Evolution of Sports Medicine and Podiatry. Dr. Bob Parks

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I love mountain biking, swimming, hiking, dancing, tap, jazz ballet,

hip hop, sprinting short distance jumping on the trampoline.

And now a new found interest indoor mountain climbing.

Thanks to my niece and nephew-in-law, Sarah and Cody.

And I know there is no such phrase as nephew-in-law, but there is now.

Well, what I was actually getting at is that my activities certainly cause,

wear and tear on my body, especially my feet, knees, hips, and lower back.

Oh, my gosh Yowza!

Sometimes.

Right.

Well, sports medicine has been a blessing.

Today's guest shares a bit of insight into sports medicine.

And here's a question.

Why do companies sell specific shoes for certain activities?

Well, it's not a sales pitch to buy the shoes.

It's real.

Well, I sat outside in the mountains with the birds and also

with legendary podiatrist, Dr.

Bob Parks..

Bob was born and raised in Tacoma, Washington during a time that

he says was a bit simpler then.

In high school he ran track and cross country and living a typical family

life in the Pacific Northwest, which he considers an astounding beauty with the

mountains and the greenery and forests

and Mount Ranier or Mount Ranier was practically in his backyard.

So life was special every day.

And like most kids, he grew up and moved away.

His college years were spent as a Cougar at Washington state

university WSU, where my sister's at.

Go Cougs!.

as the first part of the schooling, which he needed to become a podiatrist.

Some people have never heard of a podiatrist, but most people have

heard the term sports medicine.

Bob shares his positive imprints in the world of sports medicine, and podiatry.

It all started, I believe it was in seventh or eighth

grade when our teacher, we were having a vocational day and different

people would come and talk to us about their professions or vocations.

And we were assigned the task of trying to figure out what we

might want to be when we grew up.

Well I had just recently suffered a foot injury in cross country.

And I went to a podiatrist.

Now back then podiatry was poorly known by and large.

Podiatry is a rather unusual offshoot, in that, general medicine or in the

musculoskeletal realm of orthopedics

they chose to not pay as much attention to the foot, the ankle, the

lower leg as maybe they should have.

So another profession actually sprouted up and in its earlier years,

podiatrists were not surgically trained, were not hospital-based trained.

So they were looked upon a little differently at that time.

But it has evolved tremendously since that time.

But, but in any event, I went to a podiatrist and I went, mmmm.

Clean office, wears a white coat.

There's a professionalism about him.

So I put down on my piece of paper I think I want to be a

podiatrist in the eighth grade.

And it wasn't until actually I went for my interview after college,

we were going down on a scuba diving trip to Catalina island.

And I had my interview in San Francisco.

And I remember sitting, sitting in the chair and thinking, you know, this

whole idea of podiatry was just a whim.

And I certainly hope it's something I'll enjoy.

I'll enjoy because this is it.

I had my interview.

I was accepted.

And then of course podiatry is a four year course.

And then you have your surgical residency after that.

But it's funny how I just kind of slid in.

And in fact, another interesting sideline to that is when I was at Washington

state university, I went to my advisor.

I was a zoology major and pre-med major.

I told her that I wanted to be a podiatrist and she

was, well, what is that?

So I kind of schooled her in that.

And subsequent to that over the next four or five years, she had actually

sent a couple more people from Washington state to, the medical

school I attended in San Francisco.

So that's kind of an interesting story.

Interesting.

Yes.

So enlighten us a little bit more because you

have said that it has evolved.

I was fortunate enough to be in on some of the very early work

on sports medicine, investigation.

And we had some of the people, George Sheehan, who was the medical

editor for Runner's World magazine.

He would lecture, to our national sports academy.

And so I was in on the initial groundwork of lower extremity sports medicine.

And in fact, I was involved in sports medicine before it was

popular before the so-called running boom of the early eighties.

I believe you can probably remember that there was a period of time

where, any social event you might go to, the conversation comes

up, have you run a marathon yet?

So it was kind of a, a stepping stone in life that while you

have time run a marathon.

Now no longer is that the case, but.

I remember when I first came to Albuquerque after my residency,

I was doing sports medicine when it wasn't that popular.

That, and as I had alluded to the, the evolution of, of podiatry is

such that my daughter, who now is a podiatrist, she practices primarily

inpatient medicine and she, tends to specialize in trauma of the lower leg

and foot, as well as, limb threatening injuries with the increasing number of

diabetics, particularly in the Southwest.

They will be admitted to the hospital with gangrene of the leg and the foot.

And she's the one that has to manage those patients with infectious disease and, uh,

other, physicians to remedy their care.

And, uh, so it has changed tremendously and I've seen a change and it's all

been for the better I might add.

Well, that, that's a good thing.

Through the years you've shared some of the stories about how

everything has evolved in what you were seeing and what you discovered.

Well, Catherine, first of all, I might add when I started

We really didn't have MRIs, CT scans, bone scans at our availability.

And during that period of time, we relied more on our hands and

we had to listen to the patients.

And one of my, one of my closest colleagues an orthopedic surgeon, , he is

a firm believer in the fact that if you don't listen to the patient and if you

don't touch and feel, you're not going to be able to arrive at a, at a diagnosis.

It always frustrates me a bit

when you make an appointment with a musculoskeletal doctor

and before they even see you, they want an MRI and an x-ray.

And sometimes their examination is very cursory and they're waiting their

diagnosis more on the, radiographic findings then what you tell the physician

and possibly over the course of the few visits, you have to come back and say,

you know, I tried to tell you that.

But on a more positive note, we would find in sports medicine, we had a running club

in San Francisco, uh, of which I was a member and people would develop injuries.

And, you know, these were new injuries, you know, uh, the

injuries that occur after running 20 or 30 miles, we hadn't seen.

The iliotibial band syndrome and, and the shin splints and the

stress fractures and the tendency or propensity to develop these

problems; , we just didn't understand it.

.

That's so interesting because people have been running

for centuries and centuries.

Well, they weren't running on asphalt and concrete, right?

I was a firm believer that when someone came in to me that had a repetitive use

injury or what we might call an overuse injury, that one of the best treatments

is send them up into the foothills.

So as long as there's not too much up and down; put them on natural terrain where

they're dodging a rock to the right, and they're taking a left-hand turn rather

than running in a straight line with the exact motion and microtrauma that the body

has to absorb every time you take a step.

So the management

of sports injuries in a lot of senses is just a matter of moderating a person's

activities or doing cross training, which at that time was not popular.

Now it is understood that some degree of cross training is advantageous because

whether it be running or cycling, you use certain muscles, but you don't use other

muscles and you develop an imbalance, not from a chiropractic standpoint,

but your, , forward moving muscles, for example, work harder than some of the

stabilizing muscles, and, and by changing activities or sports, , we find that

this helps balance things out, not to forget , the advantages of, , stretching

and, and strength building as well.

I definitely need to do more of that because when you were

talking, I was thinking about all my dance, but I don't lift weights enough.

Right.

I'm glad that you brought that up.

Now with these injuries and as you call them new injuries, how

did you even talk to a patient?

How did things move forward with the discoveries?

George Sheehan, who I like to quote, and he was quite a character.

He was a cardiologist in Red Banks I believe New Jersey.

Um, and him and others had gone to their primary care physicians and just kind of,

well, you know, if it hurts, don't do it.

And he was helped by podiatry.

George Sheehan, really, to some extent, put podiatry sports

medicine podiatry on the map.

He had a magazine, basically he was the medical editor called Ask George Sheehan.

Uh, and uh, he was always talking about knee problems, hip problems,

and as it would relate to the foot or the foot structure, and don't forget

also that running shoes were just coming into their own at that time.

So they would make modifications in running shoes and all of a

sudden you'd see somebody with pain on the outside of their knees.

The people that would run in those shoes would be subjected to those.

And since that time, I think we've seen so many transitions and

evolutions of the running shoe.

Everything from the minimalist shoe and the barefoot running.

And, you know, all of these shoes have merits, but some of the

shoes, which were touted as being the very best I can remember, the

Nike, L D V had a very wide heel.

And what happened is when you land on the side of the heel, when you're

coming down to contact the earth, when you're running, the foot lands to

the outside and rolls to the inside, but with a very wide heel, what was

happening, it would snap the whole lower extremity because it was so stable

and it would cause this , mechanical irritation or, or trauma with and it

would ascend up the lower extremities

and it would cause all these secondary injuries.

So, so not only were we experimenting somewhat with our population because

so much of this was new, but even the running shoe industry was trying to

evolve as fast as, the number of people running to try to stay one step ahead of

all these injuries that were occurring.

But again, these were the very early days of sports medicine.

And, and at that time there weren't a lot of sports doctors, there just weren't.

And, and to be honest, there's not a lot of money in that type of

field because you have to spend an inordinate amount of time with the

patient taking a detailed history.

It was not uncommon that they would bring a basket full of shoes for you

to look at, to check the wear pattern.

Oh wow.

Quite frequently.

, and they traveled some distance to come to you because you had insight.

And I was a fellow long distance runner.

And you had to look at all of these

Items that they might bring and the stories they might tell and, and

certainly the examination and try to figure out, okay, here's the problem.

This caused the problem.

How do we reverse the problem so that you'll get better.

And then of course there are these more complicated athletes, world-class

athletes or, athletes that are very seriously training for an event, and they

don't have time to take any days off.

How do you treat them?

So these are some of the challenges of sports medicine.

It was very rewarding.

, and I, I still have, uh, a very strong affinity for that type of a

practice, as well as the surgical aspects of podiatry as well.

, Catherine: that's part

I really like what you said about listening to the patient and then

palpating, where it might hurt or where they have discomfort and

then, coming, your own discovery.

That's correct.

We have to learn to advocate.

And I had a gal on Jennifer Hunter a few weeks ago, whom you listened

to, an artist, which you two have something in common, but she

was really trying to get across to listeners that you have to advocate.

And if you don't ask the right questions, Of the doctor, then the

doctor cannot in turn help you.

Yeah.

And that's becoming more and more important now, particularly

since doctors have such a limited amount of time with their patients,

that you kind of have to be your own patient advocate and raise your hand

and say, doctor, doctor, I really need to get this information to you.

It might be relevant.

It may not be.

The other thing Catherine, I want to point out is disseminating the information on

injuries and appropriate treatment not only were magazines, a good source, but I

remember the lecturing that we would do.

I had a very strong, and rather large group of patients that came from Los

Alamos because they were all scientists and they were all runners and they

would invite me up to lecture and

I would lecture hours on hours and we'd have question and answers and

we would discuss all the problems that they might have and, and try to

relate it to the biomechanics abnormal or normal biomechanics of the lower

extremities and what might be causing these problems and what the types

of treatment might be available.

And even at that time, also, our sports academy, we had national meetings.

So podiatrists that were in the hinterlands,who didn't see many athletes

would be able to get information from us that saw a greater number and

say, these are the best socks, this is how you stretch this problem to,

to get the patient feeling better.

So we were trying to get the word out as fast as we possibly could.

and, and I think it's been pretty effective at this point.

I think it's so interesting that you had a hand in the discoveries

of, of socks, of different surgeries of injuries and, and that you have moved

podiatry forward, as well as the runner

and what types of shoes should I get?

I think that, that positive imprint that you have put forth is just an

incredible one worldwide that obviously is helping, not just doctors, but the

consumers and as, and the companies as well, that are making the shoes

because they have to get data from somewhere that is scientific in order to

build a shoe that will work for runner who runs tipsy topsy or whatever it might be.

Also, I might add that, podiatric sports medicine has

had a large part in looking at the biomechanics of certain sports and how,

uh, the biomechanics of cycling, Nordic freestyle skiing, classic skiing, some

of these events, either might aid or hinder efficiency and movement.

So how can you alter the function of the extremity or the foot in the

boot to make a Nordic skier faster?

And so not only were we treating injuries, but we were also, seeing

patients that came in and said, I'd like to be a faster, cyclist.

I'd like to be a faster skier.

And I would go up on the mountain and watch em ski and we we'd talk

and we'd ski together and try to put something together to see.

Oh a hands-on doctor completely!

I loved it.

I loved it.

And as I got older, I just loved being around these young, people

that were just so, so active in sports and being around the university and

working at the university in the, uh, uh, sports medicine department,

it allowed me to be in contact with some very, very good athletes.

And you learn so much from these people.

And it really inspired me because, I was middle-aged and I was watching some

of these people as they were getting better and better and trying to help

as best I could in their improvement.

Wow.

That's cool.

So the skis the downhill , they've gotten shorter.

So why?

Well, I don't profess it has to do with the efficiency of turning

their parabolic and, and the, the actual shape of the ski itself allows the turn

to be negotiated a lot more efficiently

so you don't have to rotate the hips.

If you used to watch, um, Stein Eriksen, or, um, Jean Claude Keely who won a number

of gold medals, you would watch them do something called vailing and vailing

was the way they'd go through the gates.

And, and it was a very beautiful movement, but now most people that get on a shorter

ski, which has been the state of the art for 20 years, probably find that you

almost just have to think move, you know, a turn and your skis will turn for you.

A lot of it and particularly in Nordic skiing, it has to do with

the balance of the foot on the ski.

And for example, in ski skating or what we call freestyle, that is almost

like an ice skating type of maneuver.

And a lot of it has to do with where your pressure is.

So there's a period of time where the ski glides; there's a period of

time where the ski stops and pushes off for the other ski to glide.

And it has to be done in a certain sequence and manner to

appreciate maximum efficiency.

And so all of these things, and, and as I was alluding to in with cycling the

same thing as what, whether the person is in-toed or out-toed looking at the

knee, if it's pistoning correctly over the pedal or whether it's going inward and how

you can make adjustments, not to mention

proper bike fit, which is extremely important.

So, so there, there are so many aspects of sports medicine that, I mean,

it just, it just baffles the mind

After listening to you, I think that for sure, I take sports medicine for

granted I just, think that, oh, , the bikes have come out now and they have

the clips, the in-toe, which I love, I won't ride a bike unless I can clip in.

Right.

And so you just think, where did they get the information from?

How did they know to do that?

And to turn the ankle?

So obviously people like you are a part of that industry.

As far as the pedals, we would actually cant or wedge

some of the pedals to allow the, the shoe, the, the cycling shoe to fit

properly and at maximum efficiency

so to generate the maximum force, when the person presses down on the pedal.,

oh gosh, you know, I, I thought it was just safety.

I did.

I just thought that the clips were for safety.

I didn't think of it as a way of in, as a means of endurance or

injury prevention.

In fact, if you think about it cycling pedals on both mountain bike

and particularly on road bikes, , as the foot sits in the shoe on the

pedal, the early ones didn't allow an inward outward range of motion.

Well, people were getting knee pain as a result of that.

,so now they allow freedom of motion and with that, it helps reduce knee

injuries significantly as well.

Wow.

Well, thank you so much for sharing the science part.

And is there anything else that you want to share about the science before we move

on to something that's not quite science.

I, you know, I think we've touched on many things, uh, I

really enjoyed it because back in those days, you weren't looking at your watch.

Things have changed.

And certainly there are a lot of patients to be seen and not a lot of

doctors sometimes to see all those patients, but, , yeah, it was, it

was a good time and I have very, very fond memories of my years in medicine.

Well, and people who've seen you and obviously the industry wonderful

that you were a part of it.

So you retired and you had this, wow,

this amazing transition in your life.

You went from science to,

I went from left brain to right brain, literally put it that way.

Yes.

Join us next week when Bob shares his incredible transformation from

surgeries and sports medicine to his new found discovery of his right brain talent.

Thank you, Catherine.

And I would just lastly, like to say that.

The fact that you have this podcast positive imprint, I am so inspired.

Oh, thank you so much for that, Bob.

And, and of course I like you would like people to go and find their

positive imprint and put it into action.

Thank you.

And I thank you for your positive imprint.

Your positive imprint.