Melanie Cole, MS (Host): Welcome to UF Health Med Ed Cast with UF Health Shands Hospital. I'm Melanie Cole, and today we're highlighting the UF Health Education Intervention Program for Adolescent Pitchers. Joining me is Dr. Ryan Roach. He's an Orthopedic Surgeon, Sports Medicine Specialist, and an Assistant Professor in the Department of Orthopedics and Sports Medicine at the University of Florida College of Medicine.

Dr. Roach, thank you so much for joining us today. This is such a great topic. So I'd like to start for other providers, what are the primary risk factors as we look at overuse, elbow and shoulder injuries in adolescent baseball pitchers? How do the mechanics and pitch counts correlate with that likelihood of developing overuse injuries? Talk about sports specific training. What's going on in that field?

Ryan Roach, MD: First of all, thank you for having me. It's really an honor to be here. When you talk about injuries to the elbow, it really is multifactorial.

 And so, as an exercise physiologist, I think you can appreciate that. Some of it has to do with the patient's body. So, we have modifiable and non modifiable risk factors. Bone structure would be one that's non modifiable. We can't easily change how our bones are designed. So, there's certain things there that can predispose an athlete, but thankfully, the modifiable risk factors are probably the more important ones. And when we talk about youth sports, probably the biggest one is pitch mechanics. So how are our athletes throwing? Are they throwing with proper form? Do they have any weakness or stiffness? What's their kinetic chain look like? And then what is their pitch load or their risk for fatigue?

It's hard to put a number as to what what the most important one, but fatigue when we look at our young athletes is one of the most important and thankfully one of the more modifiable ones.

Host: So you mentioned pitch load. When we are looking at these young athletes, they are dedicated to their sport. As we look at year round sports specialization, why don't you talk about early sports specific training and how that's really increasing those injury risks.

Ryan Roach, MD: If you look at the major league baseball recommendations on how to prevent youth athletes, one of the biggest ones is to avoid sports specialization. Now, sports specialization means that an athlete is going to specialize in one sport all year. And so the general recommendation is that you do not do that.

We want athletes to focus on a sport, but to take a break. For pitching specifically, we do not want young athletes to throw all year round. And we recommend that you take 3 months where you do not throw. That is an official recommendation from Major League Baseball and Little League Baseball and our orthopedic societies.

 One of the ways that kids can do that safely is to just play another sport. Instead of playing baseball year round, they pick up something different. So, they're still staying active, but avoiding those throwing risks.

Host: Is there any studies, Dr. Roach, or things that we know about sports that go together? Because I hear what you're saying about chronic overuse and sports specialization and doing another sport. I wouldn't let my gymnast son, he wanted to do it all year and I made him stop and take up cardio, do aerobics, go swimming, do other things.

Do we know anything about sports that might go together, wrestling with gymnastics, diving with football? Do we know anything about that?

Ryan Roach, MD: All sports carry risks. So, we shift from baseball and your risk of tearing your elbow ligament, or your UCL, to playing soccer and then tearing your ACL. Unfortunately, no sport is without risk, but when we talk about fatigue and overuse, it's really about resting the muscles.

So, when you talk about baseball and overhead athletes, I don't know that there's a best sport, but the sports that we should avoid would sports that have the same mechanics. So, for an athlete, like a baseball player to go and do track and field and throw javelin, I would say that that isn't exactly resting. It should be a sport that maintains activity, but avoids the same mechanical stresses.

Host: What are the primary objectives of the UF Health Education Intervention Program for Adolescent Pitchers? How does the study plan to evaluate the effectiveness of its intervention strategies? Help us to understand the goals of this current study.

Ryan Roach, MD: The idea for our study was brought about by another study that we had here where we basically surveyed caregivers. So caregivers can be parents, coaches, anyone taking care of a youth athlete. And we just asked them simply whether or not they knew about the general recommendations for preventing arm injuries in athletes, and 83 percent of caregivers were unaware of these recommendations.

And again, these are recommendations that aren't put out by UF Health, they're recommendations that are put out by Major League Baseball, Little League Baseball, and our national societies. So, basically a collaboration of Major League Baseball and Orthopedic Surgeons. And we said, well, obviously that's a big problem if we as professionals, Major League Baseball and Orthopedic Surgeons know what young people should be doing. But their caregivers and coaches don't, well then obviously that's a big problem. The point of this study is looking at that further and understanding what interventions we can do as orthopedic surgeons that take care of high school athletes in improving the caregiver knowledge gap.

So, our primary objective is going to be how can we change the knowledge of these prevention mechanisms? So we're doing that by administering a pre intervention survey. And then we have interventions through 9 different schools. There are three groups. There's going to be a control group, what we call a passive learning group and an active learning group and the active learning group is going to be traditional lecture based where I give the parents and coaches a lecture on arm care.

 And then the passive group is going to be flyers and placards put up throughout the school and the baseball stadiums with QR codes that link to University of Florida injury prevention guidelines, where we actually just link them to Major League Baseball. And then we're going to administer a post intervention survey and see what changed.

Host: As you're trying to raise awareness, which is really, really so important and what this is about, how do you anticipate the findings from this study will influence broader clinical or coaching practices?

Ryan Roach, MD: Well, I think we have an opportunity to really make a difference. This study was funded by an ORIAF grant with Dr. James Andrews name on it, and he's a particular mentor as I've trained under him, but if you look at the impact of Dr. Andrews research on arm care, basically every study we quote, can be tied back to him.

So, I think they see the importance in the study and I think that the potential impact is huge as we have the opportunity to really educate the caregivers, the primary people responsible for the health of the young athlete in ways to stop injuries. What Dr. Andrews has also shown is that one in four students currently is going to have a UCL injury.

These injury prevention strategies can decrease the risk by approximately 50%. So that's huge. And it's just by getting the information out there. These aren't huge recommendations. A lot of them are just, hey, you need to rest. You need to not throw so hard. You need to not throw more than 100 pitches in a game. So, incredibly modifiable things and very realistic things that we can help these young athletes do.

Host: What role does collaboration between healthcare providers such as yourself, the coaches, athletic organizations, you've talked about MLB, play in injury prevention as you're bringing this all together and it's a really wonderful initiative. How do you see this coming together in the future?

Ryan Roach, MD: Collaboration is key. Not to be cliche, but, obviously as a sports study, and I'm a sports medicine doctor, but my success in terms of what I do for my athletes is really team based and that's based on the parents, the coaches, the athletic trainers, and myself, along with the physical therapist, the exercise physiologist.

I mean, it really is just everyone, coming together to help these young athletes. And so the collaboration is critical. We can't do this without everyone's help. I think it does start, in terms of the prevention, we're the ones doing the studies. And if we're not getting that information out to our athletes, then we're not doing our job. And I think that UF Health is perfectly set up to help our communities because we already have these outreaches. We're already taking care of the high school athletes. We're already providing athletic trainers to the school.

And we already have myself and all of my colleagues as team physicians. So we have the infrastructure. We just have to get the knowledge out there and we need to figure out how to do it more effectively.

Host: How does this program fit within UF Health's larger mission for community and athlete health, keeping them active, which is what we want for our youth, playing injury free, staying in the game, really keeping healthy behaviors that will take them through their lifetimes.

Ryan Roach, MD: I personally believe that beyond my responsibility to take care of patients surgically, I have a responsibility to also help them prevent injuries. And I think that goes along with the UF Health philosophy in that we're not just taking care of the people that walk into our door, we have to do outreach, and we have to take care of the community as a whole.

One of the ways that we are naturally again, set up to do that is through the high school outreach that we're already doing. For those of you that don't know, our sports medicine outreach is very well developed and I can't remember the exact number, but I know we're over 20 high schools in the area that we have a contractual agreement with that we provide some form of care, either in the form of athletic trainers or team coverage. So, it's a tremendous outreach community. And through that, I have the potential or we have the potential of really interacting a lot with our community and through our high school students, but also through their parents and relatives.

Host: It's a great program and great study. Thank you so much, Dr. Roach, for joining us today and sharing your incredible expertise in this area. And to learn more about this and other healthcare topics at UF Health Shands Hospital, please visit innovation.ufhealth.org. And to listen to more podcasts from our experts, please visit UFhealth.org/medmatters.

That concludes today's episode of UF Health Med Ed Cast with UF Health Shands Hospital. I'm Melanie Cole. Thanks so much for joining us today.