Introduction: UAB Med Cast is an ongoing medical education podcast. The UAB division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category one credit. To collect credit, please visit UABmedicine.org/medcast, and complete the episodes post-test. Welcome to UAB Med Cast, a continuing education podcast for medical professionals, bringing knowledge to your world. Here's Melanie Cole.

Melanie Cole: Welcome to UAB Med Cast. I'm Melanie Cole and today we're discussing COVID-19 and sports medicine, this changing environment, and the latest implications of COVID-19 on the practice of sports medicine and ultimately how it will affect athletes and patients. And joining me is Dr. Amit Momaya. He's the Chief of Sports Medicine at UAB Medicine. Dr. Momaya it's a pleasure to have you on, with our world coming to this change in the sudden and unprecedented way, a lot of organized sports activities have changed the way that they're doing things. And we understand now more than ever the leadership role that sports plays in our society. This is something that we may be underestimated or didn't realize. Tell us what you've learned about sports it's roles for our youth, our communities, our state teams, and with this changing paradigm, the responsibilities of the athlete and the coaches in this time.

Dr. Momaya: Sure. You know, just like you said, these are definitely unprecedented times with COVID and it's affected the sports community significantly. I think one of the ways we realize how sports medicine and sports as a culture, how tightly ingrained it is into our society, because sometimes we take it for granted and then all of a sudden, a pandemic like this hits, and it's really knocks us back on our heels. And we start to realize what life is like without the routine sports that we are so used to kind of either watching or engaging with, or, you know, cheering on our favorite team. So it's definitely brought a lot about a lot of changes. And like I said, a lot of people in the sports community have dependent on the sports medicine physician and associated doctors to kind of help them make decisions and decide what the safest route is for a lot of things. One of the things that we talk about is the role of the athlete and the coaches within this pandemic and what they need to be doing to remain safe. You know, we often educate these athletes and coaches on taking a personal responsibility and making sure they stay safe not only for themselves, but for their teammates, for their surrounding community and their family. Which often involves kind of typical guidelines that CDC has recommended such as hand washing principles, wearing a mask, and avoid touching your face, among multiple other things.

Host: Well, I certainly agree with you and as talking about the benefit of sport and social interaction, which we've really learned so much more about what this does for our youth athletes, for our professional athletes, we're recognizing this ongoing infection risk that you just talked about. Are there some besides hand washing, mask wearing, current rules regulations, as far as sport clubs and even in the locker room? Is there anything you can tell us that maybe we're not seeing in, you know, general information that you've seen happening?

Dr. Momaya: I had the privilege of taking care of a UAB athletics and also the professional Legion FC soccer team in town. And so I've gotten a firsthand witness of a lot of the protocols that have been put into place to keep, keep these athletes and associated staff safe. And so some of those protocols involve making sure to limit the number of personnel in these locker rooms. You know, locker rooms are often a place where they're crowded and a lot of kids are often there with coaches and other staff members and so forth. And so we've put together a lot of protocols that will limit one, the number of people in, at any given time. Also simple things like keeping gates, keeping doors open to avoid multiple people touching the same door handle. In addition, you're using kind of approved cleaning products to make sure these areas such as the locker rooms, the benches, and so forth are routinely cleaned much more routinely than ever before. Another thing we're often recommending and seeing is that, you know, typically after a game most athletes will head to the locker room, shower in the locker room, change into their normal clothes, and then leave. But what we're often advising is that athletes do not do not shower in the locker room and go ahead and head out back to their home where it may be safer to where there's less people, less contact. So a lot of these changes are happening behind the scene to help keep these athletes and coaches safe.

Host: Well, thank you for telling us about that. And as practice had been canceled and spring sports, as we're thinking of a thoughtful approach to exercise, to give athletes that chance to acclimatize, to the temperatures, to the intensity duration of practice, especially for our collegiate athletes, how does a slow ramp up of practice? Can this decrease the risk of injury, heat illness? Some of the things that we might not always see because they've been doing it on a consistent basis where now some were cut off altogether, and stopped, but now they're kind of coming back looking at coming back. So what do you want to say about ramping it back up?

Dr. Momaya: Most certainly, like you mentioned, you know, we've actually in our clinics, we've seen an uptick in soft tissue injuries when these athletes are returning back right now, football practice both the high school and collegiate level are going. And a lot of these athletes are usually well conditioned throughout the year. You know, there's oftentimes an athlete has very little time off through during the year. They oftentimes have practice and lifting sessions in the spring and formal workouts in the summer. But a lot of these athletes, whether it's at the high school or collegiate level have not had the routine training. And so it's ever so more important to make sure they can ramp up in a stepwise fashion to avoid, you know, for example, pulling a hamstring or even, you know, something that they may be fatigued and their hamstrings and quads may be fatigued and put them at increased risk for an ACL rupture, for example.

So we're seeing some of these types of injuries that you may not otherwise see in these athletes who may be ready to go a much earlier time because they just haven't had the time period to introduce themselves back into athletics. But we are noticing also the, the coaches understand this and they're making sure the amount of the number of practices, the frequency, the duration are altered to accommodate for athletes who have not been conditioned throughout the spring and summer. Also similarly we're seeing, you know, with, with the heat, especially in the Southeast, we're making sure that these leagues are providing adequate water breaks for these athletes. So they are not significantly dehydrated and going to heat exhaustion or even heat strokes.

Host: Yeah. I would imagine that you have been seeing some increase in musculoskeletal injury, soft tissue from that unconditioned musculature. Dr. Momaya, and you may not be able to answer this question, but what, if anything, do we know about whether players affected by COVID-19 will endure any long-term effects? Have you seen any studies on their health or game performance at all?

Dr. Momaya: Sure. You know, that that's a very hot topic right now, and that's honestly one of the key features of why some of the power five conferences are looking at whether to continue fall sports or not. And one of the things that people are looking at very closely is the topic of myocarditis. You know, we do have some studies that show that athletes may be at increased risk for myocarditis, if they were to contract the virus, but the long-term effects, we truly do not know yet. This is such a novel situation we're in. And we don't have any long-term data to determine if one year from now five years from now, 10 years from now, we just simply do not know about what the long-term consequences are. And so at this point, you know, our biggest recommendation is preventative techniques. Like we talked about earlier is kind of the hand washing, wearing a mask, those kinds of principles to kind of prevent contracting the virus because we don't know the things like myocarditis, what effect they truly will have on these athletes.

Host: Yes. Thank you for that. And another thing that I'm finding interesting is this advent of tele-medicine and how really creative healthcare providers have had to be during this pandemic. Do you feel that tele-medicine affect the role of your hands on physical examination, Dr. Momaya? Where do you see this new role of tele-medicine in this healthcare realm? I mean, we know as sports medicine professionals, there's a lot of hands on manipulation and that sort of thing. Where have you used tele-medicine recently and where do you see it playing a role on this ongoing pandemic?

Dr. Momaya: I've embraced tele-medicine and it is a great tool to be able to communicate with patients, to be able to even do some limited exams on patients and to be able to go over results. So I think tele-medicine is here to stay. Whether it's primary care medicine or orthopedic sports medicine. As you mentioned, there are limitations to tele-medicine, the biggest limitation from a sports medicine side, being that we don't have the ability to exactly examine a knee or shoulder injury. We can't feel the ligamentous laxity that one may feel in the clinic. So that's certainly a limitation, but you'd be surprised at what patients can often tell you what their history, they can often demonstrate with range of motion on the actual platform of tele-medicine. So I found it very useful in these situations as even an initial appointment to kind of determine what the level of injury is, whether they need to come in for a formal exam, or whether based on their history, we can go ahead and proceed with obtaining x-rays and MRI.

The other role that it's been great is either someone who has come into our clinic, we've ordered an MRI, they've received it typically in the past. These people would come back in to clinic to see their MRI and go over it in person. But now with tele-medicine, we have the ability for the patient to remain in the comfort of their home and go over the results of the MRI, and even see the results on the screen. We can point out things on the screen, on the MRI, they can be looking at it actively. And it's quite advantageous to be able to do that. And also postoperatively are patients who may simply need a wound check. We save them tremendous amounts of time. And by doing that, by looking through pictures and through video, so the tele-medicine aspect of it, you know, we've adapted because of COVID. But I think tele-medicine, regardless of COVID is here to stay long-term. And it's really for the benefit of both the patient and the physician.

Host: I certainly agree with you as we wrap up. Is there anything else you'd like to share regarding COVID-19 and sports medicine in this changing environment?

Dr. Momaya: I think everyone just has to remember to be flexible and fluid with COVID-19 in sports medicine. There's so many things we simply do not know yet know. I think the most important thing is as athletes return back to play is that we practice, you know, social distancing, we practice safe protocols to mitigate the risk. There's no way to eliminate the risk, but we can mitigate the risk and always get more information regarding this. So we have to be flexible and going forth. And as we understand more about COVID-19 and how to treat it and how to prevent it, I think hopefully we'll get back to a closer reality of what we consider normal.

Host: Thank you so much, Dr. Momaya, what a comprehensive segment that was, and such an interesting time that we're living in. Thank you again for joining us. A community physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. And that concludes this episode of UAB Med Cast. To refer your patient, or for more information on resources available at UAB Medicine, please visit our website at UABmedicine.org/physician. Please also remember to subscribe, rate, and review this podcast and all the other UAB Medicine podcasts. I'm Melanie Cole.