#ICMYI - Sports Injuries and Recovery

In case you missed this episode on the Playing with Science channel… Hosts Gary O’Reilly and Chuck Nice investigate the world of sports injuries and the future of recovery science alongside New York Mets and New York Rangers physician Dr. Joshua Dines and sports psychologist Dr. Jim Taylor. Photo Credit: Bidgee [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:09Gary O'Reilly?

  I'm Gary O'Reilly.

• 0:10Chuck Nice?

  And I'm Chuck Nice.

• 0:11Gary O'Reilly?

  And this is Playing with Science. Today's show focuses on the obvious. Whether you just play or compete in sports, you are going to get injured. And to some of you and some of us, it's nothing more than an occupational hazard.

• 0:27Chuck Nice?

  Yes, and revealing the cutting-edge procedures in the play of the operating room is leading orthopedic surgeon Dr. Joshua Dines, who works with the Mets and the Rangers as well as others.

• 0:39Gary O'Reilly?

  And but to heal the body, you have to heal the mind. And sports psychologist Dr. Jim Taylor will show us how in rehab and in recovery, you can do exactly that. But first, let's get to the man who does all of the heavy lifting.

• 0:56Chuck Nice?

  Yes.

• 0:57Gary O'Reilly?

  Joshua Dines. Before we say hello, doctor, let me just put everything out. The orthopedic surgeon who specializes in sports medicine and the particular shoulder injury.

• 1:05Chuck Nice?

  Yes.

• 1:06Gary O'Reilly?

  Has been featured in New York Magazine's Best Doctors issue and Castle Connolly's Top Doctors in America. We've got the right guy, Chuck.

• 1:14Chuck Nice?

  Yes, we did.

• 1:15Gary O'Reilly?

  Right. Associate team physician for the New York Mets, assistant team orthopedist for the New York Rangers, and he's gone bi-coastal and a consultant for the LA Dodgers. Dr. Joshua Dines, welcome to Playing with Science, sir.

• 1:27Speaker 02

  Thank you. Thanks for having me, guys.

• 1:29Gary O'Reilly?

  You're welcome.

• 1:30Chuck Nice?

  Completely unrelated, um, medical question. Of all these sports teams, do you have a favorite sports team?

• 1:37Speaker 02

  I, uh, yeah, clearly the team, you know, the Mets and the Rangers are up there. And then I've got nothing to do with them, but the Giants are probably my favorite team.

• 1:45Chuck Nice?

  Okay, okay, just wondering, just wondering.

• 1:47Speaker 02

  Yep.

• 1:48Gary O'Reilly?

  And if Chuck starts booing at you during this particular interview, you'll hear his inner Eagles fan expressing himself, that's all.

• 1:54Speaker 02

  Either of them are looking great.

• 1:55Chuck Nice?

  The Mets, yeah. Exactly. Oh, nice play. We can both taste the salt of each other's tears this season.

• 2:02Speaker 02

  Not looking good.

• 2:05Chuck Nice?

  Not looking good at all.

• 2:06Gary O'Reilly?

  All righty, okay, so, um... What are the most common injuries in sports, say, from thirty years ago until the present day that you would see time after time after time?

• 2:20Speaker 02

  I think a lot of it depends on the sport we're talking about, but the most common sports injuries, you know, that I see, your shoulder and knee are the two most common when you break it down by body part, and when you get a little more granular, the shoulder, a lot of shoulder dislocations, we see that in football all the time, hockey, so shoulder instability would be, you know, very high on the list. With regards to the knee, ACL tears, clearly, you know, as an Eagles fan, you can relate to Carson Wentz.

• 2:50Gary O'Reilly?

  Absolutely.

• 2:51Speaker 02

  You know, meniscus tears, ACL tears are very common in the knee, and now those are the surgical issues, that, you know, athletes, whether it's weekend warriors or professional athletes, they have a lot more sort of minor things that come and go, you know, tendonitis type things, little tweaks, sprains that are more common, but with regards to what I see as a surgeon, it's really the more, you know, when the injuries get more severe, and that tends to be the shoulder instability and the ACL tears.

• 3:19Chuck Nice?

  Wow, so, you know, when you look at these, the injuries that you just mentioned, which have been common forever, you know, and I think it's, I guess it's the way, it's the way those joints are designed, they're, it makes it very difficult not to injure them when you look at the way and the level that we play sports today. With that in mind, they used to be career-ending injuries.

• 3:46Gary O'Reilly?

  Yeah.

• 3:47Chuck Nice?

  Whereas now, like you said, Carson Wentz, here's a guy, tears his ACL, comes back six months later, starting lineup, he's not a hundred percent, it doesn't look to me, but that's because I'm a fan, but there were, years ago, that would have been the end of an injury, what, an end of a career, what has happened in the industry, what advances have happened to make it so that you can stitch these guys back together and get them back out on the field the way it's happening now?

• 4:19Speaker 02

  It's a great question. I think, you know, the first part you mentioned is that, look, these injuries are going to happen. We're playing contact sports, playing more sports. So you're not, obviously we want to try to prevent them and we've gotten better about that in terms of making sure people are ready for play, in terms of being more sophisticated about measuring muscle strength and balance. But these injuries are going to happen and when they do happen, an ACL tear, for instance, used to be almost a week-long procedure in the sense of you'd be in the hospital for a week. So the surgery would take a few hours, it'd be done through a really big incision. Right. They put you in a cast and you'd literally be laid up in the hospital for five weeks, I'm sorry, five days. Now, it's a 45-minute procedure, the people go home later that day, they're starting to bend the knee that night and the next day. So, you know, so the recovery's much quicker. Wow.

• 5:04Speaker 02

  They develop a lot less scar tissue and that really is predicated on, you know, our anatomy knowledge is better now, but also our surgical techniques have improved. So, most things that used to be done through big incisions are now done arthroscopically through small poke holes in the skin, using a camera to help us, and that's really been the kind of the game changer. So, the advent of arthroscopic surgery has really taken these career-ending injuries, or injuries that would take sometimes multiple years to get back, and made them almost, you know, sort of commonplace that you're going to get back with, you know, in the same, you know, the next season.

• 5:35Gary O'Reilly?

  See, I can relate to what you've just described because I had that.

• 5:38Chuck Nice?

  Did you have ACL or?

• 5:40Gary O'Reilly?

  No.

• 5:40Chuck Nice?

  Well, you have back surgery too, right?

• 5:42Gary O'Reilly?

  Yeah, well, that's spinal surgery is another thing.

• 5:44Chuck Nice?

  That's a whole different thing, huh?

• 5:45Gary O'Reilly?

  Because the technology, as you've just outlined, stopped the, well, look, let's open it up and stick ahead and have a look round. Because that, without being disrespectful to some fine surgeons, that was your only way. Before MRIs came along, before you got the CAT scans.

• 5:58Chuck Nice?

  Right.

• 5:58Gary O'Reilly?

  You had an X-ray. An X-ray doesn't really give you defined imaging.

• 6:01Chuck Nice?

  Soft tissue.

• 6:01Gary O'Reilly?

  Of soft tissue. So, the only way was get eyes on it, have a look. Now, I had an MCL reffing, a rebuilding.

• 6:09Chuck Nice?

  Okay.

• 6:09Gary O'Reilly?

  But both my cruciate knee ligaments were basically at an.

• 6:13Chuck Nice?

  Just gone.

• 6:13Gary O'Reilly?

  Yeah. But because I was isolated in a, in a plaster cast for three weeks, a month, they would then bring themselves to a good position and we could go from there. Eventually.

• 6:23Chuck Nice?

  Oh, wait a minute. Now, this is fascinating because that doesn't happen anymore. So, Doc, can you explain to the listener what, what happened to Gary and then kind of, I mean, we're off track here, but I don't care because I don't know anything about this. What you just said, I know nothing about and I'm totally fascinated now.

• 6:39Gary O'Reilly?

  Yeah.

• 6:39Chuck Nice?

  That you went through that process. And so, can you explain what, what, what happened to Gary and then what would be done today?

• 6:47Speaker 02

  Yeah, so I, I, and like you Chuck, I don't know much about it either because it was sort of before my time because we just don't do that. You know, that's kind of a relic, but we, you know, we used to think that, okay, put it in a cast, immobilize it, let the body kind of scar it back in and heal it back in. It'll do well. And the truth is, depending on what you're looking to get back to, if you're going to host a podcast, you're probably fine. If you're getting back on the field to the Eagles, it's a little more difficult because during that healing process, you're also building up scar tissue and these guys don't have a lot of margin for error when you're at the top of the game. You know, you've got to get them back to exactly where they were.

• 7:18Chuck Nice?

  Right.

• 7:18Speaker 02

  And that's where, you know, we've from doing basic science studies, MRIs, we've got a better understanding of how ligaments heal. And we also learned that, you know, immobilizing them completely is not a good thing. They need to see some load, they need to see some stress so that the body is kind of constantly remodeling it in the way that it's going to work. So we've gotten much more aggressive about mobilizing these injuries a lot more quickly, which has hopefully avoided a lot of the, you know, sort of complications that we used to see.

• 7:43Chuck Nice?

  Interesting.

• 7:44Gary O'Reilly?

  So the thing is, the worst thing about having a plaster cast from your toe to your hip.

• 7:48Chuck Nice?

  Oh my God.

• 7:49Gary O'Reilly?

  No, no, no, Chuck, you're going to love the worst bit, is the itch.

• 7:52Chuck Nice?

  Oh.

• 7:53Gary O'Reilly?

  And the only thing that's kind of be long enough and usable is a knitting needle.

• 7:58Chuck Nice?

  Oh my God, that's terrible.

• 8:00Gary O'Reilly?

  And if you want the definition of mental cruelty, it's the itch just beyond the length of the knitting needle. And you're like, and you can't do anything about it. So now, we, I mean, we learned, I learnt this through spinal surgery. You used to be isolated, flat, and then all of a sudden, within the first 24 hours, the mobility kicked in.

• 8:20Speaker 02

  Yep.

• 8:20Gary O'Reilly?

  It's interesting, they've taken that thinking and brought it into other areas of joints, et cetera, which, which have to by nature articulate and move.

• 8:30Speaker 02

  Yes, right. So you don't want to lose that. It's a balance between letting things heal, but also not letting them get too stiff because then you're not helping the athlete either.

• 8:37Chuck Nice?

  Absolutely. So now, let me ask you this, because there seems to be a, in the world of professional sports, there seems to be some variation where, for the recovery with respect to the same injury. For instance, let's take the ACL or let's take a meniscus, all right? So you see one player like back a lot sooner than another player, all right? Is there a standard protocol for the recovery, number one? And how much of that coming back to true form and being able to get back on the field is up to the player themselves?

• 9:14Speaker 02

  You know, that's a great question. You hit the nail on the head. I think it's multifactorial. First of all, and I deal with this all the time because, you know, when you read it in the paper that person had an ACL tear or meniscus tear, you're not always comparing apples and apples. We'd like things to be cut and dried that every ACL tear is the same.

• 9:30Gary O'Reilly?

  Yeah.

• 9:30Speaker 02

  But that might be the main injury, but there's also lots of little things that kind of go along with the ACL that some people may have some cartilage injury, some meniscus injury that really affects the outcome, but it gets kind of brushed over in the press when it was an ACL tear. That's the main issue. So that's what's discussed, but those have real implications with regards to the recovery. If you have to repair the meniscus versus cutting it out, that changes being on crutches for about six weeks. So you're not always, so I think what gets lost in the public a lot is really the, you know, the subtleties of what is involved in a given surgical procedure. And a lot of times that's not divulged by the team or the doctors. It's really kind of patient, doctor sort of privilege.

• 10:09Gary O'Reilly?

  Doctor, what you've described is that I had a meniscus tear. And as you know, and I'm telling you what you know, obviously not to be rude. It can be a tear within the integrity of the meniscus itself, or it can breach to the outer wall. And then the surgical procedure depending on that. I had something where it was an integral tear, so it didn't breach to the outside wall. So they sutured.

• 10:35Speaker 02

  Yep.

• 10:36Gary O'Reilly?

  Then that was fine. We thought this is good. And one day I was just walking. Pop. Oh, God. Oh.

• 10:42Speaker 02

  Yeah.

• 10:43Gary O'Reilly?

  And that, yeah.

• 10:45Speaker 02

  Yeah, your recovery for the suturing is great because you want to try to preserve the meniscus, but that's a six week recovery. Whereas if it was just kind of, you know, fraying of the outside, you clean it up and you're walking that night. So you know, all meniscuses aren't the same, all ACLs aren't the same. But Chuck, to your point, it also involves a player. Look, everybody's a little different. There's, you're going to have the sports psychologist on. You know, there's a mental aspect of getting back and trusting it. So there are so many different variables, starting with the surgery, but also the athletes there. Now, at the highest level, these teams all have great physical therapists and trainers, so there's not much variability there. But, you know, all of these play important roles in the recovery process.

• 11:21Chuck Nice?

  So now there's a big, all right, we're talking about these players. I hate to look at them like commodities. Sorry to objectify you.

• 11:29Gary O'Reilly?

  By the way, we are.

• 11:30Chuck Nice?

  Yeah.

• 11:30Gary O'Reilly?

  Or I was.

• 11:31Chuck Nice?

  I was gonna say, I don't want to objectify you, Gary, but you know, you're, you're a very fetching man and you're worth a lot of money to me and I'm.

• 11:40Gary O'Reilly?

  As long as I'm worth some money to somebody.

• 11:43Chuck Nice?

  But no, so Doc, here's the deal. You know, I'm a team coach, I'm a team GM or owner. I want to see my guy get back out there on the field because, you know, they're worth a lot to me and I also want to win. I'm a player and I also want to get back on the field because, you know, that's where I find my value. But what you see in return on the flip side of that is re-injury is a huge deal. You don't want to see somebody re-injure. So where is the balance and how do you, and what's the best way to avoid re-injury? And so for all of our weekend warriors are out there that may be listening, they probably have the same problem. I've seen guys do this, but they injure themselves playing on the court on the weekend.

• 12:24Chuck Nice?

  And they try to get back out there like a month later and boom, they're sitting down or lying down or back in the ambulance. So how do you handle that?

• 12:31Speaker 02

  I think it starts with the same for both professional athletes and weekend warriors. And that really centers on patient education. And you know, setting the appropriate expectations in terms of what's the expected timeline until they are back at full strength. But also really being involved in the recovery because not, as we just alluded to, not everybody progresses at the same pace. So it's constantly checking in, make sure they're progressing as you would expect. Make sure they're meeting milestones as you would expect. And if they are, great. If they're not, then okay, then you're going to have to temper your timeline. And maybe do some things differently in physical therapy or, you know, focus on different areas of their recovery. But first and foremost, it centers on patient education and with the professional, it centers on, you know, educating the owners and the GMs as well so that they have a realistic expectation

• 13:14Speaker 02

  as to when the player should be back because you also don't want to set the player up for failure where you underestimate the time to the GM, then the player's not back and now they look like, you know, it makes the player look bad in their eyes. So, you know, if anything, it's probably better to overestimate and have them be pleasantly surprised than the reverse.

• 13:30Gary O'Reilly?

  How easy slash unbelievably difficult is it to have that GM conversation? Because the coaches. And I'll tell you this Chuck, the coach goes cold on the player.

• 13:41Chuck Nice?

  Right.

• 13:42Gary O'Reilly?

  Cause I can't have the player.

• 13:43Chuck Nice?

  Right.

• 13:44Gary O'Reilly?

  So therefore, he's a-

• 13:45Chuck Nice?

  You're dead to me!

• 13:46Gary O'Reilly?

  There you go. That is basically-

• 13:47Chuck Nice?

  You're dead to me, son!

• 13:48Gary O'Reilly?

  That is the sense of-

• 13:49Chuck Nice?

  Screw you, Dad! I'll do what I want! I'll be somebody one day, you'll see! I'm sorry, I was having a flashback, go on.

• 13:55Gary O'Reilly?

  No, no, that's fine. That is almost word for word, the conversation in the locker room, right?

• 13:59Speaker 02

  I've seen it six times. I've seen that six times.

• 14:02Gary O'Reilly?

  Oh, I've seen it personally. I've been on the other end, so-

• 14:06Chuck Nice?

  Man, that's cold-blooded.

• 14:07Gary O'Reilly?

  It is cold, and then you've got to deal with that. Yeah, we'll team hug afterwards. Um, but you have to deal with this level of expectation. And I can imagine the pressure on you is amazing. So, how have techniques, have they changed because of the sort of GM pressure?

• 14:28Chuck Nice?

  Now I wanna do something-

• 14:29Gary O'Reilly?

  That comes into the operating-

• 14:31Chuck Nice?

  Now I wanna do something really fun. I wanna role-play with the doctor. I wanna be, I wanna be the DM, and I want you to tell me that Gary is lost to me for the entire season. It is game one. He is my star striker, baby. Even though you didn't play striker, I know, but still, you're my star striker.

• 14:49Speaker 02

  That is a story.

• 14:50Chuck Nice?

  Right. I gotta build a story here, man. Okay? So Gary's lost to me for the season. You gotta have a conversation with me. How do you broach that conversation?

• 15:01Speaker 02

  I think, you know, it starts with having a good relationship with them, that they're trusting you, that you're thoughtful.

• 15:06Gary O'Reilly?

  Yeah.

• 15:07Speaker 02

  Um, and it's being honest. If you sugarcoat it, or try to kind of talk around it, set their expectations, you know, that he's gonna be back, then nobody wins. And then they don't trust you in the future. So you have to be, you know, it's a tough conversation.

• 15:19Chuck Nice?

  How do you start it?

• 15:20Speaker 02

  I didn't call this-

• 15:21Chuck Nice?

  So how do you start it? Okay, I'm gonna be the GM, okay? All right, Doc, here's the deal with respect to Gary. I'm trying to figure out a timetable for his return.

• 15:28Speaker 02

  Yeah, Chuck, I mean, I gotta be honest, we've examined him, we've looked at the MRI. I know it's frustrating for Gary, but with this injury, you're not gonna have him the rest of the season. This is a nine-month recovery, at the quickest, and maybe even a year.

• 15:42Chuck Nice?

  All right, so now, I gotta tell you, Doc, that doesn't really work for me. You know, I mean, we're looking at a season here, we have a chance to do something very significant. Uh, you know, and you're talking about nine months, that brings me into next season. What's he gonna look like to me next season?

• 15:57Speaker 02

  The problem is, look, if we rush him back, you've got him signed to a long-term deal. Then he's running the risk of re-injury and then you lose him for three years. We've got to be smart about this. It's early in the season. We'll find somebody, hopefully somebody, he's going to be a replaceable. We'll find somebody who can hopefully step up. You've got a great farm system. But, you know, it'd be foolish to look to him this year. But, you know, I'm optimistic that he'll be back for next year.

• 16:19Chuck Nice?

  Doc, you've left me no choice. I've got to go put on my cleats again and get back out there.

• 16:25Gary O'Reilly?

  That's a late entry for the Oscar nominations. All right, so that's how it goes. I mean, it is, doctor. I mean, it's, it's, it is basically that scenario gets played out over and over again. And the coach has to be cold. Because if he keeps looking over his shoulder at the guy in the stands or the guy in the treatment room, he's not focused on what's ahead of him. And what's ahead of him is another game, a whole season, or whatever the length and time is.

• 16:50Chuck Nice?

  What you have just told me is that I could never coach anything.

• 16:54Gary O'Reilly?

  No, no, no, don't do that to yourself.

• 16:55Chuck Nice?

  I couldn't do it. I could not look at somebody and say, hey, man, look, that's it. You're done. Um, have a great, have a great summer. And pretty much screw you because I got these other guys I got to deal with.

• 17:09Gary O'Reilly?

  Where do you see surgical procedures developing, progressing? Um, I mean, it's, I mean, every athlete wants the miracle cure, but that's, that's by the by. That's a wish that probably will never, ever happen. Where are we likely to be headed? And what is the thinking for surgical procedure at the moment in terms of the future?

• 17:34Speaker 02

  I think, you know, our techniques, as we discussed with ACLs earlier, they've really evolved. Um, and, or, you know, we've done a lot more stuff arthroscopically, small incisions. I think really the three things that are changing and really for the better, improving our outcomes and getting athletes back more reliably are, A, just more minimally invasive surgical techniques. With a better understanding of an individual patient's anatomy. So I think kind of tailoring the surgeries more to an individual, whether it's like patient-specific instrumentation, things of that nature, using our preoperative studies that you mentioned before, CT scans, MRIs, to kind of reproduce that given patient's anatomy as opposed to just sort of a one-size-fits-all approach. Then, you augment that with biologics. So, I'm sure you guys have heard, you know,

• 18:18Speaker 02

  everybody talks about stem cells and PRP and these biologic injections. It's still the Wild West. There's not great science behind them yet, but it's getting better. And I think, if you ask me kind of five years from now, we're gonna have a much more targeted approach with these biologics, so that to treat each person's injury a little more effectively. And then the final straw is just improving our rehab, being more scientific about, you know, assessing when an athlete can return to play, when they're ready to return to play. You put those three things together, and I think we're gonna really improve our outcomes and get athletes back more reliably.

• 18:48Chuck Nice?

  Wow, that's amazing. Especially the biologics, as you're talking about, have we gotten to a point where we're able to target specific areas with stem cells for rebuilding? So you would go in, you would do a small surgery, and then introduce that catalyst to rebuild that area? Is that what's happening?

• 19:07Speaker 02

  We're starting to, but right now, it's almost like a carpet bomb, where you're just injecting all these stem cells. I think as we, you know, as we get down the road, and we have a better understanding of the healing process, we'll be able to say, we're gonna put this one growth factor in at day two, and this one at day seven, and this one at day 10, because it's such a complex process that we're just starting to understand. And I think we'll continue to get more, you know, sort of scientific about it.

• 19:29Gary O'Reilly?

  I can imagine with, and we focused a lot on the ligament damage, that can and does happen within all sports, whether it be elite, or as you say, weekend warriors. There is a laxity in sort of breakdown, so the thing itself doesn't snap in two, but it becomes less strong, and therefore, are you able to rebuild, are you talking about being able to rebuild things like that, repair, tears quicker and stronger?

• 19:55Speaker 02

  Well, I think that, you know, that's the goal. Nobody would do that yet, you know, we don't trust it enough yet. But that's the goal. If you can kind of, you know, take a rubber band that's lost its elasticity and, you know, just repair it as opposed to using a new ligament or a new tendon to regrow it and augment it with biologics. If you could change the recovery time, even if they still need surgery, if you can cut that recovery time from an ACL from a year to six months, that becomes a huge, A, benefit to the player, but B, you mentioned earlier, look, it's a money issue for these teams as well.

• 20:22Chuck Nice?

  Yeah. And by the way, that sounds, that kind of sounds a little more like the fountain of youth, though. I think you'd end up, you know, you would end up extending the life of a player and what they're able to do for much longer periods of time if you were able to achieve something like that.

• 20:37Gary O'Reilly?

  So, I'll go back to the early 90s. One of my teammates got busted up badly with an ACL, soccer player. They came, from the UK, came here to California, and I believe, and this goes back to the sort of roots of the biologicals that we've just discussed with the doctor, they may well have put a dead man's or a dead person's Achilles tendon into...

• 21:02Speaker 02

  Yes.

• 21:03Gary O'Reilly?

  Yes. You see?

• 21:04Speaker 02

  Yes.

• 21:05Gary O'Reilly?

  So, if you follow on from that,

• 21:06Chuck Nice?

  Right.

• 21:07Gary O'Reilly?

  this is where the science and the thinking leads to, and then what goes beyond that will be incredible to us.

• 21:14Chuck Nice?

  Now, did their ankle die once they put the dead man's Achilles tendon?

• 21:19Speaker 02

  Yeah. That would be bad form. But now they're even going one step further using these grafts that they're growing in the lab, you know, kind of creating a biologic, so you're not taking it from a cadaver. But that's really kind of the, you know, the holy grail of making a fake ligament in a lab that you can plug in and it works from kind of time point zero.

• 21:36Chuck Nice?

  Wow, that is fascinating stuff, man. That is really, that is really extremely, that's just very exciting.

• 21:42Gary O'Reilly?

  See, sports injury, you think, I get hurt, I see someone like... Doctor Dines, I get into rehab, I go back and do my thing. What most people don't realize is, just like the elite organization in sports, it's always moving forward.

• 21:57Chuck Nice?

  Right.

• 21:57Gary O'Reilly?

  The thinking within medical science is always moving forward. And the demands of elite sports is in some way, and doctors agree or disagree on this, pushing, to a certain extent, a little bit of the thinking and the techniques that we are talking about right now.

• 22:13Chuck Nice?

  So do these techniques that happen, what you guys were just talking about, all these kind of, do they make their way to the regular public? I mean, is it kind of like race car driving, where you know, you see an advancement, then it happens in a regular stock car?

• 22:27Speaker 02

  Yeah, honestly, that's a great example, and it probably goes both ways, where, you know, there are certain things where you're gonna be a little more hesitant to try in the highest level athlete. You know, you're gonna want to stick to stuff that's tried and true, because I don't want to, you know, ruin somebody's career that's making, you know, twenty million dollars a year.

• 22:39Chuck Nice?

  Right.

• 22:40Speaker 02

  So, some of the stuff, we actually start at, you know, much lower, at the other end of the spectrum, with people that are lower demand, and you say, oh wow, this is working. Maybe we can start pushing it up in athletes, and there's some benefit. And then there are other things that clearly used to be reserved for the highest level athletes. Tommy John surgery is a perfect example, and now you see, you know, high school and college kids getting it. So, I think they kind of meet in the middle, coming from both directions.

• 23:00Chuck Nice?

  Interesting. I got one last thing I just got to ask you about, because I'm confused, alright? So, I had a terrible sprain when I was maybe eighteen, right? To the point where, I mean, like, completely immobile. Like, that's how bad this sprain was.

• 23:13Speaker 02

  Yep.

• 23:14Chuck Nice?

  And the doctor was just like, god, it would have been better if you broke this than this sprain.

• 23:18Gary O'Reilly?

  That I've heard before.

• 23:19Chuck Nice?

  Yeah, he was like, it would have been so much better if you broke this than this sprain right here. By the way, it still bothers me to this day. I didn't get proper rehab, um, because they didn't know about it back then.

• 23:30Speaker 02

  Yep.

• 23:30Chuck Nice?

  Uh, but I see these guys on the field, and they wear braces, and they have these support, uh, equipments, the equipment that they put on, and I was told that that actually weakens you in some way. That you start to rely on the support of the brace or the equipment. And so they told me, no, you don't want to do that. But yet, I see guys like Aaron Rodgers, and even Carson Wentz, and these guys come back, and they are wearing... So why, what is that about, and why does that happen?

• 24:01Speaker 02

  I think it's, you know, your, your point is correct. We're a lot of times, we want people, you know, you know, immobilize her to put a brace on to give some extra support initially after an injury, but you don't want to become a crutch where the muscles around it start to atrophy and they're, they're not doing well. But you're, so, so what the doctor told you was correct. The problem is that doesn't apply to an Aaron Rodgers or Carson Wentz, where these guys are strong, but they've got, you know, people trying to rip their arms off. You've got a dominant, it's too trying to rip their arm off. So a little extra support's not a bad thing. And they're not decompensating by wearing those braces for, you know, three hours on a Sunday.

• 24:31Chuck Nice?

  I got you. I got you. By the way, Doc, there's a lot of people trying to rip my arms off too, but for different reasons.

• 24:38Gary O'Reilly?

  Oh, I wish I was one of them, but I might, I might just be in there. Right, Doctor, thank you. Thank you so much, Doctor Joshua Dines.

• 24:47Chuck Nice?

  What a great conversation.

• 24:48Gary O'Reilly?

  Yeah, an enlightening conversation. And thank you so much indeed for your time. Wish you well, sir.

• 24:53Speaker 02

  Thanks for having me on. Really appreciate it.

• 24:54Chuck Nice?

  Yeah, please come back. Please come back and join us again.

• 25:02Gary O'Reilly?

  Our next guest, Doctor Jim Taylor, who has written a number of books on the psychological approach to sports injury, the rehabilitation and recovery. So, Doctor, welcome to the show firstly.

• 25:14Speaker 03

  Great to be here. Thanks for having me.

• 25:15Gary O'Reilly?

  You're welcome. What made you feel that there was something that was being neglected in this field of injury rehabilitation and recovery?

• 25:25Speaker 03

  Sure. Well, first of all, my, my initial work and the sort of the meat of my work, if you will, focused on, on helping athletes perform better, achieve their goals through better mental preparation. Inevitably, in working with athletes from junior leagues up to professionals and Olympians, a lot of them would get injured. And I began to see even when they, let's say an ACL reconstruction, or a Tommy John surgery, or a broken femur or some such, that these days, the surgical and rehabilitative technology is such that athletes can come back.

• 25:56Speaker 03

  From what used to be career-ending surgery and make a full recovery. And yet, they would often come back in terms of their full physical parameters, strength, agility, mobility, things like that, but they couldn't return to the same level of play. And also, during the course of their physical recovery, they would struggle in so many ways in terms of their confidence, their motivation, their emotions. And so it became clear that when athletes get physically injured, their minds get injured as well. And I use the metaphor of the mind as being made up of, is made up of muscles, just like physical muscles. And muscles can be either weak, strong, or injured. And so when somebody has a very serious injury that's going to keep them off the field to

• 26:40Speaker 03

  play for, for months, or maybe a year more, there's definitely mental stuff going on there.

• 26:47Gary O'Reilly?

  Is each athlete prone to the same things, or does it vary from individual to individual? And I'm guessing from a weekend warrior to an elite athlete, there'll be an awful lot more in terms of which areas are vulnerable mentally as to opposed to the other?

• 27:06Speaker 03

  Well, the answer is yes. There are general areas in which athletes, regardless of the level they're at, struggle. And some of the main ones are motivation, confidence, anxiety/fear, focus, and emotions. At the same time, because, because high-level athletes are more invested in their sport, they, they are going to struggle more because it's very often their livelihood, their identities. But that's not necessarily the case, because I've often found weekend warriors, triathletes, runners, basketball players, you know, it's just their, it's just their avocation, but they are very serious about it. Plus, their personality components. Some people are just more resilient, less emotional, tougher, who, who respond in different ways.

• 27:50Chuck Nice?

  So let me ask you this, when it comes to

• 27:55Chuck Nice?

  an athlete being recovered and psychology versus actual brain function. Can the brain send signals to someone that they should be overcompensating? Because you kind of create certain movements, you activate different muscle groups because you are suffering from an injury. So let's say you go back through and you you actually you're rehabbed and now you're at full strength. Can your brain still send signals that say, hey, man, watch out. You know, when you step this way, you're going to tear this, but you know, this muscle is going to rip. Can that happen?

• 28:35Gary O'Reilly?

  It's a great point.

• 28:36Speaker 03

  Yeah, and that is one of the great challenges with athletes who are returning to sport after a serious injury. What's remarkable about it, let's think of a professional football running back. And how many times has he made a cut in his life? Millions upon millions of times without any consequences. But that one time he makes that cut. Now, if this were simple, simple numbers and logic and rationality, that one cut where the injury occurs should have zero impact on them. But that one event had huge implications on them in terms of their identity, their physicality, their future, their earnings, all these things. And so, and also the body is wired through evolution to protect itself.

• 29:19Speaker 03

  So the last time the brain heard the body making that cut, something bad happened. So when that movement occurs again, the mind is basically telling the body, don't go there, don't do it. Like you said, Chuck, the same thing will happen.

• 29:36Chuck Nice?

  Wow.

• 29:37Gary O'Reilly?

  Yeah, and I mean, my own personal experience, you will favor. Once I've had my my MCL rebuilt, so I then favor the other leg. And over time, that other leg has come to bear the brunt of all that added weight. But the thing there is, how do you? Get the athlete's brain to, if you like, outthink your own brain and then providing the confidences there and everything is a hundred percent or as good as a hundred percent in terms of the recovery, the surgery, et cetera, to then take that out of what Chuck Star asked there, out of the athlete's thinking and allow them to pursue a balanced performance level once again.

• 30:20Speaker 03

  Sure. Well, it doesn't start when they first walk onto the field of play after they're quote unquote healed and rehab. It begins ideally the very first day. So I'll give you a couple of examples. There's been some fascinating research related to post-traumatic stress among the military, where if they sustain a serious injury, if in the 24 hours after the injury, they can reimagine the experience without the injury, it somehow seems to keep the emotional content, the trauma, out of being woven into the fabric of the neurons in the brain.

• 31:03Gary O'Reilly?

  Wow.

• 31:04Speaker 03

  It's still preliminary, but it's actually pretty darn powerful. So by doing that, in a way, the mind is healing itself in that very short period before it gets sunk in.

• 31:13Gary O'Reilly?

  Wow.

• 31:14Speaker 03

  Then it's a matter of training the mind and rehabbing the mind. So I call it the psychological rehabilitation of sports injury. So just as the athletes go in and do PT and work with athletic trainers to rehab the muscle, rehab the injured area, the ligaments, the bone, whatever, they also need to rehab the mind. And a couple of key components of that are, first of all, the notion that rehab is athletic performance. Because athletes, when they're seriously injured, they think, oh, I'm not an athlete anymore, or rehab is so different than sports performance. But doing a set of leg extensions for range of motion, or increasing power with a light squat, that is an athletic performance.

• 31:58Speaker 03

  And that has tremendous psychological value because athletes can connect with, oh yeah, this is what enabled me to be successful as an athlete. This is what's going to enable me to be successful as a rehabber. And so really, just really just changing their perspective, but I'm not an injured athlete. I'm still an athlete. Go ahead, Chuck.

• 32:14Chuck Nice?

  So with respect to that, because now, now you're talking about there's a psychology to the rehab itself, you know, I would assume the two things. One, it's hard to motivate an athlete during rehab because the immediate gratification of being an athlete is getting on the field and proving what you've done. So when I'm in the weight room and I'm trying to put on four pounds of muscle, which is very, very difficult, it's grueling and it hurts. I'm okay because I'm like, I'm seeing a little growth. I'm seeing some performance improvement on the field. How do you actually get them to, what are the metrics that you can give them? Because they're, they may not feel

• 32:56Chuck Nice?

  like I'm getting better. As a matter of fact, it's the opposite. I can't do what I used to do. I feel weak. How do you, what's, what do you do for them at that?

• 33:04Speaker 03

  Right. Well, a lot of it starts with that perspective first of rehab as athletic performance. Also, it's this belief that because they're still athletes, they're still performing. And what I've found is that very often with athletes, motivation can vary. You know, they can, it can go from zero to a, from a pity party up to I'm getting out there and I'm going to be Jerry Rice getting out on the field after three, three weeks post-op, which didn't turn out so well back in the day. But the key thing

• 33:30Gary O'Reilly?

  Someone's a 49ers fan.

• 33:31Speaker 03

  Athletes, actually, some athletes, they actually become better athletes after they recover because they learn how hard it is. They learn to suffer. They learn to struggle. Whereas many gifted athletes, everything came so easily to them. But also, the great thing about injury is that in rehab is that there are very clear metrics. Range of motion, before I could, I could bend my knee 45 degrees, now I can do it 60 degrees. Before I could lift a five pound sandbag, now I can lift a 15 pound sandbag. So the, the arc, the trajectory of improvement is still there. It's, but the difference is from, with an athlete who's healthy, they're from going trying to go from here to here. For athletes who's injured, you can't even see me on the screen. They're going from here to here.

• 34:13Gary O'Reilly?

  That's interesting. For the elite athletes, the professional guys that are at the very top, you take them out of the game. They're furious.

• 34:21Chuck Nice?

  Yeah.

• 34:21Gary O'Reilly?

  Because they they're born to play. That's what since they were teenagers, maybe earlier, will be in. So you take them out, they will do what it takes. And in fact, you have to rein them back in. And the doctor will confirm this. And I've done it myself, thinking, you know what? Just rip this shirt open. There's a big S on the chest. This is me. Watch this. Three weeks later, I'm back to that moment before I thought I was Superman.

• 34:43Chuck Nice?

  Right.

• 34:43Gary O'Reilly?

  And that's the problem.

• 34:46Speaker 03

  Yeah, well, Gary, the single biggest piece of advice I give an injured athlete when they come to me is stick with the program. Stick with the program. Don't under adhere to it. But as you suggest, a lot of seriously motivated athletes, they figure if if this much is good, well, twice as much is going to be better. And and a lot of times, especially with super motivated athletes, it's not motivating them. It's de motivating them. It's putting a bit in their mouth and ringing them in. Because my experience, both professionally and also I had my shoulder reconstructed after crashing skiing a number of years ago, was if I stuck, if if you stick with the program, you do get better. And doing too much or too little will actually set you back.

• 35:27Chuck Nice?

  Can I can I ask you about pain then? And the actual real, everyone experiences pain differently, including athletes. There are some people that just, I don't know what it is, man. They just have a higher tolerance. I'm not one of them. Uh, but how do you deal with that real? Because it's it's an impediment. Like, it's like, wow, this hurts. I don't want to do it. And your brain, by the way, is actually designed to tell you, don't do this. This hurts. The reason why you're not supposed to do it is because it hurts. And so what what are some of the ways that you help somebody get over that very real obstacle of pain?

• 36:04Speaker 03

  Sure. Well, first of all, I I educate them about pain. And there's actually been some wonderful research on how pain is not just a physical experience. It's actually filtered through the mind.

• 36:13Chuck Nice?

  Yes.

• 36:14Speaker 03

  Perceive the pain impacts the degree of pain we feel. So as an example, research has shown that when people associate uh, associate negative thoughts, like, I hate this, this is awful, this hurts so bad, and negative emotions like anger, frustration, despair, disappointment.

• 36:31Speaker 03

  They feel more pain. Wow. Now, turn that around, though, and this is where it be where pain is a tool. When pain can be looked at as information. So if it hurts, what can I, what do I need to learn from that? Do I ease up? Or is this just exertion pain? And is this actually good pain? And also conversely, from the research I just described to you, when athletes associate pain with positive things like, I can do this. This is a good sign. I'm working hard. I'm getting better and positive emotions such as pride, inspiration, excitement. Joy is probably a little too much to expect. Then, then, then they actually feel less pain. So it's really educating injured athletes about what pain is, how it affects them and giving them some tools they can use that actually ease the pain.

• 37:16Speaker 03

  Now, will thinking positively work as well as a shot of Novocain? Of course not. But it can ease the pain and also just getting them to understand that this pain is actually not bad. It's part of the deal. Makes them, makes it more helpful.

• 37:33Gary O'Reilly?

  It's interesting. I'll go back to the point you made about how with armed forces personnel, if they're injured, and this will relate again to athletes, within 24 hours, you help them revisit the incident, but with a, without the negative outcome.

• 37:48Speaker 03

  Right.

• 37:48Gary O'Reilly?

  Right. So having bearing that in mind, you've made me think, I can't then heal myself and just, you know, if there's a fracture, if there's tears in ligaments and things like, but there might be minor injuries where I can change my state of mind, as you've just described, bring that positivity and maybe not cure myself, heal myself, but speed up the process of recovery in a really, really good way.

• 38:15Speaker 03

  Yeah, that's a little bit controversial. There has been some evidence that the mind has the capability to heal. Parts of the body, not directly, of course, not by some sort of psychic magic.

• 38:26Gary O'Reilly?

  Yeah, right.

• 38:27Speaker 03

  But simply by increasing blood flow, for example, by relaxing, by having the mind relax the body, which allows the body to heal better, which activates the immune system. So there is some evidence of that, but bottom line is, if there's an injury of any sort, whether a minor pull or a major tear, the body needs time to heal and it can't be rushed. Every, yes, there are variations in healing, but for the most part, there is a general range, let's say a orthopedic surgeon will give an athlete, it's going to basically take three to six months and somewhere in that range, they're going to start feeling better and depending upon the physiology of the athlete, where they are in that range will dictate how long it actually takes.

• 39:09Chuck Nice?

  So you made me, well, Gary's question or Gary's comment about being a pro athlete and then the Superman on the chest, it just made me think, so is there any work underway or is there any counselling being given to coaches? Because I would assume that that same mentality.

• 39:27Gary O'Reilly?

  Don't talk about coaches and rehab.

• 39:28Chuck Nice?

  That same mentality could actually lead to injury itself. The idea of I'm going to push it and push it and push it as opposed to, hey, man, this is my limit, let me back off so that I don't tear a muscle or a ligament or whatever.

• 39:48Gary O'Reilly?

  Before you answer that, doctor, I'll give you a true example involving me.

• 39:52Chuck Nice?

  Okay.

• 39:52Gary O'Reilly?

  I'm in a rehabilitation unit for spinal, recovery from spinal surgery and this isn't a two week thing, this is taking several months. My soccer club sent the head coach to come find me, see what I was doing, how I was getting on, what work, why was it taking so long? Because it was outside of the club's control.

• 40:15Chuck Nice?

  Right.

• 40:16Gary O'Reilly?

  In other words, why are you still here?

• 40:18Chuck Nice?

  Right.

• 40:18Gary O'Reilly?

  And this pressure, this immense pressure, that's why athletes push, the professional guys push because they know they're going to get pushed by the coach and if they don't push themselves, you know what? They're going to get someone else in to do my job. Yeah, it's that cold.

• 40:35Speaker 03

  Right. Well, coaches play a big role because they feel tremendous pressure to get their best players out on the field. And they will often do, put pressure on that's not in the best interest of the athlete. And that's where a really strong sports medicine team needs to push back and the athlete needs to push back and say, I'm gonna go out there when I'm ready. But that's hard because the player also wants to get out there because they might lose their spot, or they, they just, they're competitive, this is what they do, they wanna realize their identity as athletes. And so again, it goes back to really trusting the sports medicine team and making sure all the physical parameters are in place. And then mentally, if they're in a good place as well.

• 41:14Chuck Nice?

  So does a sports medicine team and people like yourself, doctors like yourself, do you work with preventative measures? Because I would assume, well, forget assuming, what is the best way to prevent injury?

• 41:28Gary O'Reilly?

  Don't do sport.

• 41:29Chuck Nice?

  Don't, don't play. But is it, is it, is it proper technique? Is it, is it, is it rest? Is it training? Is it increasing range of motion? Is it, you know, what is it? Is it all those things? Whatever?

• 41:43Speaker 03

  Yes. It, it's all those things. You want to train athletes physically, technically, tactically, and mentally in ways that prepare them for the demands that is placed on the body. And so incredibly well conditioned in terms of strength, power, mobility, flexibility, stamina, and certainly good technique. Bad technique can lead to injuries regardless of the sport. As well as good nutrition is a big part of it. Rest and recovery is essential because often injuries occur when, when, when an athlete's tired and their body, their muscles, because of fatigue, simply not able to do the movement that maybe the day before when they're rested, they couldn't do. Plus, making sure that they're mentally prepared.

• 42:26Speaker 03

  If an athlete is not fully committed, if they don't truly have confidence in their ability to make that move, if they're not at the right level of physical activation, either having enough energy or just having not too much, and then being super focused on what they need to do to, to execute, all those things play into the likelihood or the lack of likelihood that a serious injury will occur.

• 42:51Chuck Nice?

  Wow.

• 42:51Gary O'Reilly?

  That's amazing. While you're talking, Doctor, and as with all of our guests generally, do they make us think?

• 42:56Chuck Nice?

  Yes.

• 42:57Gary O'Reilly?

  And I'm sitting here thinking, you sound very much at the forefront of this kind of thought process for sports injury. Have you, and you probably have identified the next level, or is there a next level for this kind of approach towards sports injury?

• 43:13Speaker 03

  Absolutely. And it's where, the reality is, is that very few sports medicine clinics have sports psychologists or mental coaches involved. And in my work, I become a very integral part of the sports medicine team. And where I develop a mental training program, a mental rehab program, just like the orthopedists and the PTs and the athletic trainers develop a physical rehab program. I develop a mental rehab program that complements what the athletes do physically. And so as the athletes improve physically, they're also improved mentally. So when they, when they go out on the field the first time, they are not only physically ready in terms of all the physical parameters,

• 43:51Speaker 03

  but they're fully committed mentally, they're in a place mentally where Chuck, as you said earlier, where their mind's not going, don't do it, don't do it, you're going to get hurt. Because that's a recipe for re-injury. And so if you want, I can briefly describe what this mental rehab program involves.

• 44:06Chuck Nice?

  Awesome, yeah.

• 44:09Gary O'Reilly?

  My knee hurts. Talk, talk quick.

• 44:11Speaker 03

  Very, very good. So a couple of key components to, to the rehab program. First is a ton of mental imagery. The most powerful mental tool is mental imagery, having athletes see and feel themselves performing. What this does, it keeps their mind in the game, because at one level, the body doesn't know the difference between real and imagined execution. So if athletes during the course of a six month or a seven or eight month rehab, if for three or four times a week, they are seeing and feeling themselves performing in their sport, they're, they're continuing to wire their brain for confidence, for intensity, for focus, three key components of athletic performance. They're also, at an identity level, they feel like they're still performing, so their identity is getting nourished.

• 44:56Speaker 03

  And so they're not going to need to go out and do, like, and push themselves excessively, that could lead to re-injury. So imagery is huge, video as well. Video is external imagery. The more the mind, when the mind is there internally imagines or watches video, it actually triggers the motor cortex. So I've seen athletes actually come back from a sport, from an injury, better athletes because A, they're better technically through their imagery and video, and because they know the game or the sport better. Because they're able to study the sport in ways that they maybe didn't have time for, or they didn't think that were that important. So I might have them be on the sidelines next to the coaches, so they can learn plays from a different perspective and much greater depth.

• 45:39Speaker 03

  Also, this idea that rehab is athletic performance. So before an athlete goes and does a drill on the sports field when they're healthy, they hopefully do things to get mentally and physically prepared. Same thing holds true when they begin a rehab exercise. They need to be committed, confident, intense, and focused. And what that does, they're not only rehabbing the mental injury, they're also training their mind to become better athletes. So when they get back out on the field, they're more capable of performing at a higher level. Because when I work with athletes who are injured, I don't want them to become and just be where they were. I want them to re-enter the field better athletes than they were before they got injured.

• 46:21Chuck Nice?

  Wow, that is fantastic. That's all good stuff, man. That's just, you know, we are out of time.

• 46:26Gary O'Reilly?

  We are, sadly.

• 46:26Chuck Nice?

  Wow, and sadly is right. I mean, you're really fascinating to speak with.

• 46:30Gary O'Reilly?

  If you take this to the next level, would you be kind enough to engage with us so as we can explore that with you?

• 46:37Chuck Nice?

  Yeah.

• 46:37Speaker 03

  I would love to. It's been great fun, you guys.

• 46:39Gary O'Reilly?

  Oh, Dr. Jim Taylor, thank you so much. Sports psychologist, working with athletes in a number of ways, but for this show in particular with sports injury rehabilitation. Doctor, thank you so much indeed.

• 46:51Chuck Nice?

  Yeah, go out and buy one of the doctor's 15 books.

• 46:55Gary O'Reilly?

  No, no, no, no, no. Go out and buy all of the doctors' 15 books. There you go, doctor.

• 47:00Speaker 02

  Thank you, you guys.

• 47:00Gary O'Reilly?

  You're welcome.

• 47:01Speaker 02

  Thanks again, doc.

• 47:01Gary O'Reilly?

  Thank you.

• 47:02Speaker 02

  It was a lot of fun.

• 47:03Gary O'Reilly?

  So Chuck, that's it. We've spoken to a surgeon, we've spoken to a sports psychologist, and we've kind of got the timeline of a sports injury and how it was done and how it is done and how it may be done in the future. And I don't know about you, but I was fascinated. I feel healed, mind and body. And it's amazing, you know what, you trust someone like Dr Joshua Dines as a surgeon to do his thing, but then having spoken to Dr Jim, you realise more of your own healing could be in your own hands. In your own, in your own mind. In your own mind. Yeah, man. And with that thought, Chuck, we're going to say goodbye. Yes. This has been Playing with Science. I've been Gary O'Reilly.

• 47:48Gary O'Reilly?

  And I've been Chuck Nice. And we look forward to your company very, very soon.