When should I see a doctor?

Health care discussions can be hard to swallow nowadays – health care decisions perhaps even more so. While many Americans find themselves between a hospital and a hard place, weighing the risks of not seeking care after an injury, even those who feel they can freely call their doctor might wonder: Is this worth it?

“Most people don’t have a home health encyclopedia anymore, and the internet is laden with information – both good and bad,” said Dr. Shane Woolf, chief of sports medicine and associate professor of orthopedics at the Medical University of South Carolina.

So how do you know when an injury warrants a hospital visit?

“The first place to go should be a phone call or electronic record message to their primary care provider, orthopedist or physiatrist,” recommended Dr. Woolf. “It’s not unreasonable to call your doctor’s office. Most of the time, they’ll schedule a visit or offer sound recommendations and save you a trip to the ER.”

When it comes to injury, everybody is different, counseled Dr. Woolf: “Injuries vary greatly by age group and activity level.”

Dr. Woolf laid the situation out like a spectrum. He’s seen the full range, from kids’ sports games to seniors’ office visits. The more severe involve deformity, laceration, dislocation or a break in skin, usually caused by impact or trauma. For these, doctors often pursue X-Rays or MRIs, and treat with surgery, prescription medications and sometimes physical therapy. On the other end of the spectrum are non-severe or minor traumas, strains and soreness where there’s no deformity or swelling. In those cases, ice, rest, elevation and an over-the-counter pain medicine often are enough.

“Sometimes a person will call our office and they’ll say, ‘I got this injury and there’s a break in my skin and my arm looks funny or I can see bone sticking out,’” said Dr. Woolf. “That’s pretty serious. Then we say just go right to the ER; you need to be treated.”

Chronic pain, as opposed to a high-impact injury, can be easy to ignore. It is most common in working-age people whose lives require certain physical motions or in seniors who experience degenerative or arthritic injuries.

While high-intensity injuries lack subtlety, they do make deciding to seek care the more obvious option. Lacerations, a break in the skin, deformity of the joint or a broken limb are all indications that medical care is probably necessary, and soon, according to Dr. Woolf.

“For kids, it might be knee injuries in soccer,” he explained. “Say they’re running down the field and they turn and cut to go to the ball without any contact. They twist their knee and feel a pop. It’ll start to swell and become painful.”

For seniors, he said, “Significant trauma could be from a fall or collision. Say, falling on an outstretched arm or rolling an ankle that then becomes so painful you can’t put weight on it. In an older individual, this seemingly innocuous ankle injury could be a fracture.”

Another example that you might not normally think of: CrossFit. According to a 2018 study in the Journal of Sport Rehabilitation, CrossFit training programs have comparable rates of injury to Olympic weightlifting, distance running, track and field, rugby or gymnastics, though people are more likely to be injured if they are unsupervised, especially men.

“The pain that comes on a day or two after activity is usually related to delayed-onset muscle soreness. Most of the time, that will subside pretty quickly without treatment,” said Dr. Woolf. “The one caveat is with people who are doing something like CrossFit, and they’re either not conditioned or not hydrated or they went out the night before and consumed alcohol.”

High-intensity workout injuries like these, in rare cases, will be at risk for a more significant issue where the muscle breaks down and spills myoglobin into the blood system. That can lead to more serious systemic issues with the kidneys.

“That’s not a real common injury but something we see with high-intensity athletes or young ones who are getting back into their sport at the beginning of a season,” said Dr. Woolf. “If the pain is severe or associated with a lot of swelling within 24 hours of the workout, they should come in pretty quickly. There have even been cases of muscle injury or even limb compartment syndrome from swelling, where swelling can actually affect circulation to the limb. Those types of injuries are rare but they can be catastrophic.”

For acute traumatic injuries such as these, quick treatment and a comprehensive assessment can be key to healing, said Dr. Woolf.

“This is a whole different discussion from the chronic overuse injuries,” he explained.

Just because there’s not blood, swelling or a broken limb does not mean that medical treatment is unnecessary.

“The majority of things we see are chronic,” Dr. Woolf said. “Usually, it’s a limb or joint that’s been painful for more than a few weeks or a month or two, and it hasn’t gotten better.”

Chronic pain, as opposed to a high-impact injury, can be easy to ignore. It is most common in working-age people whose lives require certain physical motions or in seniors who experience degenerative or arthritic injuries.

The situation Dr. Woolf described is all too familiar to many: “The older out-of-college adults who are playing rec sports or maybe have a job description that involves a lot of lifting and carrying – their injuries tend to be from overuse rather than an impact injury. Same for older people. They’re holding up but they’re more susceptible to injuries and start to develop some degenerative changes in their tissues. They start feeling pain, maybe at nighttime, and it lingers. Those folks usually have tried the over-the-counter anti-inflammatories and rest before they show up to the clinic.”

Perhaps we like to think these chronic issues can be ignored; they don’t need stitches or a cast so maybe we can simply ice them, wear a drugstore wrist brace, use some IcyHot and they’ll go away. Sometimes, said Dr. Woolf, that is the case, but, if the pain persists, don’t rule out medical help just because it doesn’t look broken.

“I tell chronic pain patients, ‘I’m happy you came in. You’ve been suffering for months. It could be we just make a minor adjustment to the care program you’ve already been doing,’” said Dr. Woolf. “Many times we can manage without surgery and the pain subsides.”

First comes an examination where the doctor assesses things like range of motion and pain, then possibly X-Rays to help make a medical diagnosis or gauge severity. Sometimes, said Dr. Woolf, a short-course prescription anti-inflammatory and a referral to a “good, manual, hands-on physical therapy program” are just what the doctor orders.

So what should people look to now that we don’t have home encyclopedias anymore and the internet can be rife with misinformation? Dr. Woolf recommended calling your doctor first; don’t be afraid to reach out, he said. Then, consider vetted online resources like the American Academy of Orthopedic Surgeons patient information portal, MUSC online patient education material or the Mayo Clinic.

It can be scary to take that first step to pursue medical care, especially when insurance becomes a barrier. For example, in South Carolina, the Centers for Disease Control and Prevention reported that 85 percent of people over 65 have a regular doctor. That number drops to less than 50 percent for uninsured seniors.

“The message to get across,” said Dr. Woolf, “is that there are occasional problems that will just need to be treated surgically, but, often, with a good treatment plan that takes into account their history, job, lifestyle and activity, they can heal well without.”

“Be mindful that there’s a lot of information out there,” counseled Dr. Woolf, “and until you have that medical assessment, we cannot completely know.”

What to look out for and how to treat yourself at home.

By Enid Brenize

INFOGRAPHIC: Injuries by the Numbers
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