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Melanie Cole (Host): From the weekend warrior to the professional athlete, physicians at UAB Sports Medicine provide care designed to enable patients to return to their active lifestyle safely and as soon as possible. Here to tell us about that is Dr. Amit Momaya. He’s an orthopedic surgeon with UAB Medicine. Welcome to the show, Dr. Momaya. Explain a little bit about the prevalence of sports injuries and what are some of the most common that you see everyday.

Dr. Amit Mukesh Momaya, MD (Guest): Sure. Thank you for having me. The prevalence of sports injuries is certainly increasing, especially in adolescent athletes. Numerous kids and more and more every day are engaging in sports. Almost nearly 30 million children actually participate in youth sports in the United States, and high school athletes accounted for approximately 2 million injuries last year, came for almost half a million doctor visits. Some of the most common types of injuries that I see include ACL ruptures, shoulder dislocations, and ankle sprains, most commonly.

Melanie: So, let’s discuss some of those and what are some of the factors that lead, like you said, ACL ruptures? And we know these are more prevalent in girls and soccer players; speak about some of the factors that lead to these or the causes that we know of.

Dr. Momaya: Sure. Some of the risk factors for injuries in general, especially with ACLs is—part of it’s anatomic alignment. Specifically, why do girls have a higher rate of ACL injury than boys? Well, boys have a wider inner condylar notch, that’s the space between the femur bone and the thigh bone called the tibia, and that wider notch appears to allow the ACL to rest without getting injured. Women are more prone to get injured because they have a narrower notch. They’re also more likely to be knock-kneed which we know can put them at risk for an ACL injury. Some of the other reasons that girls can experience ACL injuries more often than boys is because in girls, the upper leg muscles may not be as strong as for boys. Then they’re even more quad dominant sometimes, and this can put them at risk, and finally, we know from recent studies that hormones put females at risk, and so there’s something with the cycles of ovulation that definitely put them at risk for ACL injuries.

Melanie: What about overuse injuries because there’s sports-specific training, throwing injuries in baseball? As an orthopedic surgeon, what do you want other physicians to know about these overuse and counseling their patients about maybe certain amount of throwing or these overuse injuries and chronic injuries?

Dr. Momaya: Sure. Yeah. We’re seeing an epidemic of overuse injuries today, especially in a culture where kids are specializing in sports at a much earlier age than they used to. Several studies have shown that the earlier you specialize in a sport and focus on it, you’re more prone to an overuse injury, and not only that, not able to make it to the next level, whether that be collegiate or professional. An important thing for physicians to know when counseling patients that seem to be having specific injuries, for example, baseball is one of the common culprits for these overuse injuries. A lot of young kids are playing on multiple teams; they’re playing on their local recreation league. They may be playing on a travel team. They may be playing for their high school team at the same time, puts their elbows at risk. They’re still growing, and we know that the ulnar collateral ligament can feel a lot of stress early on, and if their throwing mechanics are not appropriate or if their pitch counts are getting too high, that’s way too much stress for a young pitcher to place on his or her elbow, and thus an important thing for physicians to recognize is to counsel these patients on limiting their throwing, making sure that coaches and trainers know the pitch counts, keeping track of pitch counts. We know that if pitchers are limited, we know that’ll decrease their rate of injury. Also, we want kids to be playing multiple sports. We don’t want them specializing in one sport because then the same muscle groups are constantly being used throughout the year, and we think that multiple sports allows a more complete kind of maturation of the athlete and allows them then eventually to be more successful down the road, whether that be collegiate or professionally and have less injuries in life.

Melanie: What are some key elements of a program in sports medicine? What do you feel that physicians and pediatric offices and things should know and be able to deal with the schools and the coaches?

Dr. Momaya: Sure. Just like any sports team, I think a key element of sports medicine is having a team-based approach. It’s hard for a physician to completely take care of the entire athlete and the entire team due to the busy nature of sports and of clinical practice. Part of it is to establish connections with athletic trainers, therapists, nutritionists, straight-training coaches and having that relationship with them so there’s a two-way road about discussing kind of the training regimens and how things are going. Another important aspect the physicians should recognize is that they need to have early and easy access for these athletes to get into. Oftentimes, these athletes are eager to return back to sports and will often injure themselves further if we do not provide them with easy-access care early on which may fix a smaller problem from becoming a bigger problem.

Melanie: What do you see are some challenges at adherence? You just mentioned easy access and getting in to see their trainers and learning some of the proper techniques, plyometrics for ACL protection, that sort of thing. What do you see are some of the challenges? Are these athletes also willing to go along with maybe cross training or not training all year round for the same sport? Do you see that doctor?

Dr. Momaya: That’s definitely a problem—is trying to convince these athletes that it’s okay if they step away from the baseball diamond for half a year and play another sport; do some other types of training. They’re very worried that they’re kind of missing out on these kind of marquee tournaments and scouts and so forth. So, that is definitely a problem of kind of adhering to a plan of despeciallizing in sports. Now, the other things you kind of mentioned are, you know, a lot of times we’ll teach girls appropriate jump/landing techniques, which we know that if they go into a knock-kneed state when they land, they’re more prone to an ACL rupture. We try to implement those kind of teachings. So, communicate that with the athletic trainers and the therapists out there in the community in order to help prevent ACL ruptures. However, it can be very difficult for athletes to adhere and understand these principles, especially when they’re not having any pain, to practice a preventative-type medicine to prevent a future ACL injury. So, that’s definitely an issue we’ve faced.

Melanie: Well, it certainly is, and also return to play, and as you say, these athletes are hesitant to take any time off or to do some of the just specific training that would help them to avoid these injuries, and what do you want team physicians and athletic trainers to know about return to play and allowing their athletes to get back into it, avoiding some of these chronic injuries?

Dr. Momaya: Sure. Return to play is a very key element in making a successful career in sports for the athlete. Most athletes are returning to play too quickly, whether it be from a chronic overuse injury or whether that be post-surgery. It’s important for players to rest and fully recover and not only to do that, but also address the underlying issue of why they got injured in the first place, whether it be change in mechanics, change in jumping techniques, so forth, landing technique, and other things. So, that’s an important aspect of making sure there’s communication with the therapist or athletic trainer about if we’re fixing the underlying cause before they go on to return to play. Oftentimes, the coaches will pressure some of these athletes to return to play quickly. So, sometimes we have pressure from the parents, and the athlete themselves wanting to return to play, and in addition after surgery, we often know, for example, when we stabilize a shoulder after it’s been dislocated, we often don’t want them to return to play until six months after surgery. The athlete themselves will often feel very good within a few months and want to return to play earlier, but we know that there’s continued healing of the labrum down to the glenoid, and we hope that they will continue the rehabilitation and thus decrease the risk of further dislocations.

Melanie: And, so, what do you see are some interventions besides prevention? Are Kid’s Motrin? Are they icing, wrapping? What do you recommend that they do if they have sustained even a small injury like a light sprain or an overuse chronic tendonitis? What do you want them to do for management?

Dr. Momaya: Right. For symptomatic management, you generally, when an athlete sustains, say, an ankle sprain or something overused, I think the appropriate acronym that we’ll often use is RICE, which stands for, in terms of rest—we’re resting the extremity to make sure it’s not further injured. We’re elevating the extremity to help swelling go down. We’re also applying compression. Compression’s an important aspect of controlling edema and swelling from the extremity as to let the athlete return quickly. You were mentioning Motrin and anti-inflammatories. That’s appropriate to take. We don’t want young athletes to take this long-term, as they can cause problems. We don’t want athletes to only be able to return to play by taking constant anti-inflammatories, but acutely, if an athlete does sustain an injury, then it’s appropriate to just ice it and use an anti-inflammatory to help in the acute phase.

Melanie: So, where do you see this field going from here and speak about your team at UAB.

Dr. Momaya: Sure. So, I think, you know, here we, in terms of the field going, we’re further understanding, you know, what’s leading to sports injuries and not only that is on a preventative side, but also how to treat these sports injuries. Recently, orthobiologics has become a very big hot topic in sports. Many people have heard about people, especially professional athletes, seeking out PRP injections, which are platelet-rich plasma injections and stem cell injections. Out there, there’s a lot of research being done, and there’s all the conflicting research out there. Some studies showing that it may help regenerate and heal soft-tissue injuries quicker, while others say that we’re not sure yet. We still have further research to do and doesn’t seem to change much based on placebo or other control treatments. And so, I think, the future of kind of sports medicine, in addition to preventative medicine, will be heavily based on orthobiologics and how to use the technology to help hasten the recovery of athletes and allow them to return to sports. Traditionally, orthopedic surgeons, we’re known as carpenters. We’re very good at fixing bones. We’re good at repairing and reconstructing ligaments, but I think now we’re taking a step back and realizing the basic science aspect of things are a very important part and should be in conjunction with our work surgically.
In terms of UAB, you know, working here at UAB is great. We have an excellent team. We have multiple athletic trainers, great coaches, and most importantly, great student athletes to work with. Just this multi-disciplinary approach here at UAB allows us to take care of the athlete in a full manner and thoroughly enjoy kind of working with our student athletes who are very focused both on an educational level and kind of staying with the protocol and following so they can get back to play.

Melanie: Thank you so much, doctor, for being with us today. A community physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. That’s 1-800-822-6478. You're listening to UAB Medcast. For more information on resources available at UAB Medicine, you can go to uabmedicine.org/physician. That’s uabmedicine.org/physician. This is Melanie Cole. Thanks so much for listening.