Concussions, biologics & youth athletics — What Drs. Bert Mandelbaum, Steve Jordan & Luga Podesta would do to fix the biggest problem in sports medicine

Orthopedic Sports Medicine

The sports medicine arena is growing to accommodate the young athletics market, which Time reports is swelling into a $15 billion industry. This industry growth leads to magnified problems, forcing orthopedic surgeons to adapt to the many forces at play.

Becker's Spine Review spoke with the following surgeons on the biggest problem in sports medicine and how they believe the industry can fix it:

  • Steve Jordan, MD, orthopedic surgeon and sports medicine specialist at Gulf Breeze, Fla.-based Andrews Institute for Orthopaedics & Sports Medicine
  • Bert Mandelbaum, MD, orthopedic surgeon and sports medicine specialist at Santa Monica (Calif.) Orthopaedic & Sports Medicine Group
  • Luga Podesta, MD, sports medicine and regenerative orthopedic specialist at Naples, Fla.-based Bluetail Medical Group


Note: The following responses were lightly edited for style and clarity.


Dr. Steve Jordan: I think the biggest problem currently in sports medicine is the marketing and use of biologics without scientific evidence of efficacy. Patients often present to us and ask for treatments they have read about on the internet and social media. Unfortunately, some of the claims and products advertised on these marketing sites are simply without substance and are quite expensive which victimizes the patient at the expense of profit. Having said this, I do view the application of biologics in sports medicine as an exciting opportunity for ethical research and innovation. At the Andrews Institute, we are committed to evidence-based medicine and to following regulatory guidelines in all aspects of care.


Dr. Bert Mandelbaum: If you step back and look at what is sports medicine and the tripod of sports medicine — which is prevention, optimize performance and rehabilitation and injury care — [you can see] the business model that we have in this country does not support sports medicine.


It doesn't focus on prevention, [but rather] on how we optimize performance. A lot of times [with sports medicine] and with the injuries we treat, the payer says, "You have 24 visits, but none of the visits involved return to play progression or prevention."


The whole circle of prevention to optimized performance, to injury and back to prevention is inconsistent with our business model.


[To fix it] I think a whole paradigm change has to occur in healthcare reform.


When you look at some of the elements, so much is focused on who is picking up the tab for insurance rather than what you're buying with your insurance.


The key for me when you're talking about sports medicine is about [athlete] empowerment — how to empower the athlete and how to empower the individual who is trying to maintain his fitness and wellness. We're trying to prevent a variety of illnesses in our lives, whether it be heart disease or obesity. These are all important elements of sports medicine, none of which [payers pay for] from primary care all the way to quaternary care [settings].


When a primary care physician sees a patient and says "You're 280 pounds overweight, I can refer you to a doctor who can do A, B and C." But when it comes to some of these elements [within healthcare], we're really quite thin when it comes to benefits.


In my view, when you say what's the big problem in sports medicine, we as an industry have to articulate that tripod. I think the central portion is focusing on what it is we do, rather than say what is sports medicine. [It is] also about focusing on the various elements [of the tripod] and how we can develop some type of resource or business model around so we can optimize each consumer and patient situation.


Many times it's not patients we're talking about. We're talking about population management, we're talking about young girls in soccer fields, we're talking about understanding concussions and preventing concussion in high school athletes. These are the big challenges we have from now into the future.


Dr. Luga Podesta: There are a number of problems we face in sports medicine. However, in my opinion, the greatest problem is injury prevention especially in our young athletes.


I feel the etiology of the problem is multifactorial. Young athletes watch their sports heroes competing on national TV and dream of being in their shoes and competing at that highest level. Parents see the rising costs of higher education, feel their young athlete needs to succeed in and commit to one sport to successfully be granted that illusive college athletic scholarship.


Parents are spending excessive amounts of money for private lessons, personal trainers, travel teams, showcases [and] year-round sports with the hopes that their children will be noticed by a coach or a scout offering a scholarship or professional contract.


To add to the problem, commercial private organizations, coaches and teams [are] advertising [and] marketing [to young athletes to] occasionally guarantee their ability to place that young athlete on a college or professional team if a young athlete plays or commits to training with that particular organization.


All of this has resulted in the ever-increasing rise in overuse injuries, musculoskeletal injuries [and] surgical procedures at a young age, leaving many of these young athletes permanently injured and psychologically scarred.


Unfortunately, fixing the problem is difficult. Education, of all involved is key. Players and parents need to understand the potential health risks involved with early sports specialization and overtraining. As sports medicine physicians, we must take responsibility for educating parents, especially about how to limit overexposure and stress that will result in injury.

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