Residency Insight -- A PRESENT Podiatry eZine

Guest Editorial: Alex Kor, DPM, MS

Originally from Terre Haute, IN, Dr. Alex Kor has a B.S. in Chemistry from Butler University and a M.S. in Exercise Physiology from Purdue University. He received his D.P.M. degree from the Dr. William M. Scholl College of Podiatric Medicine in Chicago. In 1990, Dr. Kor completed a Podiatric Surgical Residency at Westside V.A. Medical Center— University of Illinois. He has served as the team podiatrist at the N.C.A.A. Division I level (University of Evansville), the N.C.A.A. Division II level (Bowie State University in Bowie, MD) and at the N.C.A.A. Division III level (Knox College in Galesburg, IL ). He is certified by the American Board of Podiatric Surgery and is a Fellow of the American Academy of Podiatric Sports Medicine. Dr. Kor (as of June 7th, 2010) is ranked #118 nationally (in his age group) by the United States Tennis Association. In addition to his current duties at Bowie State University, Dr. Kor is a full-time podiatrist for Kaiser Permanente in the Washington, D.C. area.

In this week's issue of Residency Insight, Dr. Kor shares his expertise in the area of "pain" and how its tolerated and managed so differently from one athlete to the next.

—John Steinberg, DPM, PRESENT Editor


Alex Kor, DPM, MS (Got Milk?)

Got Milk, Got Pain?
Should you play in Pain?

by Alex Kor, DPM, MS
Kaiser Permanente, Camp Springs Medical Center
Attending Staff: Washington Hospital Center Residency

Every patient has a different pain tolerance. I see some patients who seem to "milk" (Figure 1) the most benign injury and request to be off of work for weeks. And , yet, I see other patients, predominantly athletes, who will endure major pain to compete.

From the perspective of the motivated athlete, this attitude should be commended and applauded. However, for the concerned parent and the medical professional , there are issues that should be discussed.


	Figure 2: Curt Schilling's "bloody sock."

Many great athlete have played with significant injuries, and have become legends as a result of these extraordinary performances. Willis Reed, of the New York Knicks, limped onto the floor to propel his team to a NBA title in 1970. Curt Schilling (see Figure #2 ), pitched the Boston Red Sox into the 2004 World Series while three deep stitches held his peroneal tendon in the proper place, and the "bloody sock" became a collector's item. And, in our sport of tennis, Pete Sampras overcome a severe upset stomach to beat Alex Corretja, and eventually win the 1996 U.S. Open. But, as magnificent as these accounts are, one must wonder where to draw the line.

Obviously, when an athlete is competing at the highest level and there are usually a million reasons ($$) to play in pain ; the decision is easy. But, at the local level, the "playing field" is different. We are no longer talking about the "land of milk and honey". As a health care provider, we are obligated to explain the risks , complications and benefits of playing on a compromised body part versus NOT allowing the athlete to compete until healing is complete. If the athlete can play with minimal to no pain and does not need pain medications, this is very significant and favorable . But, if there is a possibility that he/ she may adversely affect their long term health, I would not allow participation. If the initial exam/ radiographs are not definitive, I would consider additional imaging (e.g. CT SCAN or MRI). Although, I am quite judicious in ordering such tests, it is my responsibility to prevent further injury. It is NOT uncommon for a sports medicine provider to order an expensive test in these situations, whereas a more sedentary patient would be prescribed rest, ice, compression, elevation, etc.

Playing in pain should not include taking pain killers. That is, there does exist a difference between the athlete who has poor pain tolerance (the "Milky Way") vs. the athlete who can play through extra-ordinary injury and not ever consider using pain-killers to play (a "Milk Dud"). No one can deny that playing tennis in pain is not a fun experience, but some athletes are better able to compensate. Thus, these athletes should not be discouraged as long as their overall health is considered.

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