ones, I think the younger kids are way more susceptible injury than the adult picture.

You talk about shoulder fatigue, what are some of the, , key shoulder injuries that you'll see in whether it's a pitcher or that type of movement, whether it's baseball or something else that will impact that shoulder? So with people with mostly the ones I see, they're usually in their 15 and above. And so most of their growth plates are completed.

So if their growth plates are closed, for the most part, and number one thing is slap years. And that's a lot of. What I see in the office doesn't always need surgery, but I see a lot of slap tears and BA and high level baseball players. I probably just saw few last week, for instance. So that's one thing we see.

The other one you see is rotator cuff strains. Occasionally you see a rotator cuff tear and then bicep symptoms. , but the number one thing is a SLAP injury, , which means you, there's a tear of the top part of the labrum. , the thing is you don't need surgery. And we looked at Yankees players and we looked at the Mets and everything else, and we took care of them.

you see these in players as a result of, in [00:12:00] order to peel your arm back, you know, when you throw a baseball, you don't, you're not normally built to throw a baseball like that. Your arm goes back a certain amount. It's called external rotation. And as you learn to pitch better, you can, you find a way to get your arm out.

Externally rotate more, so therefore you can speed up your velocity. Yeah. And that's how some players get fa throw ba the ball faster, but as a result, your body's not used to that. So you peel off the labrum so that you can get your arm back farther. And then sometimes it become symptomatic. And that's called the slap tear.

I'm gonna stay with that area, right, because I'm trying to think about the arm and, and before we work our way down, I'm just gonna kind of work your way back. Would you see a back injury or somewhere along their line? Can it be, you know, anywhere it's a, a disc or a strain or something like that from, , having this, this momentum, this force as being conjured up by, by throwing a baseball like this.

You could, I mean, you heard of players with spasms, but that's [00:13:00] generally in the older kid age category. Mm-hmm. Gotcha. I don't see too many back injuries from pitching. , you see a lot more from football, et cetera, , or with, you know, like Ben Simmons with obviously the basketball, , but the, , not as much, , in the pitchers with the back, you know, you have that shoulder gerd.

Also a lot of scap. , so that's the scap is the bone, , where the socket connects in and that's where your wing bone, where people see the winging thing on the, on the back. And so pitchers get a lot of sort of, we call dyskinesis or the scapula doesn't move appropriately. And as a result, your pitching's all thrown off.

Because remember, when you lift your arm up, your arm only goes so high, then you have to use your scapula to get the rest of the way. Yeah, because your scapula is like sort of locked in or not moving appropriately. When you throw, you're not gonna throw. Well, so the thing is people always think, oh, your shoulder, you.

The main part of the throwing arm, it's way more than that. You know, there's, they use all these little sensors on people's shoulders and these baseball players to look at the mechanics of them. And we've done those in, , studies that I've been in, , a part of as well, to sort of find the biomechanics.

But it's the entire body. It's not just an [00:14:00] isolated part. If you are working with, , let's say the Mariners, right? And I know you have experience with the White Sox and, and you know, so on and so forth with all of that, , what is something that you may or you think that has been discussed, , in the room saying, okay, We have to look out for X, Y, and Z with our pitchers on the mound throwing, you know, every 15 seconds.

What, what do you think is something that might be in the, that conversation with the team doctors looking at their pitchers, not only F from game to game, but throughout the season? Well, I mean, the first thing they're gonna do is stringently watch. You know, if they start losing velocity, you have a picture that's routinely hit, throwing 95, 96 miles an hour and starts going to 93, 92, , at a much earlier stage.

You know, you, you guys would, you'd be shocked at how much da Well, you, you're a data man, so you know, but basically you'd be shocked how much data out there is out there. I mean, we basically write papers on papers. [00:15:00] That data that's com commercially available for anybody and it's free. , , and you can go on the websites and look this up, but you can see, you know, how someone pitch counts, changes and they have even more, , , impressive data behind the scenes of these of these players.

And each one can have pitch counts and it's all tracked. , so they're, you know, they're really doing a good job of trying to make sure they're watching them for. Obviously that's the number of pitches they're throwing, you know, curve balls, breaking balls, , et cetera. , but really at that speed that people are worried about, they start losing speed and losing accuracy.

that's when we say, okay, it's time for them to be pulled out, and we're watching that. And you can also see people drop their arm, certain fatigue movements. Now the high level players are pretty good. They have really good mechanics. Yeah. But no matter what you, what it is you've seen in football, you've seen in any of these sports, no matter what type athlete, athlete, you.

You still can get fatigued. And so as a result, you're watching for those signs, body movement and then the speed and then the control. Can you have some injuries from, from this? , we talked about the shoulder, obviously we talked about elbow u UCL, you know, [00:16:00] Tommy John, things like that. I'm assuming the forearm, but the hand and wrist.

how does that affect, is there anything that you know, can come. , come of this from having an injury from, you know, having this torque and, repeating this motion, so quickly. Is there something that you would look out for the hand and wrists as well? So you, you get a little, you get less hand injuries from baseball, but there you do get hand injuries usually from the baseball hitting.

So, you know, yeah. Someone gets grabs, tries to grab the ball or jams their finger or breaks their finger or sliding, you know, , into, , the plate. , so that's usually where the hand injuries come from. There's less injuries, cuz again, most of the torque you're generating is actually in your elbow, which is why the elbow is so focal.

It's also focal cause it's. Devastating of all the injuries for pitchers and pitchers are essentially the quarterback of the team. And so when a pitcher goes down, it's a big deal. Right? You know, you obviously every player's important on there, but yeah, when the pitcher is out [00:17:00] for that, that's a, that gets focal.

It's just like if a quarterback gets hurt, everybody knows about it. We know these guys train like, like there's no tomorrow. But do you think that training, and, you know, this is a tough, question to answer because it, there's such a big area, but do you think training is going to change the, do you think there's gonna be anything that, , doctors start to do with maybe their pictures or pre preventative training to help reduce injuries or in order for you to, , withstand the rigors of such a long season?

Oh, you, you can believe it. I bet they've been doing it already. You know, everyone's looking for the edge. Every single ma league baseball, whenever you work with a company. So we talked about this on the napkin innovation episode. We had two, , Two or 3, 3, 2 months ago or so. Yeah. But basically, you know, when we see new to new technology, the very first thing that technology tells us is we've already, we've already have it in all the major league baseball centers.

And so they always show the new technology to these guys, get them on board. [00:18:00] To use it to see if it works with their athletes for the most part, as long as it's safe. And wearables are a huge aspect of this. Yeah. So, you know, there's different sleeves that can track the counts. There's different baseballs, there's different other movements that, that track all the mechanics of the players.

And you, you know, they're practicing this, , during their practices and you know that they practice this, you know, they're practicing in times and you're not even thinking about it. And so they're, they're prepping for this already. , They had the whole season, you know, sort of to discuss this and seeing what's happened in the minor leagues.

You can tell they already had scouts out there doing this. So what we think they might or might not know, they're already way ahead and they've been preparing for this. You know, were the pitchers preparing for it with their standard routine? Maybe, maybe not. Yeah. , but they're also gonna adapt. Right.

You know, you've seen as soon as someone has something new way of beating the system here, they're all gonna catch on very quickly. , cause this is only a matter of. So, , Dr. Grant Garcia as a goodie bag would consist of, , wearables data, , and training. What, what, [00:19:00] what else is in that goodie bag, you know, to make sure that your guys are still, , ready to go.

Big bags of ice. They're always the, the, , baseball players, you know, you see 'em come in after the White Sox, , and they're, you know, wrapped with ice all over their body. It's just sort of, It works well. I love ice. You know, I've been injured before and I've had to use ice. It's, it works amazing. It's the, it's the cheapest, easiest thing you can do and it doesn't injure you.

but, you know, these guys are loaded with ice and wrap, , as soon as they leave, , the stadium and come, go to the locker room. , so that, you know, that's one thing you wanna put in your goodie bag too, but obviously you gotta keep it in the freezer, so that's a little bit challenging. But I think, you know, the wearables are really important, like you mentioned, , and then sort of any supplementation.

And then you're also testing sort of, you know, all their vitamins and minerals and making sure their sweat counts and they have all these different things to try to find, get these app athletes at maximum ability. And also depends on the weather too. Yeah, that's a good point. I didn't even think about the weather, how it plays a part, especially.

Early in the [00:20:00] season in, , some of these cold weather states. , and how that affects, let's just talk about it real quick since you mentioned it. How does cold weather compare to, if you're playing in, Minnesota and, instead of, , you know, Miami or something like that. How does the weather play a part?

Is it, is it a positive or negative if it's, a certain temperature. Well, I think, you know, when the low temperatures, you're concern about some tightness, right? Spasms, , you know, the arm may be warmed up, but the rest of the body may not be right. So you could have other injuries or your mechanics may be slightly off.

You know, again, a lot of these players practice in these conditions. But then again, where's most of the training? Spring trainings in warm weather climates. And so they're, they're still really adapted to this type of weather Now, A lot of the stadiums are covered, et cetera, and when you start actually playing, you know, your by temperature raises significantly.

I worry more about the extreme heat because that's when you can get fatigued. Mm-hmm. You can be dehydrated, you know, again, [00:21:00] these are professional athletes, you know, they'll only hydrate so much. You know, you have to. You know, you see them in the dugout, they're having a good time. , they're trying to have their best to try to enjoy the game.

you know, you have certain pictures that are a different animal like Verlander that probably, you know, doesn't speak and just sort of has everything that's teed up perfectly. Yeah. But that's not the way everybody is. So basically, you know, that's when you worry about hydration. Are they properly, are they properly, , setting themselves up to get it through the game because you have high temperatures, faster pitch.

You know, that's when, that's when sweat and other electrolytes are really important in understanding what the body's doing. And that's probably where they get into some of these sort of wearables. You can test the sweat, those different things. And I'm sure there, there's things that I've even heard of or seen, , that I'm sure these players are using to try to get an edge and keep themselves on top.

It'll be an exciting season. I'm looking forward to it. I'll play doctor on my couch looking for, , a, a drop in miles per hour, maybe, the ball not snapping so hard on a curve ball, and [00:22:00] I'll sit there and point to no one and say, look, he's getting fatigued. There's something going on. So I'll play Doctor on the couch as you play real Doctor in the real world.

let's talk about baseball predictions this season. Let's hear it. Who is coming out of the National League for you? What team are you picking? Hmm. You know how to do it right? I, we had to go do this, right? I know you always do this. Yeah. What you got? Come on, let's pick it. Who's your team? I'd say, you know, I don't know.

It. Maybe I would say Houston. All right. So Houston's an American league, but we'll take Houston. Right? So you think Houston will be back in the World Series and about the National League? Who do you think, let's see, I'm thinking. Dodgers. All right. That's a good one. All right. I, I'm gonna go with the Braves, even though I think San Diego is gonna give, , play really well.

I would love to say the Yankees, but I still think that the [00:23:00] Astros have, , slightly better team. But we'll see. There's so much baseball and these obviously predictions sure to go wrong. So please don't hold us to it or not do do, so we'll talk about it. , and you know what? I forgot. There's one more thing before we go and I just wanted to bring it up.

Oh, all right. Here we go. Since we're in Seattle and we're, , we're in Mariner country, we're gonna do a little trivia, and if the Mariners wanna be successful this year, they're gonna be led by their Skipper Scott's service, who was the last American League manager of the year for the Mariners. Can you pick who that coach was?

Lou Pinella. Lou Pinella, what? In 1999. In 2001. He's the only American League manager of the year for the Seattle Mariners. That answer is correct. That's unbelievable. I got that right. I never did it. Right. That's great. That is wonderful. I wanted to tie it into some Yankee [00:24:00] way. Also, I noticed Seattle Romero is fan fans to say, what are you talking about?

Yeah. Lou Pinella was in New York. Yankee, he played for the Yankees. Mm-hmm. But you know, we don't get everybody's, , Feathers ruffle. Listen, thank you for taking a little bit of time so we can talk about this show, talk a little baseball, and more importantly talk about some of the things that all of us are gonna be looking forward to, because there's so many new rules, so many different changes, whether it's, , banning the shift and, you know, getting in the box right away.

With the, the pitch, , clock and, runner of second base and so many different rules. We're really excited about this season. I hope everyone gets out to the ballpark with your friends and family. Have a good, , good time. Get your, peanuts, cracker jacks, and, you know, get your, , cold beverage and try to have some fun.

This. Summer to me, baseball is a sign that summer is around the corner and it's almost here. So we get some blue skies, some nice sun rays, and spend a lot of time outdoors. So, , I hope you're excited [00:25:00] about Summer as I am, Dr. Garcia. I'm very excited about Summer, excited about the, , the new season.

Excited about this podcast and make sure you guys, , subscribe to us. We have a brand new website, , ww SportsDocTalk.com, which has a lot of information you can learn about Will Sanchez and myself. , plus, you know, subscribe to any of the networks you want to. We're on all the major, , podcast centers and I am excited to announce we have our first listener episode coming up next.

we have a good friend that asked to learn. , how to keep our athletes who are aging back in the game, , and from a former Ironman, what does it take? And so that'll be our next episode. So everybody looking forward to doing that in the next month or so. And there's a lot more coming up. We've had a lot of requests for different things, so we're really excited.

Yeah, and please keep the request coming on. , we always put some polls in Q&A and feel free to reach out to us , in the many different forums and put in your request. [00:26:00] We want to hear about this and hear about that. So just a reminder, thank you very much for listening. Sports doc talk, all sports, all orthopedics all the time.

I'm Will Sanchez, that's Dr. Grant Garcia. Check him out. GrantGarciamd.com. He's our orthopedic surgeon in Sports Medicine specialist. Thank you for listening to the show, Dr. Garcia. Thank you for being with us and taking some time today. Thank you for having me. Take care. Audio Transcript