Carl Maronich (Host): Welcome to Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer the questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm Carl Moronich, and today I am joined by Dr. Michael Kissenberth an orthopedic surgeon and sports medicine specialist with Novant Health. And we're going to be talking about the topic of ortho focused shoulder and elbow injuries. Whether you're a weekend warrior or an elite athlete, this episode offers valuable insights into conditions affecting the shoulder and elbow, helping you stay healthy and active.

Doctor, welcome to the podcast.

Dr. Michael Kissenberth: Glad to be here. Thank you for having me.

Host: Before we jump into all the questions, maybe we can get a little bit of your background. What drew you into orthopedics, and I know you were an athlete, a much feared linebacker at the Citadel, I understand. So maybe you could talk a little bit about your background and how you got into medicine.

Dr. Michael Kissenberth: Yes, from an early age, it's so hard raising kids, you know, what are you going to do when you grow up? In high school, I always knew I wanted to be a doctor, so that part was easy. I knew it was a tough row. That's sort of unusual in all of the teaching I've done through the years, but I had an opportunity to play collegiate sports.

Initially baseball and football, focused more on football at the collegiate level. And it just so happens, and it's very common in the orthopedic surgeons, particularly sports that I train, those that are leaning towards medicine, they usually are involved in sports, unfortunately, have injuries along the way, and they get excited about sports medicine, and orthopedic surgery. And that's really what happened to me probably early on at the Citadel I said, well, yes, I'm going to go to med school and I'm going to be an orthopedist at some point. And for me on the sports medicine side, it was like, how can I stay around the sport that I love? How can I help get them healthy, get them back to participating at the full level?

And that was always the plan. And then I went off in the military for 12 years as an orthopedic surgeon, which is really high end sports, honestly. They're always in season, if you will. And that was a wonderful experience and traveled around a little bit and then been here in the upstate of South Carolina starting the Steadman Hawkins Clinic of the Carolinas and running that fellowship sports program really for the last couple decades.

Host: Very good. So a a lot of intense experience. And we'll talk a little bit about elite athletes as well as weekend warriors, if you will. But let's start by talking about overhead athletes, which I'm guessing will be tennis players, swimmers, baseball pitchers and what makes them particularly susceptible to shoulder and elbow injuries.

Dr. Michael Kissenberth: Yes, it's a great, it's been a sub passion. I've always, as a professor of orthopedic surgery, I've always done research and published a lot of papers. The area that I wanted to focus on was the overhead athlete, a couple decades ago. And really how can we find a way to keep these overhead athletes safe and hopefully outta surgery?

And yes, overhead athletes, you think of baseball, you think of pitchers, which is the primary unforgiving position. So many injuries on the mound, but also it's volleyball, it's swimming, it's tennis. Those sort of sports. There is some collision sports, but when you think of overhead athletes, you think of all of those overhead activities and overuse type injuries and not so much the collision sport. And once again, tennis, volleyball, swimming and baseball.

Host: More pickleball injuries?

Dr. Michael Kissenberth: Oh yeah. So in my mind, I'm always thinking of youth and overhead athletes, and then I'm thinking of the rest of us, which is the weekend warrior. And pickleball is, what an amazing sport. It started just with some people wanting to have fun. But yes, I would say that is the one sport in sports medicine, yes, we are unfortunately seeing a lot of injuries from that, but it's a wonderful activity that has really caught fire the last really five, 10 years.

Host: Yeah. And is it within those sports the repetition of going high and affecting the shoulder in that regard? Or is it the contact that happens or what makes them so susceptible?

Dr. Michael Kissenberth: Probably if you go back, if we think of the youth, think of overhead athletes, we could pick on pitchers or tennis players, swimmers, volleyball players when they're young or skeletally immature. So that's the important thing. So the young folks say 16 and younger, and in their baseball players, we often see a ton of overuse injuries.

Everybody's heard of little league shoulder, little league elbow. What those conditions mean is really that their growth plates are still open. And so of all of these sports, when they're playing nowadays, everybody's playing. When I grew up, you played a season and then you went to another sport.

Now it's the whole year. And so we see a lot of overuse. So a lot of our research and publication has been focused on how can we prevent and what things do we need to do to mitigate it. A great example would be weighted balls. So recently did a publication on weighted balls. These are soft plyo balls that baseball pitchers used for rehab, but there's been a lot of focus on using them to make more velocity. Everybody wants to throw 98 miles an hour. So we've shown, and there's been a few publications where if you use it in that realm, particularly if you're young and your skeleton isn't ready for it, you may pick up a mile or two, but your injury risk goes way up.

So trying to educate the populace and the coaches and the parents, less so the kid, because they're going to be the next first round draft pick that we have to be careful, maybe not the smartest thing to do. Social media is interesting because we may have a few good publications that know the science, but there's thousands of ads if you put it in ChatGPT saying, use these balls and you'll throw harder. So a lot of the youth is hopefully trying to avoid surgery and trying in any of these sports and getting them to take a break, make sure that we're working on the rest of the body to make sure they're really focused. As the skeleton matures, the rest of the body's ready to take that load.

So that's how I kind of break the overhead athletes in the younger populace.

Host: Yeah. Well, what symptoms should athletes and their parents of the young athletes pay attention to before something minor turns into a more serious problem?

Dr. Michael Kissenberth: That's right. In, in an area, a lot of the sports medicine orthopedists throughout the country will have some overhead throwing, volleyball rehab seminars and therapists that are really trained in that specific thing. So that's the first, and for the parents and everybody out there, obviously when you're young, you're going to often have some pain, but what they need to know is if they're hurting, particularly on a particular part, on the inside part of the elbow or in the shoulder, and it's not just a little soreness for a few days; they really need to stop and get care and just make sure it's okay, and most of those we can manage if we see them appropriately. Good rehab, no surgery, and they're back at it in a few months. Unfortunately, everybody's competitive so they don't listen to that until it becomes a more serious problem.

Host: Yeah. With the growth of club sports and the popularity there, and as you mentioned, athletes now playing one sport year round, are you finding that some of these clubs are better equipped with keeping an eye medically on these young athletes or is that an area that still needs some growth as well?

Dr. Michael Kissenberth: Yes, we just did a 10 year look and say, well, we have learned what are risk factors, to educate everybody, the coaches and the parents, and the athletes, what to avoid. We've learned ways to make the body stronger to avoid injury. But really looking at the last 10 year and looking at all the data, we've hardly made a dent because everybody's just trying to compete.

So at the end of the day, this happens in usually the better athletes who happen to throw hard and they want to do it. So it's continued community education. Certain things happen, for example, in South Carolina, there's some new pitching rules looking at and paying attention; you're only allowed to throw so much.

I think those rarely do state rules or laws make a whole lot of difference to all of us. But this is one that has, so I think it has made more awareness. So a lot of it's really just about awareness in the youth and hopefully creating a way that we could keep people healthier.

Host: Yeah, mechanics and how pitchers are throwing and other athletes doing things, that has to play a big role in this. How do you look at that when it comes to mechanics and what you can do about that?

Dr. Michael Kissenberth: Yeah, a good example, you, if we're talking about baseball, you can hit just like golf and practice 12 months outta the year that's okay. We don't see overuse injuries. The evil part is the mound and throwing, unfortunately playing year round, somebody has to throw to them. So really trying to make sure we tell them and the coaches and explain that at some point during the year, they need to deload and take a little rest.

They can still throw a little bit, but they gotta let the tissues heal. And what usually rings true is when we say, Hey, at the highest level, helping with some professional baseball pitchers, they all take a little break. They may be tossing. They're not, not throwing they may be doing a little bit, but if they're doing it and they're making all that money and they're older, why are we subjecting our 14 year olds to this continued problem?

And that's when things start to go sideways with some of them.

Host: What about strength training and flexibility, those kinds of things, I don't think kids often think of that, but that certainly would have a role in, in helping prevent injury, I would think.

Dr. Michael Kissenberth: You touched on a very important thing. We like to call it the kinetic chain, which is really everything. The last thing to happen, if you're swinging a racket or hitting a volleyball or throwing a baseball, it all starts at your feet and your ankles and your hips. We know that improved flexibility, core strengthening are keys to a good stable base. So, even if somebody's out because of an injury, sometimes I'm excited about that. Because finally I get to take 'them off, put them on the shelf, send them to a rehab program to focus on those things that'll get them healthy again, and keep them healthy and out of harm's way.

So all of the biomechanics are hugely important.

Host: We've talked a lot about young athletes and such, what advice do you give the weekend warrior who still want to compete, maybe they did earlier. What should they be conscious of as they head out to the courts and to different sports?

Dr. Michael Kissenberth: If you're just starting in everything you do, you just, if you were jogging, you wouldn't start sprinting right away. So, maintaining flexibility as we get older is huge. If you have some pre-existing problems, it's probably wise to see your doc and make sure certain things are okay to do.

For example, if they've had a rotator cuff repair or a shoulder replacement, it's all fine to get back to it, but we'd like to make sure they're tuned up and safe, and in some ways we just have to modify as we get older a little bit. If certain things are painful, we watch what we're doing. Having some good shoes, hugely important, and maintaining flexibility.

Sometimes people come in and they're just wearing some flip flops or whatever, and they're out there having fun and that's where we see other injuries come into it. But we know that motion is lotion we like to say. We have to stay active. If we're not moving our joints, they tend to have problems, so we need to move them and pay attention to it, and always have a good strengthening program along with your activities.

Host: Now you've come to this, as we mentioned earlier as an athlete yourself, as I said, a much feared linebacker at the Citadel. So as a former athlete you bring a different perspective to things and I think that probably helps as you take care of other athletes.

Dr. Michael Kissenberth: It does. I mean, My goal, I get it. I'm passionate about it and I know that athlete sitting next to me wants to be back in the game,. So my job is to make sure they're safe. Something that doesn't need urgent surgical solution. If we do, it is what it is, because the goal there is to get them back. But hopefully my job is to get them back as soon as I can.

Because I want them back there on Friday night. It is football season. We run into different shoulder and elbow problems. These are more in the contact variety. The most classic would be a linebacker reaching for a tackle because he forgot to move his feet. And usually it's a missed tackle. I usually ask the athlete, did you get the tackle?

Ah. But if you reach out and a big body comes in front of you, the shoulder may dislocate. So then we run into not overuse, but shoulder instability or different sort of contact injuries where things break and different problem, different subset than overuse.

Host: Doctor, I understand you're seeing folks in Greenville.

Dr. Michael Kissenberth: Yes, sir.

Host: Is where your office is. So that's a great addition to Novant's offerings to have you in Greenville. When there is an injury, the path to recovery, how long, you mentioned putting someone on the shelf, a frustrating time for an athlete, but how do you deal with athletes that are in the recovery process, making sure that they're going to go back as strong as they were?

Dr. Michael Kissenberth: Another excellent question. We've looked at that, so break it down in groups again for the high schooler. As we get older, what's big for us is little for them and vice versa. Okay? And so we know, oh, you had an injury, you'll be back next season. But this is life changing because this is all they think about.

We've looked at it, it can affect grades, it can affect a lot of things. So the mental part of all the recovery is hugely important. And the psychology part is hugely important. We can put them back together, but we gotta make sure they're mentally strong and they're confident and they're following the program.

But you have to recognize, put yourself in their shoes. This is changing their life at 16 years old when they have all these offers. And they get to go play linebacker in college and now they've blown out their knee. Blown out their shoulders. It's still going to work. Weighs on them very heavily. And I, I've been there and so I think I do a fairly good job of understanding that.

I think it is helpful when you're doing sports medicine and orthopedic surgery to have some battlefield experience.

Carl Maronich (Host): Yeah, absolutely. Dr. Michael Kissenberth, orthopedic surgeon, sports medicine specialist, offered a lot of great information today. Thanks for being part of it.

Dr. Michael Kissenberth: Thank you, Carl.

Host: And to find a physician, visit novanthealth.org. And for more health and wellness information from our experts, visit healthyheadlines.org. This has been Meaningful Medicine. I'm Carl Moronich. Thanks for listening.