Physician''s Roundtable: Sports Medicine

For many, the lure of desert living includes sunshine-filled winters primed for days out on the green or the tennis court. So much so, that our active, full-time Coachella Valley residents - and those here for the winter - are often in need of the physicians at Eisenhower Desert Orthopedic Center (EDOC). 

In 2023, EDOC had 114,000 visits, including performing 8,400 surgeries and 8,000 pain management procedures. Beyond treating patients playing at the country club or on local courts, several physicians actively support the community by working with athletes of all levels. From school-age competitors to professional players, sports medicine specialists are on the sidelines and in locker rooms, helping to determine when it’s safe to return to play or advising on best practices in healing. Discover more about their work with local high school football teams, the BNP Paribas Open, professional soccer and baseball, and the Coachella Valley Firebirds American Hockey League players.
Our panel includes:

•    Board Certified Orthopedic Surgeon Patrick St. Pierre, MD, who has been team physician for College of the Desert, Palm Desert High School and Palm Springs Power Baseball, as well as Medical Director for the BNP Paribas Tennis Open and the inaugural Medical Director for the Coachella Valley Firebirds. 
•    Matthew Diltz, MD, a Board Certified, fellowship-trained Orthopedic Surgeon specializing in Sports Medicine. He is the Director of Sports Medicine at EDOC and works as the team physician for College of the Desert and Xavier College Preparatory. He is the Medical Director for the BNP Paribas Open, Coachella Valley Invitational Soccer Tournament, American Express^® PGA Tour and the Coachella Valley Firebirds Hockey Club. 
•    Hansel Ihn, MD, a Board Certified, fellowship-trained Orthopedic Surgeon specializing in surgical treatment of sports injuries. 
•    Justin Thomas, MD, Board Certified in Pulmonary Medicine, Interventional Pulmonary Disease, Internal Medicine and Critical Care Medicine, moderated the discussion. 

Dr. Thomas: Let’s talk about sports medicine. What does it entail? Is there any extra training involved to be a sports medicine doctor?
Dr. St. Pierre: Sports medicine refers to taking care of athletes. You’re taking care of teams and you’re learning how to manage athletes differently than standard patients. There’s a wide breadth of medical knowledge required, including cardiac arrhythmias, strengthening and conditioning, weight loss and how that affects athletes’ bodies. There are sports medicine fellowships - Eisenhower Health offers a Sports Medicine Fellowship - in several different specialties as a one- or two-year program. You work with someone, usually in a college or professional setting, where you’re going to take care of those high-end athletes. When you graduate, you’ll take care of teams. 
Dr. Diltz: There are a lot of subspecialties in medicine when you think about it, and as technology advances, there are a lot of people who are really focused on their specialty, like total joints. Within all of orthopedics, there are only two recognized subspecialties, hand and sports medicine. 
Dr. Ihn: The scope of practice for sports medicine doctors varies depending on their location and the resources available to them. A lot of private practices out there do not have as many partners or specialists as our group does. Consequently, as a sports medicine doctor, you may have to take on a broader range of general orthopedic cases including, but not limited to, ankle fractures and joint replacement surgeries. We are fortunate here at EDOC because we not only have a lot of physicians with different subspecialty training, but also it is a very collaborative atmosphere. This allows us to focus on what we did in our subspecialty training, which, in our case, is sports medicine. 

Dr. Thomas: Are you all involved in the sports medicine fellowship training program? 
Dr. St. Pierre: Dr. Diltz and I have been working with Stephen Steele, DO, who is Program Director of the Sports Medicine Fellowship and Board Certified in both Family Medicine and Sports Medicine, for many years. We got involved with him and with the BNP Paribas Open when I took over as Medical Director with BNP, but we’ve always worked with Dr. Steele for the primary care oversight of the program. The family medicine sports fellows will rotate with us in the operating room and in our office. Dr. Ihn will be a part of that soon.

Dr. Thomas: You mentioned the BNP Paribas and schools. Any other sports teams that you cover?
Dr. Diltz: We cover a lot of sports teams. When you think of the Coachella Valley, you don’t realize how many teams are in motion, particularly in season. We organize care for the majority of the high schools, including Palm Springs, Rancho Mirage, Palm Desert, Xavier College Preparatory, Shadow Hills and Indio. We like to have physicians at football games in case there’s an injury, such as a possible concussion. Then, we have College of the Desert community college and those playing at the professional level. The BNP Paribas Open is well-known, but we also have major league soccer. The Coachella Valley Invitational includes 16 teams and we’re there doing sports coverage for them. The Coachella Valley Firebirds has been an amazing addition to the valley. And so in between periods, Dr. St. Pierre and I are there if they need somebody to stitch something or if they need us to look at an injury. We also work with the Palm Springs Power baseball team in season.

Dr. Thomas: What are some of the unique challenges of providing medical coverage for different sports?
Dr. Diltz: Every sport has different injuries, different challenges. The Firebirds get a lot of injuries in between periods. They can get a high stick to the face and need stitches and they have a lot of leg and hip injuries. Our job is to coordinate and provide them with first class care. Sometimes it’s tough with their schedules, but Eisenhower works with them, whether getting MRIs or getting them in to see Dr. St. Pierre or myself in clinic, and they’re appreciative of all the medical coverage they’ve received. Some of the high school football concussion injuries can be scary. Sometimes the kids have had enough training where they know how to tackle, and sometimes, they lead with their head and you worry about cervical spine injuries. We’ve worked hard to make sure we have a doctor for the high school games. I see a lot of pickleball meniscal injuries because there’s a lot of people moving around and cutting, pivoting and doing motions they haven’t done in years and that can lead to some tears. Each sport has unique injuries and it’s nice to be able to get people back out playing because it helps them mentally and physically.
Dr. St. Pierre: One thing that’s really unique is not just the player and the injury, it’s everything that surrounds it. And, it’s different for each one of the different levels of sports. When we’re working with high school players, you need to make sure you have parents on board and that the player and person responsible for the player fully understand what the injury is, the different ramifications, surgery or not doing surgery, rehabilitation, and how fast the player can return to the sport. When you look at professional sports - both with hockey and tennis - the player comes in, but then you also have the team. For hockey, it has to be immediate. We need to call the team doctors in Seattle and discuss it with them because they’re part of this decision process. With tennis players, you’ve got a manager, a trainer, a strength coach, a publicist, agents. You have all these people who want to come in and be a part of the examination. At Indian Wells Tennis Garden, we have our office with a couple of exam rooms in between both the men’s and women’s locker rooms. If it’s really busy, we’re working with two players at the same time trying to keep their privacy. That’s really important because their next competitor may be in the training room right next door. Also, when players describe an injury, they’re forthright as they have to be, but not as forthright as they could be. It’s totally different than the 50-year-old who walks into our office and we’re just taking care of him or her. 

Dr. Thomas: That’s an interesting dynamic. How does the climate in Coachella Valley impact the types of sports injuries you may see?
Dr. Diltz: The Firebirds play in a cool arena. They can play in June - when it could be 110 degrees outside - and you have to wear a jacket. The biggest effect with the climate is the beginning of the football season for the community college and high school teams. You have to worry about dehydration and heat exhaustion. For eight to nine months out of the year, this place is paradise and the climate is perfect. That’s what draws so many people in for the tennis tournament and now major league soccer at the Empire Polo Club in Indio.

Dr. Thomas: How does your team collaborate with athletic trainers, coaches and other health care providers to ensure seamless care for athletes during major sporting events? 
Dr. Diltz: We make sure we have the lines of communication open. There’s a physician assigned to each high school and the athletic trainer typically will have our contact information. If the trainer needs medical advice right away, the trainer reaches out to us and we can help get those athletes in for care. As far as working with physical therapy, Eisenhower has an incredible physical therapy team and they reach out to us if there’s any question about an injury or a recovery. There is a consistent training staff at the tennis tournament who we’ve gotten to know very well, and they’ll reach out to us and ask us for advice. 
Dr. St. Pierre: The tour for the Women’s Tennis Association (WTA) and Association of Tennis Professionals (ATP) both have their own cadre of therapists. We’ve gotten to know them through the years and they have our phone numbers. So, if something comes up in the middle of the night, then they call us. With hockey, there’s two trainers, but the head athletic trainer is constantly talking to us about players’ injuries, especially if we need diagnostic MRIs or lab workups. We’re talking to them almost on a daily basis.

Dr. Thomas: There are a lot of teams requiring personnel. How many are there in EDOC?
Dr. St. Pierre: We have 19 physicians and 19 physician assistants. Eisenhower Desert Orthopedic Center is really set up like an academic setting at a hospital or university. We have subspecialties in everything except oncology and pediatrics. We don’t have enough volume here to support those practices, but we have relationships for referrals with places in Southern California and an affiliation with UC San Diego Health Cancer Network.

Dr. Thomas: What are some of the most common injuries you see in high school or college athletes and how do they differ from professional athletes?
Dr. Ihn: Perhaps the most important thing to remember when comparing amateur athletes and professional athletes is not only the talent and skill level, but also the resources available to each group. As a result, amateur athletes often experience more injuries due to inadequate training in proper body mechanics and poor conditioning. This is especially critical in the desert’s arid climate, where athletes are more prone to excessive sweating and muscle fatigue. These factors significantly increase the risk of sprains and strains for athletes in the region.
Dr. St. Pierre: If you’re working a job and have three kids, you don’t have time to do all the warmup and training. When we take care of the hockey team and the tennis players, they warm up for an hour to two hours prior to going to their event. 

Dr. Thomas: How does injury prevention education for young athletes play into your job? 
Dr. Ihn: Over the past 10 or 15 years, there’s been a lot more work specifically in anterior cruciate ligament (ACL) injury prevention. There’s a program out of Santa Monica called PEP, Prevent Injury and Enhance Performance. It goes through different exercises and a stretching regimen to prevent in-game injuries in adolescents, specifically patients over 10 years old and modified for under age 10. If you look at the numbers, ACL injuries in the United States are just continuing to rise since the early 2000s. There aren’t many resources for amateur athletes, so programs like this, as well as one from Federation Internationale de Football Association (FIFA), are put into place to help adolescents avoid injury. 

Dr. Thomas: Have any recent advancements in sports medicine technology influenced the way you’re caring for athletes, both in terms of injury prevention and treatment?
Dr. Diltz: I think there’s been a lot of research, especially with concussions. Eisenhower has been really good about keeping pace with it. We recently hired a primary care sports medicine physician who helps to ensure our concussion protocols align with the latest standards of care.
Dr. Ihn: With regard to concussions, there’s a lot of high schools who are implementing sensors in helmets. These sensors detect impact and can act as a threshold to say, “Hey, this guy needs to come out for a little bit and get checked out.” 
Dr. Diltz: They’ve started using that at Xavier. That technology isn’t perfect yet, but in the future, it’s going to be a nice advancement to try to protect the student players.

Dr. Thomas: How do you stay up to date on the latest treatment modalities for sports-related injuries?
Dr. Diltz: Luckily, like with many other areas of medicine, we have access to a robust academy. We actively engage with colleagues, attend conferences, and explore diverse presentations as part of continuing medical education to maintain our board certification. 
Dr. St. Pierre: There are subspecialty organizations within orthopedics, like the American Orthopaedic Society for Sports Medicine, which is a big sports group, that have annual meetings every year and courses. The other one is the Arthroscopy Association of North America. I’ve been involved in both groups throughout the years. 

Dr. Thomas: How does your team involvement with local high schools and community college help promote community health engagement in the Coachella Valley? 
Dr. Diltz: There’s a lot of organized sports for people, even as they get older. Numerous studies have shown the more you’re involved in the community, typically the happier you are. It’s worrisome when people start to isolate, so sports in general creates an opportunity for people to continue to participate in activities, which is healthy for the community and healthy mentally for the person doing it.

Dr. Thomas: We mentioned pickleball earlier. Why has it gained a significant amount of popularity recently? What kind of injuries do you typically see for those playing?
Dr. Ihn: On first look, a lot of people - myself included - think of pickleball as a low demand type of sport. It actually is not. You are moving around quite a bit, so you’re prone to the same injuries that you would see on a tennis court. You’re changing directions with your knees, so you’’re prone to knee and ankle sprains. You’re prone to lateral epicondylitis (tennis elbow) like you would if you were to play tennis. Also of note, a study found the number of fractures related to pickleball has grown by 90 times between 2002 and 2022. That’’s a testament to the age group of players who are getting involved. And not only your elderly females, but also your elderly males, who are falling and breaking their bones. It’’s uncommon, but it’’s not unheard of to get hospitalized after a fracture from a pickleball injury, usually involving the hip. 
Dr. St. Pierre: There’s been a lot of fractures, but pickleball is now attracting younger participants and now there are professional leagues starting with younger people playing pickleball. It’s taken off and it gives people an alternative to tennis because tennis just demands such great athletic skill. Pickleball allows you more of an entry level, but then it can be very competitive.

Dr. Thomas: Is there anything you’d recommend to people who are considering exploring this sport before they get into it? 
Dr. Ihn: Take some time to warm up and make sure you’re game ready. 
Dr. St. Pierre: On the other hand, we have people playing seven days a week who are setting themselves up for injury and need time for rest and recovery.
Dr. Diltz: If they do have an injury or even suspect one, they can always come in and get it checked out. Eisenhower has an excellent physical therapy program, as I mentioned, but they also have balance classes. For older athletes are getting back into sports, it’s a good idea to address any concerns early and work on improving balance. 

Dr. Thomas: You’d mentioned earlier an increase in ACL injuries. What do you attribute that to? What has caused that increase?
Dr. Ihn: Since the passage of Title IX (in 1972), there’s been a significant increase in female participation in sports, as well as more young people getting involved in athletics overall. With the growth of sports participation in the U.S. and worldwide, there’s been a rise in sports-related injuries. These injuries often occur during activities that involve sudden changes in direction, which puts stress on the ACL.
Dr. Diltz: The highest at-risk group for ACL injuries is young female athletes. Many studies suggest this is due to differences in anatomy and the shape of the area where the ACL is located, often referred to as the notch, which tends to be narrower in women. It may also be related to neuromuscular firing where the body doesn’t react quickly enough to protect the knee during movements that create a valgus force. 

Dr. Thomas: How do you handle the long-term care rehab for athletes recovering from major injuries and what role do you play during return to play?
Dr. Diltz: Dr. St. Pierre and I just collaborated on physical therapy protocols for patients recovering from surgery. Physical therapists will have access to these online, including timelines for when patients can safely return to activities like throwing after a shoulder injury or cutting and pivoting when it’s an ACL repair. Sometimes we see repeat injuries when the athlete is released too early  from an ACL recovery, so we’’re working to ensure patients and therapist have clear timelines to guide their recovery.
Dr. St. Pierre: It differs between our amateur and recreational-type athletes in managing post-surgery care. We’re very specific about the rehabilitation program, whether it’s a therapist or home program. The professional athletes have athletic trainers and people often wonder why the professional athlete is back playing basketball in three weeks after a meniscal tear and it took three months for a nonprofessional athlete. Firstly, they’re a professional athlete and they’re most likely in better physical shape. Secondly, they have athletic trainers seeing them every day and working them for two, three, four hours with all kinds of different modalities. Their job is to be an athlete and we really do try to encourage our patients to do therapy with the therapist, but also a lot of home therapy. We have videos on our website and I have all my shoulder patients watch videos demonstrating exercises that we want them to do on a daily basis in between their physical therapy visits.

Dr. Thomas: There are so many patients coming in asking about PRP. Could you explain platelet rich plasma?
Dr. Ihn: The overall process involves taking a quantity of a patient’s blood and putting this through a series of “spins” where a centrifuge is used to separate out red blood cells and white blood cells from platelets. The layer of platelets has concentrated platelet-associated growth factors and bioactive molecules. We inject this into wherever it’s needed, the knee, hip, glenohumeral joint, rotator cuff or tendon, providing not only an analgesic effect, but potentially regenerative effect. Studies have consistently shown that PRP is good for an analgesic effect, but it still remains to be seen whether or not they actually provide a regenerative effect.

Dr. Thomas: Let’s move on to mental health. Some players get significant injuries and it really impacts their ability to continue playing a sport they love, which might affect a scholarship and a livelihood. How do you address mental health concerns that might arise from injury or performance pressure in both professional and amateur sports?
Dr. St. Pierre: With professional athletes, there’s a lot more emphasis on the mental health issues because there is a lot of stress. The athlete highlighted recently is Simone Biles, who pulled out of the Olympics four years ago because of mental health issues. And there’s a wide range of different components. It can be stress, anxiety, or being able to recover and being confident in what you’re doing. For some of the professional athletes, a little lack of confidence can tremendously affect performance. The great thing about Simone Biles is she’s been willing to talk about it and she had it addressed. She was able to come back four years later, go back to the Olympics and was stellar. So that’s a huge success in taking care of that mental health issue. We also see it in other sports. There is a sports psychologist on site every day during the BNP tennis tournament and players can make appointments. Also, there’s performance sports psychology. It’s huge in golf because golf is such a mental game. That’s the good thing about taking the whole black curtain away from mental health issues and making it something people can address. At the high school level, it’s a whole different story. We don’t have quite that same access. But again, there are more programs in high schools and people are looking at it. You’re really talking about teachers, coaches and school nurses being able to identify these things and then getting them to professionals. And, if we see a mental health issue as an orthopedic sports medicine doctor, we’re not going to treat that. I’m not going to take an athlete under my wing and try to coach them through their mental health issues, but what our goal and our role is to get them involved and connected to someone who can help them.

Dr. Thomas: What strategies do you use to ensure that all athletes, regardless of their level, receive equitable care?
Dr. St. Pierre: When you retire, you’ve worked all your life to get this time to be able to do this stuff. A lot of people want to play golf four times a week. They want to play pickleball and they want to work out. I’ve had the opportunity to take care of an 87-year-old patient who does a hundred pushups a day. I’ve replaced one shoulder and he may need the other one, and he is considering doing it. We enjoy taking care of teams and it’s fun and it’s nice to be in the coaching environment, especially in the professional levels, but at the high schools we get to speak with young people who are thinking about going into sports medicine or pursuing a career as a physical therapist or an athletic trainer. They talk to us about going to medical school. The biggest challenge is balancing our own lives between spouses and kids and our commitment to the players in the community.
Dr. Diltz: Yeah, I would say that we are orthopedic surgeons who specialize in sports-related injuries, but not all sports related injuries occur in sports. You could be walking in the grocery store, trip or slip on water, and tear your ACL. Or, you can get a meniscus tear taking a wrong step coming downstairs too quickly or coming down a ladder. Sports-related injuries are our specialty, but they occur in all aspects of life. 

Dr. Thomas: Do patients get referred to physical therapy at EDOC? 
Dr. St. Pierre: We’re involved in all the physical therapy throughout Eisenhower. Eisenhower has several physical therapy locations throughout the valley. In addition to the one at Eisenhower Desert Orthopedic Center in Rancho Mirage, we also have another location on the hospital campus in the Dolores Hope Building, two locations in La Quinta and one in Palm Springs.

Dr. Thomas: Has the EDOC been able to attract new physicians to the desert? 
Dr. St. Pierre: When I came in 16 years ago, the practice was half the size, maybe smaller. It’s really grown throughout the years and having a great facility does help to build a practice. Also, we’re busier. The valley is bigger and more people live here year-round, so there’s a higher demand. We get an influx of half a million people and when that happens, our backlog gets bigger. That’s why we need to keep bringing in new physicians to not only replace those who are retiring, but also to build our practice so we can take care of all these patients. Not only do we have one specialist in every subspecialty, we have at least two or three. We have the ability to cover all the injuries and the people that need us in the valley.

For more information about Eisenhower Desert Orthopedic Center, 
visit EisenhowerHealth.org/EDOC or call 760.773.4545.