Keeping High School Athletes Safe & Healthy with Matthew Geswell, M.D.

A new partnership between MUSC Health Lancaster Division and Lancaster County and Chester County school districts offers efficient, open-access healthcare for young athletes and their sport-related injuries. In this episode of Advance with MUSC Health, Matthew Geswell, M.D., an orthopedic surgeon practicing at MUSC Health Orthopedics and Sports Medicine in Lancaster, shares details on the benefits of these partnerships. Geswell offers his expertise on the most common sports injuries in youth sports today, prevention of such injuries, as well as treatment and recovery strategies.

“I've had some sports injuries in my history, and I had some really great experiences with some orthopedic surgeons as a child. Something that sticks out to me is showing the kid that you really do care about them and you're interested in what they want to do. They're not just their injury. They are the athletes… and you have to show that you understand and can empathize with them and share with them what they're going through.” – Matthew Geswell, M.D.

Topics covered in this show

• Dr. Geswell shares his own athletic background and how his passion for sports has played a central role in his personal and professional development, especially regarding orthopedics becoming the ideal balance between field sports and medicine for him.
• Youth sports provide a long list of both short-term and long-term benefits and can contribute to a lifetime of health and wellness, not only in terms of physical health and resilience but emotional and psychological health as well.
• This new and exciting partnership between MUSC Health and Lancaster and Chester County schools will allow easy and open access to high-level medical care to all students in the category of sports-related injuries, more efficiently bridging the gap between families and healthcare providers.
• Dr. Geswell explains the difference between acute and overuse sports-related injuries as well as strategies of prevention for both. For example, encouraging cross-training as well as avoiding long-term specialization in one sport can decrease the likelihood of an overuse injury.
• Recovery can be especially challenging for young athletes and can require anywhere between 6 to 12 months of rest depending on the type of injury. Dr. Geswell reviews examples of some of these injuries and shares strategies for both practically and emotionally coping with the difficult necessity of recovery. He also reviews what parents and young athletes can expect during a standard office visit, from x-raying and other imaging to potential surgeries.
• Dr. Geswell shares his own philosophy for treating young athletes, explaining how important it is that the young athlete feels seen and validated, how important it can be to demonstrate empathic understanding of the athlete’s desire to return to playing, and how to empower older youth to take responsibility for their own recovery.

Transcript

Erin Spain [00:00:04] Welcome to Advance with MUSC health. I'm your host, Erin Spain. This shows the mission is to help you find ways to preserve and optimize your health and get the care you need to live well. The number of students taking part in high school sports has been increasing steadily in recent years, and keeping South Carolina's student athletes safe and healthy is a goal of sports medicine physicians at MUSC Health. In fact, the MUSC Health Lancaster Division has been named the official sports medicine provider of the Lancaster County and Chester County school districts. Here with details on these partnerships and ways parents can help their young athletes thrive is Dr. Matthew Geswell, an orthopedic surgeon who practices at MUSC Health Orthopedics and Sports Medicine in Lancaster. Welcome to the show.

Dr. Geswell [00:00:57] Thank you very much for having me.

Erin Spain [00:00:58] Well, you're not only an orthopedic surgeon, but a former high school and collegiate athlete yourself. Tell me about the role that sports have played in your life, from childhood to the work that you do today.

Dr. Geswell [00:01:10] I played pretty much every sport growing up. I played soccer, baseball, basketball, was a skier, played golf, etc. So I played everything as a kid. And I think sports are important for kids for numerous reasons: friends, team attitude, that kind of thing. So, I ended up stopping playing baseball in high school because I couldn't hit curveballs, and then I ended up playing soccer in college. That was an excellent experience. I was able to play college soccer with my brother, and my best friends to this day are still teammates I had from my college soccer career. And we were pretty good. It was nice. We won a lot. It was Division Three soccer, but we were great. I played at Hobart College, which is in upstate New York, and I had an awesome experience doing that.

Throughout medical school, I guess sports played a large role in choosing my field, not only medicine but also orthopedics, because at some point I decided that sports was such a large part of who I was, and as I was growing up that it was important to me to 1). Play college sports for that reason, and then 2). Make it part of my career. So orthopedics kind of has a natural fit with sports and injury. So that is kind of what drew me to orthopedics in the first place. I had some encounters with orthopedic surgeons as a kid treating some different overuse injuries and things like that that went well. So I had always kind of had that in the back of my mind, but made that decision in college and then into med school that orthopedics was what I wanted to do. I think sports is my passion and it's kind of allowed me to get through orthopedic residency and then sports medicine fellowship and kind of make that a part of my career as I've gotten to this point.

Erin Spain [00:02:47] What do you think are the benefits short-term and long-term of youth sports?

Dr. Geswell [00:02:52] So I think that the benefits of youth sports are numerous. I think it can teach you how to win. I think you teach you how to lose. I think it teaches you maturity. I think it teaches you how to work as a team. It teaches you how to work on your own. It teaches you how to practice and what that means to improve, not only a skill for the sports field, but in your career and what you ultimately plan to do. So I think that that's more of a philosophical idea. But besides the obvious physical ideas of physical fitness and other things like that -- weight management, stuff along those lines,

Erin Spain [00:03:26] Self-esteem even, right?

Dr. Geswell [00:03:26] Exactly, self-esteem would be another one. I think that it can instill a positive pattern of behavior that will lead to a lifetime of health and wellness and instill good habits like exercise, like good self-esteem, like self-care, like being able to cope with winning and losing and all that kind of stuff that happens throughout our lives.

Erin Spain [00:03:48] Well, now there's this exciting partnership between MUSC Health and Lancaster and Chester County schools that's going to allow you more access to young athletes. Tell me about this partnership and the importance of these types of relationships with local schools.

Dr. Geswell [00:04:04] MUSC Lancaster has been able to partner with the local county school districts. There are four high schools in the county: Andrew Jackson, Buford, Indian Land, and Lancaster High School, and we've been able to kind of partner with them, which involves supplying the schools with athletic training coverage, as well as some physician coverage for certain games. So I was able to work with the Lancaster High School and Indian Land High School this fall to cover some football games on the sideline and help take care of their athletes. The ultimate goal is to provide that kind of service to all four high schools and basically allow open and efficient access for any high school injury, sports-related or otherwise, and get them the appropriate and high-level sports medicine care that they require.

Erin Spain [00:04:53] Before this, these student athletes, it would kind of be up to the coaches and parents if they needed attention. And you're saying that now, this is going to be something that's just kind of a routine part of the programs.

Dr. Geswell [00:05:06] We're basically giving the athletic trainers a place to basically have a go-to sports medicine clinic that they can get these kids into. So working with the trainers and knowing the trainers -- they all have my cell phone and they can directly contact me to ask me questions about certain injuries or get kids into my office clinic to be evaluated in a really short period of time. Usually the same day or day after. And just having that kind of access I think will overall improve the efficiency and quality of care that these kids are receiving.

Erin Spain [00:05:43] Injury prevention is so important for young athletes, and injuries among young athletes typically fall into two basic categories: acute and overuse. Can you tell me about those two injuries and what you're likely to see with high school athletes?

Dr. Geswell [00:05:57] Acute injuries is something that happens with an event: a shoulder dislocation, a buckling knee or a fall onto an outstretched arm, something along those lines. An acute injury is a fracture, broken bone, dislocated joint, ligament or tendon tear or something along those lines. And an overuse injury comes from basically repetitive, similar motions that happen over and over again. Pitching is a good example. Common overuse injuries from pitching are shoulder injuries, elbow injuries, that kind of thing. But you can get overuse injuries in other sports like basketball from repetitive jumping, landing, all that kind of stuff. The difference is a little bit of the, I guess, treatment algorithm and work-up. The acute injury usually requires quick imaging, that kind of thing, whereas an overuse injury may require physical therapy, mechanics improvement, MRI, other kinds of investigation if they're unable to improve with more conservative measures. And sometimes, unfortunately for kids, sometimes some rest.

Erin Spain [00:07:04] What are the most common injuries that you see? You mentioned quite a few there, but which ones are just the ones you see coming in all the time?

Dr. Geswell [00:07:12] Fractures, trauma, broken bones are common in all kids, whether they're playing sports or not. So we see a lot of that in the office. Sports specific injuries involve usually knee injuries, so any ligament is knee injury, such as an ACL tear or an MCL tear are fairly common, as well as shoulder dislocations from football -- we see those in linebackers and that kind of thing. Other injuries from something like baseball, you can get an ulnar collateral ligament rupture, which would be an injury to the elbow from throwing and other things such as that.

Erin Spain [00:07:46] You said yourself, you had an overuse injury as a high school student. What did you have?

Dr. Geswell [00:07:50] I had something called Osgood-Schlatter disease, which is an apophysitis of the tibial tubercle. It happens from repetitive jumping. I got it from playing basketball, but it happens from repetitive jumping and that kind of thing, and it is something that is self-limited and kids grow out of it ninety-nine percent of the time. It just sometimes takes a little bit of rest and changing certain activities, sometimes embracing to help them get through the pain and continue to do what they love.

Erin Spain [00:08:19] Tell me what parents, coaches and young people need to keep in mind to prevent these types of injuries and avoid these more common sports injuries. Are there things they can do?

Dr. Geswell [00:08:29] Variety is good for children playing sports. I keep using baseball as an example, but baseball is kind of a classic instance where you can get an overuse injury from too much pitching, too many pitches thrown. What is happening in today's sports world is that -- just like medicine really -- everything becomes so sub-specialized. Often at an early age, kids are getting placed into one sport and continually staying in that one sport. Variety is good to train different sports because it gives certain areas of your body periods of rest. It changes the motions you're doing, changes the repetitive motions you're doing. It also helps develop different skills. So agility, power, things like that. So I think that a variety of sports activities is good, especially when kids are younger through elementary and middle school age. As you become older into the high school realm and you're looking at college scholarships, etc., I think it makes sense sometimes you start to specialize in a particular sport. But again, I think that you have to keep in mind certain limits to things like pitching, jumping, running, all of that kind of stuff.

Erin Spain [00:09:35] And maybe cross-training as well if you are a one-sport athlete.

Dr. Geswell [00:09:39] Correct. Exactly. I think that proper training, cross-training, is a good option to try to prevent some of those injuries. A lot of kids these days have personal trainers, things that help them train certain sports, certain activities, that kind of thing. And having someone that is experienced in that area is good to help you kind of gauge all that stuff as well.

Erin Spain [00:09:59] So recovery can be so difficult for young people. You mentioned sometimes resting, sitting out, not playing your sport of choice for an amount of time can be difficult. Tell me about what recovery looks like for some of these common injuries. How long are athletes typically out?

Dr. Geswell [00:10:14] So it depends exactly what injury we're talking about. So, to start with the overuse injuries, it depends how long it's been going on for, what the specific injury is. If it is an overuse injury, often that comes with a period of six weeks of rest, something along those lines, to see if we can get that tendon, that joint to kind of calm down and start to feel better. With that rest, we do some physical therapy to strengthen the proper muscles and help either that joint, tendon, or muscle function more appropriately and more efficiently. So the timeframe for a lot of these injuries does vary for an injury that may require surgery, such as an ACL tear or a shoulder dislocation or labrum tear of the shoulder. The recovery for an ACL to return to play can be as long as 9 to 12 months. For a shoulder dislocation, it can be somewhere in the realm of 6 to 9 months, depending what sport you're trying to get back to, what activity you're trying to get back to.

Erin Spain [00:11:08] So this can be pretty difficult for young athletes to cope with. Tell me about some of the services there that are available through MUSC Health to help these young people cope with their injuries.

Dr. Geswell [00:11:17] We have a great primary care pediatricians, I think, in the area out here that can help in regards to some of the psychological issues that come along with these injuries and just overall explaining the injury to the kid. Being upfront with your expectations, I think from a surgeon's perspective, can really help them cope with it and deal with what they're going through. Oftentimes, if a child is having difficulty with an injury, I'll try to put them in touch with another kid who has been through that and recovered from it. And I think hearing from them can sometimes help that kid kind of get through that and know that they will get through it and be back to their normal self as soon as they can.

Erin Spain [00:11:52] Just to give people some idea of what it's like to bring your child in to see an orthopedic surgeon, tell me about the experience from the time they come into your office. What are some of the tests that you run? What are some of the things that they might see and experience during the visit?

Dr. Geswell [00:12:07] So when visits usually start, they'll see our front desk staff, they come back, meet our nursing staff, are placed into a room. Oftentimes, we will get an X-ray of the affected body part just to make sure there is no fracture. X-rays can tell us a little bit about any bony injury, some soft tissue injury that can show some soft tissue swelling. Then, after the X-rays are done, they're usually evaluated by myself for one of my partners. We do a full musculoskeletal exam of whatever body part is affected, try to figure out exactly what is going on, if there's any instability, if there is any limited range of motion, that kind of thing. Depending on what the injury is and how long it's been going on for when it happened, etc., we will sometimes order further tests. Those can often include an MRI or a CT scan. Those are examples of advanced imaging, which will give us a better picture of certain bone abnormalities or certain soft tissue abnormalities.

Erin Spain [00:13:00] Perfect. And then from there you're able to if they need surgery or whatever the next steps may be.

Dr. Geswell [00:13:06] If something needs surgery, a lot of the time it requires some sort of advanced imaging. They come back. We'll talk about the imaging study and a follow-up visit. I'd tell them their options, what the non-operative options are, what the operative options are, and I try to make a recommendation for the patient and family that I would want for my family or my kids.

Erin Spain [00:13:26] Tell me about your philosophy when it comes to treating these young athletes.

Dr. Geswell [00:13:30] So like we mentioned at the top of the show, I've had some sports injuries in my history and I had some really great experiences with some orthopedic surgeons as a child. I think something that sticks out to me is basically showing the kid that you really do care about them and you're interested in what they want to do. They're not just their injury, they are the athlete, they are the kid that's in here and you have to show that you kind of understand and can empathize with them and kind of share with them what they're going through. My philosophy is get them back to -- if we're talking specifically sports -- get them back to playing as quickly as possible. I like to tell, especially some of the older kids, the high school kids, is that "this is your knee, this is your shoulder and you are in charge of you." So I kind of like to treat them as adults and explain to them that some of the decision as to how fast they're able to progress, how quickly they can return to sport, is up to them. And they need to be honest with me. They need to be honest with their parents and to be honest with their coaches and tell them what they're feeling and how that knee is doing. So I like to try to get kids back as quickly as possible, but I like to give them some ownership in that decision as well. And I think that helps everybody get on the same page and leads to excellent outcomes.

Erin Spain [00:14:40] And what do you want parents to know about this partnership? Because it really is pretty extraordinary that these young athletes are going to have access to all these folks at MUSC Health. So just tell me for parents who are curious about what this was going to be like, why is this beneficial to their student athlete?

Dr. Geswell [00:14:55] I think that the access is key. I think the access allows for quick, safe, efficient and high quality treatment of these kids to quickly diagnose the problem and then take steps to fix it. If it's something that I can't fix, I'll find them the right person who can. And I think that the benefit is finding out what's wrong quickly, finding the right person to help fix it, whether that's myself, whether that's physical therapy, whether that's another physician, and then get them back to play as quickly as possible, so they miss the minimum amount of time that they can.

Erin Spain [00:15:28] What do you do to optimize your health and live well?

Dr. Geswell [00:15:32] So honestly, since I've started my new job, I've been quite busy. In normal times I am a big runner, so I'd probably be running about 30-40 miles a month and lifting weights two or three times a week. So that would be my normal thing. I also play golf, which is not the most physically active sport, but it is good for concentration and other things. And I've recently picked up tennis, which is a good sport to play as well as I get a little older.

Erin Spain [00:15:58] Well, thank you so much for coming on the show and telling us about this partnership. We are really excited to see what happens next.

Dr. Geswell [00:16:03] Yeah, thank you very much for having me. I appreciate your time.