Intro: Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward. Here's melanie Cole.

Melanie Cole, MS (Host): Welcome to UAB MedCast. I'm Melanie Cole. And today, our discussion focuses on the evolving role of Primary Care Sports Medicine in Athlete Health and Performance. Joining me is Dr. Steven Brown. He's the Division Chief of Sports and Exercise Medicine in the Department of Family and Community Medicine at UAB Medicine.

Dr. Brown, I'm so glad to have you join us today. What a great topic this is. So, I'd like you to speak just a little bit to other providers about what Primary Care Sports Medicine really is and how does it differ from when we think of Orthopedic Surgery and managing sports-related injuries. We think of athletic training. We think of all of these different aspects of our fields that are coming together now, really coming together. Tell us a little bit about Primary Care Sports Medicine.

Steven Brown, MD: Yes. Well, first off, thank you so much for having me. Excited to share all of the things that we're doing here at UAB, specifically in Primary Care Sports Medicine. So here at UAB, Primary Care sports Medicine is all about treating active people. That includes athletes and non-athletes alike without jumping straight to surgery. You know, in Primary Care Sports Medicine, we manage everything from sprains to overuse injuries to concussions, and even exercise related to medical conditions like asthma or fatigue.

So unlike orthopedic surgeons who focus predominantly on the surgical solutions to Sports Medicine conditions and musculoskeletal problems, as Primary Care Sports physicians, we're often helping people avoid the operating room altogether by using a full-body, whole-person approach. So for instance, if a high school basketball player comes in with knee pain, we're not just looking at that joint, we're looking at their training habits. We're evaluating their biomechanics, even looking at their sleep and recovery. Our goal is to keep people moving and doing what they love safely and sustainably, and hopefully avoiding that surgical intervention if possible.

Melanie Cole, MS: See, I love that. And how these treatment approaches have evolved to, as you say, look at the whole person, look at their biomechanics, look at their training regimens, even the shoes that they're wearing, the surfaces that they're training on. There's so many complex issues nowadays. Dr. Brown, what are some of the most common conditions that you see in Primary Care Sports Medicine?

Steven Brown, MD: Yeah. So, it varies from sport to sport and season to season. But commonly, we see a lot of tendonitis or inflammation of muscles. We see muscle strains and pulls. We see lots of concussions and stress fractures and other overuse injuries. These are really common things for athletes and weekend warriors.

What's exciting about this changing and evolving practice of Primary Care Sports Medicine is just how much treatment has evolved even over the course of my career. And here at UAB, we're really embracing the future of Sports Medicine. We're using things like point-of-care ultrasound in our clinics to diagnose and guide treatments like injections right there during the visit.

So instead of patients having to wait for a follow-up appointment, we can use ultrasound and other technological advances to diagnose at the bedside, and then develop treatment plans that are centered on that whole body approach. So, I like to think about my runners who come in with heel pain that's been lingering for a while. Using ultrasound, we can check for plantar fasciitis on the spot, and then we can create a customized treatment plan that includes referral to our partners with UAB Physical Therapy. We can make shoe wear adjustments. We even have the ability to create custom orthotics in our clinics. And then, if need be, we can perform those ultrasound-guided injections all with the same visit. So, UB sports medicine, we're really priding ourselves on providing precision Sports Medicine that's efficient and it gets people back to activity faster.

Melanie Cole, MS: That is so awesome. I love to hear that. Now, we think of rehab and the things we're going to continue to discuss, you and I. But one of the things I think that's evolved in our field so much, Dr. Brown, is the strategies for injury prevention. And we've learned so much about chronic overuse injuries and how so many of the youth in sports today are so sports-specific. When you look at sports like baseball and tennis, and there are certain sports that lend themselves to athletes saying, "That's all I want to do. That's all I want to train for." But then, they also lend themselves to very specific injuries within those sports. I'd like you to speak a little bit about cross-training and some of the strategies that you recommend to coaches, to athletes, to parents to really enhance their training at all levels of the sports.

Steven Brown, MD: Yeah, this is a topic that's really popular with our patients. And here at UAB, we really do believe that prevention is just as important as treatment. Ben Franklin has the famous quote, "An ounce of prevention is worth a pound of cure." And it's something that we really take to heart at UAB Sports and Exercise Medicine.

As I referenced earlier, and you alluded to, we partner with local teams to think about pre-participation evaluations. One of our greatest partnerships is with Birmingham City Schools, and we actually perform free pre-participation fiscals for all middle school and high school Birmingham City School athletes.

And during these pre-participation evaluations, we're not just given a thumbs up. We're trying to identify red flags like previous injuries or muscle imbalances before they become a problem. We try to target underlying medical conditions, whether that be asthma, skin conditions. We think about in Birmingham we've got a fairly large population that suffers from sickle cell and sickle cell trait. So, how can we counsel those athletes and how can we create individual training regimens so that they can perform at peak performance and do so safely? We also run injury prevention programs that focus on ACL training, specifically in soccer athletes. We know that female soccer players are at an exponentially greater risk of tearing their ACL when compared to their male counterparts.

So with UAB Physical Therapy, we've created a program that teaches proper landing and cutting techniques. We've utilized this with our community partners like Hoover and Vestavia Soccer, Vestavia Hills Soccer Club, and Hoover Soccer Club, and Homewood Soccer Club in order to try to reduce that injury rate.

In addition to these programs, we also emphasize the basics. Rest, sleep, nutrition, hydration, and mental health. And that's why we employ a multidisciplinary approach. Here at UAB Sports and Exercise Medicine, we employ orthopedic surgeons, primary care sports medicine specialists, nutritionists and mental health specialists, in addition to our physical therapist and athletic trainers, to keep our athletes at their peak performance and prevent that injury.

So whether you're a college sprinter or a weekend pickleball player, these fundamentals can make a big difference. And at UAB Sports and Exercise Medicine, we offer it to everyone.

Melanie Cole, MS: Thank you for that. And I'm so glad you brought up ACL and girls soccer because it really is something we're just learning so much more about, but we still really don't know the causes, but what you're teaching is so preventative and such a great initiative. Now, other things that we're learning in Sports Medicine, Dr. Brown, are the role of orthobiologics and how these treatments such as PRP stem cell therapy are really changing the way that we manage sports injuries. How are you using them?

Steven Brown, MD: The better question is how aren't we using them, right? So, orthobiologics are really kind of the newest frontier in sports medicine. If you look over Sports Medicine, there have been advances that have occurred over the course of Sports Medicine. But really, orthobiologics is kind of that new frontier. And what orthobiologics are, it's where we harness the body's natural healing potential. And we leverage that to treat musculoskeletal conditions. So, some examples of orthobiologics include things like platelet-rich plasma, platelet-poor plasma, and as you mentioned, stem cells.

So UAB, we use orthobiologics like PRP, platelet-rich plasma for certain conditions that haven't responded to traditional treatments. So, think of your patients with chronic tendon injuries, chronic rotator cuff problems, osteoarthritis that just isn't responding to those more traditional treatment methods, things like oral anti-inflammatories, physical therapy, bracing, and those patients aren't ready to undergo surgery, platelet-rich plasma and orthobiologics provide us a great opportunity to improve their quality of life.

So, one of the more common patients that I see in clinic are tennis or pickleball players with this stubborn elbow pain. They've tried physical therapy, they've tried the braces, they've tried oral medications. They are great candidates for PRP injections under ultrasound guidance. So, we need to know that orthobiologics are not a cure-all. It's not for everyone, and it's not for every condition. But in the right case with the right patient, it can make a real difference when paired with a structured rehab plan. And we are able to offer a full suite of ortho biologic options, it vary affordable prices, here at UAB Sports and Exercise Medicine across our entire enterprise.

Melanie Cole, MS: Such an exciting time in your field, Dr. Brown, and how do you work with coaches and athletic trainers to develop a safe and effective return-to-play plan for injured athletes? Because I feel, as I've observed in so many years, athletes, they want to get back in the game as quickly as possible, and they don't even want to sit it out, whether it's concussion or some sort of a physiological injury. What do you do when it comes time to return to play? What are some of the criteria you'd like to inform other coaches and parents about?

Steven Brown, MD: Yeah. So, teamwork is really the backbone of Sports Medicine. So at UAB, we're in constant communication with our athletic trainers in the community, physical therapists, orthopedic surgeons. And most importantly, the parents and the athletes alike. If a high school athlete's injured during a game on a Friday night here in Birmingham, our trainers are often the ones right there on the sidelines. So, they're able to evaluate, determine the next step.

 At UAB, we pride ourselves on same day, next day availability of appointments for those athletes and weekend warriors, so we can usually get them right into our clinic with board-certified Sports Medicine specialists within a day or two for evaluation. From there, we worked together with the families to create a specific treatment plan for that individual patient, because we know it's not one-size-fits-all. From there, we guide the recovery process. We help to coordinate therapy and if surgery becomes necessary, we work very closely with our orthopedic colleagues to ensure a smooth handoff, but that also includes pairing with coaches. So in addition to having that open communication with everyone who's involved with the care of the patient, we also implore lots of educational opportunities. So, we host seminars and conferences throughout the year to try to educate coaches on best practices for strength and conditioning for nutrition.

In fact, we're hosting a Sports Medicine Summit just this fall on how do we help to prevent injury and return athletes to care. It's really that collaboration that's imperative and leads to faster and safer returns to sport for all our athletes.

Melanie Cole, MS: Well, that's certainly true. As we wrap up, and this has been such a great discussion, Dr. Brown, I'd like you to tell other providers how you see the field of Primary Care Sports Medicine evolving in the next five to 10 years, innovations that are on the horizon. And for any other Sports Medicine clinicians that would like to start a program like you've got at UAB Medicine, what advice would you give them?

Steven Brown, MD: Yeah. So, I think when it comes to why we've been successful at UAB and why we've been able to build the program that we have is because we really keep the patient at the center. Everything that we do, it's not about us. It's not about what Dr. Brown wants. It's not about what the health system wants. It's really thinking about what the patient needs and that's what drives us.

As far as the future of Primary Care Sports Medicine, we're really moving towards more personalized and tech-driven care. At UAB, we're starting to use wearable devices and performance monitoring tools to track recovery and prevent injuries before they even happen. There's also exciting work happening here at UAB and areas like genetic testing and movement analysis to tailor care even more precisely, both for return from injury and prevention of injury altogether.

Another part that's really important to us and really the future of where Sports Medicine is going, it's addressing mental health is that's becoming such a big part of athlete care as well. And honestly, I think it's long overdue. And luckily, we work with great mental health professionals. We employ multiple psychologists that help us really address that need in sports medicine. And on the treatment side, we're refining how and when we use things like PRP and other regenerative therapies. The bottom line is Sports Medicine is evolving to care for the whole athlete, not just the injury. And here at UAB, we're happy to be the pioneers of this movement.

Melanie Cole, MS: Well, you certainly are, and thank you so much, Dr. Brown, for sharing your expertise for other providers in the field of Primary Care Sports Medicine, because this is new, it's burgeoning, and it's not something that everybody knows about. So, thank you so much. And for more information, you can visit our website at uabmedicine.org/physician. That concludes this episode of UAB MedCast. I'm Melanie Cole.