VOL. 10 | NO. 21 | Saturday, May 20, 2017
EMPHASIS: Health Care
Q&A: Campbell Clinic’s Miller Talks Sports Medicine, Injury Prevention
By Don Wade
Dr. Robert Miller graduated Vanderbilt University School of Medicine in 1980 and completed a residency in 1985 in Memphis and a fellowship in sports medicine in Georgia in 1986. So, he was pretty much in on the ground floor of the sports medicine discipline.
Campbell Clinic’s Dr. Robert Miller serves as team physician for Rhodes College and assists with the Memphis Grizzlies, Memphis Redbirds and University of Memphis. He says injuries are fairly similar in all levels of a sport. (Memphis News/Patrick Lantrip)
Today he practices at Campbell Clinic and serves as team physician for Rhodes College while providing assistance with the Memphis Grizzlies, Memphis Redbirds and University of Memphis. He is certified by the American Board of Orthopaedic Surgery and is an associate professor at UT-Campbell Clinic in the Department of Orthopaedic Surgery.
Recently, Dr. Miller sat down with The Daily News to discuss the progression of sports medicine and what some of the treatments of the future might entail.
So where was sports medicine when you entered the field in the 1980s?
Miller: Back in ’85 it was just starting its real growth. The primitive days were in the ’60s and ’70s. In the ’60s, there were people that thought of themselves as sports doctors. Then in the early ’70s, a bunch of guys got together and formed kind of a sports medicine society. And that’s kind of when it started to become a sub-specialty unto itself.
The late ’70s is when the development and perfection of the arthroscope occurred. And that’s when some of the real improvements in the surgical aspects of sports medicine came into being.
How much was early growth driven by natural advancements in the field and how much by the needs and desires of professional and college sports teams?
Miller: I don’t know that it was driven so much by the money or the business aspect of it. Many of the godfathers of early sports medicine were athletes in their own right and probably wanted to improve the care given to athletes. Simultaneously, it overlapped with the interest in physical fitness in the country at large. There were a lot of weekend warriors. And then we had the appearance of the MRI in the late ’80s, early ’90s, and it improved dramatically our ability to make diagnoses.
Youth sports have exploded in the last 20 years or so, but we also have seen a proliferation of injuries. With girls, for instance, a lot of ACL injuries. Why are they so vulnerable?
Miller: The anterior cruciate ligament (ACL) in the girls, we see differences in anatomy. … The ligament can be smaller in girls than boys. … Girls have a wider pelvis, so they have more of a knock-kneed alignment. There seem to be subtle differences in how quickly the girls activate the muscles compared to boys.
Another big component is the difference in core body strength in boys vs. girls. And girls typically tend to land from a jump in a slightly different pattern than boys; they land and bring their knees in together. The boys land with the knees straight out in front of them and the boys’ pattern puts less stress on the anterior cruciate ligament. And then there seem to be some hormonal issues during the menstrual cycle; there can be some weakness to the anterior cruciate ligament.
And then with males who are baseball pitchers we see major elbow injuries becoming more and more common resulting in the so-called Tommy John surgery. Theories?
Miller: Probably the result of almost year-round participation. They play for multiple teams. More a matter of overuse. The problem with the pitching motion is the forces on the elbow with each pitch are enough to exceed the strength of the ulnar collateral ligament (UCL). The reason it’s not torn every time you throw is it’s protected by the muscles of the forearm. You start getting fatigued from overuse, then the muscles stop protecting the ligament. And that’s when the ligament undergoes stress. Probably starts with microscopic tearing and then progresses to the point where it ultimately fails.
What’s the difference between working with NBA players and, say, a Division III athlete at Rhodes College?
Miller: In all these situations, the athlete and his health is the primary concern. The injuries are fairly similar in all levels of a sport. There are other factors that are different. At the NBA level, for example, you’re dealing with the agents, the front office, so there can be a lot of pressure and a lot of money involved. Still, the primary concern is the health and welfare of the athlete. Rhodes College, I deal with parents.
Which is more difficult, dealing with agents or parents?
Miller: I’m not sure either one is any easier than the other.
There are newer, less invasive treatments out there, such as using stem cells or platelet-rich plasma (PRP). What’s your opinion on them?
Miller: We’re trying to figure out when the platelet-rich plasma makes a difference in the therapeutic regiment. Stem cells, we haven’t had any good double-blind, randomized controlled study. There are a lot of little anecdotal type studies, where you have a small series of patients you tried it on and documented some improvement. You can’t always scientifically say it was solely do to the stem cells or PRP. Consequently, insurance companies have not chosen to cover it. And neither one is particularly cheap. So it’s not commonly used. Pro athletes are using PRP a lot with muscle injuries.
What else is on the horizon?
Miller: In the future, we’re working hard to develop a synthetic meniscus. And also on ways to repair or regenerate the joint surface of articular cartilage. Knees, hips, elbows, shoulders, ankles, any joint. Once you’ve done that, you start thinking about ways to prevent arthritis. It’s hard to do because many times the traumatic injury that set it in motion occurred 15 or 20 years earlier and might have been an injury you didn’t think much about.
Unfortunately, the meniscus and articular cartilage are very complex structures. The further we go the more we are impressed by the skill of our original creator.
So prevention still has its place in sports medicine. What’s your advice for parents of youth athletes?
Miller: Actually, if you talk to a bunch of the coaches and physicians, they would recommend diversity. Not just focusing on one sport. A lot of coaches feel that produces a better athlete. And it definitely reduces the chances for an overuse type injury. And also take a break, some time to rest and recover.
What about for people 45 and older, if you’re still active and you have one or two sports you still do. What advice do you have for them?
Miller: The biggest recommendation I would have is if you decide to make a change in your activity level you do it gradually. Too often, I see they have increased the distance they’re running, the frequency of their runs, the speed of their runs, or the terrain on which their running. They make a change too quickly before their body can adapt to it. That leads to an overuse injury.