BackTable Bone & Sports

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