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Today’s fifty-year-old deadlifts, plays pickleball, and does yoga. When pain starts at the base of her thumb and the X-ray looks normal, it is easy to call it tendinitis and miss early arthritis. On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Jamie Alexander and Dr. Daniel Torres, orthopedic hand surgeons at Houston Methodist, to discuss how they diagnose and manage thumb carpometacarpal (CMC) osteoarthritis in active and younger patients. They explore why early disease often gets missed, which metabolic and inflammatory workups matter, and how a multidisciplinary team helps patients get the right care. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction07:02 - Prevalence and Underdiagnosis of Thumb CMC Arthritis13:56 - Instability in Younger Active Patients15:34 - Metabolic and Inflammatory Workup21:27 - Multidisciplinary Care27:22 - Limits of Trapeziectomy and the Move to Implant Arthroplasty36:43 - Conservative Management45:54 - Injections and Bracing50:21 - Candidate Selection and Bone Health55:18 - Surgical Pearls and Revision Options57:58 - Closing Remarks --- More about this episode The conversation moves from conservative management, such as splints, hand therapy, grip changes, and injections, to surgical options. Dr. Torres and Dr. Alexander explain when to consider dual mobility thumb CMC arthroplasty for patients with good bone stock, how trapeziectomy compares, and why setting realistic expectations about function and recovery is so important. They share pearls for picking candidates, protecting bone health, and keeping surgical options open for future revisions, closing with advice for sports medicine physicians and therapists about recognizing instability and early arthritis before it progresses. --- Resources American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020https://doi.org/10.1002/acr.24131 Own the Bone, the American Orthopaedic Association bone health and fragility fracture prevention programhttps://www.ownthebone.org/ Dr. Daniel Torres, Houston Methodist physician profilehttps://www.houstonmethodist.org/doctor/daniel-torres/ Dr. Jamie Alexander, Houston Methodist physician profilehttps://www.houstonmethodist.org/doctor/jamie-j-alexander/ Houston Methodist Orthopedics & Sports Medicine at Clear Lakehttps://www.houstonmethodist.org/orthopedics/locations/clearlake/ Dr. Larry Balle, BackTable contributor pagehttps://www.backtable.com/shows/msk/contributors/dr-larry-balle --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

When a college basketball player asks when he can go back in the game, the person making the call is rarely wearing a white coat. On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Matt Townsend, ATC, head athletic trainer for Arkansas men’s basketball, for an inside look at basketball medicine from the training room. They walk through the basketball calendar, common injuries, and the return-to-play decisions that happen in real time, including movement screening, tendinopathy rehab, vitamin D supplementation, and the impact of name image and likeness (NIL) on athlete advocacy. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:21 - A Day in the Life of a Basketball Athletic Trainer12:47 - Common Basketball Injuries16:20 - Training Load and Recovery Education19:44 - Return to Play Philosophy25:45 - Name Image and Likeness and the People Around the Athlete28:59 - Taping and Bracing Decisions35:11 - Anterior Knee Pain and Tendinopathy Management39:08 - Vitamin D and Bone Health45:50 - Agents, Pressure and Athlete Advocacy51:14 - Communication With Coaching Staff55:20 - Advice for Future Athletic Trainers1:00:36 - Closing Remarks --- More about this episode They walk through the basketball year from pre-participation physicals and movement screening to the injuries that define the sport, like lateral and high ankle sprains, MCL injuries, anterior knee pain, and stress fractures. Townsend shares how return-to-play decisions are made in real time, balancing objective force plate data, player feedback, and the demands of coaches and agents in the NIL era. The conversation covers the shift away from rest and ice toward progressive tendon loading, how quad weakness explained a player’s chronic knee pain, and how vitamin D protocols are managed for indoor athletes. They discuss bracing and taping as negotiations, the realities of injury prevention and load management, and why pre-participation screens can reveal more than a clinic visit. The episode closes with insights on athlete advocacy, team communication, and the reminders that even elite athletes are often just eighteen years old. --- Resources Matt Townsend, ATC, Head Athletic Trainer, Men's Basketball, University of Arkansashttps://arkansasrazorbacks.com/support-staff/matt-townsend/ University of Arkansas Sports Medicine staffhttps://arkansasrazorbacks.com/sports-medicine/ Dr. Larry Balle, BackTable contributor pagehttps://www.backtable.com/shows/msk/contributors/dr-larry-balle Dr. Larry Balle, Houston Methodist physician profilehttps://www.houstonmethodist.org/doctor/larry-balle BackTable Bone and Sports Ep. 100, Return to Play Post-Injury: Balancing Risk and Recovery, with Dr. Andy Glidewellhttps://www.backtable.com/shows/msk/podcasts/100/return-to-play-post-injury-balancing-risk-recover BackTable Bone and Sports Ep. 103, Sports Medicine and Lifestyle Medicine Intersections, with Dr. Megan Ferderberhttps://www.backtable.com/shows/msk/podcasts/103/sports-medicine-lifestyle-medicine-intersections Andrew M. Schween, DPT, physical therapist, UAMS Healthhttps://uamshealth.com/provider/andrew-m-schween Barrie Steele, athletic training, University of Idahohttps://govandals.com/sports/general/roster/barrie-steele/1205 National Athletic Trainers' Associationhttps://www.nata.org/ Kaminski TW, et al. National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. J Athl Train. 2013https://doi.org/10.4085/1062-6050-48.4.02 --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Why is rehab for the overhead athlete so nuanced—and how much of the answer is hidden below the shoulder? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Corbin Hedt, PT, DPT, SCS, CSCS, to explore upper extremity rehabilitation, fellowship training in sports physical therapy, and the evidence behind advanced throwing programs. Hedt breaks down the kinetic chain from the ground up, explains why only a few accredited fellowships exist for upper extremity athletes, and shares why modern rehab is all about proximal stability leading to distal performance. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction07:43 - Nuances of Upper Extremity Rehab14:22 - Upper Extremity Fellowship Overview21:12 - Barriers to Fellowship Expansion28:15 - Kinetic Chain in Throwing33:03 - Core Control and Movement Quality37:27 - Evaluating the Softball Pitcher44:24 - Blood Flow Restriction Training49:42 - BFR Protocols and Study Findings56:06 - Injury Risk and Workload Research1:03:37 - Imaging Findings in Asymptomatic Throwers1:07:36 - Curveballs, Velocity and Volume1:11:01 - Final Takeaways and Closing Remarks --- More about this episode The discussion covers clinical decision-making for common injuries like rotator cuff tendinopathy and UCL injury, the use of blood flow restriction therapy, and how evaluation and rehab protocols are evolving with new research. They dive into the mechanics of throwing, movement quality, imaging findings in asymptomatic athletes, and what really drives youth arm injuries. The episode closes with practical pearls for trainers and clinicians, including the dynamometer trick for patient buy-in, and why looking at the whole athlete, not just the pain, matters most. --- Resources Lambert BS, Hedt C, Ankersen JP, et al. Rotator cuff training with upper extremity blood flow restriction produces favorable adaptations in Division IA collegiate pitchers: a randomized trial. J Shoulder Elbow Surg. 2023;32(6):e279-e292.https://doi.org/10.1016/j.jse.2023.02.116 Intelangelo L, Lassaga I, Gonzalo E, et al. Is Strength the Main Risk Factor of Overuse Shoulder Injuries? A Cohort Study of 296 Amateur Overhead Athletes. Sports Health. 2025.https://doi.org/10.1177/19417381241298287 Bowen L, Gross AS, Gimpel M, Bruce-Low S, Li FX. Spikes in acute:chronic workload ratio (ACWR) associated with a 5-7 times greater injury rate in English Premier League football players: a comprehensive 3-year study. Br J Sports Med. 2020;54(12):731-738.https://pmc.ncbi.nlm.nih.gov/articles/PMC7285788/ Erickson BJ, Camp CL, D'Angelo J, et al. Musculoskeletal Findings of the Major League Baseball Combine: A Description of the "Normal" Prospective Professional Baseball Player. Am J Sports Med. 2025.https://doi.org/10.1177/03635465251339773 Fleisig GS, Andrews JR, Cutter GR, et al. Risk of Serious Injury for Young Baseball Pitchers: A 10-Year Prospective Study. Am J Sports Med. 2011;39(2):253-257.https://doi.org/10.1177/0363546510384224 Ready To Throw, the free throwing program, rehab protocol and pitching mechanics repository https://www.readytothrow.com/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Which athletes actually carry the highest cardiac risk, and is the sideline ready to act? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Nick Larson, emergency medicine physician, to discuss cardiac risk, screening, and sideline response for athletes of all ages. They discuss which athletes are at highest risk, what preparticipation screening does (and does not) catch, and how a working relationship with cardiology and a strong emergency action plan can change outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction05:39 - Emergency Department Arrival Priorities10:13 - AED Access and Arrest Incidence15:33 - Cardiac Risk Patterns by Age and Sport25:12 - Preparticipation Physical Limitations29:14 - Commotio Cordis and Blunt Chest Injury39:37 - Hypertrophic Cardiomyopathy in Athletes45:56 - Exertional Syncope Workup53:00 - Myocarditis and Viral Risks01:03:44 - Ischemic Events in Older Athletes01:09:39 - AED Use and Emergency Action Plans01:17:16 - Rapid Fire Takeaways01:21:15 - Closing Remarks --- More about this episode The conversation covers the diagnosis and management of commotio cordis, hypertrophic cardiomyopathy, myocarditis, and ischemic events in both young and older athletes. Dr. Larson shares his approach to exertional syncope, red flags for on-field collapse, the practical realities of AED use, and why follow-up is critical after the initial event. The episode closes with advice on team drills, the importance of rapid decision-making, and why “time is tissue” when cardiac emergencies strike on the field or sideline. --- Resources Petek BJ, Churchill TW, Moulson N, et al. Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study. Circulation. 2024. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.0659082024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy. Circulation. 2024. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001250 Revisiting Commotio Cordis: Novel Insight Into Clinical Variability, Diagnosis, Epidemiology, and Prevention. Journal of the American Heart Association. 2025. https://www.ahajournals.org/doi/10.1161/JAHA.125.045115 National Athletic Trainers' Association Position Statement: Emergency Action Plan Development and Implementation in Sport. Journal of Athletic Training. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11220767/ Life in the Fast Lane (LITFL), recommended on air by Dr. Larson https://litfl.com/ EMCrit Project, recommended on air by Dr. Larson https://emcrit.org/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Could platelet poor plasma be the missing link in muscle injury recovery? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Ryan Kruse, a sports medicine physician at the University of Iowa and team physician for the Iowa Hawkeyes and US Soccer, to explain what platelet poor plasma actually contains and why it has become his primary treatment for acute muscle injury. They discuss how PPP differs from PRP, the challenges of defining the optimal dose, and the growing interest in exploring the bioactive components that make PPP worth keeping. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction05:01 - Defining Platelet Poor Plasma11:22 - Volume, Dosing, and Fibrosis vs Regeneration19:00 - Choosing PPP by Injury Grade and Treating Chronic Scar25:30 - Blood Draw Volume, Kit Selection and Spin Speed32:12 - Filters and Protein Concentrate38:19 - Building a PRP Lab and Concentration Questions43:26 - Keeping PRP Away from Muscle Injury53:05 - Ultrasound and Return-to-Play58:46 - Recovery Timelines and Recurrence01:06:18 - The Evidence Gap in Orthobiologics01:11:37 - Osteoarthritis, Intra-Articular Use and Replacing Cortisone01:21:26 - Closing Thoughts --- More about this episode The episode dives deeper into which injuries are best suited for PPP, when surgery is still necessary, and why PRP may actually increase fibrosis in primary muscle tears. Drs. Kruse and Balle compare kit selection, spin speed, filter pore size, and blood draw volumes, and discuss how to use ultrasound to guide both injury assessment and safe return to play. They also tackle the logistics of building a PRP lab, the use of PPP in osteoarthritis as a cortisone alternative, return-to-play timelines, recurrence risk, and the need for higher-level randomized data to move the field forward. --- Resources Platelet-Poor Plasma for the Treatment of Acute Hamstring Muscle Injuries in Collegiate Football Athletes: A Cohort Studyhttps://pubmed.ncbi.nlm.nih.gov/39576137/ Platelet-Poor Plasma: A Novel Treatment for Acute Quadriceps Muscle Injurieshttps://pubmed.ncbi.nlm.nih.gov/42037020/ Platelet-Poor Versus Platelet-Rich Plasma for the Treatment of Acute Thigh Muscle Injurieshttps://pubmed.ncbi.nlm.nih.gov/38958567/ Platelet-Poor Plasma for the Treatment of a Quadriceps Muscle Tear in a Division I Football Athletehttps://pubmed.ncbi.nlm.nih.gov/39888358/ BackTable MSK Ep. 102: Understanding PRP and Orthobiologics for Musculoskeletal Medicinehttps://www.backtable.com/shows/msk/podcasts/102/understanding-prp-orthobiologics-for-musculoskeletal-medicine --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

When does a knee cartilage defect need more than a clean-up, and how do you decide on the best repair? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes orthopedic sports surgeon Dr. Sachin Allahabadi for a practical tour of cartilage restoration. Together they explain what articular cartilage is, why it rarely heals on its own, and how to distinguish focal chondral defects from diffuse arthritis. The discussion covers the full spectrum of treatment, from chondroplasty and microfracture to cell-based restoration, osteochondral autograft, and allograft transplantation. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:39 - Cartilage Structure and Focal Defects13:37 - Cartilage Healing Biology16:51 - Evolution of Cartilage Repair Techniques24:04 - Candidate Selection and Defect Characteristics29:06 - Bone Marrow Edema and Offloading33:46 - Osteochondral Autograft and Donor Sites39:18 - Alignment, Meniscus, and Ligament Correction45:31 - Cell Based Repair Indications and Procedure Durability51:11 - Defect Sizing and Allograft Matching59:29 - Rehabilitation and Orthobiologic Graft Integration01:09:59 - Takeaways and Misconceptions01:14:21 - Closing Remarks --- More about this episode Dr. Allahabadi discusses how to select the right patients for different cartilage procedures, including how defect size, alignment, meniscus status, and ligament stability all factor into the decision. They review advances in cartilage repair techniques, the process of storing and matching fresh donor tissue, and the use of bone marrow aspirate concentrate to promote graft integration. The conversation also addresses the durability of allografts in real-world practice, setting realistic expectations with patients, the importance of referral to high-volume surgeons, and why thoughtful clinical decision-making is often more challenging than the procedure itself. --- Resources Allahabadi S, Quigley R, Frazier L, Joyce K, Cole BJ. Outcomes and Return to Sport After Knee Osteochondral Allograft Transplant in Professional Athletes. Orthop J Sports Med. 2024.https://pubmed.ncbi.nlm.nih.gov/38410170/ Elias TJ, Allahabadi S, Haneberg EC, et al. Osteochondral Allograft Reaming Significantly Affects Chondrocyte Viability. Am J Sports Med. 2024. https://pubmed.ncbi.nlm.nih.gov/39186448/ Allahabadi S, Haneberg EC, Elias TJ, McMorrow KJ, et al. Osteochondral Allografts: Pearls to Maximize Biologic Healing and Clinical Success. Arthrosc Tech. 2023. https://pubmed.ncbi.nlm.nih.gov/38196872/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Why do overuse injuries keep coming back even after the pain settles down? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Grant Ralston to define overuse injury as a load-related disorder, and to work through its causes, diagnosis, and management in both pediatric and adult athletes. They review common conditions like bone stress injuries, chronic tendinopathy, plantar fasciitis, and apophysitis, and discuss why year-round play, early sport specialization, social media, and name, image, and likeness (NIL) pressures are making these cases more frequent in clinic. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction06:22 - Defining Overuse Injuries08:31 - Why Overuse Injuries Are Increasing15:33 - Corticosteroid Injections in Chronic Tendinopathy22:05 - Relative Rest and Cross-Training26:28 - Lower Extremity Overuse Injuries34:40 - Gluteal Tendinopathy and Greater Trochanteric Pain39:17 - Hydrodissection and Prolotherapy51:37 - Upper Extremity Overuse Injuries56:05 - Early Sport Specialization and Time Off01:00:39 - Training Load, Sleep, and Nutrition01:08:20 - Imaging, Physical Therapy, and Treatment Options01:15:40 - Final Takeaways and Wrap Up --- More about this episode The conversation moves through the lower and upper extremities, addressing Achilles tendinopathy, medial tibial stress syndrome, gluteal tendinopathy, patellofemoral pain, and rotator cuff tendinopathy, all with a focus on underlying biomechanical deficits. Drs. Ralston and Balle dissect the pros and cons of repeated corticosteroid injections, explore alternatives like ketorolac, prolotherapy, PRP, hydrodissection, and shockwave, and clarify when imaging should and shouldn’t drive decisions. They close with tips on relative rest, scheduling breaks from sport, optimizing sleep and nutrition, and building strong referral networks to support patient recovery. --- Resources Fredericson M, et al. Tibial Stress Reaction in Runners: Correlation of Clinical Symptoms and Scintigraphy with a New Magnetic Resonance Imaging Grading System. Am J Sports Med. 1995 https://journals.sagepub.com/doi/10.1177/036354659502300418 Taheri P, et al. Comparison of Subacromial Ketorolac Injection versus Corticosteroid Injection in the Treatment of Shoulder Impingement Syndrome. J Res Pharm Pract. 2017 https://pubmed.ncbi.nlm.nih.gov/29417082/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What characteristics make bone biopsies unique in both presentation and procedure? In this episode of the BackTable Podcast, Drs. Junjian Huang and Majid Khan join host Dr. Neil Jain to break down the complexities of bone biopsy technique. They discuss key strategies for tackling difficult cases, from understanding referral patterns and pre-procedure planning to selecting the best guidance modality and anticipating complications. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Varian OmniBonehttps://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone --- Timestamps 00:00 - Introduction08:06 - Referrals And Pre-Procedure Planning12:35 - Triaging and Managing Difficult Cases17:06 - Measuring and Improving Diagnostic Yield18:58 - Knowing Boundaries Behind Difficult Cases22:37 - Choosing the Best Guidance Modality26:16 - The Future with Augmented Reality28:11 - Tough Case Scenarios and Setup41:27 - Preventing and Managing Complications47:49 - Technical Tips for Future IRs51:40 - Wrap-up and Credits --- More about this episode The conversation covers how to triage complex cases, adjust technique for smaller or hard-to-reach lesions, and benchmark diagnostic success. Drs. Huang and Khan share their preferred imaging guidance, from CT to fluoroscopy, and explore new frontiers like augmented reality. Case scenarios highlight practical problem-solving, and the episode wraps up with technical pearls and complication-prevention tips gained from years of experience in targeted bone biopsy. --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How do you navigate the evolving science and controversy of concussion care in athletes and beyond? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Ryan Stempniak to break down the fundamentals and emerging advances in concussion management. They define concussion pathophysiology, highlight why most injuries occur without loss of consciousness, and discuss delayed symptom onset that can complicate diagnosis and treatment. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction07:16 - Who Manages Concussions?12:21 - Defining and Understanding Concussions23:31 - Injury Mechanisms and Pathophysiology26:56 - Recognizing and Grading Symptoms35:00 - Assessment Tools: SCAT6 vs. SCOAT38:34 - Return-to-Play and Return-to-Learn50:42 - Medications, Supplements, and Treatment Advances57:10 - Concussion Subtypes and Individualized Care01:02:01 - Helmets, Wearables, and Emerging Technology01:10:11 - AI, Imaging, and Research Directions01:13:01 - Myths, Facts, and Protocol Updates01:16:57 - Closing Thoughts --- More about this episode The conversation covers mechanisms of injury, symptom assessment, sideline and office evaluation, and the critical role of return-to-learn before return-to-play. Drs. Balle and Stempniak discuss concussion subtypes, medication and supplement limitations, and the latest on helmets, wearables, and AI-driven research. They also emphasize individualized care plans, the importance of school and work accommodations, and practical strategies for clinicians managing this complex and ever-changing condition. --- ResourcesDr. Ryan Stempniakhttps://www.linkedin.com/in/ryan-stempniak-843545295/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How have modern surgical techniques, pain management algorithms, and focus on rehabilitation transformed joint replacement outcomes? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. William Bryan of Houston Methodist to share his insights from decades of experience in orthopedic surgery and sports medicine. Dr. Bryan reflects on his journey from mentorship under Dr. George Lane and Dr. Michael DeBakey to serving as team physician for the Houston Astros, emphasizing the importance of restoring normal function and keeping patients active. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:55 - Praising Mentorship11:59 - Evolution of Total Joint Care18:44 - Optimizing Pain Control Post-TKA30:42 - Discussing Operative Approach, Implants, and Emergence of Robotics38:21 - Longevity of TKAs in More vs. Less Active Patients41:58 - Knee Pain Eliciting Surgical Intervention50:13 - The Balancing Act of Orthobiologics as a Conservative Modality55:44 - Imaging Myths in Total Joint Surgery58:02 - Sharing Surgical Pearls 01:03:42 - Advice for Non-Operative Colleagues01:07:38 - Final Takeaways and Wrap Up --- More about this episode The physicians explore the progression of arthritis, conservative treatment options, and the evolution of joint replacement, from early complications to advances that have improved implant longevity. They also discuss anesthesia advancements including periarticular nerve blocks, emerging calcium channel-blocker analgesics, and the use of the ROMTech home rehabilitation device. Curious about common misconceptions surrounding total joint replacement? Dr. Bryan and Dr. Balle address the role of orthobiologics, imaging myths, and other frequently misunderstood aspects of arthroplasty. Throughout the conversation, they emphasize the importance of ligament balancing, the unique challenges of treating ligamentously lax patients, and practical strategies for maintaining joint health through low-impact exercise and diet-driven weight loss. --- Resources Dr. William Bryanhttps://doctor-bryan.com/ ROMTechhttps://romtech.com/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What’s your game plan when heat illness strikes on the field? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes sports medicine physician Dr. Irvin Sulapas to discuss how clinicians and athletic trainers can use wet bulb globe temperature (WBGT) and other tools to improve athlete safety. They highlight best practices for communication with coaches, modifying training protocols, and recognizing the full spectrum of heat-related illness from heat rash to syncope and exertional heat stroke. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:12 - Defining Heat Stress and Its Risks08:26 - Cooling Strategies in Sports and Mitigating Risk 17:11 - Wet Bulb Globe Temperature Explained22:37 - Collaborating with Coaches and Trainers26:02 - Identifying High Risk Athletes30:57 - Heat Acclimatization Protocols33:17 - Physical Exam for Heat Illness39:12 - When to Activate EAPs and Call EMS47:02 - Return-to-Play Guidelines49:45 - Debunking Heat Illness Myths54:11 - The Future of Heat Safety57:13 - Key Takeaways and Wrap-Up --- More about this episode The discussion covers risk stratification, early interventions like cold-water immersion and tarp-assisted cooling oscillators, and practical protocols for emergency response. Dr. Sulapas and Dr. Balle also address key physical exam findings, when to activate emergency action plans, and guidelines for returning to play after heat illness. They debunk common heat myths and look at future directions for improving heat safety in sports medicine. --- Resources Dr. Irvin Sulapashttps://www.houstonmethodist.org/doctor/irvin-sulapas/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Time is money, but when it comes to ACL rehabilitation, the calendar alone does not determine readiness for return to play. On this episode of BackTable Bone & Sport, host Dr. Larry Balle is joined by returning guest Dr. Andy Glidewell to discuss modern protocols for anterior cruciate ligament (ACL) rehabilitation. They cover the ACL’s role in knee stability, common injury mechanisms, and why moving beyond timeline-based milestones is crucial for optimal recovery. Glidewell emphasizes that while surgery reconstructs the ligament, rehabilitation is what restores true knee function. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps00:00 - Introduction05:55 - Collaborative ACL Protocols 09:56 - Anatomy Review: The Role of the ACL 14:41 - ACL Rehab Misconceptions19:04 - Rehab Goal Metrics: Time vs. Subjective Measures28:55 - Early Post-Op Priorities36:26 - Tweaking ACL Protocols Based on ACL Reconstruction Graft 42:30 - Use of Orthobiologics in Surgery47:15 - Progressing BFR to ARPE to Hypertrophy in Rehab56:38 - Incorporating Plymometrics and Agility Training in ACL Rehab1:00:19 - The Mental Hurdles in ACL Rehab and Return to Sport01:08:00 - Clinical Pearls in ACL Rehab01:10:20 - Wrap Up --- More about this episodeThe conversation explores early post-operative priorities, the importance of progressive strength and functional testing, and the need for closer collaboration between surgeons and physical therapists. Additional topics discussed include shifting from time-based to subjective and objective criteria for return to sport, and evolving approaches to open-chain knee extension to address persistent quadriceps deficits and reduce anterior knee pain. --- ResourcesDr. Andy Glidewellhttps://www.trainrecovermove.com/andyglidewellpthttps://uamshealth.com/provider/michael-a-glidewell/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

Ergogenics: supplements NOT substitutes. On this episode of BackTable Bone & Sports, host Larry Balle joins Dr. Ryan Rhodes, a sports medicine physician and Army National Guard flight surgeon, in a discussion about ergogenic aids and supplements in athletic and military populations. They distinguish supplements from substitutes and define ergogenics broadly, noting limited evidence for popular peptides and the “bro science” culture. The doctors review historical and modern pharmacologic performance enhancers including anabolic steroids, selective androgen receptor modulators (SARMs), growth hormone and hormone replacement therapy (HRT). --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 04:03 - Ergogenics Overview07:17 - A Brief History Lesson in Performance Hacks14:54 - SARMs Explained18:00 - Supplement Industry Economics24:28 - Growth Hormone and HRT Nuance34:50 - Stimulant Use in Sports37:30 - The Hype Around Creatine 44:03 - Addressing the Renal Safety Myth with Creatine Use46:02 - The Rundown on Protein Intake Basics49:47 - Future Discussions on Ergogenic Aids52:02 - Closing Key Point: Five Point Supplement Test57:14 - Wrap Up --- More about this episode This episode also features case discussion surrounding injury risks from exogenous testosterone use and nuances associated with hormone-replacement. Dr. Rhodes shares his appreciation for creatine, highlighting its strong evidence and safety profile. Key takeaways include the five-point framework for evaluating supplements: safety, claims, meaningful impact, correcting deficiency, and cost. --- Resources Dr. Ryan Rhodeshttps://www.ochsner.org/doctors/ryan-rhodes/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

A bone biopsy can reach the target and still miss the diagnosis. In this episode of the BackTable Podcast, host Dr. Neil Jain is joined by Dr. Peter Thurlow to discuss how lesion selection, imaging review, trajectory planning, and device choice determine whether a targeted bone biopsy produces a useful sample without compromising future treatment. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byVarian OmniBonehttps://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone --- Timestamps00:00 - Introduction04:17 - Approaching Focal Bone Lesions06:17 - Differentiating Lesions and Pain Management13:13 - Settling on Bone Biopsy Imaging16:55 - Understanding Pre-Op Imaging from Lesion Characteristics 21:50 - Maintaining Communication Across Specialties24:21 - Which Devices To Select and Navigating Challenges32:28 - Trajectory Paths and Surgical Considerations35:30 - How to Avoid and Mitigate Biopsy Complications41:30 - Wrap Up --- More about this episodeThe conversation begins with a systematic approach to evaluating focal bone lesions, including the likelihood of malignancy, lesion location, number of lesions, and selection of an appropriately sized sampling device. Dr. Thurlow reviews anesthesia and pain-management strategies for both superficial and deeper osseous targets, as well as the respective roles of MRI and CT in procedural planning. For challenging lesions, he explains why needle-guidance technology may be preferable to adjusting gantry tilt and outlines how imaging findings and biopsy strategy should be tailored to lesion type, with particular attention to the difficulties associated with blastic lesions. The doctors also discuss the importance of communication with pathology, surgery, oncology, and other collaborating specialties before proceeding. Dr. Thurlow shares his preferred biopsy devices, considerations for selecting a safe trajectory, and ways to account for potential future surgical approaches. The episode concludes with practical strategies for avoiding complications, minimizing tissue injury, and obtaining an adequate diagnostic sample. --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

Whole-body MRI is moving beyond diagnosis and into prevention, but is the technology ready and are clinicians prepared to interpret and act on what they find? On this episode of BackTable Bone & Sport Podcast, host Dr. Larry Balle welcomes back physical therapist/athletic trainer, Dr. Andy Glidewell to dive into the controversy of whole-body MRI screening for athletes and fitness-focused patients. They discuss how imaging has evolved from simple diagnosis to clinical mapping for rehab and performance planning, drawing on experiences like the NFL Combine’s extensive MRI use, and examine both the clinical opportunities and the practical barriers to broader adoption. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:57 - Athletes Hunger for Knowledge13:22 - Preventive Care vs. Reactive Care15:53 - Understanding Limitations and Liability20:00 - Evolution of MRI Technology34:53 - When to Order Whole Body MRI44:24 - “If You Go Looking”: Addressing Incidental Findings56:51 - Identifying Good Candidates for Whole Body MRI?58:56 - Addressing Cost and Marketing Reality01:05:24 - Vision for Preventive Care01:07:18 - Final Thoughts and Wrap Up --- More about this episode The conversation covers the latest in MRI technology, including how AI can improve image quality and reduce scan time, as well as typical whole-body protocols and their limitations. Dr. Glidewell shares personal stories about incidental findings and offers insight into issues like cost, radiologist expertise, and the importance of a single communicator for care. Together, they explore who might benefit most from whole-body MRI, how it could influence preventive care and long-term healthcare costs, and the challenges and opportunities that lie ahead. --- Resources Dr. Andy Glidewell https://www.trainrecovermove.com/andyglidewellpt https://uamshealth.com/provider/michael-a-glidewell/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app