Ron Gregush, MD, is an orthopedic surgeon who specializes in active families and sports medicine. Using cutting-edge arthroscopic surgery, he approaches some of the most common injuries from a different perspective. Reflections sat down with him to discuss his thoughts on specialized sports, ACL tears and more.
On orthopedic surgery and sports medicine:
“I most enjoy working with people who are physically active— anyone from high-performance athletes to people who do a sport recreationally once or twice a week—because I love the idea of helping make people better and getting them back to what they want to be doing. In many fields of medicine, such as primary care or neurology, physicians spend much of their time helping to manage chronic disease, which is incredibly important but involves incremental, slow-paced progress. I like being able to help people fix something so they can move forward in their lives."
“Arthroscopic surgery involves making little incisions around a joint, which means avoiding unnecessary damage or muscle dissection. The minimally-invasive nature of arthroscopy helps patients recover faster and get back to being active much more quickly. It's a surgical method that is relatively new, and the advances being made in arthroscopic surgery are incredible. For example, when I was a resident 15 years ago, I learned how to do arthroscopy around knees, shoulders and ankles. In my sports medicine fellowship 10 years ago, I began doing hip arthroscopy to treat young-adult hip problems. Hip arthroscopy is still relatively new and cutting-edge, so there are not a lot of orthopedic surgeons doing it. Because I was fortunate to be trained by some of the pioneers in that technique, I now do a lot of hip arthroscopy on young, active people. I still do plenty of knee and shoulder arthroscopy, but hip arthroscopy is my real specialty."
On young-adult hip surgeries:
“When older people come to me with hip pain, it is usually because they have degenerative arthritis in their hip. The only way to really treat their pain is to do a hip replacement. That is a surgery I do a lot and is very rewarding because people feel so much better after they have recovered, and they can often become much more active than they have managed to be in years. When younger people come to me with hip pain, it may be arthritis, but the pain can also be caused by a labral tear, which happens when the soft tissue or cushioning around the hip socket is damaged. Sometimes that is caused by a subtle deformity of the hip, which causes hip impingement, and sometimes that is caused by an injury due to repeated crouching or squatting. There are a few sports, such as football, ice hockey, ballet and yoga that can require that motion, so athletes in those sports tend to suffer labral tears more than others. No matter what the cause, once you have a labral tear, the only way to truly get the pain under control is to undergo hip arthroscopy. The pain relief that people get after hip arthroscopy can often gain them 20 more active years."
On preventing hip impingement:
“Unfortunately, for most people with a subtle deformity of their hip, which results in hip impingement, the cause is congenital. There is nothing you can really do to prevent it. You are either predisposed to it or not."
ON ACL TEARS:
"One area where there is clear evidence that injuries can be prevented, though, is ACL tears. Adolescent female athletes are twice as likely as adolescent male athletes to tear their ACLs. If, however, they do a specific set of exercises to prevent injury to the ACL, they can decrease their risk of injury to the same level as adolescent males."
On specialized sports for young kids:
“I don't like that kids have to specialize so early. I have a 5- and a 7-year-old, and I don't like that if my kids want to play soccer, they have to get into select or premier level soccer by the time they are 8 years old. If you start playing one sport exclusively too early, your overall physical development can be negatively affected. There are a lot of examples of that. For example, gymnasts' growth can be stunted because their growth plates are affected by all the jumping and pounding they do at such an early age. In soccer, I think it is ridiculous that 10-year-old kids are expected to play four or five games in one weekend. It is no surprise they get injured. The Sounders play a game every other week. Those are grown men who play soccer for a living. It is not healthy for young children and adolescents who are not yet fully developed to handle so much repetitive activity. I think it was much better in the days when kids could be a three-sport athlete. It actually makes them better athletes. Look at professional athletes like Russell Wilson, Steve Young, Ben Roethlisberger and Jimmy Graham—to name a few—they were all athletes who excelled at more than one sport and managed to become some of the best in football."
On parental expectations:
“Some of these issues arise because of unrealistic expectations from parents. In my clinic, I occasionally have a young athlete who comes in with a sports-related injury caused by excessive practice and playing, and I'll tell them they need to rest for six weeks. Sometimes their parents are realistic about it and agree to get them to rest and be healthy. Other parents argue with me that those six weeks will derail their child's athletic career—from high school, to college, to the pros. Maybe that kid will make it to the pros, but the likelihood is so low that it isn't worth the long-term damage that injury could cause. Sports should just be a way to get kids to enjoy exercise and have fun."
On preventing sports-related injury at all ages:
“Cross-training. Warm up, go out, do something, and change it up day to day, week to week, season to season."
On Americans’ tendency to rely on surgery:
“It is interesting that so many of my patients want me to operate on them—to "fix" them—when that isn't necessarily the best thing. Take ACL tears. Most of my patients want me to operate and repair their torn ACL. But, about 15 percent of people don't need their ACL for stability. It is difficult to know who those 15 percent of people are, but there are NFL players who have played with an ACL tear and never needed surgery. So there are definitely plenty of non-professional athletes who can live just fine with an ACL tear. In Denmark, only about 50 percent of ACL tears are treated with surgery. There, people undergo intensive rehab first, which can often improve the pain and general stability enough for people to be able to do what they want to do. That said, there are plenty of people who can benefit from having an ACL tear repaired. For example, if a 17-year-old athlete has an ACL tear and wants to get back to playing volleyball or soccer, then it is a very worthwhile surgery. If you are over 35 years old and not a professional athlete, I first suggest modifying your activities—get into running or swimming—and be cautious about doing activities that require cutting and pivoting, such as skiing or playing basketball."
On general advice:
“I just wish everyone would exercise more. My wife loves to tell her patients that there is no downside to exercise. It helps with everything—diabetes, high blood pressure, arthritis pain—literally everything gets better when you exercise. It is the best thing for your brain. Exercise is the only thing that has been shown to delay or prevent dementia."
On his favorite athletes:
“In what sport? There are so many athletes I admire, often more for the way they behave off the field or court than on it. Although I grew up a Steelers fan, I am now a huge Seahawks fan and have season tickets. I think Russell Wilson, Richard Sherman and Doug Baldwin are all really admirable guys who use their influence and intelligence to make a difference. Ultimately, the athletes that I admire are the ones who use their fame to help raise awareness about issues or improve the lives of people who are less fortunate than they are. Playing a sport well often lasts a few seasons; making an impact can last forever."
Dr. Gregush currently practices at ProOrtho. For more information, please visit proortho.com.