My Starting 5 – April 2021

I was supposed to have this published on the fifth of the month, but instead of working over the weekend we took some much needed time off! A mini babymoon night was just what the doctor ordered. It was great to be able to just relax and spend a few moments away to ourselves after such a hectic year. Just wish it was a longer trip!

I am back on my game plan and writing in real time so that I can get you my Starting 5 for the month of April.  As a reminder, the Starting 5 is my list of the top of items or tips/tricks that I am loving and would share with you over the water cooler at work or over wine with my BFFs. There was a great response to last month’s list… (Here!) hoping you find some gems in this one as well. 

Without further ado… the April Starting 5. 

Hypervolt

Hpyerice Hypervolt in gray and black shown zoomed in
Hypervolt with Bluetooth Percussion
  • 2 words: Game Changer. I have experience with these devices as a team doctor and know they can be great. I was trying to come up with a fun Christmas gift for my husband this year and came across an advertisement. I thought he might love it as he gets a little stiff from his workouts mixed with long days standing over the operating room table. So yes, this was actually a gift I bought for him knowing full well I might use it too… #marriage Come to find out, it is a total game changer for me in this pregnancy! I have been using it daily on my hips, low back, glutes etc. My SI joints have been a hot mess since the second trimester and this little nugget has been worth every penny. Note that I did get it on sale for the holiday… so keep an eye out for a deal but knowing how much we both use it I would absolutely pay full price. 

Be Well By Kelly Protein Powder

Be Well By Kelly Protein Powder
  • If you follow me on Instagram (which I hope you do! @sportsdrmorgan) it is no secret I love Kelly Leveque and her nutrition concepts. When she launched her brand of protein powder I needed to test it out. Prior to this, I have used several whey and plant-based powders. Some I still love (Tone it up Peanut Butter is delicious!) but wanted something less processed to use during pregnancy. Enter BWBK Protein. It is extracted in a chemical free manner, is made from grass-fed beef and contains collagen. I choose the vanilla flavor and have been loving it in my morning smoothie. Also, hot tip- you can mix a small amount in almost anything to up the protein. Another current go to: mix a half scoop in all natural PB and spread on an apple as a balanced snack. 

Hatch Belly Oil

Hatch Belly Oil
  • Staying with the pregnancy theme I splurged on the luxurious Hatch Belly Oil. I have been slathering on all the balms and oils and creams I can find to aid in the stretch as my belly grows. Nothing truly prevents stretch marks according to the science, but it sure doesn’t hurt to keep the skin hydrated. The Hatch Belly Oil is pricey, but it lives up to the hype! The smell is soft and pleasant and it dries super fast. I also love applying it because it feels like a little dose of luxury. And in the times of COVID, while pregnant, staying home all the time… there is something to be said for feeling a little luxury in my post-shower routine. 

Getting Dressed

  • Speaking of little luxuries… getting dressed while pregnant isn’t one of them. Nor is getting dressed during a pandemic! Anyone else switched to a 100% sweats and yoga pant wardrobe? Then one day I got dressed. Nothing fancy, just something that made me feel good to wear. I also put on my engagement ring and a splash of makeup. I don’t usually wear my ring when I am home since the majority of the day I find myself doing chores like laundry or washing dishes. That day I noticed immediately I felt better. Putting a small amount of effort can make a huge improvement in your mental wellbeing. Hopefully this is something I can remember to do postpartum as well!  Funny story one day I did ‘full makeup’ for a photo I was taking and when I walked into the bathroom I caught my own reflection in the mirror and literally jumped. I scared myself because I didn’t recognize my own reflection. Haha. Definitely time to step up my day-to-day game for no one except me and my own mental wellbeing. 

Outlet Shopping

  • It is no secret I love a bargain. I needed new bedding for our a new California King size bed. (bed linked here  … I love it!) But I also didn’t want to spend a fortune on the linens. Bedding is important for sleep yes, but my 28lb Frenchie sheds on it. I also needed a few furniture items for our nursey but didn’t want to break the bank.  Baby stuff adds up and is expensive! I will do another post on what we bought for the babe, spoiler alert, you don’t need as much as the registry folks want you to think you do. 
  • After ogling a few of the duvets online from Restoration Hardware I serendipitously found an RH outlet nearby. I did the same for Pottery Barn when hunting for a glider and crib. Here’s the tip. Look for an outlet version of these stores. They sometimes carry ‘scratch and dent’ products, but they also sometimes have perfect returns that cannot be resold. 
  • While in the RH Outlet I stumbled across a pair of Cal king sheets that matched my aesthetic, but no duvets.  I didn’t go to buy sheets. Ugh. I decided to pull them out of the packaging to be sure I didn’t also ‘need’ to buy sheets even though we had just bought two sets… and low and behold it was a DUVET! I was ecstatic. I continued my hunt by searching for shams… but couldn’t find 2 that matched and were the appropriate size. That is until I again opened a package that had been mislabeled. No way, right!  The sales lady was laughing with me by the time I finished. She said the product comes in on large pallets and they cannot look through each in detail. So, if you do venture to find a bargain don’t be afraid to ask to look inside the packaging!
  • While on my Pottery Barn Outlet shopping trip I had another great experience. I had started my search for nursery furniture online, but to my dismay every glider that I did not find hideous was backordered or special order and wouldn’t arrive until months after our due date. Did you know some of these chairs take like 10-20 weeks to produce, let alone ship? The gestation on the chair is as long as on the actual baby. A friend told me to try the PB Outlet as I could take the pieces home the day I purchased. I found the perfect glider in a neutral gray fabric… and while there saw a crib that would work too. We had initially intended on the cheapest crib possible and had considered one from Ikea. But those looked flimsy in person and I was concerned about function.  I also did a deep dive into crib and nursery safety one afternoon (working from home = lots of deep dives into the internet baby space) and I found out about Greengold Certification and the chemical free nature of the products from PB. This was a win win. We got our glider and crib, and I grabbed a stuffed lamb toy to add to the mix. All in all, we saved money and were able to get them set up in the nursery in plenty of time. 

My Starting 5 – March 2021

I enjoy reading ‘Things I love’ posts from bloggers, but they sometimes feel overly sponsored and materialistic. That said, I love seeing the true gems others find. Enter: My Starting 5. These are the 5 things this month that I am totally into. They might be items I love, but I also want to focus on fun experiences or useful tips.   Think of it as the former chats about the latest gadget with a coworker or the tip your BFF gave you over dinner.

It also goes without saying none of this is sponsored because well, no one sponsors me. If that ever changes I will update accordingly. 

Without further ado, the March Starting 5!

Breville Smart Oven Air

Our new Toaster Oven
  • Let me back up… I contemplated adding a toaster to our wedding registry.  The one we used I swear my husband had in college! After reading some reviews I was drawn to the idea a toaster oven instead.  Basically, why have a toaster that literally is an appliance for 1 thing- toast bread?  The toaster oven which does all sorts of things. Right before we made the move to Phoenix I saw this little gem on sale. And when I thought about turning a real oven on to cook in the 115 degree desert heat it seemed worth trying. Let me say, it may be my favorite adult purchase EVER.  Seriously this thing is genius. It toasts, roasts, air fries, bakes and the convection feature makes it heat up so fast without heating the whole house. Literally almost zero preheat time. I think I lived here a month before I even had to turn the real oven on… and that was Thanksgiving when I was using BOTH the toaster oven and real oven.  Simply genius. 

Simple Modern Tumblers

Best Tumbler
  • I mentioned in my 1st trimester post (linked here) that I really had to focus on upping my hydration game during pregnancy. These cups made it happen. I love the neutral colors and size.  I filled it with extra cold water (which it keeps maintains temperature on very well) and thanks to the nifty straw I can chug it down easily. Bonus tip for staying hydrated- every time you take a drink think about 10 big gulps. Boom, you are on your way to hydration.  I use a free app on my phone to track the volume I drink (Water Llama) and know if by noon I am 2-3 fill-ups in I am on track.  I bought my first one at Target… and also they have them on Amazon. 

New Planner

My new 2021 Planner
  • Ah Amazon how I hate to love you so much.  At the start of 2021 I was looking for a simple monthly calendar to help keep this website and instagram on track. Everyone says you need a content calendar (still learning all these things…) but being a visual person I hoped it would help me see everything together.  Most calendars I used before were too busy and had too much space for things I didn’t need (birthdays and to-do’s, etc-  I keep those on my online calendar). Enter this planner from Amazon.  It is thin and simple has just enough space to layout my ideas for the weeks and months ahead.  I have never felt more organized in my content planning. Now time to execute! 

 Podcast Walks

  • That first trimester is a doozy! Nearly all my exercise came from walks in the neighborhood. I have always loved podcasts but found a new appreciation for them while on these walks, and also while working from home and needing a source of stimuli other than my computer screen. Or Francis snoring on the couch. I have been catching up on Oprah’s super soul, re-listening to old favorites from How I Built This, for a short burst I enjoy The angry therapist, and recently have following Be well by Kelly. 

Sunday Pizza Night

  • The Sunday pizza night tradition started in LA when I first moved in with my husband.   And it is one of my favorite easy traditions we have maintained.  It works for several reason.  First, who doesn’t love pizza?  Second, I love having one night a week I never have to think about what to make for dinner.  Our routine is to order a giant salad to split and pizza to share.  After relocating to Phoenix we found ourselves deep in the largest pizza scene I have ever seen (Thrillist Best Pizza Phoenix) . And although I miss my beloved Manhattan Beach Pizza in Southbay— the fact that we can find a wood fire/artisan/special pizza place on every corner certainly helps.  We have tried a new one almost each week! I don’t see this tradition ending any time soon. If you want to try one but don’t live locally… goodbelly.com actually delivers Pizza Bianco nationally. Crazy, right.  If you end up in Phoenix we also love Cibo, The Parlor, and Base Pizzeria. 

Need to know: Ankle Sprain

The ankle sprain… One of the most common reasons patients see me in the office. Here is all the information you need to know if this happens to you.  It will be just like if you were visiting me in the office!

An ankle sprain occurs when your foot rolls in or out putting extra stress on the ligaments.  This causes the ligaments to stretch/tear, which is by definition an ankle sprain. If your ankle rolls where sole is facing in, it is called an inversion injury (most common). If your ankle rolls where with your sole facing out, it is an eversion injury. These injuries can happen during sports, basketball and volleyball are common, or in any setting when athletes can land awkwardly from any jump or step. Sometimes though for the unlucky patient the injury can occur during day-to-day activities, something as simple as stepping off a curb wrong at the grocery store.  I have seen all of the above (and more) in my office!

During the sprain, the ligaments are stretched/torn which causes pain and swelling. The great news is these ligaments are not typically the type we need to fix with surgery, and most people heal quickly without long-term problems.  However, more complex types of sprains do exist that take longer to heal or may need more intervention.  For example, a “high ankle” sprain results from a more forceful twist that injures the ligaments above the ankle between the lower leg bones in an area called the syndesmosis. With other high energy injuries, you can also injure ligaments lower down in the foot or even break the bones.  If you are a kid and still growing, your growth plates are weaker than the ligaments.  Because of this when you twist your ankle, the bones may be more likely to break than for a ligament to tear.  This is a commonly missed injury by non-orthopedic physicians, can take longer to heal, and needs a correct diagnosis to be treated properly.

 Today we focus on the essential adult ankle sprain, the inversion (sole of foot turning in) injury that tears ligaments mainly on the outside part of the ankle. The most common injured ligament is called the ATFL, or anterior talofibular ligament.  If you look at your right foot it is that approximately at the 2 o’clock position on the top of your foot about 1 cm from the ankle joint. 

The injury causes a tear/stretch of this ligament resulting in pain, swelling, and bruising. 

 Treatment is usually very straightforward. I recommend starting with ice for the first 24-48 hours with rest (doing as little as possible) and elevation (at or above the level of the heart) for swelling. You should only do light activities that do not increase pain. If you have a more significant injury and you cannot walk normally, sometimes I recommend using a brace or other support device like a medical grade boot short term.

The timeline for recovery is variable and depends on how bad the injury is and what your goals for return to activity are. If you have a small injury and are doing low impact movements (sitting/walking) a full recovery is quicker than if you have a larger injury and play sports that require cutting, jumping, or pivoting. 

The biggest risk with an ankle sprain is repeat injury. Once the ligaments are injured, your ankle is more unstable and weaker.  You are more likely to sprain it again or injure it further if you have not fully regained all your strength, balance, and coordination lost with the initial injury.  Your body normally controls ankle stability (balance and strength) with proprioception. Proprioception is a protective sensation where your brain sends a signal to a joint and the joint responds with position updates.  Think of it like you brain asking your ankle, “Hey, how’s it going down there, which way are you pointing, how stable is that ground?” And your ankle responds, “I am okay, pointing straight ahead, ground stable no cause for concern.”  This happens constantly and nearly instantaneously with movement.  Consider this – don’t you always know where your ankle is without even having to think about it?  When you have an injury that feedback communication does not work as well.  The ankle’s response can be slowed and inaccurate.  This causes an increased risk of a second injury.

We can improve the ankle’s ability to communicate via proprioception, as well as its strength and our balance with physical therapy. A physical therapist can assess how the ankle is moving and what needs to happen to retrain it to be pain free and moving well. In my office I see people with the initial injury and then depending on the degree of injury will either send them straight to physical therapy or will send after a period of rest. It takes several weeks to get the ankle back to moving normally, but most often after doing so people do very well.  

One common question I get is why the swelling lasts so long after the injury, even if they are progressing well otherwise. This is usually not cause for concern. In addition to injuring the ankle ligaments the other soft tissues around the ankle were injured.  Because of this, swelling can persist for many months even after your ankle feels better.  Another common question is why the ankle feels stiff or not quite like the other ankle.  The stiffness is from the lack of movement in the early recovery and from scar tissue that forms during healing. The great news as that the stiffness dramatically with time and work with physical therapy. 

My goal with treating an ankle sprain is to get patients safely back to all the activities they love as soon as possible.  At my initial evaluation we make a plan for what one should expect in the next few days to week and schedule a follow up to assess progress.  Having two visits helps me understand your trajectory for healing – two data points helps me see the line of how quickly you are progressing much better than single point.  Once physical therapy is started, I continue to monitor progress and help determine when one can return to sport activities. 

A final word on return to sport.  I return most people cautiously.  As I mentioned, recurrent injuries happen.  I unfortunately see patients that have long term chronic ankle pain or instability due to having multiple sprains.  This is a harder problem to fix and may even require surgery.  Getting the physical therapy right from the first injury can help prevent this problem.  For those with recurrent sprains, optimizing a physical therapy program and integrating ankle rehab into your exercise will absolutely be helpful and may also prevent the above. 

Any questions about ankle sprains? Let me know!  Share this with anyone you know that may find this useful. 

The ACL Tear.

As we approach the end of football season, there is one injury that we have heard of several times throughout the year (and past years as well). The ACL tear.  Most sports fans have seen this listed on the injury report and heard the announcers talk about concerns for this when a player goes down on the field, but what is it? Why is it a big deal, how does it happen, and what is typically done about it?  

First, knowing a little anatomy of the knee is important. The ACL – or anterior cruciate ligament – is an important structure inside your knee joint.  We have 4 ligaments in and around that area, named for where they are located. Anterior (front) and posterior (back) cruciate ligaments, and medial (inside) and lateral (outside) collateral ligaments.  Today we focus on the ACL because it is usually the most ‘tragic’ when injured in sports. By tragic, I mean the one that is the most worrisome for an athlete because of the long treatment and recovery process that often alters one’s career short and long term. 

The ACL connects the bottom bone in the knee (tibia) to the top bone of the knee (femur) from front to back.  It plays a key role in stabilizing the knee. In medicine we would say it “resists anterior translation of the tibia on the femur.”  Stick with me here… this means in regular language that it stops the bottom bone of the knee from sliding forward in relation to the top bone during normal movement, aka inside the knee joint where it bends.  This bending is what allows us normal knee motion needed for walking, running, jumping, playing.  But we need something to help keep the bones attached to one another or else the knee may feel unstable (jelly-like) when we put stress on it.  [Think of the knee as a door hinge where the ACL is the pin that connects the two pieces of the “hinge”; without this the door can swing open and closed gently, but if it’s pushed too hard the hinge may not line up properly and may become damaged].  Not an ideal situation if one is interested in getting back to doing higher impact activities like playing football. 

If the ACL is torn the knee becomes unstable because the bottom bone can shift away from the top bone.  The cool thing the human body is that there are often redundant systems.  For the most part (although not always for every person) normal walking and low-impact day-to-day life can still be achieved without the ACL because the other ligaments and muscles around the knee can pick up the slack to provide stability.  This means even without an ACL, for daily life activities, many people move about fine.  The problem is with any sudden or shifty movements, such as cutting in sports or in high-impact jobs like law-enforcement or firefighting where folks are required to do movements that aren’t straight forward or backwards. These types of movements are more complex and require more stabilization, so without an ACL the knee can feel unstable and even give out.  For football and other sport athletes, one also would not get the control or explosive power she or he needs to play.   

An ACL tear most likely occurs when the leg is forced in a way that stretches the ligament too far.  Remember, the ACL blocks forward movement of the bottom part of the knee.  Consider a  a football player whose foot is planted to the ground when his knee gets pushed backwards, pushing the top bone away from the bottom bone. Pop!  The ACL is overstretched and gives way.  This is just one example, and there are of course other ways this happens.  Sometimes it involves a collision with another player (as described above) and sometimes it involves getting the leg in an awkward position when a person is running or jumping with the knee buckling inwards/backwards due to the force of the jump or a bad landing.  In this case, it is simply the lack of control and force of the jump landing or cut that causes the tear.  We tend to think of these “non-contact” tears occurring most frequently in young female athletes (maybe a teenage basketball player) that hasn’t developed full hip/knee control. 

The tearing of an ACL is an abrupt injury and not usually subtle.  Sometimes people hear a pop (but not always), feel a pop, have sudden onset of significant pain, and usually fall to the ground.  Most of the time the injured can’t walk easily (if at all) and don’t usually keep playing the game after.  The knee swells up from the inside due to the trauma (effusion).  I usually ask patients if it swelled up like a water balloon as an analogy.  A former mentor of mine taught me when I was learning about knee injuries that a young person running or cutting during sports with a sudden burst of pain with a pop in the knee and large swelling is an ACL injury until you prove otherwise.  This still rings true for my patients today.  #mentor

To diagnose the ACL tear we first talk about what happened when the injury occurred in great detail.  Then, we do an office examination of the knee, as well as the hips and lower legs.   Looking at the other nearby joints is important! Just because it seems that it might be an ACL tear it doesn’t always mean that is our answer.  We complete a few special maneuvers that help clue us in to what possible problem could be happening inside your knee. These maneuvers are helpful to distinguish other injuries that present in the office like an ACL tear.  This exam also helps us determine what next steps to take or if there is concern for other associated injuries (ACL tears often occur with other injures such as MCL tears, meniscus problems, and bone or cartilage injuries).

So you tore your ACL, what now?  Since it is such a crucial ligament for knee stability, most highly active people or athletes should discuss surgery to repair or reconstruct the ligament in the knee.  It does not grow back. It does not scar into place or heal. That said, it is important to note that older patients or people who are less involved in side-to-side/cutting sports or activities may not need surgery.  Be sure you have a discussion with your doctor about what the benefits of surgery are for you, the associated risks of the procedure, as well as the expected long term outcomes.  We practice medicine using the guide of high quality research, and if the studies show that you may do just as well without surgery, that may be the best way to treat your specific injury. Most important is to have these discussions with an orthopedic sports trained surgeon.  They will discuss options, the optimal timing to have surgery if it is thought to be best for you, and also very importantly your rehabilitation and expectations for recovery.  

Whether one has surgery or is treated without operation, he or she will need extensive physical therapy/rehab.  It takes many months for one to get back on the field!  One has to be patient.  For professional athletes that have dedicated athletic trainers and rehab specialists, these are season ending injuries. Often with great rehab, they can return in 6 months (at the earliest) though it can take 1 or more years to reach the prior level of sport.  But these are gifted individuals with many many resources.  For the average injury, it will be at least 1 year before one may feel 100%. And keep in mind, once a person has had an injury, and then had surgery, it is quite possible the knee will never feel 100%.  [Stay tuned for my article discussing preventing injuries like ACL tears.]

Stay healthy-