Daniel Martin: Dr Yip, Welcome to the program. Are you a big fan of the world cup?
Dr Kevin Yip: Yes
Daniel Martin: Who are you rooting for this year?
Dr Kevin Yip: well I think Brazil may have a good chance, I think
Daniel Martin: Nobody plays better than them. You know what? What’s gonna happen I’m sure. I mean this happens around tendencies, around all the major sporting fields you know people feel a little bit encouraged, they wanna get out, they wanna, you know, practice what they see on the screen themselves. It looks great all wild and good. But when it comes to sports injury, people tend to think that they can treat it themselves. “Oh I’ll just wear a knee brace to prevent the knee pain” I’ll play a little bit. I’ll spray some deep heat after that.” Is that a good idea? Can we cope with sports related injuries and pains like ourselves?
Dr Kevin Yip: I think to some extent some of the sports injuries; I think it is possible to treat the problems themselves initially. And I’m sure that many of the conditions will get better, which means the symptoms will improve. For instance, the ice pack, resting and maybe taking a panadol and so on. But I think if the problem persists, like if the symptoms are quite severe, then I think one should seek additional advice
Daniel Martin: Does it have to be debilitating in order to be severe or can it be even an early sign of a chronic pain that just won’t go away?
Dr Kevin Yip: I think it’s the in addition to the magnitude of the symptoms and the chronicity of the symptoms is important as well because the problem will not only be very painful, if its persistent then the body is telling you that something is wrong there and one should then seek professional advice.
Daniel Martin: Let’s talk about some of the common sports injury. I mean the main area is already covered obviously but very subtle and weaker ones but I’ll be talking about knee injuries coming up and of course lower back pain. But I think the first thing that an average person will encounter is the aspect of the sprain or the strain, especially if we haven’t been exercising for a long time and suddenly we just hop on out there and start doing our thing again. The sprain or the strain, first of all, is that a common body response or is it natural to feel it?
Dr Kevin Yip: Yes. I think when people talk about the common sprain, I think what they are referring to is soft tissue injury and usually because of the injury to the ligament or to the capsule of the joint and that’s what people mean when they talk about sprain to the ligament.
Daniel Martin: When we feel it, is it an indication that an injury has happened? It is about to happen? Or is it something else altogether?
Dr Kevin Yip: I think that it usually means that something has already happened. It may be at a low intensity level. People will tend to say, “Oh, I strained my joint”. And then they will say, “I sprained it, I sprained my ankle”. Then usually, this will apply if it is a little more severe and they may not be able to continue with their normal activities. They can’t walk normally, they have to limp and so on.
Daniel Martin: So is the best route, the best approach really just to not add pressure to that limp or that ligament?
Dr Kevin Yip: I think if it is painful, then I think one should take a rest until the symptoms improve.
Daniel Martin: Is it always necessary to see the specialist or your doctor for a sprain or a strain?
Dr Kevin Yip: Again, I think it’s what we were mentioning earlier on. I think it’s quite a broad spectrum in that if it is quite painful or if the problem has been persisting that is not going away then I think one should seek professional advice. Well, if it is a little bit of ache and it tends to go away after two days. Well, I think it is possible for one to treat oneself.
Daniel Martin: We’re speaking today to Dr Yip who is a Senior Specialist Orthopaedic surgeon from the Singapore Sports and Orthopaedic Clinic. You have a strong background when it comes to knee injuries and the meniscus problems as well and knee injuries and problems with meniscus tears and so on are very common among soccer players especially. During this world cup season, I am sure you have heard quite a bit about that. Dr Yip, is that true? Is it very common particularly for people who play and engage in soccer?
Dr Kevin Yip: Yes, the meniscus is essentially a shock absorber system inside our knee joint and it protects the two surfaces of the cartilage inside our knee and prevents them from hitting against one another and it can be damaged when we twist our knee and injure it during a fall or something like that and that may result in excessive amounts of shielding for and that can tear the meniscus.
Daniel Martin: What can this result in? I mean, tearing of the meniscus, how significant an injury is this?
Dr Kevin Yip: The patient may feel consistent pain after the injury and there may be some associated swelling and sometimes the knee may lock in certain position or may not be able to bend fully or straighten the knee fully and if there isn’t a meniscus tear in our knee.
Daniel Martin: I’ve heard of one that sometimes that there can be a folding of the meniscus.
Dr Kevin Yip: Yes. And what it means is that normally our meniscus is actually fitting nicely in our knee joint and if there is a tear then the increased flood, the flood can either fold forward or backwards and it is this that prevents the person from straightening or bending the knees fully. A tear will result in floods and this flood is actually a mobile structure that prevents the knee from straightening or bending the knee fully.
Daniel Martin: What then is the approach for this? Would you say that this is a common injury first of all?
Dr Kevin Yip: Yes. It is quite common. It is common both in the young people and at the same time; it is also common amongst the older generation. And generally, there are two types, those that are usually an acute fall, which usually occurs in young patients. But meniscus injuries can also occur in patients who are in relatively older age groups and that’s because the meniscus can degenerate as we get older and that tends to be quite prone to tearing as well.
Daniel Martin: Lets talk about the long term consequences from this. I mean, is it true that if somebody does have meniscus damage that in the long term this can actually lead to arthritis as well. If it has been removed.
Dr Kevin Yip: Yes, that’s right. The meniscus tears easily can lead onto arthritis because the function of the meniscus protects the cartilage on either side of the knees from crashing against one another. And therefore, without the meniscus, you can get more damage with the cartilage and hence lead on to arthritis.
Daniel Martin: One would think that most importantly we are trying to preserve the meniscus. I mean if the surgical approach is always about removing it?
Dr Kevin Yip: No. I think that with meniscus injuries, nowadays, our aim is to repair the structure of the tear so it will then heal by itself rather than to treat it conservatively where the tear may then further, resulting in a bigger tear.
Daniel Martin: How do we do that? I mean what if the particularly young person had experienced it. I mean I have heard of thirteen fourteen year old boys who have meniscus tear at a young age.
Dr Kevin Yip: Young patients tend to have a much greater healing power. So many of them will tend to heal much better than adults. For adults it is a bit more difficult because the meniscus tends to move all the time and it is difficult not to move our knee. It is very difficult for our meniscus to heal because it is constantly moving. Secondly the meniscus itself doesn’t really have much blood supply and therefore it doesn’t really have a good healing power like other tissues which is the part of the skin or the other structures in our body. So that is why on the whole the meniscus tends not to heal well.
Daniel Martin: Dr Yip, in the first part we ended up talking about meniscus tears and meniscus damage and problems associated with knee injuries. What would you say is the best approach for people to prevent knee problems in the first place?
Dr Kevin Yip: I think in order to prevent knee injuries, I think it is important to have a proper warm-up before the game and there should be adequate stretching of the soft tissue just to improve the flexibility and to warm it up such that it will not get easily injured. I think that most of the time, people tend to be a little too aggressive as well. For instance, they tend to be too competitive. And they tend to go all out and that’s where you will get an injury whether it’s an acute injury or a strain to their ligament. So, I think that if one is not used to doing sports. There is always a danger when we go all out straightaway and do too much all in one go. So I think that it is important to build it up slowly. And of course, right shoe wear and the right equipment is very important to prevent sports injury.
Daniel Martin: You just described a very common aspect of the weekend warrior where there is nothing on Friday but on Saturday, Bang, everything is squeezed into a few hours and that can put a lot of impact onto the body and onto the joints but you often see people trying to counter that, you see people wearing knee braces and things like that. Does it help at all?
Dr Kevin Yip: It helps to some extent but if there is a significant force involved then the brace is not going to save the person from injury.
Daniel Martin: When is a surgical option the most important option?
Dr Kevin Yip: I think that would depend on the actual injury itself. Whether is it severe or what kind of tissues I’m dealing with and on the whole we try to avoid surgeries as much as we can and it is important to recognize which is the injuries that will eventually heal by itself, which are the ones that can be treated conservatively and if the problem persists, we know that certain conditions are not going to get better by conservative treatment then they may require surgical intervention.
Daniel Martin: Dr Yip, I wanna spend some time talking about the next most common sports related injury that we may identify – lower back pain in particular. First of all, I think that we all encounter back pain doing sentry and working in offices and things like that but for sports related as well that tends to arise as well doesn’t it?
Dr Kevin Yip: Yes. I think during sports that is always a lot of sudden twisting and turning and after all a lot of the game which is football, they are so-called the contact sport where a lot of the times we focus on the game, focus on the ball and so on that we tend to forget a lot about how we run and how we are going to be in contact with the fellow players. So a lot of the time, yes, we can get quite a lot of the injuries and to our back because there is so much twisting and turning involved.
Daniel Martin: Talking about the different natures of lower back pain and I mean whether it’s acute or moderate or mild back pain, what is the difference there?
Dr Kevin Yip: Acute back pain on the whole implies that the patient does have back pain whether he is ok in the morning and then after awhile he suddenly gets the back pain and it becomes very severe so that we call it acute lower back pain and this is those patients that may have chronic back pain in that it is always lingering in the background and that it becomes worst over time and becomes chronic back pain.
Daniel Martin: What would likely to occur for our soccer fans if you put it that way, you might wanna get on up there and help them.
Dr Kevin Yip: I think for the acute back pain, there is one possibility, that if they suddenly go to the football field and really try to go all out to score, they can get acute lower back pain.
Daniel Martin: Some people describe what is commonly referred to as back spasms or muscle spasms. Are these related as well?
Dr Kevin Yip: Yes. I think whenever you have an injury to the back, you are going to get a lot of muscle spasms. The muscle spasms is in a way trying to stabilize the spine and in doing so, if your muscle is in spasm, it will also cause further back pain.
Daniel Martin: And that will be leading me to my next theory. A lot of people are very concerned about pain or injuries to the back because they worry whether they can be permanent and lead to long term consequences. When it comes to the back, is there a high risk in there?
Dr Kevin Yip: Yes. I think if the pain continues despite the resting then yes, one may well have sustained a prolapsed intervertebral disc or a ruptured disc and that can lead on to more serious conditions in the future.
Daniel Martin: What kind of conditions are you talking about, Dr Yip?
Dr Kevin Yip: Well, the patient may experience pain radiating to the back of the spine and something known as sciatica and the reason for that is that the disc is now pressing against the nerve root that normally serves the back of the leg. So the patient will experience pain at the back of the spine and far down to the calf.
Daniel Martin: Can back pain, besides leading to sciatica which you described, can it lead to things like slipped disk and scoliosis even?
Dr Kevin Yip: Not so much of scoliosis because scoliosis is a developed mental condition that usually develops at the age of 12 to 17 where slipped disk will be prolapsed just like what we were talking about tends to curl when we are in our early adulthood and that is because of a repetitive strain and certain abnormal posture that will result in slipped disk.
Daniel Martin: How then would you go about managing and treating somebody who came in and reported this kind of back conditions, Dr Yip, Are we talking about long term managements handsays, immobilization surgeries?
Dr Kevin Yip: I think there are patients with acute low back pain we would want to make a diagnosis of the condition by closely listening to the patient and to examine the patient very closely and to initiate some simple treatment and if the symptoms subside then that’s great. If not, then we may require further investigation including x-ray and sometimes we may be required to use MRI, which we will be able to see the soft tissues much better. And with this, one will be able to gauge the severity of the problem and to be able to predict to some extent as to whether the condition is going to get better by itself. Certainly, we would want to give patients some medication that will help to reduce the inflammation. Courses and all this to help support the back and to encourage the patient to bend a little bit more. And a portion of these patients may require further treatment including physiotherapy. If the problem persists, or the intensity of the symptoms is very bad combined with a large disk that one can see on the MRI then some patients may require surgical treatment.
Daniel Martin: What do you think about pain relief as well? Many people do try and do things to relieve the pain in certain.. We’ve heard about mild opium being used as well. Is there a benefit to that?
Dr Kevin Yip: Yes. Certainly, mild opium is used quite frequently. It helps many patients with acute back pain because it reduces the pain and hence reduce the spasm to the back and that will in a way break the vicious cycle and that will help to reduce the symptoms and to help the patient recover from the injury.
Daniel Martin: How does it actually work? You mentioned all this mild opium and combination of narcotics such as pain relievers combined with parasasemore. How do these work to alleviate the pain?
Dr Kevin Yip: They block the pain fibers and the receptors and that will become numb briefly. Some of these are found in the spinal cord as well and that will reduce the amount of pain the patient feels and hence, with the reduction of the pain, the patient will have less muscle spasms and as we mentioned earlier on, if the patient has a lot of muscle spasms, then it will lead on to further pain so by giving this medication, it will help to break this vicious cycle.
Daniel Martin: Dr Yip, just as we wrap up our discussion in a while, I would like to talk about one of the methods that have been commonly taught in our home first aid kits and things, that the RICE method – Rest, Ice, Compression, Elevation as well. Do you think that is a good approach to sports related injuries?
Dr Kevin Yip: Yes. I think many people have heard or come across this. So the soft tissue treatment, the demonic is R.I.C.E, it is read as RICE and R stands for rest. It is important to have adequate rest to the injured part. Ice is very important to reduce the inflammation. C stands for compression and that will help to reduce the swelling and that one can wear a tuber grip or some kind of support brace that will help to reduce the swelling. E stands for elevation. Elevating the injured limb will definitely help to reduce the swelling by gravity. In addition to RICE, it is important also to add to this, medication. Medication helps to speed up the recovery
Daniel Marin: Dr Yip, it has been an absolute pleasure. Thank You for speaking with us today.
Dr Kevin Yip: Thank you