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Send us Fan Mail Sports physical season hits fast, and it’s easy to let a pre-participation sports physical (PPE) turn into a rushed checklist. We slow it down and get clear about what these screenings are actually for: catching life-threatening risk, spotting conditions that need further evaluation, and documenting a baseline that helps later when injuries happen. I’m Chuck Dowell, and I share how our clinic handles high-volume PPE nights while still making smart sports clearance decisions. We focus on the part that matters most for screening: the history. We talk through the questions that uncover red flags athletes often miss or minimize, including exertional chest pain, palpitations, syncope, and family history of sudden cardiac death or inherited conditions like long QT syndrome. We also cover practical, real-world topics that show up every day in sports medicine and orthopedics: concussion history and persistent symptoms, asthma that does not improve with rest, heat-related illness risk, sickle cell trait concerns, supplements like creatine, menstrual history and anemia, RED-S, substance use, and mental health and safety questions that may need a more private approach. Then we get into the physical exam that supports better referrals and safer participation: auscultation in multiple positions, using Valsalva for dynamic murmurs, and screening for connective tissue features that raise vascular concerns. We explain when to stop the exam and send an athlete for a cardiology or primary care workup, where EKG screening fits (and where it doesn’t), and why restrictions often beat disqualification when you tailor clearance to the actual sport. Subscribe for more clinical and functional orthopedics, share this with a coach or parent, and leave a review if it helps. What’s the one question you never skip on a sports physical?

Send us Fan Mail A 17-year-old volleyball player walks into clinic with a week of non-traumatic low back pain, but her story has a detail I never ignore: months earlier, she felt a “pop” during a jump and her symptoms worsened with trunk extension. That combination of athlete profile, mechanism, and exam findings should immediately put pars interarticularis stress injury on your radar. I break down exactly what I saw on exam, why extension pain is such an important clue, and how this presentation can mimic a simple muscle strain while actually being spondylolysis in progress. From there, we move into imaging and diagnosis in a way that is practical for real-world orthopedics and sports medicine. I walk through the lumbar x-rays, the limits of plain films for early stress reactions, and why MRI is often the preferred next step in adolescents to identify bone marrow edema and unilateral pars involvement without radiation. We also define the terms clearly: spondylolysis as a pars fracture and spondylolisthesis as a forward slip, plus what symptoms and red flags to listen for when an athlete reports buttock or upper hamstring pain. Finally, we build a management plan you can actually use. I cover conservative treatment options including activity modification, the pros and cons of bracing, physical therapy priorities like core strength and hip mobility, and return to play criteria that focus on being fully pain-free with normal strength and sport-specific tolerance. We also touch on surgical indications, what direct pars repair can look like, and prevention strategies that start with training volume, flexibility, and avoiding year-round overuse. If you found this helpful, subscribe, share it with a clinician or coach who works with young athletes, and leave a review with your top takeaway.

Send us Fan Mail We break down a real clinic case where a simple misstep leads to a suspected Lisfranc injury and a fast track from urgent imaging to surgical care. We share the exam and X-ray clues that help us spot midfoot instability early, plus what recovery often looks like after fixation. • case presentation after a plantar-flexion misstep with a pop and immediate inability to weight bear • key exam findings including diffuse midfoot oedema, focal medial midfoot tenderness, and pain with forefoot compression and rotation • X-ray alignment changes that raise concern for Lisfranc disruption and why CT helps define the injury • Lisfranc ligament anatomy and why plantar arch bruising can be a high-value clinical sign • when non-operative care may fail and why surgical referral is common with widening and instability • post-op course including splinting, casting, strict non-weight bearing, and gradual return in a walking boot with physical therapy • realistic healing timeline, persistent swelling, and practical counselling points for patients

Send us Fan Mail We walk through how pediatric distal radius fractures behave differently from adult injuries, using real X-ray cases to show what to measure and why it matters. We focus on remodeling potential, age-based angulation limits, and practical casting choices that keep kids safe while they heal fast.  • case study of a seven-year-old with a subtle metadiaphyseal distal radius fracture and dorsal angulation best seen on lateral view  • why distal radius and forearm fractures are so common in children and how buckle fractures can look deceptively mild  • how the distal radial physis drives growth and remodeling potential  • age-based acceptable angulation targets and why malalignment can block pronation and supination  • immobilisation strategy including short arm casting, cast moulding and typical timelines for cast then brace  • older teen sports injury example and why acceptable alignment is stricter after age 10  • red flags and associated patterns to rule out including Monteggia, Galeazzi and DRUJ injury  • urgent care and ER options including sugar tong or volar splint with orthopaedic follow-up  So you can log on to the YouTube channel and see the x-rays and the images that we discuss during the presentation itself.

Send us Fan Mail A snowboard edge catch, a fall on an outstretched hand, and a wrist that instantly looks wrong. We take you step-by-step through a classic distal radius fracture presentation in orthopedic urgent care, featuring a 22-year-old with dorsal displacement and the unmistakable dinner fork deformity often seen in a Colles-type fracture. If you want a practical, real-world framework for evaluating acute wrist injuries, this case is built for you.  We start with how we describe the fracture correctly on imaging, focusing on the distal fragment, and what we look for on AP, oblique, and lateral X-rays including loss of radial height and radial inclination plus concern for intra-articular involvement near the DRUJ. From there, we shift to what can’t be missed: a careful distal neurovascular exam. With dorsal displacement, traction on volar structures can lead to neuropraxia, and we talk through why leaving a fracture unreduced can put nerves at risk.  Then we get hands-on with the hematoma block, a useful option when IV sedation is not available. I explain why the dorsal approach is typically safer, where to place the needle relative to the dorsal step-off, how much local anesthetic we commonly use, and why timing and patience matter, especially within the first three to five days. We finish with closed reduction mechanics, the alignment numbers that guide “good enough” reduction (radial inclination, radial length, volar tilt), and how a sugar tong splint with a strong volar three-point mold helps prevent the fracture from drifting back dorsally.  If you want to follow along visually, check out the YouTube version for the X-rays and illustrations, then subscribe, share this with someone who treats wrist injuries, and leave a review with your go-to reduction and splinting tips.

Send us Fan Mail A “simple ankle sprain” can be the most expensive diagnosis in sports medicine when it’s wrong. We’re unpacking a case that looks ordinary at first glance: a 16-year-old wrestler who can still walk, has normal-looking initial X-rays, and yet can’t return to the mat because the pain is higher than the usual sprain spot. That detail changes everything, pushing us toward a high ankle sprain and a syndesmotic injury rather than a routine lateral ligament strain.  We talk through the exact mechanism that should set off alarms, forced external rotation often paired with dorsiflexion and sometimes eversion. From there, we map the anatomy in plain language: the lateral ligaments that drive most inversion sprains versus the anterior inferior tibiofibular ligament and the wider syndesmosis complex that stabilises the distal tibia and fibula. We also share the exam findings that matter most, including tenderness at the distal tibiofibular junction and pain reproduced with dorsiflexion plus external rotation.  On the imaging side, we cover the practical radiology checks clinicians use every day, including tibiofibular overlap, tibiofibular clear space, and medial clear space on AP and mortise views. We explain why gravity stress views can help but also why MRI is often the decision-maker when X-rays don’t match the story. Finally, we walk through treatment and recovery: conservative care with a CAM boot and delayed weight bearing versus surgical stabilisation such as tightrope fixation for athletes chasing a faster, more reliable return to sport, plus what rehab progression typically looks like.  If you found this helpful, subscribe, share it with a teammate or clinician, and leave a review so more athletes and providers can spot a high ankle sprain before it costs a season.

Send us Fan Mail In this episode we discuss a case presentation regarding a greater tuberosity fracture in a young patient. The X-rays and video presentation can be seen on the YouTube channel.

Send us Fan Mail In this episode we discuss a case presentation regarding a commonly seen hip injury in young athlete. The X-rays and video presentation can be seen on the YouTube channel. https://youtu.be/5PsWcvPSaI0

Send us Fan Mail In this episode we will discuss a case regarding recurrent effusions in a young athlete. The images including x-rays, MRI and operative photos can be seen on the YouTube channel for the podcast.

Send us Fan Mail This episode I talk with Emily Kosderka Ph.D., ATC Assistant Professor at Linfield University. Emily's research is in the use of exercise as a therapeutic intervention following sport-related concussion and she hopes her work will further our understanding of how exercise can be used safely to improve recovery. She is on the advisory board for the Collegiate Athletic Trainers’ Association and has been an invited speaker to conferences around the country. In this episode we discuss how to evaluate and treat concussion.

Send us Fan Mail This is a great episode with the team at Summit Physio and Performance on all things hip. Dr. Tessa Kothe and Dr. Cat Cui, join me as we dive into the most common hip problems we see, how to diagnosis and fix them. Discuss specific PT exercises we can use to improve hip strength and mobility.

Send us Fan Mail This is a great episode; I am joined by Laura Rinne (@coach_laurarinne) youth athletics coach and CrossFit level 2 certified trainer. We discuss all things involving youth athletics including when to start, how to prevent injury, how to motivate kids to participate.

Send us Fan Mail In this episode I am joined by Vanessa Smith, PA-C. She is the founder of OrthoRefresh.com an online platform with talks and videos involving evaluation, casting, splinting and treating upper extremity complaints. We have a great conversation about some common hand and wrist complaints.

Send us Fan Mail In this episode I am joined by Darin Yantis, DPT. We discuss common ski and snowboard injuries that we see in the Orthopedic and PT clinic. We address symptoms to watch out for, injury prevention, exercises to warm up and prepare for these dynamic sports and activities.

Send us Fan Mail I am joined in this episode by Dagan Cloutier, PA-C. Dagan is an orthopaedic PA working in New Hampshire, editor and chief of JBJS Journal of Orthopaedic for Physician Assistants. He currently specializes in orthopaedic urgent. care. In this episode we discuss acute ankle injuries, evaluation, treatment, patient education and return to activity.