In 2013, William Meyers, MD, established the Vincera Institute, a center dedicated to the prevention, diagnosis, treatment, rehabilitation, research and education of core injuries.
The institute includes participation from all the Philadelphia medical schools, plus the Hospital for Special Surgery in New York City and Duke University Health System in Durham, N.C.
He also recently published a book titled Introducing the Core: Demystifying the Body of an Athlete. Here, he discusses the big trends in sports medicine and what to expect in the future.
Question: What are the top two to three biggest trends in sports medicine today?
Dr. William Meyers: Sports medicine is a rapidly advancing field because both the care providers and the athletes are aggressively seeking out ways to decrease down-time and maximize performance. The most important trend is a growing appreciation that there really is something to this concept that the muscles of the core are important. Athletes with core muscle injuries were given nebulous diagnoses like 'sports hernia' and told to rest. One big thing I hope to eradicate is the term 'sports hernia' forever from the English language. Or die trying. There is no such thing.
Core injuries involve tears, pulls and strains. They involve disruptions of big bony, muscly joints. They aren't simple protrusions or bulges, and they aren't simply hernias to be repaired by mesh. There's an awful lot going on in the core, what with all the biomechanics and the big blood vessels and organs in there. Orthopedic surgeons tend to stay away from that stuff. Neurosurgeons will take on the spine but aren't about to go near the pubic bone. Other specialists — GI surgeons, urologists, and gynecologists, to name a few — see the core's muscles and bones simply as the black box that encloses their provinces. For too many years, we have ignored the core, and that means we haven't known what's going on.
More and more, people will understand that these are definable injuries with excellent treatment options.
Q: How are biologics used for common sports injuries? How can physicians incorporate those treatments into their practices?
WM: Biologics are attractive because they harness the athletes' healing mechanisms and target them towards injuries that would otherwise take a long time to heal or never heal at all. The most popular biologic currently is Platelet-rich plasma. Sports medicine practitioners are using PRP for injuries to tendons, ligaments, cartilage and muscles. Because the technology is relatively new, we don't know much about the long-term effects of PRP.
In the last few years, more and more of my patients come to me having already tried PRP injections for their core injuries. Unfortunately, PRP does not seem to heal these injuries and there appears to be a correlation between bone formation in the core muscles and previous PRP injections. The bone tends to rub against the surrounding muscle and create another source of pain. It can have devastating effects in terms of fibrosis and heterotopic ossification and has taken away careers of pro athletes when injected into the pubic and adductor areas.
Q: What is your best advice for orthopedic surgeons and sports medicine physicians early in their career that aim to treat elite athletes?
WM: Elite athletes have the same injuries as everyone else. The first step is to completely define the injury. Only once that is complete should you bring the other variables, such as timing, contract issues, etc., into the discussion. Also, get to know the functional anatomy of the core. It is really important. It affects the upper and lower extremities and even cognition.
Q: What technologies and treatments do you see on the horizon that will make an impact on the sports medicine field?
WM: We have a long way to go with biologics and tissue regeneration, but the progress is happening fast. Stem cells are already a reality. Once we couple that technology with a clinically useful scaffolding on which to grow those cells and surround them with the right mixture of chemical signals, we will have an answer for what are now career-ending injuries.
Further understanding of core health and core medicine will have a deep impact on sports medicine as well. There are new and correct treatments of our athletes as well as prevention methodologies. Understanding the core and its implications on performance sets the foundation for the future in terms of prevention of injuries.