5.9 — Sports Medicine: Pushing Ourselves to the Limit

Host Walter Isaacson talks with sports injury experts about how medical professionals are using new technologies and advanced training to keep athletes in the game. 
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In this episode:

  • Tommy's elbow (0:00)
  • As old as competition itself (3:05)
  • A resurgence of sports medicine (6:42)
  • About Tommy John's elbow (9:28)
  • Conversations about concussions (14:20)
  • Prevention through prediction (20:03)
  • The effects on the mind (25:03)
  • The sports we love (29:45)

From concussions to broken bones and torn ligaments, most sports injuries occur because our bodies sustain an impact that is just too much to bear. Sports doctors are constantly trying to find ways to push our bodies to their peak performance without sustaining these types of career-threatening ailments. How do they do it? Listen to find out.

Don’t injure yourself searching for more information about sports medicine. We’ve got you covered.

Guest List

  • Jack Berryman is Professor Emeritus in the Department of Bioethics and Humanities and Adjunct Professor Emeritus in the Department of Orthopaedics and Sports Medicine in the School of Medicine at the University of Washington.
  • Rob Neyer is a baseball journalist and the host of the baseball research podcast, SABRcast. He's written seven books, the most recent of which, POWER BALL: ANATOMY OF A MODERN BASEBALL GAME, won the CASEY Award as the best baseball book published in 2018.
  • James Noble is an Associate Professor of Neurology in the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University Irving Medical Center. This work led him to partner with engineering colleagues at Columbia University to develop the concussion detection technology now in use at NoMo Diagnostics.
  • Marcus Elliott is the founder and director of P3 Applied Sports Science. Dr. Elliott’s primary focus is on peak performance and injury prevention in U.S. professional power-based sports, including baseball, basketball, football, and soccer.
  • Andy Etches is the Co-Founder and Sports Director of Rezzil. Rezzil VR technology offers tools for post-match analysis, rehabilitation, and virtual training. Andy works with professional soccer clubs in England and many other sports across the world.

“There's always going to be injuries in sports, no matter how smart we are.”

— Marcus Elliott, founder and director of P3 Applied Sports Science

Walter Isaacson:

It’s July 17, 1974, one of the most famous dates in baseball history. On the mound for the LA Dodgers is a 31 year old southpaw named Tommy John. He’s got a wicked fast ball and he’s halfway through the best season of his career. It’s the top of the third inning, and Tommy John and his Dodgers are up on the Montreal Expos four nothing. He winds up to deliver a pitch. And all of a sudden, he feels a stabbing pain in his elbow. He knows he’s injured, and it’s bad. Among the 25,000 fans at Dodger Stadium that night is the team’s orthopedic surgeon, Dr. Frank Jobe.

Walter Isaacson:

After the game, Jobe and John meet to talk about the injury. Jobe knows the problem is the ulnar collateral ligament in John’s elbow. It might be torn, or it might have snapped completely off the bone. Jobe fears the worst. He thinks Tommy John’s career might be over, but he has an idea. It’s never been tried before in a baseball player. He wants to try and completely replace the injured ligament attached to John’s pitching elbow. Dr. Jobe explains to John that the odds of success for this experimental procedure aren’t very good.

Walter Isaacson:

In fact, they’re terrible. There’s only one in a hundred chance it will work. John turns to his doctor and says, “Let’s do it.” The odds are against both the pitcher and the surgeon. But if the surgery is a success, it will be a historic moment in sports medicine and change Major League Baseball forever. Today, sports medicine technology plays a critical role in both protecting and repairing athletes.

Walter Isaacson:

But as we strive to throw harder, run faster, and jump higher, we must also search for new ways to repair and even prevent the injuries that inevitably materialize when we push our bodies to the limit. I’m Walter Isaacson, and you’re listening to Trailblazers, an original podcast from Dell Technologies.

Audio:

Well, the pitchers are just about warmed up. The demand for competent, experienced guidance in sports has literally created a brand new profession. We are privileged to have an authority in this field. The whole body is resting. And for the medical man, these people are very interesting. He’s gone for a touchdown.

Walter Isaacson:

Training athletes for competition is as old as competition itself. The ancient Greek physician Herodicus was a wrestling coach and the first to write about the connection between exercise and endurance. Weaker athletes, he remarked, could be made stronger through training. Greeks were obsessed with fitness, not only for their athletes, but for everyone. Their gymnasiums were the world’s first health clubs.

Walter Isaacson:

They created the Olympic games, where tens of thousands of spectators watched and cheered as their heroes pushed the limits of athletic performance, all for the glory of sport and homeland. Hippocrates, whom we know today as the Father of Modern Medicine, was the first to notice the relationship between diet and fitness. He came up with the concept of a training regimen to prevent injury. But probably the most influential doctor in the history of sports was another Greek. His name was Galen.

Jack Berryman:

Galen was a Greek physician practicing in Rome and up until the age of about 28 suffered from a variety of illnesses.

Walter Isaacson:

Jack Berryman is professor emeritus in sports medicine and orthopedics at the University of Washington.

Jack Berryman:

And then, as Galen said in his own words, “I discovered an art of health.”

Walter Isaacson:

Galen came up with a kind of formula for maintaining a healthy body and preventing injury. To distinguish these elements from the natural gifts bestowed upon humans by the gods, Galen called them the six non-naturals.

Jack Berryman:

The six non-naturals were the air we breathe, food and drink, our diet, sleeping and waking, motion and rest, which includes exercise, excretions and retentions, and interestingly, the sixth one he called passions of the mind, which is basically our mental state. Galen’s idea was is that if we do these things in balance and moderation, we will be healthy.

Walter Isaacson:

That emphasis on moderation was Galen’s most important legacy. It was good advice for everyday Greeks and Romans, but for athletes, this was terrible news. Athletes don’t practice moderation. They push themselves to extremes. In fact, as a doctor, Galen disapproved of all competitions, boxing, wrestling, running, even gladiator battles. And amazingly for almost 2000 years, Galen’s theory dominated Western medicine. Until the late 19th century, it was standard medical advice not to engage in too much exercise. But slowly that began to change.

Walter Isaacson:

One reason was the development of athletic clubs and team sports, especially at universities. As more people started to compete at higher levels and competition grew more fierce, doctors renewed their interest in how athletes could achieve peak performance while mitigating injury, and they began to question Galen’s emphasis on moderation.

Jack Berryman:

The real serious organizations involving sports medicine really came about with the Olympic games starting in 1928. They had an International Congress of Sports Medicine, and these were all Olympic team physicians representing different countries. This was one of the examples then of how sports medicine really became a field in and of itself.

Walter Isaacson:

New laboratories were established. Founded in 1927, the famous Harvard Fatigue Lab studied the effects of extreme performance on the heart, lungs, joints, and muscles. The lab also wanted to determine how much training and rest athletes needed in order to keep their bodies in peak shape. Harvard physician Augustus Thorndike was the founding father of modern sports medicine in America. He declared that physicians should be present at every athletic event to determine if injured players were safe to go back out and play.

Walter Isaacson:

And in 1954, the American College of Sports Medicine was founded, which expanded the field to include physical education, training, preventive medicine, and, importantly, medical supervision of athletes. This also happened to coincide with the meteoric rise of sports entertainment in America.

Jack Berryman:

Professional sports, mainly because of television, became very much a popular entertainment.

Audio:

Always a thrill when the home team takes the field. Here are the Red Sox pouring out of their dugout.

Jack Berryman:

And as that happened, athletes became millionaires and owners wanted to protect their athletes. If they’re injured, they’re not going to help the team. And of course, winning was the key. Beginning in the late ’50s, early ’60s, but more so in the ’70s, athletes became high cost performers and along with that came a whole group of physicians and trainers and so forth to look after the health and well-being of athletes.

Walter Isaacson:

And that’s how Frank Jobe found himself with the Dodgers pondering Tommy John’s elbow injury. The odds of Jobe becoming a doctor for a Major League Baseball team were about as good as the odds of his experimental surgery, saving Tommy John’s career.

Rob Neyer:

When you think about Jobe’s life and the impact he’s had on baseball, it’s worth remembering for a moment, just how easily all of this might not have happened.

Walter Isaacson:

Rob Neyer is a baseball journalist and the host of the baseball research podcast, SABRcast.

Rob Neyer:

Jobe was quite a character. He enlisted in the army in World War II as a non-combatant because of his religious beliefs, but saw a great deal of combat in Western Europe. He was even briefly captured during the Battle of the Bulge and escaped. He was in a lot of scary situations, dangerous situations, and it didn’t all have to happen this way.

Walter Isaacson:

Jobe served with the 101st Airborne Division in the medical unit, and the military doctors told him he had a talent from medicine. After the war, he earned his medical degree from the Loma Linda University of California. In another stroke of luck, one of his professors was Dr. Robert Kerlan, the first team doctor for the Dodgers. When Kerlan retired, Jobe took his mentor’s place, and then he met Tommy John. Most people don’t need a perfectly functioning ulnar collateral ligament to enjoy a healthy life, because most of us don’t throw baseballs for a living.

Rob Neyer:

But pitchers absolutely need a healthy UCL. They can’t throw without it. And when Tommy John’s snapped, at that point in baseball history, that was a death sentence. Untold hundreds or perhaps thousands of professional pitchers over the years had torn that same ligament and very few of them had ever come back.

Walter Isaacson:

Jobe’s idea was radical. He knew the ligament couldn’t simply be repaired. It would need to be replaced. So his plan was to take a tendon from Tommy John’s right forearm, his healthy arm, and graft it under the elbow joint of his left arm. Such a procedure had never been attempted in the world of sports.

Rob Neyer:

That’s what’s pioneering about it is that this particular surgery on this particular part of the body, it was no sure thing. Jobe didn’t know what would happen. It was essentially a grand experiment.

Walter Isaacson:

The surgery lasted three hours, then came a year and a half of rest, rehab, and waiting. Finally, on April 16, 1976, Tommy John took the mound again for the Dodgers. Dr. Frank Jobe could barely watch. John threw five innings and he felt good. Five days later, he threw seven innings against the Astros. His new elbow was holding up.

Rob Neyer:

What’s sort of mind blowing about Tommy John is that a pitcher who doesn’t get hurt or does get hurt and has successful medical procedure, we would expect them to pitch effectively into their early, mid, maybe even their late ’30s. Tommy John was still pitching in the major leagues at 46. That just doesn’t happen.

Walter Isaacson:

The most daring surgery in sports history turned out to be a wild success. John went on to play for another 13 years, winning 164 games. In the entire history of baseball, only the great Nolan Ryan ever pitch more seasons than Tommy John. His impressive recovery and pitching record earned him the nickname “The Bionic Man.” Meanwhile, Frank Jobe used his success to improve the field of sports medicine. He founded the Kerlan-Jobe Clinic, which has trained more than 250 sports doctors.

Walter Isaacson:

Since 1974, more than 1,000 professional pitchers have had what is now known as Tommy John Surgery. What used to be the end of a baseball career is now a new beginning. And today, the daring spirit of Frank Jobe permeates an entire industry of innovation in sports medicine. We all risk injury when we play sports, whether we play professionally or just at the park on a Sunday afternoon. But some sports are inherently riskier than others and some injuries have greater consequences for our health.

Dr. James Noble:

My name is Dr. James Noble. I am the chief medical officer and co-founder of a startup called NoMo Diagnostics or NoMo Dx.

Walter Isaacson:

Noble is a leading expert on one of the most alarming injuries in sports today, concussion. He’s been on the sidelines of football games, assessing athletes who have sustained hits to the head.

Dr. James Noble:

Basically I’m being asked to say, is it okay for this person to go back and do what they did and potentially get injured again? It’s a tough question to be posed. There’s always the snowing feeling of, I think I’m doing the right thing, but I’m not sure.

Walter Isaacson:

Football has long grappled with head injuries. Back in 1905, President Theodore Roosevelt convened an emergency conference of Ivy League football coaches, because at least 45 young men had died in recent years from football injuries, most of which were sustained to the head. The conference came up with a series of rules to make the game safer, and the focus on safety eventually led to the development of the first football helmets. But helmets alone can’t prevent concussions.

Walter Isaacson:

Concussions can lead to all kinds of problems, from headaches and memory loss to chronic traumatic encephalopathy or CTE. CTE is a serious degenerative brain disease. That’s received a lot of attention in the media in recent years. Research has revealed that 99% of NFL players whose brains were studied post-mortem suffered from CTE. Symptoms of the disease, include depression, loss of motor skills, and erratic behavior.

Dr. James Noble:

Most athletes who play competitive football will on average have hundreds of meaningful hits that they take to the head every season. But of those many, many hits, only a small percentage, sometimes only one or two of those hits, will actually cause an athlete to become concussed.

Walter Isaacson:

The problem that Noble shares with everyone who studies concussions is that it’s very difficult to diagnose them in real time. Historically, doctors can pull an athlete aside and examine their cognitive function, balance, and gait, all of which might indicate a severe head injury. More recently, medical staff have outfitted players with helmets embedded with accelerometers capable of measuring the force of a hit. In fact, helmets possessing this technology are already on the market.

Walter Isaacson:

And while measuring impact to a player’s helmet and examining cognitive function can help determine the likelihood of a concussion, Noble understands that neither method provide sideline staff with conclusive evidence.

Dr. James Noble:

So I started thinking, is there an objective physiological way that we could diagnose concussion that didn’t rely upon a sideline report?

Walter Isaacson:

Noble thinks helmets should do more than help minimize the likelihood of concussions. He thinks they should be able to diagnose them too. Noble had an idea. He knew that the most accurate way to diagnose a concussion is to measure brainwave activity in real time, at the exact moment an athlete takes a hit. And the way to measure brainwaves is to use an electroencephalogram or EEG, which is usually done in a medical lab. What Noble had to figure out was how to bring the lab to the football field.

Dr. James Noble:

We now have the capacity of assessing it through dry electrode interfaces, through systems that can be miniaturized. Given that a quarterback football helmet has a radio in it already, it probably could just be embedded in a football helmet.

Walter Isaacson:

Noble teamed up with a biomedical engineer named Barclay Morrison to design and build a miniaturized EEG. Fitting inside a helmet, the sensors monitor the brainwaves of athletes and transmit a signal to a tablet on the sideline.

Dr. James Noble:

The front end, what the user sees, the coach or the athletic trainer physician on the sideline sees, is basically a go, no-go signal. Is there enough concern to bring them off and be assessed? The goal is to identify it before it gets to the point that an athlete has to raise their hands or a more serious injury occurs.

Walter Isaacson:

While the project is still in its trial phase, Noble and his colleagues are optimistic that smart helmet technology can significantly reduce concussion injuries. As both a doctor and a father, he wants to make sure he never again has to make a decision based on a guess.

Dr. James Noble:

The game itself will continue, but the way we make a diagnosis will differ. So that’s one other thing we’ve been mindful of is that this is not intended to disrupt a game. This is intended to make the sport and the athletes safer by helping objectively determine when an injury has occurred.

Walter Isaacson:

From concussions to broken bones and torn ligaments, most sports injuries occur because our body sustain an impact that is just too much to bear. And if we can’t protect ourselves, then perhaps we need to change the way we train.

Marcus Elliott:

There’s always going to be injuries in sports, no matter how smart we are.

Walter Isaacson:

Marcus Elliott is the founder and director of P3 Applied Sports Science. And while he understands that injuries might be inevitable, Elliott and his team at P3 strive to predict their likelihood so they can try to prevent them from happening.

Marcus Elliott:

There’s this classic foot bone connected to the ankle bone and connected to the shinbone, and so on, the song. That’s really how the body works. Those interconnected movement patterns end up defining whether you’re at risk for an injury, whether you’re at risk for wearing out knees, wearing out hips, having repetitive ankle sprains. There’s a real physics behind these issues.

Walter Isaacson:

Elliott has firsthand experience with how injuries can change a person’s life. As a teenager, he was a star athlete with big dreams. And then in one devastating moment, those dreams came to an end.

Marcus Elliott:

When I was just about ready to start my senior year of high school, I had a giant knee injury. Tore every ligament in my right knee playing football. I felt like my life was over at 17.

Walter Isaacson:

Elliott found himself sinking into depression. But even at his lowest point, he realized there was another direction he could turn. Instead of devoting his life to playing sports, he would study the science of sports injuries. And that science points to one simple question, what can our bodies teach us about what they can and cannot do?

Marcus Elliott:

Injuries happen when forces are applied to a system beyond what that system is adapted to handle. When you have injuries, either you haven’t trained that system correctly, or the forces it’s being asked to absorb are just too much for the human body.

Walter Isaacson:

The answer lay in studying that system, the human body, and examining down to the most granular level how it moves and how it responds to impact. After graduating from Harvard Medical School, Elliott founded P3 with a goal of studying professional athletes, especially basketball players. Step one was obvious. He needed data, a lot of it, but it didn’t exist.

Marcus Elliott:

The model that was in place was it was a really a one size fits all model. Every athlete was mostly treated the same as the athlete to his left and to his right, and that just didn’t make sense. And so we said, what technology can be used that will give us insight into these systems?

Walter Isaacson:

Much like James Noble, Elliott found inspiration in technology that already existed. In this case, camera-based motion capture. That technology has been around for more than 70 years. Today, of course, the cameras are much more advanced. But what’s really changed is our ability to collect and process data using specialized software and wearable biomechanical tracking technology. Elliott began to develop a program that creates a complete three dimensional motion analysis of every part of an athlete’s body.

Marcus Elliott:

We assess all the players at the NBA Draft now for the NBA, in a partnership with the league. We’re collecting the super granular data, like thousands of data points on how these athletes are landing, how much force is going through their right leg versus their left leg when they’re jumping, how much rotation is across left knee, and how much their tibia is externally rotated as they go through a full jump range or are cutting or stopping.

Marcus Elliott:

We can ask amazingly detailed questions from all this data that we generate. That gives us insight into how they execute those movements.

Walter Isaacson:

When athletes go through the P3 program, they uncover the natural weaknesses in their body, and they use that knowledge to modify how they train and how they move to help predict and prevent injury. Much like Augustus Thorndike and the pioneers at the Harvard Fatigue Lab 100 years ago, Elliott wants to understand how the body responds to the stress of sports and data technology allows him to see what no one has seen before.

Marcus Elliott:

We’re not going back to the old way. This is all just going forward. We’re just going to get better and better in being able to look into our crystal balls and see how these bodies are at risk or not at risk, where they have advantages or disadvantages. The space that we operate in of uncovering these mysteries of human movement is just going to continue to be illuminated.

Walter Isaacson:

Elliott will never know if his data could have predicted his own devastating high school football injury. Some injuries are simply the result of random events. But injuries don’t just have an effect on our body. They can also affect our mind. The city of Manchester is the beating heart of English soccer. The rival teams, Manchester City and Manchester United, are among the most popular and successful sports clubs in the world. They invest millions in player development and state of the art training facilities.

Walter Isaacson:

But like all top tier teams, they know that even one random injury can derail a successful campaign, and getting players back from injury quickly and safely is the most important investment they can make. That’s reality. And nowadays, it’s also virtual reality.

Andy Etches:

My name is Andy Etches, and I am a co-founder and sports director for Rezzil.

Walter Isaacson:

Andy Etches grew up a diehard Manchester United fan. But a few years ago, he found himself working for Manchester City in their innovation department. His project was a virtual reality simulator that would allow fans see the game from the perspective of the players on the pitch to experience the pressure of a high stakes match. As he immersed himself in the world of VR technology, Etches realized something.

Andy Etches:

Over time basically the idea was this is too good for just fun. This can be meaningful. With the right support and the right data collection strategy behind it, it can be something that’s actually productive and can be impactful in high performance spot.

Walter Isaacson:

Fan experience was important, but Etches realized that the best experience is seeing your favorite players in peak form. So he decided to adapt his VR game to become a rehabilitation tool. He co-founded Rezzil.

Andy Etches:

If we take a player up to let’s say Premier League level and they suffer an injury like an ACL or something that’s going to keep them out of the game for six months, maybe longer, what that player loses in that time that they are are is often their connection with the game a little bit. Their reactions get dulled.

Walter Isaacson:

The advantage of virtual reality is that it can address both the physical and the psychological aspects of recovery. And it’s the latter that we often forget about when our favorite players are sitting on the sidelines in a cast. Even the best athletes in the world can lose their feel for the game, especially if they’re worried about reinjuring themselves. Rezzil’s VR program allows a player to retrain their minds, as well as their bodies.

Andy Etches:

One of the beauties of VR is that we own the world that you operate in. We can create scenarios that you’re never going to face in a real game. We can present a scenario where every single one of the opposition is Cristiano Ronaldo or Lionel Messi. We can create false pressure, false intensity, and we can overload you in a way that you would never get in a real game situation.

Walter Isaacson:

Inside Rezzil’s simulator, a player can practice their footwork, passing, shooting, and tackling in a 360 degree virtual environment. They can interact with virtual teammates and hear the roar of virtual fans. Every stage of the player’s rehabilitation is compared with baseline data of their peak form. So coaches and trainers can know just how close they are to a full recovery. And with that knowledge comes confidence, the most important psychological factor in recovery.

Walter Isaacson:

Etches and his team at Rezzil have received a lot of positive feedback on their technology, and several Premier League clubs are already using their VR system. That says a lot about how the new technology of sports medicine has become mainstream in the modern age.

Andy Etches:

I think technology is going to grow and play an even more important role across not just for soccer, but across all sports. Everybody can be bigger, faster, stronger. Everyone can work on those kinds of things. There’s a gym on every corner. But if you’re looking for the edge, it’s smarter that counts.

Walter Isaacson:

Ancient Greece’s Galen wasn’t wrong when he cautioned against athletic performance. After all, what can we really predict about how our bodies will respond to such extreme force? Maybe we were never meant to throw a baseball 100 times in a single night, or crash into each other at full speed on a football field. But these are the sports we love and it’s their physical consequence that makes them consequential. Pushing ourselves to be faster, stronger, and better is an inescapable reality of the human condition.

Walter Isaacson:

That’s why the field of sports medicine has evolved to study the heights of physical performance and how to minimize the risk of injury. So Galen, if you’re listening, rest easy. We’ve discovered a new art of health. It’s called innovation. I’m Walter Isaacson, and you’ve been listening to Trailblazers, an original podcast from Dell Technologies. For more information about any of the guests on today’s episode, please visit delltechnologies.com/trailblazers. Thanks for listening.