As Featured on CBN: Back Injuries, Pickleball Injuries, and How to Prevent Them

Lorie Johnson: Trying a new sport can be intimidating, especially if you’ve been on the bench for a while. Pickleball can be easy, fun, very healthy, regardless of age. And joining me now is spine surgeon Dr. Colin Haines with the VSI, and I should point out, an avid pickleball player. Dr. Haines, thanks so much for joining us. We appreciate your time today. 

Dr. Colin Haines: Thank you for having me. 

We saw that  pickleball is catching on like crazy. Why is it that people are becoming injured? 

There’s no doubt that pickleball is taking off. It’s a great sport, a lot of fun as you said I play myself, but you’re correct. We are seeing people getting injured more and more commonly, largely because not only is it taking off like crazy, but we aren’t taking the sport seriously enough. It’s a real sport, and with that come real risks. 

So what types of injuries are people suffering from? 

You know, speaking from personal experience, I grew up playing tennis; I worked out, I thought I was in shape and still think I am but I went off to play pickleball for the first time. I didn’t warm up, I played for about three hours – I could barely walk the next day. My back and my legs are so sore. So we really got to be cognizant that this is a true sport. You got to warm up properly. You’ve got to cool down properly, but there are specific risks to the bat. What I felt was kind of in the grand scheme of things relatively minor muscle soreness, I didn’t tune my body up enough. But, we are seeing people with more serious injuries; specifically with the spine. A lot of times it’s coming from the low back, the lumbar discs we call them or the shock absorbers to help our spines to move but also protect yourself. 

So, you look like the picture of health. I can’t believe that you were injured because you know when I was shooting this story, I met a lot of people who are, you know, not spring chickens anymore and they haven’t exercised for a while, and yet mentally they still feel like they’re in their 20s and can still do the things that they used to do when they were in their 20s and become injured that way. So a lot of it is sort of realizing hello you’ve gotten a little bit older right? 

Weekend Warrior system we call it – you know, we have to be cognizant of our body. I’m again as well, I’ve got three wonderful kids that are making me older by the day. So we gotta take it pretty seriously. 

Yeah, I mean and this is something that we see I’m sure you do too, as a spine surgeon across the board with people you know where, you know people who are older and they get out there and they shovel snow and they’re really not in that great of shape and they start getting injured. So I guess the first thing also is to kind of do a reality check and type tickets sort of temperature check of how much exercise you’ve been doing recently, right? 

I think being very honest and cognizant with ourselves is important when we’re talking about any activity. With that being said, I want people to still live the lives they want, and I encourage my patients who haven’t had surgery, and those who have had surgery, to live the life you want. You know, for example I have a patient who is a MMA fighter and has had surgery and he’s back to fighting in MMA. Now that being said he’s very smart about his fight as hard as you can be. But it’s important that we do live the lives we want. I think that philosophically we want to keep doing what we enjoy for longer. So this is all very achievable. Just some things we have to do to our bodies, and preparation to make sure that we keep moving.

So, how important is, for example, stretching?

Big time. I’m a big fan of stretching before the warm up before and the cooldown after; so I call it a five to five rule. What I mean by that: five minutes of warm up, five minutes of cooldown. Now delving a little bit more into the specifics: I like to split up each session into half, just getting the muscles warm with a little bit of walking, some jumping jacks, something just to get the blood pumping and the other half to stretch and get your body ready. 

So you want to actually raise your body temperature a little bit before you start stretching. So maybe do a little bit of running in place or jumping jacks like you said and then stretch the muscle? 

Yep, so that’s how you get the blood pumping and then stretching. On the back end, when you do in the cooldown, stretch and then you do the walking or the jumping jacks on the back. 

Oh, okay. So and then what types of stretches should we be doing? Sometimes when I stretch, I feel like the stretches might hurt my back. 

You know it’s doing it in a proper manner. I think that for the most part people think of stretching. We jump straight to the hamstrings. You know we’ve seen people bending over and stretching out the hamstrings, we think of the calves and those are critically important; with that being said we want to make sure we don’t neglect the spine, when it comes to the spine or muscles in general; the way we think about muscles is they are protected. If your muscles aren’t working properly, they offload that work that your spine in your bones and joints have.

So importantly, there are three exercises and stretches before we get to pickleball with respect to the back. One, the simple cat-cows where you’re arching forward leaning backwards. One where you’re doing simple twist side to side. And the last one we’re focusing on the upper part of the back, stretching in those lap muscles and holding for a couple more seconds. 

So we talked about the importance of stretching to help prevent back injuries. What do we do once we get on the court to stay safe?

Well, preparation is critical. Fortunately, I can give you some tips of the mistakes that I’ve made myself. But believe it or not when I first started playing pickleball because I just started getting in the sport I was using running shoes. I mean it’s amazing the difference proper footwear can make. And what I noticed when I was wearing my running shoes is that they’re designed for forward and backwards – really not the side to side movement that pickleball requires. Actually, my shoes ripped. The shoes aren’t designed to tolerate that side to side motion. So once my shoes ripped, that was a trigger for me to say okay, it’s time to get smart and buy some real equipment. Once I started wearing tennis or pickleball shoes (essentially the same thing) the stability I felt in my ankles was tremendous. So not only was equipment functioning appropriately, I actually could notice a tangible difference. So when it comes down to the equipment, I think it’s a wonderful way to start. 

And what about form and the way you play? 

A lot of times you create these contrasts between tennis and pickleball and one of the things that I noticed myself is that with pickleball the paddle is really short. So a simple way to pick up a ball with tennis, you’ve got a long racket, so you squeeze the ball between your foot and your racket and you lift it up as one. Different ballgame when it comes to pickleball. There’s a lot of bending forward to pick that ball up. Making sure you use good posture when bending forward is critical. What you don’t want to do is you don’t want to round your back and arch over too much. That puts some additional force on the discs, the shock absorbers of the spine. While most of the time the body tolerates it just fine. That’s a position that puts your back in a little bit of risk. So instead, using an old adage, bend with the knees, bend with the hips, and keeping your back with a nice curvature upward, keeping that proper posture – that’s really safest for your back when you’re picking the ball up. 

So any any other advice during the game because I’m sure you’ve got tips on what to do afterwards – besides stretching 

Don’t kill the ball. You know, that was a big contrast that I noticed compared to tennis. You know, when I’m playing at the net in tennis, you can oftentimes win the point by using power. Well, the ball in and of itself just doesn’t go that fast – it’s much more of a control thing. So when I first started playing, I was trying to kill the ball. I was really swinging very hard, actually too much force, too much of an aggressive twist at the waist – and that does risk the back. So not only does it make you better at pickleball when you’re just using your angles, and using more gentle form, but it’s safer for your body as well when you’re not trying to overhit. 

That’s really good advice because it’s kind of a wiffle ball. So you know you don’t need all that force to get it to go. Anything else as far as when you’re playing on how to protect your back? 

I like to start slowly. I start playing in the kitchen. You know you don’t want to go and start swinging the paddle really hard to try to connect with the ball with too much velocity. Start slow, work yourself into the kitchen initially then step back to the baseline and do some actual hits. 

And regarding once the game was finished, you talked about stretching, what else can people do off the court? 

So really taking a nice cool down walk – take some laps. Not only is it good, it’s social and good for your mental and emotional health, but it’s really good to let the muscles cool down properly. It’s like you know, if you’re driving a car zero to 60 is supposed to slow down as you drive down the back and you just don’t stop immediately the same thing with the human body.

So obviously a lot of these tips translate into other sports injuries. And now that we’re getting into the summertime sports, I’m sure you see a lot of sports injuries. Can you give us some broader tips on how to prevent them, not just for pickleball players but for everybody? 

Well, you know, I think my sports injuries are going to come from lugging my kids equipment to the pool all summer. So with that being said that’s something to think about – equipment can be heavy. Take a couple of trips. I did that yesterday bringing my kid’s equipment home from the pool and you know, I took two trips, I used proper form. I kept the equipment close to my chest. I just didn’t go quite as heavy and took a couple extra steps. So for me that was a wonderful preventative thing that I was able to do. A lot of the other summer activities you know, swimming clearly is a big one. I’m a big fan of swimming in general for kids and adults, it’s wonderful for the core. So making sure you’re picking the proper type of exercise is really important and then also knowing your limits. Don’t expect if you’re going to go running for the first time that you’re going to run a marathon. You don’t have to keep up with the person who’s been running for the last 10 years. Slow and steady really does win the race. 

Talk about the importance of diving correctly and properly 

It’s huge. Fortunately we don’t see this too often but it’s up to some injuries happen when people don’t acknowledge the depth of the water. Making sure that if you’re diving, it’s the proper depth. Don’t go dive in the kiddie pool and really double check and test the depth before you jump in. Then of course when you jump in, form is absolutely critical. If you hit the water too hard, even though it’s just water it does transmit force to the spine. So making sure you’re cutting through the water with the proper diving form, once you’ve established the depth is appropriate is really important. 

And so if you’re in a lake or something, a lot of times you can’t really see how deep it is wherever you’re you’re planning to dive, right? 

Correct. I mean I’m sure most of us here have these one in a million terrible stories about a friend of a friend who broke their spine because they dove into shallow water. That’s probably the single most important thing to know before you contemplate jumping in.

Yeah, I remember I kind of shudder to think about some of the cliffs that I used to dive off of when I was much younger and we couldn’t see. We just assumed the water was deep and we were very blessed and very lucky at the time. All right, we’re going to take another break and be right back with spine surgeon, Dr. Colin Haines with Virginia Spine Institute to talk about ways to prevent back injuries. Stay with us.

Welcome back and we’re talking with spine surgeon, Dr. Colin Haines with Virginia Spine Institute, about ways to protect your back from injury. And we talked about you know a lot of protection measures.

What are the most common back injuries that you and other doctors see when it comes to the neck and the low back? 

When it comes to the neck and low back, a weak point in general is the disc. The disc itself is the shock absorber; it’s the part that separates one bone from another. An analogy to think of is if  you’re in your car and you drive over a pothole, chances are you’re gonna pop a tire and not break the axle. It’s the same thing with your spine because the disc itself is mobile, it’s more likely that that is going to be injured because it’s the weak point. Now the symptoms you can experience with disc injuries and disc pain can be neck or back pain so localized right to the spot of the injury. Or if a disc herniates or squirts out and causes pressure on a nerve, it can cause shooting arm pain or leg pain and tingling, numbness or even weakness. 

So what should people do when they experience back and neck pain? Should they do ice or heat or back and forth. Tylenol? Or just go straight to the ER? What’s your recommendation? 

That’s a wonderful question. Especially when it comes to ice and heat – that’s a question I get all the time. In general, ice tends to be better early. The whole premise in the whole way that ice works is it decreases inflammation. It cools things down and decreases inflammation, which is the swelling that causes a lot of the pain. So in general for the first day or two, ice tends to be preferable to heat. Heat usually is better a little bit later. A couple days after the fact because the way heat works, is it dilates the blood vessels, increasing the blood flow and helps induce some actual healing. Now ultimately, I tell people whichever one feels better. There are certain circumstances where heat feels better than ice early. But in general terms ice first, heat later. As far as your next question, I’d say well, when do I get this checked out? You know there’s a little bit of common sense test that applies. There are certain red flags we call them that we look out for. When people have seriously bad shooting pain, numbness or especially weakness – those are some red flags we look for that says hey, get in sooner rather than later. If it’s something that gradually gets better over a couple days and the pain is relatively controlled, it’s usually something that’s worthwhile taking anti inflammatories as long as it’s safe for you and trying some ice before you call your doctor. But in general terms if there’s a question if something doesn’t feel right, call your spine doctor, call your PCP, get seen by Urgent Care sooner rather than later because the sooner we get you answers the faster we get you feeling better.

And obviously, rest. Don’t go back to the pickleball court or whatever else you are doing right and so you feel better. Am I correct? 

There’s no ego when it comes to injury. If you’re hurt, the smartest thing to do is slow down. 

Yeah. And then also talk about some of the treatments we see with this opioid crisis that so many people get hooked on these opioids after having back injuries. Back injuries are so prevalent as far as people leaving people, what’s your reaction to that? And what can you add to that conversation? 

You know, the wonderful news and people ask us all the time, I’m a spine surgeon but the vast majority of what I do, while I do a lot of surgeries, is actually non surgical treatment of the spine. 90% of spine injuries, people get over and we get this cleared up without surgery to get people back to the normal, active, functional lives they want. Now the good news also is whether it’s with or without surgery, we pretty much do that in general without opioids without the narcotics or without the addictive medications. They have their role in the short term, but long term, studies show that they’re not overly effective for managing pain because our bodies can build up this tolerance. And then we end up needing more and more medications to achieve the same results. So oftentimes, as long as it’s safe, there are a couple of reasons make sure you check your primary care doc about why you might not be okay to take anti inflammatories but ibuprofen, naproxen, Aleve, those medications actually tend to be the first line that we use to help alleviate symptomatology. 

That is just really a huge statement that you just made. I was wondering if you could make it again about, you know, the opioids really not being as effective long term a lot of people do not realize that or even believe that.

So when someone takes medication, an opioid, and they’ve never had any opioids before, it gives them a bump to their pain of about here, but over time, the body catches up. So then, once you have developed a tolerance, you need to take more, and the body catches up, and that phenomenon keeps going. So we see the natural history of people who take chronically opioids is this sort of game of catch up which requires more and more medications. 

You can see why so many people get addicted. All right, well, on that note, we’re gonna take our final break, and be right back with Dr. Colin Haines, a spine surgeon with Virginia Spine Institute. Stay with us.

Welcome back, and we’re continuing our discussion with Dr. Colin Haines. a spine surgeon who was discussing all the non surgical ways to heal back injuries. Can you talk about the other types of ways? 

So while most of the time back injuries, neck injuries, disc herniations get better without surgery, there are times that interventions are needed. Well once upon a time, the only option was a fusion or basically having the spine grow together as one solid piece. The problem with that is our bodies want to move. Nowadays, we have disc replacements which are wonderful treatments. You know, we’re not fusing people with knee arthritis, we’re doing replacements to keep the body moving and we can do the same thing in the spine. We have low back and neck disc replacements. Another really exciting thing is actually the field of regenerative medicine – stem cell therapy, platelet-rich plasma. We can use someone’s own healing cells and own healing tissues to actually heal injured areas. So a really, really exciting time for the spine because we’re more effective, but also able to do stuff less invasive. 

I love to hear about all these exciting new advances. All right. Well, unfortunately, Dr. Haines, we’re out of time, but we definitely appreciate all your expertise and the advice that you’ve given us. Let’s get all that free medical advice. Can you tell our viewers where they can find out more about you? 

Yeah, there’s wonderful, more free medical advice on our website, spinemd.com. Also, I put a ton of tips and tricks on Instagram itself, @Dr.Colin_Haines. 

All right. Well, once again, thank you so much for your time today. We appreciate it. Thank you so much. And thanks to you for joining us for this edition. of healthy living. I’m Lorie Johnson. And we’ll see you again next week. Bye now.

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