Medical Bankruptcy

When I first started writing this column, it was all about sports injuries. It actually started out as a question and answer thing, answering questions about athletic injuries.  Dr. Bob Haralson and I took turns answering the questions in this space. It was called “The Jock Doc.” We did it that way for about a year.


It became a column not long after and I’ve been writing it every week since then. For 34+ years.  In all these years, I have covered a wide variety of topics, often having little to do with sports. But it’s always been about helping this community be a better place because…well…I’m all about making this community a better place.


When I arrived in Maryville in 1977 (December 12^th, to be exact), there were three physical therapists in all of Blount County. Blount Memorial now has about 90 Physical Therapists and Physical Therapist Assistants and a whole host of other rehab clinicians that are Occupational Therapists, Athletic Trainers, and Speech Therapists. There are other rehab clinics and clinicians around our community providing good care.


Obviously, health care has changed. The medical community here has grown to meet the needs of our county, also reaching into surrounding communities. Our population is now over 130,000. Here’s the problem:  Every single day, I encounter someone without health insurance or someone that is terribly under-insured.


All too often, I will get a boy or girl having had surgery to repair a torn ACL, a devastating injury to a young athlete. And maybe they have no health insurance or are under-insured. The rehab following ACL reconstruction is extensive. But even if they have insurance, maybe their insurance has a hard max of 10 visits for physical therapy (that means that insurance will only pay for the first 10 visits). They need more than that to get back to their sport.


Health care costs, including the costs of providing physical therapy, are expensive. Insurance and other forms of third party-payment are important in helping us get the care we need while protecting our financial viability. Unfortunately, over 500,000 people go bankrupt because of medical bills every year. That constitutes a national crisis.


Let’s look at this from a different perspective. One of my best friends in the world just got back from M.D. Anderson Hospital in Houston. He has a rare and aggressive form of cancer. So he traveled to the best cancer treatment center in the world. The cost doesn’t matter. His life is in the balance.

In the United States, we have the best medical professionals, the best technology, the best hospitals, the best medical care in the world. Twenty years ago, my friend would not have had a chance. Now, he does. And he will pay whatever it takes to beat this thing.


I’m not going to get political on you and offer my opinion about what we should do as a country. I don’t think there is a single best solution. But I can tell you my opinion about what you and I can do.


We can get healthier. We can take better care of ourselves. We can eat better. We can control our weight. We can exercise daily.


We can get an annual physical, not because we’re sick but because we’re making sure that we stay healthy by controlling our blood pressure, managing our diabetes, and by discovering medical problems early, before they turn into catastrophic events and diseases.


We can stay away alternative forms of “health” care that claim to treat everything from glaucoma to asthma to bedwetting. We have research that tells us what the best course of action to treat injury and disease is. Insist on evidence that what any provider is suggesting will really work.


We can prioritize our health and take ownership of our personal wellbeing at a level that will drastically decrease what we spend on health care. And be healthier and happier because of it.

More on Simply Moving

I want to talk about movement again today. I listened to a podcast this week about movement and it had some really great points. We just really don’t move much anymore. Modern conveniences have created a sedentary culture.


I see tons of patients with shoulder problems. A lot of those are related to their posture and a lot of that is from spending too much time in front of computers and digital devices. Neck, shoulders, upper back…all pay the price for sitting too long.


Lots and lots of jobs consist of sitting in front of a computer all day long. Even my job requires me to sit at a computer for long periods of time (hello, medical documentation). We even advise people who work at computers to set an alarm to tell them to get up and move around every so often.


Modern conveniences have been built around not moving. Drive up for fast food. Eat in your car. Drive up to the pharmacy to pick up your medicine. Drive up to the bank to handle transactions. We don’t even get out of the car.


We can call in our grocery order, pull into a designated spot and someone will bring everything we ordered and put it in our vehicle. I realize that can be a great blessing for those with limited mobility but I still advocate for getting out and going inside to do your shopping, even if it is in one of those motorized wheelchair-type things.


Even when we get the stuff home from the grocery store, we don’t have to do anything to it. We don’t have to wash it. We don’t have to chop it, peel it, or dice it. It’s already in a bag ready to eat. Instead of planning, assembling, and preparing dinner, you can get a complete meal at the grocery store that requires only that you heat it up.


And ordering things online. First, you sit in front of a computer, making your choices. You wait a couple of days and then it is delivered to your door. It couldn’t be easier. And it couldn’t require less movement unless somebody carried from the porch into your house.


You can order take-out from lots of restaurants and don’t even have to go pick it up. Someone will pick it up and bring it to you. You could conceivably exist in today’s world without ever leaving the house.


Even the rear facing cameras on our cars can be seen as a deterrent to movement. You don’t even have to turn around to look behind you. (But don’t take mine away—it’s a blessing for senior citizens like me.)


When I was a child, we had three TV channels. And those channels signed off about midnight. Heavens forbid that the President was talking—it would occupy all three channels. And the remote was my Dad telling me to get up and change the channels. You actually had to touch the TV!


Today we have an almost infinite number of shows to watch, 24 hours a day. That means that you have the potential to sit for hours on a time, completely captivated by what is on the TV screen. For goodness sake, we had to suffer through the Lawrence Welk Show when I was growing up!


We need to move, not just when we exercise. We need to move throughout the day. Don’t drive around looking for the closest parking spot. Don’t take the elevator up one floor. Never surf channels just trying to find something you might like to watch. Walk. Meander. Shop. Move!


You might find this hard to believe, coming from me, but exercise is not the solution. Exercise without a life of movement is like taking vitamins and supplements to provide you with what you’re not getting from what you eat. If you are sedentary much of the day but spend an hour in the gym exercising, you just aren’t getting the movement that your body needs. You’ve got to move all day.

You need to MOVE!

I’ve got a patient right now that came to me about three weeks ago with back pain. At her first visit, she was in a world of hurt. I had no idea how she was still going to work every day. But this isn’t a story about the patient. Or even about back pain.


This is a story about movement. This patient had been having back pain for about three years. She had tried a lot of different things before she found her way to my door. Previously fit and always active, her back pain had limited her activity level and added 70 pounds to her frame.


When I first saw her, it was clear that she was terribly deconditioned. For three years, she had simply failed to move. Any initial injury was likely long since resolved but now she had to get over the recovery from whatever it was that started her back pain.


Our bodies need to move. No…our bodies have to move. We are made to move. I don’t mean we have to run or jump or play sports. But we do have to move.


A lot of the health problems that we as Americans are suffering from today are due in no small part to the lack of movement. Obesity. Diabetes. Heart disease. Vascular disease. All those things and more can be effectively treated with movement.


Let me break it down in a little different context. Years ago, rehab, my world, was focused on joint protection. In other words, after knee surgery or shoulder surgery, we might brace or splint and protect the joint from movement. Then we got smarter. Now we know that early movement is a huge advantage in rehab. Total knee replacement? Needs to move early and often. Rotator cuff repair? We will even go into the recovery room to start early movement.


Our joints, ligaments, tendons, and muscles need to move. Put a healthy joint in a cast and take it off in a month. That joint, which didn’t hurt before, will now hurt.  I guarantee it. Our heart, GI tract, lungs, and blood supply need us to move. Our bodies are amazing and how they work is simply incredible but without movement that body starts to deteriorate.


You don’t have to run a marathon but you might need to walk around the block. If you can’t walk, then maybe you ride a bicycle. If you can’t ride a bicycle maybe you can swim. If you can’t swim maybe you can just get into the water and move around. It works. It really does.


Our bodies are not made to sit in the same place for long periods of time. People who spend too much time at a computer have all sorts of issues. People that drive for a living will eventually pay the price.

Something will fail them. Their back. Their neck. Most likely, their shoulders.


I don’t watch much television. I do have a favorite show:  Madam Secretary. I can’t tell you when it is on but I know that my wife keeps it on DVR so I can watch it whenever I want to, without commercials. The only other time that you will catch me sitting in front of the television is when
Clemson’s football team is on. But sitting even that long leaves me feeling…well..yucky. And stiff. My body is telling me that it needs to move!


So here’s the rest of the story about my patient--the first time I took her to our rehab gym, she cried pretty much the whole session. I picked her exercises carefully (and wisely, I hope) but I was convinced she just needed to move.


The second session she cried but cried less. The third session she noted that she was better. By the fifth session, she declared that she felt “marvelous.” For the first time in three years. I didn’t provide her with any great physical therapy interventions, I simply asked her to move. And gave her parameters to do so safely.


What about you? Do you need to move more? Do you stay in the same position doing the same thing for long periods of time? I’ve got one really important piece of advice for you, simple as it may be. JUST MOVE!

Be A Generalist!

I just finished a book called Range, by Daniel Epstein. The subtitle on the book is “Why generalists triumph in a specialized world.” The book starts out by comparing the development of the careers of Tiger Woods and Roger Federer, the greatest golfer and tennis player of their generation.


Tiger was destined for golf from an early age. At age 4, he was beating 10 year-olds. Everything from birth to his professional career was focused on making him the greatest golfer ever.


Roger, in contrast, played everything.  His mom was a tennis instructor but she did everything she could to discourage him from a tennis career. He played squash, wrestling, and basketball and went skiing, swimming, and skateboarding.


When other kids were attending tennis academies, working with personal trainers and nutritionists, and competing around the globe, he was agonizing over having to give up soccer. And at an age when most tennis professionals retire, he was still the number one ranked player in the world.


The book is full of statistics and research and reaches some pretty startling conclusions. In a nutshell, the most successful of athletes in pretty much every sport played lots of different sports growing up.

The exceptions were gymnastics and…well…gymnastics. That’s it. Really. Everything from golf (well, except for Tiger) to football to equestrian events, the most successful athletes were generalists.


The easy answer to why is athleticism. The more complicated answer is in emotional development.

It seems like there is a ton of pressure on young athletes to be stars, to be on the winning team, to be successful in sports at an early age. Pitching coaches for 8 year olds. Sports performance training for adolescents before their body is ready for that kind of activity.


According to the American Academy of Orthopedic Surgeons, more than 3.5 million children age 14 and under are treated for sports-related injuries each year.


Dr. Jim Andrews is probably the leading sports medicine physician in the world. An orthopedic surgeon in Birmingham, Dr. Andrews’ patient list includes Michael Jordan and Tiger Woods. His surgery allowed Drew Brees to return to the NFL after a devastating shoulder injury.


Dr. Andrews on youth sports injuries: “I have seen my patient population and surgical cases get increasingly younger. Children, parents and coaches need to realize that kids need to take a break from playing one sport year round. Sports should be fun for children. Overuse injuries in children is a concerning trend.”


His core advice is simple—Take time off, don’t specialize. OK, but when is it OK to concentrate on only one sport? Maybe in high school. Maybe later. Certainly not before they reach puberty.


The bottom line is that there is no way in the world that anyone knows that a 10 year old is destined for sports stardom. Oh, we can have a good idea that they’re going to be really good at something, but we can really never know exactly what. Everybody thought Roger Federer was going to be a soccer star.


Winning a weekend baseball or softball tournament is meaningless if your child doesn’t get better. Winning a flag football league is a waste of time if your child doesn’t have fun. Let your kid play. Let your kid have fun. And let them play everything.

Not necessarily vicarious

OK. I get it. You want your children to have opportunities that you did not have. You want your children to accomplish things you did not or could not.  I appreciate that. I understand that may not be living vicariously (something that very involved parents get accused of all the time).


Let me back up a minute. The last two columns have preached a harsh sermon at parents that would yell at their children’s games. Yell at the referees. Yell at the coaches. Yell at their kids. Lots and lots of yelling.


In 34+ years of writing this column, I don’t think I’ve ever had more positive response to a column. Tons of emails, getting stopped by friends and strangers, text messages—you name it, I’ve heard about it. And they’ve all been positive.


Well except for the examples shared from all across the country about youth leagues being abandoned because they couldn’t get referees or coaches. That part is sad. And devastating to the physical and emotional development of our children.


As so often happens, instead of focusing on all those negative comments, I started looking for the positive comments. And they were everywhere. Positive far outweighed negative. Oh sure, there has still been the occasional parent yelling about a missed call and I really did hear this week a parent yell “BLOCK SOMEBODY” after their own child was tackled for a loss.


But I really liked most of what I was hearing. I watched a kicker run off the field being mobbed by his teammates after making a kick (he had missed one earlier). I heard people in the stands whooping it up after a big play. I heard parents and others clapping for a goal or a good play, regardless of which team they were on.


And I realized a few things. I realized that good parents want things to be better for their own children than maybe it was for them.  That is what being a good parent is. Good parents want their children to have positive experiences in sports, again, that maybe they didn’t get to have.


Wanting those positive experiences for your child isn’t necessarily living vicariously through them. There’s a basic difference…if you are doing it for you, then it is living vicariously. If you are doing it for your child, it is not. If their success somehow validates your unrealized potential, then it is living vicariously.


I learned some things through being a parent. I learned that I could not make success happen. I learned that nothing I did came with a guarantee. I learned that coaching from the sidelines never helped anything. I learned that yelling at the referees didn’t change a thing. I learned that being critical or second-guessing teachers or coaches never accomplished anything.


I certainly wanted my children to be successful in everything they did. Everything. I wanted to enable them to achieve their dreams. But here’s the difference—I wanted them to achieve THEIR dreams, not mine.


At the end of the day I found that it is most important to teach your children how to be happy, to enjoy life, and to be satisfied with what they have instead of always wanting more.


It’s OK to enable your kids to have experiences that help them achieve all that. It’s OK to insist that they be treated fairly and have opportunities. But if it is not kept in perspective, if it isn’t fun, if winning becomes more important than playing, then we have a problem.

You may not choose to be a role model but you are

I happen to believe that our true character is revealed by how we act when no one is watching. We need to also consider that even when we don’t know it, somebody might be watching you, copying you…wanting to grow up and be just like you.


A year ago, I told the story about taking one of my granddaughters to a soccer game. We stood at the playing of the National Anthem and I saw this granddaughter look at the team lined up and slowly copied them—her right hand over her heart and her left arm behind her back.


I snuck a photo which is an all-time favorite. The story was about role models. About how children are looking at others to learn how to behave. About how impressionable children are.


And how important it is for us to set a good example. That is a timeless message. Age doesn’t matter. Somebody, somewhere is looking at you, especially if you are an athlete.


Just last week, another story about the same granddaughter came out. It seems she is now copying the hairstyle of her favorite soccer player. Something about putting bands in her ponytail all the way to the end.


Thankfully, this young lady has embraced the fact that she is indeed a role model. She is now playing soccer in college but knows that her influence can reach all the way home.


We should all be prepared to assume the responsibility that comes with being someone’s role model. It may not be a role that we want and we might not be ready to accept it, but it often belongs to us anyway.


I’ve told the story here before about sitting on the balcony at a basketball game dropping popcorn on people below. A young mother turned to her son and said “don’t grow up to be like them.” I might have been 10 but I remember it to this day.


We are constantly role models for someone. Take smoking. Statistics tell us that if both parents smoke, there is a very high likelihood that their children will smoke too. Often while still teenagers. Is that what you want for your child?


And a sedentary lifestyle. We don’t inherit obesity. We get it from a sedentary lifestyle and bad eating habits. If the parents sit in front of the TV for several hours each day and dinner is fast food, that is what the kids learn to do.


When I was a teenager, I had this family friend that I thought was from the coolest family ever. They lived in a house north of Atlanta that had a wilderness playground for a back yard. The dad had model trains. Three brothers, something I always wanted. When I visited, we were always fishing and exploring.


Mark decided in high school that he wanted to be a wildlife biologist. I thought that was pretty cool. Any guesses what my first college major was?


I had another friend that I thought had great taste in music. Guess what I listened to? Yep, whatever he was listening to. Another friend was a great dresser. Guess who I copied?


My point is this…you should always be conscious that somebody might be looking at you to learn how to dress, talk, behave. And it might be your friends. Maybe it is your family. Teenagers, those little kids in your life are going to look at you as their role model much more than they do their parents.


Embrace that role. It will help you make better decisions. If you even think that someone is modeling their behavior after you, it makes it easier to do the right thing all the time. And you never know when little eyes are watching.

I'm not going anywhere

I will retire one day. Not today. Not soon. But one day. I will give up my spot on the sidelines of the Maryville High School football team. A spot and a privilege that I will always cherish. It will be someone else’s turn. Someone younger. Someone just as qualified. Someone who will hopefully love it as much as I do.


And when I do, I’m not sure I’ll ever go back. For sure, I could never walk the sidelines with the team and the coaches. Whomever takes my place doesn’t need that. Too many years and too many relationships—I wouldn’t do that to my replacement. The last thing they would need is them thinking that I’m looking over their shoulder, judging whatever they are doing. I won’t do that. They will do fine and I hope will do a better job than I ever did.


I won’t sit in the stands either. I just don’t think I could listen to people yell at the players and the coaches. There probably isn’t enough bond money for me to do that.


I remember when my son was playing football in college. It’s probably the only time I consistently sat in the stands and watched a game of any kind. I’ve always been a part of whatever game I attended.


All the parents sit in the same section at college games. Obviously, those deciding such things know better than to put families with the fans. It was also one of the coolest things about having a son playing college football—we made lots of friends with other parents.


One time, there was this family sitting on one side of us and one of the family members said something about one of the players. That player’s family happened to be sitting on the other side of us. Now, keep in mind, this sort of thing doesn’t happen often. Families understand things. 

Just when things between them started heating up, one of them got distracted and things went back to normal. Being in the middle of that mess told me pretty quickly that I didn’t want to sit in the stands very much, especially if I had a vested interest in the team on the field.


As for MHS football, for the rest of my life, this team and these coaches will be my family. So no, I won’t be able to sit in the stands and listen to people criticize them.


I just don’t get it. These are teenagers and these coaches want nothing but the best for these kids. I remember hearing someone yell from the stands to George Quarles “you need to pass more coach.” Really? You know more about calling the offense than GQ?


My least favorite is “BLOCK SOMEBODY!” Uh…I don’t think so. Block somebody on the other team, not just any somebody. That one hurts more as the parent of a lineman (and a former lineman myself) when it comes from the parents of a running back that just got tackled.

I wrote last week about yelling at referees and umpires. That column got a lot of comments on social media and a dozen or more emails in my box. Everyone had egregious examples of bad behavior by parents of young children. My son-in-law thought he might have to protect his 9 year old son from the other team’s parents in a soccer game last weekend.


It’s beyond ridiculous. I had several people send me articles about youth sports leagues having to close down all across the country because they can’t get officials.


If you are a parent, support your son or daughter. Be their parent, not their coach. You do not know more about what is going on than their coaches. If you disagree with the officials, understand that they know that they don’t get everything right, every time. If you think you can do better, great. They would love to have you.


But be kind. Be positive. At the end of the day, these kids aren’t going to be making their living playing sports. And maybe 3% of them will get college paid for by their athletic exploits. They are much more likely to get college paid for by their academic exploits. I heard a statistic once that said for every athletic scholarship, there are 1000 academic scholarships.

You are much more likely to get there by reading to your younger children, taking them to the museum and art gallery, and expecting academic excellence. Sure, sports are important, essential even, but you're not helping them in any phase of life by yelling at their coaches and referees or by coaching them from the sideline.

You want you child to be a great athlete?  Get out in the yard with them. Throw a ball with them. Run with them. Encourage active play.  Let them play everything. Hike, paddle, ski...do it all. You're building athleticism when you do that.

Let our children learn positive lessons from their sports. Don’t teach them what they don’t want be like with their own children.