Meet Dr. Elise Gordon, a primary care sports medicine physician with the Andrews Institute who specializes in prevention, diagnosis, and management of musculoskeletal injuries. After completing her medical internship, she spent 21 years as a Navy flight surgeon at the Naval Aerospace Medical Institute in Pensacola, Florida.
The veteran surgeon graduated in 1986 from Smith College where she played varsity soccer. She completed her medical training in 1990 in the Dartmouth-Brown Program in Medicine.
Currently specializing in concussions, female athletes and performing athletes, Dr. Gordon answers some questions for us about hot topics in sports medicine.
Concussions in professional football are constantly in the news. What other athletes should be concerned about this issue?
It isn't just in football, I see a lot of concussions in cheerleaders as well as from falls, especially from stunting. So that's another growing risk of traumatic injuries, and concussions being one of those, is in that cheerleader population.
Are girls more susceptible to concussions? There have been a few reports that suggest women's soccer has the highest number of reported concussions. Is this true?
There really is no data to suggest that girls are more prone, as far as gender differences. The thing that may be happening is people are becoming more aware, sometimes initially. When you're looking at reporting numbers, you have to look at who's reporting. Is it women or is it young girls that are coming and telling more about headaches and other concussion symptoms. It's probably more of the nature of which sport rather than gender differences.
What do we know about concussions in youth? With their brains still developing, it seems like the long-term effects of a concussion on a young brain can be very damaging.
That's the major issue, concussions in the younger population. And that includes the high school population because, like you said, high school brains are still developing. During middle school you go through another large development cycle and that's not just physical. We all know the growth spurts and the changes and going through puberty, but there's also development in the brain. And so they're also highly susceptible.
And no, we don't know exactly what some of the long-term effects are. Now in the NFL, they're starting to try to see the long-term effects of the professional players because they're a good example of having played through the course of years. So they're starting a project to examine the brains posthumously to start trying to collect that data. But we know a child has a developing brain and is more susceptible to any kind of damage or change at this early age. We suspect that they're going to have problems long-term, but we don't have any long-term studies as of yet.
Are there any other sports in particular, other than football, where concussions are a huge issue?
Soccer has come under scrutiny as well as far as long-term injuries and heading the ball over the years, which is something similar to boxers. The high school level is not as significant because the speed of the ball isn't as high as when it gets up to a professional level. But still, it brings in the question - who do we want heading the ball? And there's even been discussion and recommendations that kids shouldn't be heading the ball until they're 10 or 12 or 13-years-old, or maybe not until high school, to mitigate any long-term damage from heading the ball. Not just from specific incidents but from the number of heads throughout the game.
What does your patient population look like?
I do have quite a range of patients - a lot of youth. I see grade school, middle school, a lot of high school and college. And then I have regular, weekend warrior kind of people or just people who get hurt falling down. I have a geriatric population as well that's a mix of geriatrics and osteoarthritis evaluation. I have some professional athletes, not so much in the professional range.
You also specialize in female athletes, specifically pregnant athletes. Is there anything you want people to know working with this population?
The key with the pregnant athlete is that people look at pregnancy as a disease. But it's a normal, healthy condition. It's not pathologic. There are a lot of changes that are associated with the body. And a lot of physiologic changes. But the key to remember is that as long as she has a normal, healthy pregnancy, she not only is able to exercise, she should exercise.
Should pregnant women exercise?
Now this is not the time for someone to decide to train for their first marathon, but if they are a runner and they're already running long distances many marathoners will continue to run during pregnancy. It's usually a little harder when they get up to eight months and a little bigger but we don't have any data that shows that's harmful to the baby and what we know is exercise is helpful to mom and in her labors, and we're starting to tease out that it's also helpful to the baby long-term. And that means a healthy regimen, not anything excessive. Again, anything that endangers the baby or that you might worry about, there are some limitations.
You see a lot of dancers. What are some injuries that you most often see?
There are characteristic injuries that you see in ballet dancers, particularly in their feet. You also see injuries in their hip because ballet has marked turnout. Their hips are externally rotated and they're turned to the outside. Their whole range of motion is shifted to the back as opposed to most other sports and most other kinds of dance where their toes are still pointing forward. So that's a whole other issue in the hips.
I like to compare the ballet hip to the baseball player's shoulder. It's a very similar problem. The baseball pitcher has a lot of external rotation, has to rotate back so that they can throw. The shoulder and the hip have roughly 180 degrees of motion and in ballet dancer and in the baseball player, most of their motion is shifted to the back. And because of the repetitive motion and also where the hip fits, or the shoulder in the pitcher, they have more risk for tearing those.
Why did you decide on sports medicine?
My internship is in general surgery, that's what I thought I wanted to do. I was a flight surgeon for a while, and that was me trying to figure out what I wanted to be when I grew up. One of the things I discovered while I was a flight surgeon and one of the things I knew before I left general surgery was that I loved orthopaedics. But I didn't realize I loved also having patients that I saw all the time and taking care of some of their primary care needs. I didn't realize I loved women's health, which I really love. And once I discovered family medicine and musculoskeletal, and how I can try to combine that, I knew that's what I needed to do.
A good chunk of my sports medicine career was active duty, so I was taking care of sailors and Marines and getting them ready, back to work and back to the field. I did that for a long time before I came out. I went from taking care of the warrior athletes to regular athletes.
What is the most rewarding part of working with athletes?
Whether they're an elite athlete or a 13-year-old rising basketball star, I love it all. I love teenagers, in fact, because I can make a difference. Youc an make a change, teach them something, talk to them about how posture matters, talk to them about how to take care of their muscles. You can teach them that now's the time to rest and get rehab so they're fabulous when they get to high school and college.
I don't watch professional sports or college sports. I'm more interested in the athletes. I was a soccer player in high school and college. Now my favorite things to take care of and that I see a lot of are the runners, the tri-athletes, the dancers, and I do a lot of performance stuff now. I do dance, I also perform with a singing with an opera company. So I look at the performance population as my favorite to take care of. Then kids and teenagers, and I don't care what sport they play, I'll go and take care of any of them. That's what I care about.