In this insightful podcast, we dive deep into the world of sports injuries, focusing on the intricacies of knee health, particularly ACL (anterior cruciate ligament) injuries. Joined by a leading orthopedic sports medicine expert, we explore the causes, prevention, and treatment of common injuries faced by athletes and fitness enthusiasts alike.  

We are talking about sports injuries here. Don't indulge yourself in the same sport every day. If somebody is doing strength training every day, he is more prone to have injuries.

Ryan: What is the most common issues that people are facing today in orthopedics?

Chirag: We have so much of buzz about ACL in today's day.

ACL. ACL. ACL injury. An individual having an ACL tear has a lot of baggage. At least three out of ten people coming with knee problems walking into my office. First thing they ask me is, Doctor, the shoe we

Ryan: choose for any activity that we do could also cause an injury? I think most of the injuries today are related to the knee.

So what's your opinion on this?

Chirag: Injury prevention is very important. There are various ways how one could prevent an injury. So, Ryan, these are possibly the best practices to prevent injuries. Number

Ryan: one being Have you ever heard of an ACL injury? ACL injuries are everywhere these days. If you're into sports or fitness, you've probably heard of them or know someone who's had one.

I definitely have had one too. Well, they are definitely making the headlines if not giving you some pain in the lower part of your body. Now, the question is Why is this tiny ligament in your knee such a big deal? A new episode is out, and this time, it's with my dear friend, Dr. Chirag Thonsay, an orthopedic surgeon who's seen it all when it comes to sport injuries.

Don't know what an ACL is? Dr. Chirag is here to break it down. Already familiar? Learn why it's so prone to injury, how it affects performance, and most importantly, how to protect it. If you're an athlete looking to avoid injuries, build stronger knees, and take your game to the next level. This episode has everything that you need.

It's packed with tips so you can actually use them. So hey, why would you even think of missing this episode? Now before we get started, you know I bring these episodes to you with love. I am looking to make you a better person as I bring health and wellness. to the entire world. What I need from you is a little bit of love, a love of a share, like, comment, and best of all, the greatest gift that I can give from you is a click button subscribe.

And that click actually helps us go longer, stronger, like running a marathon for you.

Dr. Chirag, one of my good friends, and it's so exciting to have you here today. Now you're a sports medicine doctor, an orthopedic sports medicine doctor. I'm super happy to have you because I work with so many athletes and one is to enhance their performance, but the other one is to take care of them.

Now you take care of a lot of our athletes. Orthopedics, what was your journey? Did it start in medical school? Did it start when you were in 9th standard? Talk to us about your journey on becoming one of India's best doctors

Chirag: on the outside. Thanks Ryan for inviting me here. It's such a pleasure to be talking on especially sports injuries.

And that's my forte. Orthopedics. Yes, of course. Your passion drives a profession. Got into my medical school. inclination towards orthopedics, the kind of work what orthopedics does is phenomenal. Always wanted to be a surgeon though. A surgeon provides a good quick result and orthopedics is one branch where you have patients coming in limping, going out walking and furthermore start playing and it's a very gratifying job.

It's a very satisfying job and that's where my passion drew. Over the period of time I took inclination towards arthroscopy. It's also the the need of the hour, the way how India is going, the way how the sports scenario in India is, is, is grown over the last one decade. That drew my attention a little more towards sports injuries and seeing all these athletes being with them furthermore here we are.

I'm a sports surgeon now. And what

Ryan: are the most common Not only sports, but orthopedic injuries that people have. And have you seen it in your career as an orthopedic surgeon evolve? Like in the olden days versus now. So what is the most common issues that people are facing today in orthopedics?

Chirag: Orthopedics generally, conventionally orthopedics means fractures. Okay. So, a fracture can be because of accidents, because of fall. That was what conventional orthopedics was. And as medical sciences have probably taken a makeshift in the last last couple of decades, we have seen a speciality developing in orthopedic practice.

And that's where we come into picture in these days. Speciality in the sense you have sports injury as a separate speciality, you have shoulder knee specialists. You have spine specialists, you have hand specialists, and you have various other specialty branches in orthopedics. Now, where I deal with is knee and shoulder.

That's my forte. And I, I deal with a spectrum of knee and shoulder problems. Replacements, sports injuries, ligament reconstructions. Of course, even injury prevention is also another thing which we look into in today's date.

Ryan: So you talked about the different departments, right? Shoulder, spine, knee, ligaments.

And obviously, when I work with athletes, it's my thing that I'm hearing very often. that most of the injuries today, I don't think all of them, but I'm feeling most of them are related to the knee. So what's your opinion on this? Is the knee the most susceptible organ in the human body right now?

Chirag: Not exactly, but but we need to understand that we are talking about sports injuries here.

And what kind of sports you play. India by large is is, is not attuned to much of upper body sports. It's more of a lower body sports scenario in India. Still, you talk about cricket, you play about badminton, you talk about football. All of them, hockey, all of them involve kabaddi. All of them are majorly lower limb kind of activity demanding sport.

So the injury rates may be more in the lower limb. But of course, if you look at the other spectrum of sports, like, you know, swimmers, badminton players, racquet sports players, in U. S. maybe, Shoulder injuries also may be equally in terms with your knee problems because they're involved in a lot of baseball pitching and all those things, which is not very commonly seen in India.

But of course, if you look at it, the ratio is almost I would say a little more than one is to two.

Ryan: In fact you know, before we started the podcast, you sent me a lot of research and data to browse through. And this is lovely graph of all the sports. So, you know, the knee. As a lay person and for everyone out there, I want you to walk us through so that athletes and even people can understand how delicate or how important or how strong the knees.

So can you deep dive into the knee and guide us on the anatomy of the knee?

Chirag: Oh, I just love this. See Ryan, I've been in orthopedics for a while now and knee is something which has driven my passion so much and it's such a wonderful structure. When I look at the knee, I feel as if I'm looking at Taj Mahal.

Chirag: I'm in love with knee for decades now, and this would be very apt for me to tell you what exactly is a knee. Let me just brief you about the brief structures of the knee joint quickly. Let's just have an image of the knee joint here. Let's quickly look at the human anatomy of the knee joint, and one can see here.

A knee is a nice, beautiful structure with a lot of ligaments and other structures here. Basically, when you look at the knee joint, it is formed out of three bones. The upper bone is called the femur, the lower bone is called the tibia, and this kneecap bone is called the patella. So this, a confluence of these three bones hold together the knee to functionally make it feasible to perform various kind of activities.

Now, what holds the knee together? are these structures called ligaments. The two bones of the knee joints are attached by these ligaments and there are four ligaments. The side, the side ligaments are called the collateral ligaments and the inner ligaments are called the cruciate ligaments. So when these collateral ligaments are towards the midline of the body, it's called medial collateral ligament and the other side is called the lateral collateral ligament.

Likewise. The cruciate is inside, they are criss crossing ligaments, each one of them cross each other like a criss cross structure and they are termed as anterior cruciate ligament and a posterior cruciate ligament.

Ryan: So anterior cruciate is in the front of the front of the knee? Yes, yes. And posterior cruciate is in the back.

Okay. So if somebody gets a pain in the back of the knee. Then does that mean that that ligament is affected?

Chirag: Could be. Okay. Not necessarily be.

Chirag: Ligaments basically provide stability to your knee joint. They don't really reflect to the pain.

Chirag: Of course, the initial part of the injured knee could have some amount of pain.

Yeah. But eventually it's more of a stability what, what a ligament provides.

Ryan: And in this beautiful picture, obviously we have the two, the two bones that are there and these, I'm, I'm thinking ligaments are these wires that kind of hold the whole thing together. Is there any fluid in all of this? Because people say there's some, my fluid has gone and all of this stuff, you know, so is that the right thing to say?

Chirag: Yes. Furthermore, to elaborate on the knee joint, this whitish thing what you see here is called the cartilage.

Ryan: Oh, this is

Chirag: cartilage. Yes, yes, yes. Cartilage is basically the lamination of the ends of the bones. These are the smooth, glistening, nice structure.

Ryan: So when I eat my chicken and I get that, I get that white, soft thing on the top of the chicken bone, that's the cartilage.

Yes,

Chirag: that's, that's a hyaline cartilage and that is what provides a lamination to the bone. The cartilage has to be smooth and nice for normal functionality. Any breach in the cartilage will bring about pain and discomfort to the knee joint. How does that happen here? That could happen because of various reasons.

But, to elaborate on that, can you see this structure here?

Ryan: Yes, what's that?

Chirag: That is a cushion between the two bones, or the two cartilages. This is called the meniscus.

Ryan: Oh, this is the meniscus? Yes, yes. Okay, okay. Meniscus

Chirag: is basically the shock absorber of the knee joint.

Ryan: Okay.

Chirag: So, the two bones are shock absorbed by the structure called the meniscus.

And the meniscus is a cartilage? It's a fibrocartilage. Your cartilage is a hyaline cartilage. The lamination what I was talking about and this meniscus is a fibrocartilage. So

Ryan: it's almost like, it's like, it's, it's in, it's in this whole shock absorber in over there. Yes, yes.

Chirag: It provides, it takes away the load from the knee joint.

When you're standing, walking, climbing stairs, what happens is a tremendous amount of load which is translated from the upper bone to the lower bone between the two cartilages. So, this meniscus acts like a shock absorber. It, it takes as a load spreader and a load sharing device between the two bones and that protects your knee joint, basically.

Now, when this meniscus is damaged, that's when you have kind of a pain and discomfort. Okay? Now, also we need to understand you're talking about the fluid. This is called a synovial fluid. There's some amount of fluid. Any, any, any joint is a closed chamber. And this closed chamber would require some amount of lubrication of the knee joint for a normal functionality.

It's like providing a kind of a lubricating gel inside the knee. And that is called a synoil fluid. It's about 3 to 5 ml fluid which is inherently there.

Ryan: So is this meniscus important for the

Chirag: athletes? Very important. How so? I would say it's the lighthouse of the knee joint. Lighthouse? Yes, of course.

Without a meniscus, imagine sitting on a chair without a cushion. And if you do that repeatedly, it's going to hurt you exactly. So that's when athletes would have pain. If there's any kind of a breach in this meniscus, you have a meniscus tear. Because of various activities, maybe because of a fall, maybe because of a twist, you can have a meniscus tear, meniscus injury.

And that could lead on to symptoms like pain, locking, so on and so forth.

Ryan: So when you as an orthopedic surgeon, a patient comes to you and says, I have pain, right? Is that the reason why you ask for x ray or MRI? Yes, of course. So how does that help you as a doctor?

Chirag: Pain is subjective. Now pain could be because of various reasons.

It's not necessarily a structure problem.

Ryan: It's not necessarily a structure problem? Structural problem. Okay, structure could be because of genetics.

Chirag: No, no, no. It, it, it could be a problem because of the muscles. Okay. Tendons.

Chirag: Tissues. Okay. Nerves. Okay. Or else the integral. Structures of the knee joint.

Okay. Pain could come from anywhere. Now if somebody has got a persistent pain which is non specific into multiple joints there could be something else like an inflammatory pathology. We need to think about inflammation, post viral arthralgia. If it is specifically after an injury then we need to think about ligaments and cartilage and meniscus which are damaged.

So,

Ryan: I hear with my athletes a lot of time, meniscus tear, meniscus tear. Yes. Why is that a common injury? Is it because sports is so aggressive? It's multi direction. Do you see that? And how can we save the meniscus?

Chirag: See, that's a, that's a very tricky question. Okay. Now, it depends on what activities you're involved in.

Chirag: If you look at any injury in the body, it could either be traumatic or it could be a repetitive stress injury.

Ryan: So traumatic is sudden. Yes.

Chirag: Sudden if somebody is playing a football sport and is ping with that foot in the wrong direction, in the wrong direction or else if he is, if he is not planted his foot in a appropriate way.

Mm-hmm . If a person has got a bad foot alignment. Yeah. And if he's playing in a in a, in a manner where he is not supposed to play or if he is not strengthened his. Muscles are on the knee joint, which we call the balancing muscles. And if he is up to playing some sports, what do you call the weekend warriors Nowadays, we fine.

All of us are, I mean, we play sports, so we weekend, so I, I told,

Ryan: I told my ACL karate knees, muscles, not strong enough. Pivoted hip was too tight. Knee took the, the rotation and tore the whole thing.

Chirag: Exactly. Now you have retrospectively thought about all these things. Correct. But do we introspect on this?

And we don't

Ryan: tell our children to strengthen their their muscles. Absolutely. They just go into a sport directly. Absolutely.

Chirag: There's no neuromuscular coordination training done there. There's no strengthening training there. There's no alignment assessment done and we jump into sports. This is where all the, the crux of the problem is.

Coming back to your meniscus tear, it could happen either because of one such instance where you, where you fall or twist or have kind of a sporting injury. It could be because of a repetitive stress injury. Now you see some of the gentlemen in the gym, they do 100 squats with weights, deep squatting, or else people who frequently take stairs, or else people who are involved in a lot of jumping activities, if they're on a higher BMI, or with the wrong foot alignment, they're also prone to have a repetitive stress injury of the meniscus, tearing certain part of their meniscus.

On the contrary, somebody who's 50 years or 60 years coming to me with a knee pain, And I find a meniscus damage in the MRI, it could translate to their age related problems. It's a degenerative tear of the meniscus. So we need to categorize these patients into young athletes and elderly individuals and treat them accordingly.

Ryan: So we've talked about the meniscus. So you were talking about the ACL. Yes. Right. So what is the ACL in this for me to understand now? So where is the ACL in this knee anatomy?

Chirag: Yeah. So. ACL is a very, very important structure and we have so much of buzz about

Background: ACL

Chirag: in today's day. We hear at least three out of ten people coming with knee problems walking into my office.

First thing they ask me is, Doctor, do I have an ACL tear? Because ACL is so much in buzz, because of various reasons, we'll talk about it later. Because of the social implications, because of the sporting implications, one person, one individual having an ACL tear has a lot of baggage along with him. Now, as I, as I spoke about the knee anatomy, let's just revisit it.

The upper bone and lower bone is held together by these two crisscross ligaments inside the knee joint. And the structure from the, going from the front to the back is called the anterior cruciate ligament or the ACL. Now you look at this ACL, it's a very small structure, about, if I would say it's about 3.

5 centimeters in length. That's all. It's quite a tiny structure. But the function is great. It is the central ligament of the knee joint, which holds the axis of the rotation in the center. It is basically a pivoting ligament. You told me that you had an injury while playing karate, because karate is a pivoting sport.

Likewise, we have a lot of footballers coming to us, people who land with their foot during balancing act, dancers, they are prone to have an ACL injury, because it's a pivoting ligament. And when your stresses go beyond what a, what a ACL ligament can hold. I would say on a normal situations when the stresses go beyond about 3, 000 N or 3, 500 N force on this ACL ligament, that's when you rupture your ACL ligament.

Ryan: Yeah, but the common man doesn't know the understanding of Newton force. Yes. So I think athletes can rehab and prehab themselves. Yes. But what about, you said BMI also affects people? Yes, of course. So that means overweight people are more. prone to have greater force on the knee, which could cause the rupture, depending on what position you are, what you're doing.

So, could it be that in athletes, it's because of sports injury, but in Aam Aadmi, it could be because of a fall or an accident or stuff like that?

Chirag: Yes. See, high BMI is a root cause of many problems.

Ryan: Yes.

Chirag: If you'd ask my cardiology friends, they would say, yeah, heart attack, the diabetics would say, so on and so forth.

You as a nutritionist, you would want to see all your patients. young, healthy and

Ryan: low BMI, maybe

Chirag: low BMI. Why so? Because the longitudinity of the, of the, of their life span. Likewise, longitudinity of the knee also depends on, to some extent, on the BMI. Of course, injury, head injury, all of them do play a role.

Anything, any structure in the body which is overstretched or over pressurized will have some implications on that structure. So when you have a high BMI, and when you're prone to that kind of an injury, the chances of rupturing is much more than a normal individual.

Ryan: So if somebody already ruptured an ACL, non athlete, this is the armadami, let's say they're above 40, 45 then do we also ask them to still further lose weight?

Does it, does it still affect the knee? I'm assuming logically it's still going to affect your meniscus and other parts.

Chirag: Yes. I mean, that, that's very very rightly asked question. Well. There are implications of any injury of the knee is not only short term, it's also the long term. We all know the risk of wear and tear or the progression of arthritis into any form of an injured knee is much more higher than, than a normal knee joint.

Now by statistics and data ACL injured knee, which is untreated for the period of 20 years has got about 56 percent risk. of developing osteoarthritis as compared to the normal knee joint.

Ryan: Yes. So I am more prone to get arthritis because I have already

Chirag: That depends on what you have done, what kind of sports you play.

I

Ryan: am

Chirag: hoping there is going to be stem

Ryan: cells soon so that I can inject it over there and everything. Let's talk

Chirag: about it. But for now this is the data where we stand.

Ryan: Okay. So it

Chirag: is very important that we recognize our injuries, we recognize our injury pattern and we have certain amount of injury prevention programs.

Ryan: Do you have old players coming back to you after 10 years or so and you see, further issues with their knees like once, once they retire and all. So they have the injury when they are young age, but they either don't rehab it or they don't operate it and then they come back later with these issues.

Chirag: The implications of knee injury are very high. Now if you understand. about the meniscus. I told you that meniscus is very important to provide a cushion. Now what happens if somebody has neglected a meniscus tear? The meniscus is basically defunctional. So you do not have a shock absorbing effect within the knee joint.

And that would in turn lead on to an early wear and tear. Now if you have an ACL injury, that again has its own repercussions. One can have a simultaneous meniscus tear, cartilage defects, because of your neglected ACL. And that would lead on to a quicker wear and tear. So you, you have this term called young arthritic knee in these days.

People at about 50 years, 45 years coming to us with wear and tear of the knee joint. And one of the reasons is neglected ligaments or Meniscus injuries.

Ryan: So you're saying to people that sometimes it's better not to neglect because down the line. Yes. These conditions will, could have been avoidable.

Yes. So a lot of times, you know, people say, Oh, that surgeon just wanted to operate and he wanted to, you know, make some money. But I think now what you're saying to me is that a stitch in time saves nine.

Chirag: Absolutely. So we need to understand about medical science and the way how it's progressed.

Okay. So, any technology which comes, it's for the betterment of human society. And I think when we have the facilities available, now see you have robotics, you have MRIs, you have navigations, so your diagnosis is very precise. Prediction of your return to sports is very high. And you have a facility, why not avail it?

Ryan: True. In fact ABS systems in car, braking system came out in Formula 1 sport. So, I think anything that gets developed for sport ultimately trickles down into mainstream population. Yes.

Chirag: That's very interesting to know. Ryan Indian scenario is very different from the West. Okay. Now, you look at this data here.

People usually presenting to us with, with their ACL injuries.

Chirag: Now, if you look at this, most of them come to us saying that I had a fall. Fall.

Ryan: So, this could be everybody.

Chirag: Anybody. Anybody. You have some dancers here, work related injuries, assault, motorbike accidents, all this account to large population which has got an ACL tear.

This graph is pertaining to our ACL tear, which is almost, accounts to about 14 percent of your knee injuries. Now, ACL alone accounts to 14 percent of your knee injuries. And we need to probably look into the scenarios. West is a different scenario than India. Now, India sports is just branch right now.

Most of the injuries, most of the athletes who come to us are not sportsmen.

Ryan: So is there a more awareness that is happening around ACL or, or what is it doctor? What are you seeing as a trend in the ACL injuries?

Chirag: ACL injuries in the last one decade has drawn a lot of attention.

Ryan: Is it that in the olden days people got injured and they continued playing and then they retired?

No, no, no.

Chirag: There are various various studies which have actually looked into why the instance of sports injuries, I mean, ACL injuries are so high. If you see in the last five years, the detection of ACL injuries or the incidence of ACL injuries have grown up to about 23%.

Chirag: U. S. alone, in the United States of America, you have about two lakh individuals having ACL tears every year.

We do not have a data coming out from India as yet, but imagine what would be the Yeah. In India, it's, it's a huge amount of population. As I said, it, it accounts to 14 percent of your of your knee injuries. It could be because of various reasons. One either one could one could attribute it to the increased amount of sports, which is happening in these days in the last one last decade, you would see a huge makeshift of your, of your of your activities.

Like even not only the younger guys, even the middle aged guys are involved in a lot of sports. And if you look at the data now, the instance of a c injuries, which used to be called as a juvenile or a youth injury. Now the instance between 30 to 50 years of age group is higher than the juvenile age group

Ryan: could be that people are also saying that they need to get fitter or work out for good health.

Chirag: Yeah.

Ryan: Lose the BMI, which is going higher. They want to eat more.

Chirag: Yeah.

Ryan: So they're taking up a sport.

Chirag: Yeah.

Ryan: And

Chirag: and, and you have an access to pivoting sports these days. You have a lot of football arenas coming up. You have a lot of badminton courts coming up. So people are taking into contact sports also.

As you said, you are, you are into martial arts. So I've seen a lot of people show enthusiasm towards your contact sports, your MMA and Jiu Jitsu and Karate. So even these sports put you at a risk. So Doctor,

Ryan: We talked about the age group and what could be sports and non sports, but is there any relationship between gender?

male and females, who is more prone to injuries.

Chirag: Statistically, if you look at it, the incidence of an ACL injury in male and female is something like this, a ratio of 25 is to 75. Wow. So for every four

Ryan: people, three are males.

Chirag: Yes. This could be because of various reasons, the access of sports to, to males, the kind of activities they're involved with.

That is one part of it. But if you look at the athletes. The incidence of ACL injuries in female athletes is higher as compared to the male athletes.

Ryan: Wow.

Chirag: That's a very nice data which has come out. It's as high as, exponentially, into four. Four times more. Yes, yes. The various reasons could be attributed to this.

One is your basic alignment. Ladies inherently, most of them have a knock knee.

Background: Mm

Chirag: hmm. What we call the Velgas knee. And that is one of the ways where you land. And have your ACL ruptured.

Ryan: So doctor, is it important that if the females that are four times elevated risk as athletes we should be encouraging parents to screen their daughters for posture, for gait analysis and things like that?

Chirag: Now when I spoke to you about the knock knee, it's not necessary that everybody with knock knee would have an ACL injury. It's one of the risk factors. Now, there are various papers which have come out saying that menstrual period. During that, that time, since the oestrogen levels are high, these oestrogens play a role in stretching out of ligaments, making them more prone for, for an ACL injury.

Wow. Of course, it's not a proven data as yet, there should, there needs to be more study in calculated into this, but this is the basic data which has come out and that could be one of the reasons they attribute that women athletes have more injuries of ACL as compared to the males.

Ryan: So irrespective of male or female.

Yes. Assume they suffer an injury, an ACL injury, what happens if they leave it untreated as a sports person? Yes.

Chirag: So, I tell my patients the same thing. Other than appendix, every other structure in the body has got a role to play. And ACL is such a, such an important structure. So, there will be repercussions for that.

I don't think it's wise to leave an ACL alone. In fact, if it's, if it's, if it's symptomatic, now let me, let me,

Ryan: what do you mean by symptomatic doctor?

Chirag: Yeah, so let me tell you something very interesting. There's something called a new classification come out saying that copers and non copers.

Chirag: You may be a coper, that's why you are able to play karate in spite of having your ACL injury. Now copers are individuals who can resume their normal activities of daily living and play sports in spite of having a complete ACL rupture. This is a small subset of population. Now a non coper is an individual who cannot resume his normal sports having an ACL injury.

Chirag: Yes. So you need to categorize these patients and the patient who is not able to sustain his normal activities, unable to return to his pre injury activity level, needs to get operated. That's simple. This is to prevent a counter injury happening over the period of time.

Ryan: So let's assume that is there a risk element in the sports also for ACL injury?

Are there higher incidences in different sports? Very much.

Chirag: Let's look at this graph. What rules the chart is football. Yes, because soccer is such a pivoting sport. The nature of that sport is such that you are putting your leg at risk. There are various phases where you can have this injury, various, various positions in your, in, in playing while tackle, while shift and all those things.

So, but basically you're looking at. Football, then comes, let, let's look at the Indian sports scenarios. Football, then comes hockey, martial arts badminton, baseball, baseball of course, in India it's not much, tennis, cricket. So if you look at it, this is the sequence, golf, of course, even that is a pivoting sport.

When you pivot in your left leg, if you are a right handed, that can put your knee at risk of having an ACL rupture. So, when you look at it, sports does play a role in the nature of sports does play a role in your in your ACL injuries.

Ryan: I, you know, I, you send me a document about I'm just thinking for my athletes, right?

Obviously, if somebody gets injured and you're telling me football, people do get injured or all the sports that get injured. So, you get injured, you ought to meet the sports medicine orthopedic surgeon and get it treated, get it operated. Cheeky question, doctor. Can we prevent the ACL from getting ruptured or partially torn or injured?

As a doctor, do you have any recommendations for ACL prevention?

Chirag: Yes, of course. Everything has a prevention strategy, isn't it? Likewise, even ACL injuries. There, there are certain programs which are meant to, meant to probably protect you from having ACL injuries, which are called the ACL perturbation programs.

Now, this is very interesting to know. You have something called as a hamstring to quadriceps ratio. The strength between your quadriceps and your hamstrings of the same leg. In case there is a discrepancy between these two, like, you know, we all strengthen our knee joint. What they say, how do you prevent an injury by strengthening your knee joint?

People go to the gym, do squats, do weighted squats, do seated squats in an inappropriate manner. They only concentrate on your quadriceps rather than concentrating on your hamstrings also. So this brings about a discrepancy between your hamstring and quadriceps strength and bulk ratio. And the people who are having a discrepancy of this are more prone to having ACL injuries.

So it's very important that you talk to your physiotherapist, your trainer, and work towards a good hamstring to quadriceps ratio in order to prevent your ACL injuries. Wow. I'm

Ryan: going to get my son tested very quickly as an 11 year old. Second,

Chirag: there's something called the neuromuscular coordination. It's very important that you, your trainer, recognizes your sport, recognizes your risk elements in playing that sport, and trains you accordingly.

A mind needs to understand where your foot is planted, how you're going to pivot, what kind of a tackle you're going to do in your football. So that needs to be taken into account, and you need to train accordingly. Your mind needs to sync with your body. When there's a disconnect between your mind and your body.

That's when your injuries are more prone. So, there's an element of neuromuscular coordination. There's an element of strengthening of your lower limb muscles, which, which forms the injury prevention program.

Ryan: Okay. What are the different types or mechanisms of the ACL injury that could happen? So, assume that the ratio of hamstring and quadriceps are imbalanced.

Somebody gets the injury. What, are there different types of ACL injuries?

Chirag: ACL injury happens because of a certain set pattern of, of your fall or twist of a knee joint. Basically when you are loading your leg with the knee bent a little bit and a pressure on the leg in the opposite direction. Basically what we call as a valgus external rotation force.

Your foot is planted in the ground, your knee is bent to a certain degrees and your knee is bent inwards. With your body rotating on the, towards the outer side.

Ryan: That's almost like twisting. Yes,

Chirag: yes. I can have a quick picture depiction of that. This is exactly what I was talking about. The knee bent to some extent.

There is a dynamic valgus force into the knee joint. And a differential rotation of the shin bone and your thigh bone. This is the most common pattern where you tear your ACL.

Ryan: It's a typical karate move. You got your hip in one direction, you pivot to the other way. You name

Chirag: the sport. And you will see this.

Ryan: Or even, when people are driving their bike, this is a high likelihood chance that when you put your leg down, and the bike goes the other way, is that also another reason people get tears?

Chirag: So people with all walks of life can have an ACL tear. As

Ryan: simple as that. As I

Chirag: said, I had a housewife who came to me yesterday.

with an ACL injury, moderately built, sedentary lifestyle, doesn't do anything much, doesn't even go for a walk.

Chirag: I told her, you have an ACL tear. She fell off in the house while climbing down the stairs. She was stunned and she was like, how can I have an ACL tear? I'm not an athlete. Oh. So, ACL tear doesn't only resonate on your sports what you play.

It is just the mechanism of injury, how you fall.

Ryan: So this housewife or this lady that came to you is not a sports athlete, right? The common scenario, even me as a person was if I do the surgery, right? I'm going to be out of action in my sport for a minimum of nine months as an Aam Aadmi athlete. Elite athletes may come back in six to nine months with your approval.

So the common people, what we think? I'll be out for nine months, one year. It's better to not even do the surgery. Now what's your take on that?

Chirag: So definitely there's an social and economic implication of an ACL injury. So if you look at the data, the duration on an average, a person is out of his work within surgery, without a surgery is about nine weeks.

So definitely nine weeks is a period of time. This is an average I'm talking about. There are some people who recover quickly and go back to. Their workplace in about a week's time. It all depends on how motivated you are, what kind of an activity you are involved with. Saying that looking at a long term gains is better than looking at a short term gains.

Now if you are symptomatic, you are unable to perform your normal activities, it's better to get treated, early rehabilitation, early mobilization and get going with your activities.

Ryan:So doctor, don't mind me, I'm taking some free advice now on the podcast, okay? I've got a partial ACL What is this? I heard on the internet some cross bracing protocol and all of that stuff.

What's all of that?

Chirag: Yeah, there's a lot of buzz about this ACL cross bracing protocol. This is one of the modalities of treatment.

Ryan: Oh, it's not a surgery?

Chirag: It's not a surgery. Oh, I thought it was some surgery or something. It's a conservative line of management, which is still not very established. There are some reports or papers coming out with short term results of this.

So what effectively happens in an ACL cross bracing protocol? is your knee is put in a brace for a period of three months, 24 by seven.

Chirag: yeah. And you're allowed restricted mobility initially to start with a little bit of a bending and the bending progresses on further. Restricted weight bearing in the sense for the first six weeks, you're not supposed to be putting weight on that leg.

And then eventually you gradually start putting weight at the end of three months, you're full weight bearing with a good range of movement. And then you start your your return to sports program, your balancing program, so on and so forth. Basically it's a conservative line of management, which is, I think, so still in a very nascent stage, where one could predict the functional outcome in a long term prospect.

But if so, of course, if you have a complete ACL tear your surgeon is the best person to take a call on what is the best lines of treatment.

Ryan: And when people do this surgery, I know this question is not there in the podcast. How do you know a surgeon is a good surgeon? I think, like, people come to me for a diet plan.

They probably look at the celebrities that I work with. But that's a very unfair measure. A fair measure would be what is the outcome. So if an athlete wins a medal, then Ryan Fernando's diet is good. How do we judge a good surgeon?

Chirag: Yeah, so let's, let's again go back to data. This is the data which has come out about, roughly about 10 years back.

About 2014, that is the last data what we have, return to sports after an ACL injury. By statistics and data, about 80 percent of the patients who have had an ACL surgery get back to some form of sports. 65 percent of the patients who have had an ACL surgery get back to some form of a contact sports.

Only 55 percent of them get back to a pre injury activity level of elite sports.

Ryan: But 55 percent is damn good. Yes. It's more than half. And

Chirag: this is the data which is about 10 years back. In today's date, the sciences have advanced so well, your techniques have advanced, your fixation modalities have advanced, your post operative rehabilitations are so well.

So in our center alone I do quite a bit of ACL surgeries about roughly about 300 to 350 ACL surgeries every year. And we have our own database where we look into our return to sports. In our center, return to some amount of sports is about 85 percent.

Ryan: Wow. That's a high figure. And return

Chirag: to pre injury activity level is as high as 65 to 70 percent.

So you may have various surgeons doing ACL surgeries. Now it is up to your confidence on yourself, on the surgeon. And the holistic approach of the entire team, which gets you back to sports.

Ryan: We have worked on many athletes together. And one thing that I've seen about you is that the confidence that you instill in the patient who is an athlete post coming back.

You're like, don't worry, I've done it really well. You're, you're even better than before. How important it for the doctor to be positive with athletes? In, in any, in any surgery department, in any medicine department, how important is that bedside manner of the doctor one second is, do you have any interesting story of somebody who's had amazing willpower versus an athlete who has average willpower?

Are you able to see this in the comeback from an ACL surgery?

Chirag: Yeah. So, to answer your first question, surgery in today's state. It's still a stigma in India.

Ryan: Why is that?

Chirag: Because of various inputs what an individual gets. People feel

Ryan: you should not do the surgery.

Chirag: Yeah, it's a various inputs what people get.

I mean, once you have an injury, some, I still have educated patients coming to me and tell me that, doctor, somebody says me that once you have had a surgery, your knee is no more functional. All these myths have to be broken. You need to look at the statistics what's available. You need to understand what is the right approach for your, for your, And you need to be open regarding this and get your best possible treatment done.

Saying that a psychological element of a patient, it's not only the knee what you deal with, you deal with the human body. And a psychological element forms a big chunk of that. If a, if a surgeon does a good job. And the patient is not motivated enough, or he's psychologically not fit enough to get back to sports.

He cannot get back to sports. So there's a huge psychological element which plays back. I always tell my tell my IT professionals who come with ACL injuries, compare yourself to an athlete. You talk about various athletes getting back to sports. You see that the athletes get back to sports. What is the difference between you and, you and him?

God has not made your ACL different than his ACL.

Ryan: Very valid point. Yes.

Chirag: It is one. For an athlete, it is bread and butter and it's necessary to get back to sports. So the motivation level is quite high as compared to a normal individual. Second, the follow ups are so thorough. They know that they need to do that.

So they visit the doctor regularly. They do their post operative rehabilitation very thoroughly. and get going with this. Third, the psychological element. It, it doesn't take them back in their life. One injury, of course. You have an injury, they have a mindset of get going with this and get treated and get back to your sports.

Whereas a normal individual, like you and me, Oh, I have an injury, that's the end of my story. So that approach should change. Until and unless you change your mindset and have a good positive outlook, you're not going to get better.

Ryan: I'm convinced. Yes, I think I should get my ACL operated with you. But what are the different types of procedures on an ACL surgery and the things that are involved in grafting and also can you share with us some of the insights?

Chirag: Yeah, that's, that's, that's my passion. And that's my job. And I would love to speak on this. So basically we talk about arthroscopy. Nowadays, everything is minimal. What is arthroscopy? Arthroscopy is a minimal invasive surgery. Like how we have an arthroscopy or a laparoscopy in your abdomen, you have an arthroscopy.

So if you look at this this is me doing an arthroscopic surgery. So arthroscopy means actually you don't

Ryan: cut. It's just a,

Chirag: it's

Ryan: a

Chirag: small

Ryan: insertion. Keyhole

Chirag: surgery.

Ryan: Keyhole. This is the meaning of

Chirag: keyhole. Yes, yes. You, you make a puncture hole into your knee joint.

Ryan: Yeah.

Chirag: Put in a telescope inside.

Ryan: Doctor, when you first started in medical college, was this there at that time?

It

Chirag: was in a very nascent stage. So you would do the proper Yes, yes. Conventional approach. Cut in everything and suture it. About two decades back, there used to be open surgeries. But today everything is minimally invasive. And

Ryan: between those days and today, is the recovery faster because of keyhole surgery?

Chirag: Yeah.

Ryan: By how much? Like at least a month or two? Exponentially. What do you mean by exponentially?

Chirag: So when you have an open surgery, you cut in a few structures there. Stitch it back. There's some amount of pain.

Background: Okay.

Chirag: There's some amount of guarding. Lot of bracing, so on and so forth. But a minimal invasive surgery.

This can be done, might as well done even in a daycare basis in today's date. Daycare? Yes. Meaning you come in and go out in the evening? Yes, yes, yes. A patient can come in the morning and if it's a minor procedure like a meniscus, patient is discharged the same evening. If it is an ACL surgery, the patient walks in today morning, gets operated, and next day morning he's discharged from the hospital.

Ryan: Wow. So it's not a major, major type of surgery. I mean, it's major for you. It goes, how long does an ACL surgery last? An ACL

Chirag: surgeon typically takes about 45 minutes to one hour.

Background: Okay. And a

Chirag: bad one? In a well seasoned setup and a bad injury like maybe associated with some cartilage injury complex meniscus tear along with an ACL or else multiple ligament injuries may take up to about one and a half to two hours.

Ryan: Have you, have you ever been caught surprised because today you have diagnostic scans, right? And they're supposed, the MRIs are supposed to give you a bird's eye view inside. But have you ever been caught unaware when you've gone in for a surgery because the injury is so traumatic? Yeah.

Chirag: Basically, when you're talking about an arthroscopy, arthroscopy means looking into the knee joint.

Ryan: Okay.

Chirag: Arthroscope. Arthro means joint. So, you

Ryan: actually have a camera in there? That's why you're looking at a screen? Yes.

Chirag: Yes. Yes. You have a, you have a telescope and a monitor in front. Okay. Most of my patients also are watching the procedure when I'm doing it.

Ryan: Hang on. One second. Yes. So, if you're doing my surgery, I have to be awake.

Chirag: Yes, I mean it's, it's an option but most of the patients are done under local, that's a spinal anesthesia. Okay. And you are watching it with me. Okay. It, it gives me a comfort of talking to the patient.

Background: Huh. And

Chirag: telling them this is your pathology. Huh. And this is how I'm going to treat it.

Background: Okay.

Chirag: At the same time, if there is something, as you said, if there's something which, which is caught by surprise, now MRI are only 75 to 80 percent specific in their diagnosis.

Ryan: Okay.

Chirag: are sensitive in their diagnosis.

Ryan: Another 15 percent you have to be in there to see it. Yes, yes.

Chirag: So they can be surprises. They can be concealed injuries, which cannot be picked up on, on imaging.

Ryan: So you're constantly kind of, checking and then moving along in a surgery as it's happening.

Chirag: Yes, yes. So you are first telescoping inside, visualizing the structures, seeing what are your tears, and then you have, have, have, then you start off repairing each of the structures.

Ryan: Is the blood around the, when you get into the arthroscope, a lot of blood comes out, or the knee and the meniscus and the ACL is all housed in a non bloodless entity. How? It's

Chirag: by larger bloodless surgery because you have a blood flow restriction there with the tool cake. Oh. So your field is very clear.

Okay. And when you do an arthroscopy, you put in a lot of saline solution there. Okay. To increase the pressure of the knee joint. Okay. You understand, I was talking about the synovial fluid is only 5 ml inside the knee joint. Correct. You

Ryan: need more fluid in there. You

Chirag: need more distention, you need space to work on.

Correct. How would you do a surgery with only so much volume? That explains

Ryan: why there is less, small bulbous amount of bloating out there. Yes, yes. So, so you can see

Chirag: this. So, this is the telescope what I have put inside, this is the camera. And this is my instrument what is passed in there and this is the fluid irrigation which goes, goes inside.

Distance the fluid while you're doing your surgery. So you have a better vision, better access to the structure. And the patients are awake watching this? Yes. And most of them are comfortable. But do people

Ryan: panic in the middle

Chirag: of a surgery? And then you knock them out? Yeah, you can sedate them. Okay.

That's an option which is available. Okay. So most of them like it to see what's happening into their knee joint. And yeah. Most of the patients who come to us nowadays are aware of what they, what an ACL is, what a meniscus is. They do research. Yeah, yeah. Or they watch this podcast. Most of them come to me and say, you know, sir, I have a tear.

Stitch it for me. Okay,

Ryan: so what is this graft options? What is that? When we talk about ACL, you do different procedure. What is a grafting option?

Chirag: Yeah. So when you talk about meniscus injury, you stitch it, let's call it meniscus repair, whereas the ace ligament, if it is stone and if it's stoned for some time.

You cannot put it back to place. Okay. You need to replace it with something else. So it's synthetic? You have various options. Okay. So the most common option in today's date in India is something called the autograft. Okay. Your own tissue what you can use. Like, you have various tissues what you can use as a new, new graft.

You can use your own hamstring tendons. You can use your patella tendon, your cordyceps tendon, so on and so forth.

Ryan: So

Chirag: that is your Is

Ryan: there any research where they're growing tendons outside the body and then putting it back in the body?

Chirag: Not yet. Not yet. So you, you have something called the allograft option.

Chirag: Where you have a donor.

Chirag: And that donor tissue can be used, that's called an allograft. Then in the market, what was nowadays is about synthetic grafts. These are basically polyester material, which you, polyester synthetic material, which you use instead of an ACL ligament. And they've, they've shown quite some challenging results.

So that's, that's probably still in a nascent stage of research.

Ryan: Now, assume this gentleman. Yes. Doing the surgery, an athlete. How much time after this surgery does he recover? You already said that the person will walk out on the next day morning. Yes. Right? But how long does the actual recovery process take?

And how often do I have to come in for rehabilitation? My physiotherapy? How long do you do that? And what's the timeline? From the day, the day you put the camera into the knee to when I can come back to play sports.

Chirag: So, ACL post operative rehabilitation program is tailor made. It is not one size fits all.

Chirag: It depends on the nature of injury, what are the associated injuries. Suppose somebody has only an ACL tear, his recovery is much more quicker. His rehabilitation is much more quicker. As compared to somebody who is coming with an associated cartilage injury, associated meniscus injury. So if you have associated injuries, the rehabilitation protocol may vary.

I would give you a brief of a standard ACL surgery. A patient coming in, getting his ACL surgery done, he goes out of the hospital with a brace. And that brace would vary from duration to duration, depending on the individual. If it's a nice, good athlete with a good quadriceps control, who has prehabbed himself well before the surgery.

We could have a limited period of bracing. As compared to an obese individual who's got less musculature, the bracing period to protect the graft would be a little higher. Knee bending starts off immediately. Strengthening starts off immediately. Of course, there are various phases of rehabilitation protocol.

First phase. The second phase involves the balancing exercise program. And the third phase is basically return to sports. So, if I would Put it in a nutshell, it would take an individual about two weeks to get back to his office work. It would take about three months for an individual to start running, doing his morning jogs, swimming and feel comfortable.

It would take him about six months for recreational sports and nine months to play contact elite competitive sports.

Ryan: So how often, let's say nine months, does this Player need to see you or this individual need to see you and do you do a repeat MRIs to check the healing process or you just look at clinical outcomes?

Chirag: Yeah, there is no established data on getting a repeat MRIs. So in case you suspect something, you suspect something else going on, you are arousing the patient as a laxity, what you call, he is not comfortable with the knee. Or if he's got a re tear of his ACL, re injury, then you may, yeah, there is So

Ryan: you could be end to cutlet in a rehabilitation and actually tear it further?

The

Chirag :failure rates of an ACL surgery is as much as 7 in today's data.

Chirag: Okay.

Chirag: Saying that this depends on the ACL surgeries also done in the peripheries in setups which are not very great for these surgeries substandard situations, patients who do not. follow up well, do not do the rehabilitation. So if a patient is operated well, in a good setup, with a good post operative rehabilitation, failure rates are much, much, much lesser.

Until and unless somebody goes and really bumps off himself and falls somewhere. Or starts driving the

Ryan: scooty on the second month. Yeah, yeah, gets back

Chirag: to premature sports. So, you can have ACL ruptures. But very less in today's date.

Ryan: So, I always shout from the rooftops about nutrition. How important nutrition is for performance recovery.

Yes, and even post operative Surgery of any kind. Yes in your experience Have you seen that athletes or normal people who have poor quality diets or good quality diets? There is a better outcome or it really doesn't make a difference. They can eat whatever they want post surgery.

Chirag: No, there is a huge Importance which we play which we pay into a holistic approach of your ACL injuries or ACL surgeries, one needs to not only have a good surgery, he needs to have a good support system in terms of post operative rehabilitation, psychological element as I spoke to you, if need may be a sports psychologist, one may need to have a good nutritionist.

I think, I usually tell my patients that a good nutritionist is very, very important for a good recovery. They need to have good proteins. For their healing, they need to have some antioxidants, which I think you know the best. There's a period of recovery or recoup from any surgery. The first three to six weeks is very, very important and I would say up to three months is also important for them to recoup from this at the same time because their activity levels are lesser, one should not put on weight

Ryan: because they're stressing out their knee again

Chirag: and when you're sedentary, you tend to eat a little bit more.

In fact, doctor, this

Ryan: is the biggest problem we have that after the surgery, the athlete goes into shutdown mode and I worked so hard before. Now I got this injury. Woe is me. And then they tend to anxiety eat or sadness eat. And they're like, okay, we'll see after 9 months when I come back. And some athletes come back 10 15 kgs heavier.

Because first of all, they do so much of activity and they eat so much and they have these big appetites. So I think sometimes I keep telling the athlete or I quietly call up the doctor and say, Please tell the athlete that they can't eat ice creams and they can't eat chocolates and pastries post surgery.

Because they're stressed out, they're emotionally traumatized for not playing. And they're getting fat.

Chirag: So that's, that's your department and you know the best how to handle them, Ryan. But saying that, it's very important that the patient understands the nature of injury and he needs to have a confidence in himself and the doctor that this injury is no more a stigma.

You have this injury, you can well go back to your sports. And you need to be in that bracket of 80 percent who gets back to your pre injury activity level rather than sit and sulk over this. As I said, one needs to have a right approach, one needs to have a right mindset, and the success is 100%.

Ryan: You know, mindset is very important because a lot of athletes would be watching our podcast, a lot of coaches would be watching our podcast the first time I mentioned, I'm seeing a doctor mention you should have a sports psychologist, right?

And, and we normally think about sports psychologist, oh, I'm going to the Olympics, so I need to prepare for that. But how important is the mind? In terms of your recovery from injury, your experience.

Chirag: So just take an instance, right? I just had my friend the other day come into my hospital and just happened to have his BP about 130 to 90.

And he was petrified with that. Telling that, you know, I'm hypotensive. What will happen to me now? So if Blood pressure variation of ten points. Yes, minor variation there can cause so much of an psychological anxiety to him. Imagine an athlete or an individual having only two knees and tearing the most important ligament.

What goes through into their head? It's very important that one talks to them, makes them understand the nature of the injury, repercussions of this, and give them that confidence that they're going to be back. playing their sports, resuming their career.

Ryan: You know, Chirag, we talked all about ACL and on the foot and all, but you also operated on one of my best friend's foot.

So, that's an extension of the knee downwards and you also deal with feet and I think there are a lot of injuries with triathletes, runners, mountain climbers taekwondo, karate, you know, you hit. So, one is a traumatic injury. And one is a repetitive injury. So in the foot department how vulnerable is the, are the feet?

We have two feet. And ligaments, tendons, are they different from the knee? What's, what's your experience in the foot department?

Chirag: There's no building without a good foundation.

Ryan: There's no building without a good foundation. Yeah. Oh, I get where you're coming from. The feet are your foundation. Yeah,

Chirag: yeah, yeah.

The feet are your foundation. I mean, your entire weight. is translated to your knee and your foot. You need to have a good alignment of the foot. Now if you look at, if I, if I would put it into a simple terms, there are three, three types of foot. One is a plantigrade foot, which is normal in alignment. One is a pronated foot, which the foot is going outward.

One is a supinated foot. Oh, you have supinated also? Yes, yes, yes, with a high arch. So there are various kind of foot patterns. One needs to identify this foot pattern. If you are, if you are having a plantigrade foot, which is normal, and you do not have a flat foot, nothing to worry about it. But in case if you feel that you are seeing any variation in your foot, and if you see that this variation in the foot is progressing as you age, you need to consult a podiatrist.

You need to get your foot assessed. Consult a foot, podiatric.

Ryan: Podiatric is a foot doctor. Yes, foot doctor. What does he do? He looks at your feet? No, no,

Chirag: no. He gets your foot assessed. He looks at the pressure points where you, where your foot. When you are, when you're walking, when you're running,

Ryan: Oh, this is why all the athletes are going and doing the gait analysis and foot and where everything and then how to Yes.

Yes.

Chirag: It's very important that you know, getting a good foot footwear, which is appropriate for your. So we

Ryan: shouldn't buy any footwear that we just see on an advertisement. No, no, no, no,

Chirag: no. So, so now running shoes is different from a football shoes. You cannot mix the both mix both of them. A running shoe is different from a football shoe.

Even in football, you have different kinds of shoes, different kind of coats in what you play. And you have to custom make your footwear according to that. If not, you land up in injuring yourself. So it's a small element, but it's of very, very critical importance that you need to pay attention to before you get back to any kind of a sport.

Ryan: Awesome. So, doctor, the footwear, I've got an 11 year old son. He does karate, he does tennis he does judo he's trying to do a little bit of football. That means the shoe we choose for any activity that we do could also cause an injury in the human body? Is that we footwear?

Chirag: I think yes, we should be.

Because, you know, as I said, it's not that One size fits all. So it has to be tailor made to the sports. Now if I tell you simple. There is something called toe drop. Now when you have your normal shoes it should have about a centimeter of toe drop. In the sense your toe should be dropped a centimeter from your heel.

This is a normal shoes what you need to use on your normal activities. It varies. A person who is running can have less of a toe drop. A patient or a person playing football should have less of a toe drop. A counter of the shoes is also very important, like the back support what you have in case a patient is involved in kind of a pivoting sports, or like a football, you should have less of a counter to prevent any kind of an ankle injuries.

The flexibility of the shoes is important. If you go to the gym, you should have more flexible shoes. If you're playing outdoor sport, you should have a little more rigid shoes. So there are various, various parameters which you need to look into. Football, you talk about it. You cannot use a same stud for your synthetic coat as compared to your turf.

You cannot use a spiked studs for playing in a synthetic coat. That'll make you more prone to injury.

Ryan: You know, sometimes I go to Alsoor Lake and I watch people walking and all. First of all, I look at the gait. So now I'm working with my strength and conditioning guy. After I tore my partially tore my ACL, I work with my physiotherapist.

Then I've understood hamstring to quadricep ratio. We get it measured and then how it's improving. And I look at people and I know what is pronation. So I can see this right when you're walking. Well, one thing I've noticed is that. The shoes, right? You have different types of shoes. Now you're talking about the toe drop and this is the cushioning on the heel.

So some people have really those thick cushioning ones and all. But then I see a lot of people. Who's shoes are really old and I'm thinking you know, I'd rather you wear old gym wear old walking clothes, but get your shoes new. So what's your opinion on shoes and the shelf life and how often should we change them?

Chirag: See Ryan, shoes in today's data are discussed over parties and drinks. Wow. So it's become as fancy as that. So getting a good footwear is very important. It's very important that we invest. The footwear can be as expensive. You know, you name it and you have it. You can get a good watch for the same rate.

Now ideally, every 5, 000 miles, you need to change your sports shoes.

Ryan: So almost like at least every year you should be able to Six to nine months. If you are actively involved in running. Six to nine months is what you are involved in. Or I have a benchmark as I turn the shoe upside down. And when those small threads start to wear away, I'm like, okay, it's time, it's time to change the shoe.

It's not only

Chirag: the sole, you also need to look at the inner aspect of your knee joint, of your, of your footwear. Now if you have a pronated foot, if somebody has a pronated foot which is not corrected, one can have a wear out of the insole or the inner aspect of the heel. That's an indicator when you need to change your footwear.

If not, your pronation just progresses.

Ryan: A lot of my tennis players put these special scans and they get a special insole done and all. Yes. Does that help prevent injury?

Chirag: To some extent. You need to have a good plantigrade foot, especially in running sports or in, or in sports where you're landing your foot.

It's very important that your pressure points where you land is very important. If you land in an inappropriate manner or if you're running in a, with an inappropriate footwear. You tend to have foot problems. You can have callosities. You can have heel pain. You can have foot problems. At the same time, if you are wearing too tight shoes, in some sports, it's inevitable, but generally, if you are wearing too tight shoes, you can have your foot deformed a little bit, your toes going across, which is called a helix valgus.

So, you need to Take all these things into account before you buy a good footwear.

Ryan: Doctor, you operate on hundreds of people in a year. What does Dr. Chirag Tansay do? for his workout. And what does he do for his diet?

Chirag: So that's a very tricky question. That's also the podcast. But you

Ryan: want to give us something healthy that you do in the day.

Chirag: Yeah. So my routine involves a little bit of a tight schedule. I start my work by eight o'clock in the morning. And, you know, I wind up late in the night. So it doesn't allow me to do a lot of sporting activities. I used to be an athlete. I'm a martial arts. I know you have a black belt in karate. I play all form of sports.

But in today's date fitness should be in the mind. Keep your mind free and healthy. That is the most important thing.

Ryan: One healthy food that you take home

Chirag: food.

Ryan: Good point.

Chirag: Brown rice. Moderate your calorie intake. I don't talk about calorie deficits and things like that. Moderate your intake. Of course, a good energy is required to, to have your activities going on.

Even your mental health depends on your energy level. Eat home food. Eat healthy food. Whatever your mother gives, eat it. The best, best cooked food is at home, which involves less of your ingredients. Taking adequate number of steps is very important. I make sure between my work, between my OPD and my rounds and things like that, I take at least 8 to 10, 000 steps in a day.

That takes care of my exercise. Yes, yes, exercise. Once or twice a week, I indulge myself in some format of sports. May not be too vigorous. Maybe a swim, maybe a run. Simple. You know, you need to cross train yourself. Don't indulge yourself in the same sport every day or a same format of exercise every day.

If somebody is doing strength training every day, he is more prone to have injury. Cross train yourself,

Background: offload

Chirag: your body, run for 2 days, get into aqua sports 2 days, get into yoga 2 days, this will prevent you from having a repetitive stress injury of that part of the body.

Ryan: Brilliant advice, doctor. And if the world wants to reach out to you, where can they find you?

Chirag: Of course, they can go to my website.

Ryan: So what's your website?

Chirag: Drchiragtonesay. com

Ryan: Okay.

Chirag: Numbers are available there. My availability is also put in there. So one could reach out to us for any kind of sports related queries. One could reach out to us and we could help them out.

Ryan: Dr. Chirag, it's been an amazing podcast today.

I've understood the knee like I've never understood it before, even though I did a little bit of research when I tore my own ACL. So, thank you for enlightening me and all of us out there on taking care of our health, taking care of our physical activity and having home cooked food. Yeah. Thank you so much.

Thanks.

Chirag: Thanks for it.

Ryan: Thank you for watching this far. It's been an amazing episode and I'm so grateful to have you till the end. If you like this video, please share this video with your loved ones. Better still gift me a subscribe, a like, or even a comment and we'll come back to you.

Key highlights include:  

1. Understanding ACL Injuries: What makes this small ligament so vital, and why is it prone to tears? 

2. Injury Prevention: Best practices like neuromuscular training, muscle strengthening, and selecting proper footwear for various sports. 

3. Surgical and Non-Surgical Treatments: From minimally invasive arthroscopy to ACL bracing protocols, we cover the latest advancements in medical science. 

4. Psychological Recovery: The importance of mindset, sports psychology, and motivation in recovering from injuries and getting back to peak performance. 

5. Gender and Age Dynamics: Why female athletes are at a higher risk of ACL injuries and how injury patterns vary across different age groups. 

6. Practical Tips for Fitness: How to maintain a healthy BMI, avoid repetitive stress injuries, and cross-train effectively.  

Whether you're a professional athlete, a weekend warrior, or simply curious about injury prevention and recovery, this episode is packed with actionable advice, expert insights, and motivational stories. Don't miss this comprehensive guide to mastering sports injuries and building a healthier, stronger body.  

Stay tuned for fascinating discussions, practical tips, and expert guidance to elevate your understanding of sports medicine and overall wellness.  

Subscribe now, and let’s embark on this journey of health, recovery, and resilience together!  

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