- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Anthony Martin,
clinical assistant professor
of Family Medicine at Wake Forest School
of Medicine, part of Atrium Health.
Dr. Martin, it's a pleasure to
have you on the podcast today.
- Thanks so much for having me. I'm excited to chat.
- Now, I know we have a lot to talk about.
We're gonna dive a little bit into sports medicine
and some of the work you're doing to care for elite athletes
as well as other athletes within the community.
But before we dive into my broader questions,
can you tell us a little bit more
about yourself and your background?
- Absolutely. Um, so yeah, I graduated from, uh, university
of Pittsburgh, um, undergrad in, um, 2003.
I went to Temple University School of Medicine,
graduated in 2008.
I did my residency at Reading Hospital in Reading
Pennsylvania, which is now Tower Health.
Um, and then I did a sports medicine fellowship at Carolinas
Medical Center in 2011
and joined, um, atrium, which is now advocate.
I currently, uh, sit at the rank
of clinical assistant professor at the Wake
Forest School of Medicine.
Uh, I also serve as the associate program director
for the Primary Care Sports Medicine fellowship,
and I'm also the point of care ultrasound director
for Department of Family Medicine in my sports, uh, roles.
I am the head team physician for UNC Charlotte Football, uh,
although I work with all the sports as well.
Um, I also, um, served as ringside physician
with USA boxing, covering regional events
with Golden Gloves in North Carolina, uh, from
around 2015 to around 2019.
- Wow, that's amazing. And it seems like, you know,
it would take a lot to care for athletes
who are competing in such a high level, um,
whether it it's locally
or kind of in some of those international competitions.
- It, it can, um, you know, you have to kind
of always be available, um, you know,
and communicate well, whether you're discussing
with athletes, um, in person
or coordinating care through the athletic training team and,
and and whatnot.
So, um, availability is really important in being able
to work in those athletes when those injuries happen,
because unfortunately, we don't have a crystal ball.
So being adaptable, it's important.
- Absolutely. That, that's such great advice, and,
and certainly I can imagine for someone who's trying
to get into the sports medicine space
and really to understand what that schedule looks like,
and, um, you know, what you need in order
to be successful there is truly helpful.
Now, what are some of the big trends
that you're watching in healthcare as well
as sports medicine in particular? You
- Know, one of the biggest trend I've seen in sports
medicine is just general awareness.
You know, um, we used
to talk about Monday morning quarterbacks, uh,
and speak that would traditionally be about coaching
decisions and players' abilities.
Uh, you know, uh, uh, at the beginning of the week,
although there's been more of a spotlight on the sports
medicine team that I've noticed, right.
Some of the, um, specific instances include Tua, um,
when he was, you know, at Miami
and the management of his brain injury during
that NFL game would, in the initial diagnosis
of a potential back injury, was highly criticized, not only
by medical professionals,
but also by commentators in the general public.
Um, and his early return to play put him at risk
for further injury given he was still
suffering from concussion.
Um, there was a big, you know, backlash.
Um, as a result of that,
because of all the awareness, you know,
I think there's also been a dramatic increase in the
awareness of sudden cardiac arrest in athletes.
One of the most public examples of this was DeMar Hamlin
with the BLO he received through the chest during
and a violent tackle.
Um, and then Bronny James who collapsed as a result
of his congenital heart condition.
Um, you know, the prompt response
and recognition of life-threatening condition in these
started athletes literally saved lives, right?
So awareness not only amongst professional
and collegiate sports medicine teams have increased,
but also equally, um, importantly at the high school varsity
and junior varsity levels as well, just
because awareness at all levels are important if we're gonna
prevent these events from happening,
and if they do happen to make sure we respond appropriately.
So I'd say just awareness of the sports medicine team
and our role, um, and some of the services we provide.
Um, that's one of the key areas that I've noticed.
- That's fascinating to hear.
And certainly, you know,
looking at those big national instances of people guessing
or second guessing, you know,
what should have happened on the medical side, um,
for any given situation, um, you know,
it definitely seems like it would be a challenge to have
that kind of scrutiny on you,
and obviously maybe you're not, you know,
on the NFL sideline.
But, um, when you think about the decisions
that you're making with the athletes, um, you know,
from kind of snap decisions in some cases during the game or
after the game, trying to decide about, like you said,
awareness of avail availability
and knowing that in some cases there's gonna be a
lot of opinions about that.
Um, how much pressure does that put on you?
How do you respond to that?
And I can imagine, you know, definitely needing
to keep the player first and foremost in your mind.
- Uh, you just said one of the most important things right
there at the end of your statement, uh,
keep the player at the formo at first and foremost, right?
You, you may be the team physician,
but your obligation is to that individual who's
who you're treating in front of you.
You want to keep them as healthy as possible,
and you want to attend to
that injury in real time and make the best decision.
You know, like I said, I serve in an academic role as well,
so I, I usually have fellows
or residents with me on the sidelines.
Um, and I always tell them, you know, try
to forget the cameras are there
because, you know, if it's a televised game
and it's a lot of pressure, it's a conference game
and it, it has eligibility for bowl game implications,
you know, that part's not important.
What's important is the person in front of you
who needs your, who needs your help, who needs your care,
um, because literally sometimes lives
are on the line, right?
So, uh, it's a, it is just important to always be vigilant
and, um, be ready to attend to what needs to happen as well
as, you know, have a good awareness of the, what's common
and what's uncommon, and being prepared
for whatever may happen in front of you.
I,
- I think that's such a great point
and so helpful to kind of cut through everything else
that potentially arises, you know,
when you're in such a high profile situation and,
and being able to treat the patient
and understand what they need in any given situation.
When you look at sports medicine as a whole,
what are you excited about
for the next year and what makes you nervous?
- Uh, yeah, there's a,
there's a lot I'm excited about, right?
You know, I mean, research, sports medicine is,
is a younger field compared to some other areas
of medicine, right?
So there's still a lot of publications
that are, uh, coming out.
One of the areas that I'm really excited about
is orthobiologics.
Um, orthobiologics is a, a broad area that is,
you know, it's receiving a lot of attention in the media,
the advertising world, and professional collegiate sports.
This category of medicine is using human tissues
or growth factors to help facilitate recovery in an injured
individuals, right?
This can be with elite athletes trying to return to sport
after an injury such
as a partially ruptured pectoralis tendon
or maybe some refractory patellar tendon issues, um,
and get them back on the field faster.
Or it can be a chronic degenerative condition like
osteoarthritis in a 50-year-old who used to be an athlete,
but just wants to stay in the game
and, um, keep up their activity levels, play
with their kids, whatever the case is.
Um, some examples of this,
specifically platelet rich plasma, um, is one
that receives a lot of attention,
but also some of the, um, up
and comers are bone marrow mesenchymal aspirate concentrate,
which is known as bmac, as well
as micronized fat or lip aspirate.
The latter of these two are considered stem cells. Okay?
Um, these tissues are harvested from
potential donor sites like drawing blood with PRP,
doing a bone marrow harvest from the hip or the bone for,
or hip or leg bone for bmac,
and then aspirating fat from the abdomen or flank region.
Um, and then you're injecting
that into the target area, right?
To try to activate the body's natural inflammatory cascade
to either restart the healing process, promote growth,
or, or both of these things.
Um, the, the data that's already out there,
the safety data is robust and, and compelling.
The, um, early data is robust,
but, you know, there, there's just
a little bit of bias out there.
'cause a lot of the studies are done
by the industry that makes a product.
So that always puts an asterisk in people's mind.
I'm excited for all the research
that's developing in this area.
Personally, I've seen a lot of success
with it in my patients.
I do. All of the procedures that I mentioned,
it's been a game changer, not just for my athletes,
but my weekend warriors too, who are in their forties
and fifties, have some mild to moderate, um,
arthritis from prior injuries
and just want to keep that active lifestyle.
You know, it's exciting
because, um, of the success I'm seeing now,
the concerns I have in this same vein, um, are also related
to some of the bad actors in the space.
There's people out there promoting
that they're doing quote unquote stem cells when they're
actually not, they're, they're using amniotic fluid products
or, um, different, uh, variations thereof
or other products that, that aren't necessarily regulated
by the FDA as well as, um, some, some
of these clinicians aren't, uh,
actual physicians doing the procedures and, um, and or, um,
or advanced practitioners.
Um, they're, they're just in a different field altogether.
Um, so, you know, concerns for people who are charging,
you know, tens of thousands of dollars
and creating all this marketing campaigns and,
and people are dipping in their 4 0 1 ks and,
and paying all this money, um, where they're,
they might not be getting exactly what they say they are.
So, you know, I, I, I'd I'd recommend for folks
who are considering any of these procedures
to do your homework and know what you're getting, why,
and the reality of what's happening with these procedures
and not, um, just listening to the, um,
the snake oral salesman
who might be lurking around the corner.
- That's such a great point,
and certainly, you know, fascinating to see some
of the different developments on the sports medicine space.
Um, like you mentioned, some of the things
that are actually, um, science-based and in fact-based
and have a really great, um, literature behind them to show
that they're forwarding the field in comparing
that into something that, you know,
really is more hype in marketing dollars.
Um, it, it just really seems like there is a lot
of opportunity for, um, improving patient care,
but then to try and educate patients
and understand that, you know,
not everything they hear about is gonna be,
um, beneficial for them.
And some things can actually be hurtful
from your standpoint when you're working with athletes
and trying to help them decipher
what the next step in their care is gonna be.
Um, what are those conversations usually like?
How do you really make sure that you are partnering
with them to help them achieve their goals
and then, you know, really looking ahead to, um, what,
what is gonna be most helpful
for them in different types of treatments?
- Yeah. Whenever I'm dealing with an athlete
who has a specific injury, I, I try to one, just be,
you know, open to all, all avenues of treatment
and I try to be complete, right?
So there's always a lot,
there's always more than one option, okay?
So that, that's the complex portion.
Uh, the complex part of this is, um, you talk
to five different, um, physicians
or providers, you might get five different
approaches to the same problem.
I try to incorporate my athletes', um, opinions
and, um, decision-making into it, you know, in,
in a model called shared decision making.
I give them the information about
what's going on with their body.
I tell them, Hey, you know, based on my,
based on your history, my observation of the actual injury
or watching a video of it
or whatever, you know, um, your exam findings as well
as the imaging that we may have ordered, including MRIs,
ultrasounds, lab work, whatever.
Here's my understanding of what's going on, right?
So here's your actual diagnosis.
Now here's everything that can be done about it.
Now, some of those things may be conservative, some
of those things may be middle of the road
and include, um, different types of injections, some
of which, like I mentioned
before, um, could be a standard corticosteroid injection.
It could be different medications.
There could be surgery required or optional, right?
And there might be several different surgical approaches
to the, the same problem, right?
So I try to actually educate the athlete on all of the,
those options and let them let
that kind of resonate with them for a minute.
Oftentimes, based on their own personal values,
they might have a, one of those areas that
sits better with them than others.
Um, or sometimes they just say, you know,
Hey doc, I trust you.
I really want your opinion.
What would you do in this scenario?
And then I give 'em that opinion.
But I, I try to really incorporate their, their values in
what we want to do, um, to best treat them
and get them back on the field.
'cause at the end of the day, I think every athlete just
wants to be able to perform.
Um, that's my goal is to help 'em get, get back out there,
perform, do what's best for themselves to get,
get 'em back out there quickly.
But, you know, I also try to prep them like, Hey,
we could do this and it might get you out there faster,
but at the same time, here's what you may have
to deal with long term.
If we continue to do, you know,
things like repetitive corticosteroid injections
or if we continue to ignore this ruptured ligament
that you may suffer from some arthritic changes over the
road, uh, down the road,
or, you know, here's what's okay to play through
and here's what's not okay to play through, you know, I kind
of ge try to guide them in that role.
- That's fascinating to hear.
Well, before we wrap up our conversation,
I know you mentioned you work with, um, training physicians
and in early career physicians focused on sports medicine.
So I was wondering if you could talk about what it's like
to care for an elite athlete as a team physician,
and what advice do you have
for those early career physicians who want
to follow the same path?
- One, it's truly a blessing to be able to work
with like high level athletes, elite athletes.
I take care of, um, UNC Charlotte, like I mentioned,
you know, I'm, I'm fortunate enough that some
of my colleagues who work with, uh, the Panthers
and the Charlotte FC have referred me those athletes in
helping get them back on the, the field sooner, sometimes
with orthobiologics or other endeavors and things like that.
It, it's an honor and a blessing to be able to work with,
you know, the folks we're watching on Saturdays
and Sundays with that, you know, not to quote Spider-Man,
but I'm gonna do it anyway with great, um,
power comes great responsibility, right?
So you have to, while it's a privilege, you have
to take it seriously and you have to do your due diligence.
One, I'd say, um, be vigilant when you're on the sidelines
to my younger colleagues who are just getting into the game
or, um, or interested in the future
of it, put your phones away.
You can't treat what you didn't see,
especially on high velocity plays like kick returns when
players reach top speeds, have a good understanding
of what's the worst thing that can happen.
For instance, there's a, there was a death in a, um,
hockey player who was a former Pittsburgh penguin.
I, I say this 'cause I'm from Pittsburgh
and a big, big fan of Pittsburgh sports in general.
Unfortunately, he caught a blade to the throat from, uh, uh,
from somebody's skate and died from the injury.
Um, now that's a hard thing to predict or prevent,
but being aware of all potential
catastrophic things that can happen in your sport, whether
that's boxing, whether that's hockey, whether
that's gym gymnastics, whether that's, uh, football,
you just kind of gotta know what's the worst thing
that can happen and kind of have a game plan as far
as far as what you're gonna do.
Now you can have all the best intentions,
all the best training, and still have some unfortunate
circumstances like that one.
But doing things like making sure your a ED works prior
to every game, you know, checking that, making sure
that it's out and, and accessible.
So if you have any of the events like we saw
with DeMar Hamlin, you can respond appropriately
and potentially save a life.
Finally, the one
of the last things I'd say is put your egos in check,
because at the elite level,
these folks are receiving usually five
or six opinions, right?
You may be one of a host
of opinions that people are getting.
Be honest with your athletes. Gain their trust.
Don't be upset if they're getting multiple opinions from
other specialists, providers, anywhere else.
Um, and, and don't be expected to be the team doc in the NFL
or MLS or right out of the gates or, or Division one school.
Just put in your time, grow your reputation
and do what's best for athletes.
And people notice, right?
So, um, athletes talk, coaches talk and, and,
and that, that's a great way to just do your job
and good things will happen.
- I love it. Well, thank you so much
for joining me on the podcast today.
This has been really a fun and fascinating conversation,
and I look forward to
connecting with you again in the future.
- Thanks so much for your time.
I appreciate the opportunity.
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