The Sports Physical Therapy Podcast
The Sports Physical Therapy Podcast
Managing Injury Risk and High Performance in Baseball with Chris Camp - Episode 31
Full show notes: https://mikereinold.com/managing-injury-risk-and-high-performance-in-baseball-with-chris-camp
Want to learn more from me? I have a variety of online courses on my website!
Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.
_____
Want to learn more? Check out my blog, podcasts, and online courses
Follow me: Instagram | Twitter | Facebook | Youtube
On this episode of the sport physical therapy podcast, I'm joined by Dr. Chris camp. Dr. Camp is an orthopedic surgeon at the Mayo clinic in Rochester, Minnesota, and is the medical director and director of high performance for the Minnesota twins. Dr. Camp's a prolific researcher in the field of baseball injuries with an enormous amount of publications. And this episode, we're going to talk about building a high performance team and professional baseball. And how we can predict and mitigate injury risk, and then some of the trends in injuries that he's seeing in baseball.
Mike:Hey Dr. Kemp. Thanks so much for joining us on the podcast today. Really appreciate you, uh, taking some time outta your, uh, I'm sure hectic schedule is you're getting ready for the baseball season. But thanks so much for joining us.
Chris:You got it. Mike. Thanks so much for having me. It's a, it's an honor and a pleasure to be here.
Mike:That's awesome. Um, I, I recently had an episode with Dr. Brandon Erickson, and I had a very similar introduction with him where I said, gosh, we could, we, I don't know how you do this much research in baseball injuries, and we could talk about about a thousand things. But we are super thankful for all you're doing because you've really helped us understand baseball injuries so much more with just your, your mounds and mounds of research that you guys published. So thank you for all that you do.
Chris:Oh, you got it. I l love to do it. And obviously, you know, Brandon and I are good friends. We work together on a lot of things too, and he and I share a similar passion. You know, there's a, we, we've got a lot to figure out. Um, and I, we feel like we're just getting started. We're just sort of hitting the tip of the iceberg. So very excited about what we've done so far, and even more excited about what lies in the future.
Mike:Do you ever look at the research and think to yourself that, wow, like we, we feel like we're advancing ourselves, but the more we dig into it, the more we realize that injury rates just keep going up and up and up and we're, we're ultimately failing, right?
Chris:No question. And that, that's one of the funny things about research too, is I always tell folks if you, if you do a really good job designing a, a study and you conduct that study, it gives you an answer to a question. And then it gives you three more questions. And so I, I feel like we are learning more, but we're also learning more. We're also learning how much we don't know. The more, the more of this we do too. So there, there's a lot of, uh, job security in it for sure.
Mike:Yeah. You know, and I, I think you said that really well too. If you even just look at y you know yourself and others, but you know the history of some of the data that we're getting from Major League baseball injuries, we're seeing it progress from like broad strokes. Like, you know, you know, demographic, uh, epidemiology type things based on, you know, simple demographics and stuff like that, um, to now getting more specifics. So I, I think you're right. I think over time we are getting more and more out of all this data that hopefully continues to make progress, but we'll see. Right.
Chris:Yeah, absolutely. And I think you always have to start with the. So you, you always wanna ask what's going on out there? What, what are the injuries? What's really happening? What is impacting players? And, and that's sort of what the, the first phase or wave of the MLB research has done for us. It's kind of told, told us what's happening, uh, now the next question we have to start asking is why. And, and then we have to ask how do we fix it? So tho those are the harder questions that are, that are coming up for.
Mike:Well, you, you, uh, what I'm excited about is that people like yourself are behind these, uh, endeavors in the future because, I mean, we, we've seen this in the past when, when all you see is injured baseball players. Then sometimes it skews your perspective a little bit. And what I like about yourself now you're, you know, you're currently the director of high performance, the medical director of for the twins, right? So you are not just seeing injured players, you're seeing healthy players, and you're seeing players that not only wanna prevent injury, but want to enhance performance. Right? So, you know that perspective to me, I. Gives you a, a, a better, a better approach to your projects. Right. And I think we're starting to see that when, when you start publishing things that, you know, I can see that at least where, where you're coming from.
Chris:Yeah, that, that's a great thought, Mike and I, and I think it's true. I think for all of these problems, the the solutions are gonna lie in. Bringing together people who have broad perspectives. Each one of us sort of has our own biases and ways of looking at things and our own past experience that shapes and mold us. And because of that, no one person has all of the answers. And, and so I think to figure out these relatively complex things, we've got to bring together people from. Diverse backgrounds, experiences, diverse ways of looking at things because we, we sort of need to look at these problems from a 360 degree view all, all the way around, and that's the only way we're really gonna be able to make any serious headway on
Mike:I like that and, and it really sounds like that is what you put behind your current. Role with the twins. Um, and you know, I, I, I, I like your title. I thought that was nice too, because most orthopedic surgeons are either team physicians or maybe they're, uh, you know, head surgeon or medical director, but you added director of high performance to that. And I think that speaks volumes about probably what yourself and the organization are thinking about our department now. It's not just health, but also performance. Um, tell us a little bit about that role that you play with the.
Chris:Yeah, absolutely. So, so I think most people are sort of familiar with the team physician role, um, covering games, taking care of injuries that they come up, and also sort of familiar with the medical director role. So trying to make medical decisions about injuries and illnesses across the organization. But the. The high performance role I, I think, is a little bit unique, uh, for us ev Most teams now have some sort of. Director of Sports Science or, you know, some, something along those lines. But with this, what we've put together in, uh, this role of director of high performance is really something that we have been thinking about for several years. Uh, myself and some of the folks in the front office, Derek Fowley, FA Levine, about how we could really shape the, the entire department. And for us, what we define as the, the High Performance Group is not just folks in. Um, not, not just the physicians, but also our athletic trainers, our physical therapists, strength and conditioning. Our dieticians and nutritionists massage the. Uh, sleep hygiene folks, mental skills, sports psychology, chiropractors, sort of everybody in in that group. And, and it's a, it's a big group. It's a diverse group. We all have a different way of looking at things, but ultimately we need to, to try to unify our, our vision, and that's kind of how we see that. In. In addition to that, we're also starting to bring in more of the, the sports size people, the research and analytics, uh, into that same space as well. And I think for any of us to be successful in this area, we have to recognize that no one person has all of the answers. Um, no matter how good you are, how much you've done, or what your experience is, you, you're still very limited. And me as an orthopedic surgeon, I, I could spend the rest of my life, you know, studying and I still wouldn't be nearly as good as our strength and conditioning coaches that have already been doing it for so many years. Right. And so I can't pretend to have domain expertise in that area. Um, even if I think I really like it and I pay a lot of attention to it, and I, and I study it extensively, same thing. You know, I can't. Even begin to imagine having domain expertise in the, in the world of sports psychology. I, I know a little bit about it. I'm interested in it. I think it's critically important, but I'm not an expert in it. And so really in that role, I, I sort of view myself as kind of a coordinator of experts and, and that's really how we've tried to shape it, um, with, with the twins organization. So it's, it's not one person who's, uh, completely in charge. We're a team of equals, everybody's sort of on the same page, the same level. Uh, there's sort of minimal. Hierarchy to it. Everybody has a seat at the table. Um, and we care about what everybody thinks. And, and I think that taking an approach like that is definitely difficult at times. Um, it's a little bit counterculture. To a lot of organizations and baseball in general. So it, it's definitely different, but I think that it is, it, it's worth doing it. It certainly comes with some, some nuanced, uh, headaches and, and, uh, problems, but I think that those are all worth having and worth sorting through because if we're ever, if we're ever gonna get it, we're gonna have to get it together and we're gonna have to go collectively as a team.
Mike:That's awesome and, and totally refreshing to hear, um, what, what I like more than anything else was just listening to that from your perspective. To me is this is what makes you a great team physician. Right? And, and not every doctor is the best. And just like, not every, any profession is, is great, but the understanding of the role of a team physician, it's not a dictatorship. It's not an ego trip thing. It's, it's, it is about being there for the players and being there for leadership. Um, I, I just think the way you said that was, So excellent that, um, I really hope a lot of people get to, uh, you know, experience working with a, a physician like yourself in this environment because that's exactly what we need, right? We are, we're evolving as a game. We're evolving as all these interdisciplinary people like work together and, and it's oppressive thing that you guys are building with the twins, we put all those people together. It wasn't that long ago that a a, a big. Medical staff was a head trainer and assistant trainer and one strength coach. And that's it. That was, and I'm talking about like single digit years ago, right? Like that wasn't, that wasn't decades ago. Right. And look at how much you guys have built. So when you started with the twins, where, what was, what did the department look like and what does it look like now? I know you kind of alluded to like all those different people, but how have you seen that grow? And the reason why I ask that is because I think a lot of my listeners are very eager to get into pro sports, and I like how there's so many different avenues now to get there. It's not just, oh, you have to be an athletic trainer. There's, there's 10 different professions that you just listed right there that can get in there. But tell us a little bit about the evolution of the twins, because I think we're gonna start seeing that more and more with other.
Chris:Mm-hmm. Yeah. So, and that's a great thought and, and I think our evolution has probably mirrored that of a lot of other organizations in that, you know, let's say five years ago we had components of strength and conditioning and. Athletic training, physical therapy, nutrition, a little bit of sports, psych and mental wellness. We, we sort of had all of those components, um, some of them more robust than others. And so I, I think that our biggest evolution has, has not necessarily been adding new domains to the team, but actually expanding. Each of those domains and collectively bringing them together. That's it. So, so we now have, we've always, we, you know, we've had strength and conditioning for a while. We now have more strength and conditioning coaches.
Mike:Right.
Chris:We've also sort of changed the structure and the hierarchy with within the, the strength and conditioning area and within the physical therapy space and, um, and, and in all of our spaces, um, to create, to create a system where there's a lot more coordination within that domain and across all of the other domains and in collaboration. So I think our biggest evolution has not just been growing in numbers and size. But more so growing in collaboration and making sure that everybody understands what everybody else is doing, what they're capable of, what their skill sets are, where their shortcomings are, you know, how we can help them make up for those and, and those sort of things that that's been the biggest focus of our evolution over the last several years.
Mike:That's fantastic. And, and I, I, I like that progression. That's something that, um, I've been trying to build with the White Sox myself. Too. I mean, we're al Central competitors here. We shouldn't be giving each other secrets maybe. But, uh, it's, uh, the, um, uh, you know, the concept of a leadership tree, and I think that's exactly what you just, you know, provided a framework for right there. It's the same thing, but is that we have a bunch of peers. That are all within leadership, right? It's not a dictatorship. It's not like one person type thing. It's about how do we put all our heads together and how do we collaborate and how do we leave a room where we're planning on something? Anything a a, a strength and conditioning program, a a prep work. Program, a rehab program for one player, how do we leave that room in unison where everybody's had a chance to talk about it? Everybody's had a chance to voice their perspective, which, which often changes the overall program. Um, it's, it's really, really awesome to kind of hear that and see that. And I have a lot of friends that have come through the twins organization that speak really highly of it. So, um, you know, again, kudos to you for, for seeing this and for, you know, emulating this for some of the peers that you've worked with around the league. Um, it, it just sounds like you guys are doing a great.
Chris:Good. Well, we're enjoying it. And you know, we're, we're seeing some, um, some dividends pay off too, so it's been great. We're gonna keep at it. It's obviously, it's a lot of hard work. It's anytime you're changing, you know, the culture of, of baseball. With an organization can, it can be difficult. But, uh, it has been very good. We've made some tremendous progress, so we're, we're excited about where we're at now and where we're headed in the future.
Mike:That's awesome. That's awesome. And it, and it helps that you have a great front office and you have a great manager. Right? A modern think manager. I mean, it's, um, it's, it's it's support, right? That's, that's what you need in your role is support from everybody, from field staff, from front office, from data analytics. It's, it's, that's what, what's the glue that keeps everything together? Is that everybody's on the same page.
Chris:A hundred percent. And, and that's a lot of what we're trying to do is, you know, we're breaking down silos not only within the performance space, but also within the whole organization. So we we're very blessed in our organization in that we do, we have a front office that sort of believes in this model. We have a manager that believes in this model, and I think part of our job, in the performance space is that we have to reflect the culture of the other areas in the clubhouse. So a player needs to be able to flow freely from the dugout to the clubhouse or locker room, into the weight room, into the athletic training room. With that same sort of feeling, that same sort of culture, that same sort of vibe, that same energy in all of those spaces. You don't want'em to all of a sudden come into the athletic training room and think, oh no, this, this is where I have. Do X, Y, Z or I gotta change my behavior in this space, or I gotta act a certain way in this spaces. Now we, we want the whole thing to sort of have the same, same feel and vibe. And I think that's really critical for our players in order to be comfortable to understand what we're doing to buy into the programming that we have. And you can't do that without a supportive coaching staff, front office staff and players, uh, to be honest. And we're, we're blessed to have all of those.
Mike:Sure. And, and great leadership from yourself too. I mean, to give yourself some, some credit here, it's, it's putting that glue together as well. So, um, um, great stuff. Um, one of the biggest roles that these departments play, right, is in risk. Mitigation, right. Injury prevention, injury prediction. Even. Um, you know, some people refer to this, you know, 20 years ago, you know, uh, you know, we, we were talking about this as the money ball for, for medical, right? Where we started taking data and trying to, to, you know, predict and prevent injuries. Um, what, what do you think the role of your department is for injury prediction in risk management? Not, not just prevention, but prediction. How have you guys worked towards.
Chris:Yeah, that, that's a, that's a great question. And honestly, you know, it's part of the, part of the holy grail. It's, it's complex, it's difficult, but in reality, one of the things I've always talked about is if you look at our research and analytics team, I think this is the same. This is true of every organization. They do a phenomenal job of predicting on field performance of players. They have a pretty good idea. It's never perfect, but they, with some reasonable accuracy, can predict the number of wins. A team will have the predicted war of this player, that player wins losses, starts batting at those sort of things. They, and they do a remarkably good job. It's never perfect, but it's pretty good. And so one of the questions I've been asking myself is, why can't we do the same thing? Health and injuries. You know, why, why can't we? And we haven't been that great at it in the past, but I think we can be. I, I, I really do. I I truly confidently, uh, believe that that is the case and we're gonna get there. Um, but it's not easy. And, and I think in, in my mind, there's, there's really probably. Five major steps that we have to take in order to start talking about risk, uh, our injury, risk prediction and mitigation. And I think number one, we have to first define the problem. Uh, and we've been spending a lot of years doing that, sort of identifying what are the big injuries? What are we actually missing out on? And then second, I think we have to think about once, once we identify the. We have to recognize which of those problems we can actually influence. You know, there are certain injuries that we probably will never control. Um, liner comebacker to the pitcher, hits'em in the auto fractures. You, you can't predict that. You can't control that. Don't waste your time, you know, on that. So, so figure out which, which of the injuries can you actually influence and. Once you do that, the, the third step is sort of identifying all of the factors that contribute to that injury, which is difficult, and that, that sort of takes that approach across all of the different domains. Um, and I, and I think that's very complex and very quickly you start running into a lot of information and a lot of data because, you know, some of the things that contribute are prob their, their movement patterns, their strength, their diet, their sleep, their workload. um, their overall performance, their running speed. I mean, all of these sort of things contribute. So you sort of have to figure out all the factors that contribute. And then once you do that, fourth, you have to figure out which one of those you can intervene on and modify. And I think that has to really be individualized to the player. Um, because some players you can modify certain things or intervene on certain things. Other players, they, you may not be able to modify that. Or if you do, Lowers their competitive balance and you know, that's not something they're willing to do. So you sort of have to identify those factors and actually intervene. And then the fifth and final thing I think that we have to do is that we have to continue to measure our progress and then adjust. So, you know, you, you go through all of these steps and you say, okay, did we actually make a difference here with this, with the injury? We identified the steps they contributed to at the interventions we interact, we. Now, did it work? What, what's the difference? And if so, great. Now how can we incorporate this into the normal routine? If not, let's go back to the drawing board, try it again. And, and it's sort of that five step iterative process that you just have to keep going through, over and over and over again, um, to infinity really, to, to try to figure it out.
Mike:And, and just when you think you've, you've figured something out. You, the unexplainable happens. The, uh, extra inning game, the, the. West Coast Road trip, although that's not as exciting for the Al Central as it was for the AL East. But there's, you know, there, I don't, I, I try to tell people this all the time, but some people don't realize this. You know, we play, I, I, what is it, 162 games in 180 days. And I try to explain to people like, you wake up, you go to work, you come home, you know, you turn on the twins game. great. You know? Then next day, you know, you wake up, you go to work, you come home, you turn on the twins games, like, wait a minute, now they're, now they're in Tampa. How'd they get to Tampa? Like, like, like how, how'd that happen? Be like, people don't, people don't appreciate the stresses that go into the body here, and when you have to play every. Day, like every single day. It's, it's super challenging because the players, if, if they're not performing well, they, they wanna practice more. They wanna take extra reps in the cage, they want to throw more in the pen. And that's almost like the, that fine balance between workload and capacity that they're dealing with at all times over the year. That like we can do as best as we can. And then you just get thrown such a curve ball. You can't control everything. It's frustra.
Chris:It, it's extremely frustrating and we, we've all seen that too. You know, you, you get the player that you know needs some, some rest and you show you try to work, give him a day off. Then you go in the weight room and you find I'm just crushing the weights for three hours. Like, it, it would've been less work had you played today. You know, this was not difficult. So, yeah, it, it is tough and, and also too, The other thing that's hard is that if you look across injuries, uh, as the entire professional baseball world, you know, that's about 7,000 or so players. So you have a pretty large denominator to look at injury trends and things. If you look at it within a single team or just within a major league, an active major league roster with 26 or so players, it's a really small sample size. And so having that small sample size makes it difficult to know when I see injuries, you know, ticking up. Is this a true trend? or is this just random randomness? Because we have such a small denominator, it, it does make the, the comparisons are pretty fragile, so you have to be really careful not to overread, um, into negative trends or give yourself too much credit if things go well. You know, because
Mike:that's, that's great.
Chris:every year, I mean, sometimes you're just a couple of injuries, one to two injuries. From having a terrible injury ridden season versus the best season you've had in years. So it's such a fine balance and we have to be very objective about how much of that we actually control to the positive and the negative in, in both directions, which I think also makes this more complicated and complex.
Mike:That. Absolutely. So in your position, in, in your research, you've done a lot about, um, tracking trends. In injuries in baseball, and I could say over my almost 25 year career right now, the, the injuries that I was seeing in the first half of my career are different than the injuries I'm seeing now in my second half of my career. Uh, it's almost like the games evolved. The the players have evolved, their practice patterns have evolved and their injuries are, uh, evolving with. And you know, it's, it's funny when, when you see that, because you still see some outdated things based on some of the, the information we had 20 years ago. Uh, but I'm curious from your perspective, somebody that's not only on the inside every day with the team, which is an amazing resource for your own knowledge, um, that I'm sure you appreciate, but like, don't ever take for granted that you. Best Petri dish in the world is those 300 baseball players that you take care of. Right. But, um, uh, in your perspective between that and the data collection that you're seeing from Major League Baseball, what are some of the, the, the trends that you're seeing, some of the things that are evolving, what are we, what do you think we might start seeing more of? I, I'd love to just, you know, you know, and I hate to give you such a crazy vague, open-ended question, but let's, let's start chatting
Chris:Yeah, absolutely. So, uh, that's a great question and I think there's a lot of different ways we could take this. And I mean, one of the most interesting and obviously the most sort of publicized, um, injury trends that we see is that of Tommy John injuries or, you know, media honor, collateral ligament injuries. And for years and years we've just talked about, oh, rates are going up, going up, going up, going up. But I think we're at a spot now. It's a little more complicated than that. And, and actually if we look within the last few years, what we've seen is we've actually seen a slightly lower frequency in Major League players with Tommy John injury, which is great. And there's a tendency to stop and say, Hey, we're doing a good job. Let's pat ourselves on the back. We've
Mike:Right,
Chris:thing out.
Mike:right.
Chris:there's even, there's been a few And, and there's even been a few articles that have been printed to that effect. But then if we really look at the data, what we see is, Although Major League, Tommy, John injuries are going down the minor league, injury rates are going sky high.
Mike:Enormously Enor, and that's one of my favorite graphs that you show. That, that I've, I've used that. Stan, let me borrow one of your graphs, I'm sure. But, um, like omg, we talk about this Tommy John injury. Epidemic, right. That, that, that we have in major league baseball and it's nothing compared to the lower levels, minor league baseball. And heck, I, I, from my perspective of what I see in my practice college in high school, it's the same thing. They're going crazy. So it's funny you said that, that, you know, we, we pat ourself on the back for a hot second there about Major League, but it's just that they're happening earlier.
Chris:Yes, exactly. And that, and that's what's happened. So they're getting shifted to younger ages, whether that's minor league college, and now even starting to be in the high school. And what I worry about with that is that as those. The rates of primary Tommy John surgeries and first time Tommy John injuries starts to shift down to the younger players. If in response to that on the back end with the major league players, we're gonna start to see an uptick in the number of secondary Tommy John injuries or revision Tommy John
Mike:Sure.
Chris:So I think we're already starting to see that now. Where? Where, yeah, the number of primary surgeries is. Probably down in the major leagues, but the number of revisions are ticking up and that's because now guys are not having their first Tommy John as a major leaguer. They're having it as a minor leaguer or a college or even a high school athlete.
Mike:Yeah. Wow.
Chris:it's becoming revision time by the time they get to the leagues. So I, I think that is something that we're probably going to see and then that opens up a whole nother can of worms is how do we, how do we handle these revision cases, which we know are a little bit tougher and harder to rehab and less predictable? And so I think this problem's gonna get harder before it gets easier.
Mike:And I remember too, we used to say that, uh, Tommy John lasts like 10 years, right? And we were doing them in 32 year olds, right? That that was, that was 20 years ago. And we'd say like, nah, this will, this will last longer than your career. Then we started saying, okay, maybe they last like seven or eight years, and now we're like, okay, maybe they last like. Five years Right. So it's, it's like they're even trending that way. But you know what, I think we're at a really great spot though for this to occur because we have some options now, right? We have the new internal brace with the repair, um, even some hybrid techniques and know you and I have, we've shared patients that have had a revision with, with the internal brace that are still doing outstanding several years later. So, um, where do you see that evolving? Where do you see that coming into?
Chris:Yeah. And, and I think that this is an area that is ripe, uh, for, for some advancement. You know, if you, if you think about the most common surgical techniques for Tommy John's surgery are the, uh, figure of eight of the modified job technique and the docking technique. And both of those were described in the early two thousands. 2001, 2002. So almost 20 years. And not a ton has changed, and there's hardly anything in orthopedic surgery that we're doing the same now that we were doing 20 years ago.
Mike:That's a good point.
Chris:but this, that has been the case for that surgery. And that's, and it's not from a lack of trying. People have tried, there's all sorts of different techniques that have been described out there that just didn't quite pan out. Nobody's really been able to figure, figure out what the next level is. And then in recent years, we've introduced the concept of the internal brace, um, which has been really helpful, particularly for milder injuries that are suitable for just a repair. So that's when we repair. The native ligament back down and we don't add a new ligament. Um, and adding the internal brace to that adds some biomechanical strength, makes it a little bit stronger, and then seems to allow those repairs to do well. The repair, when we were doing just repairs without the internal brace, they didn't do so well, but then we added the internal brace, which gave a little bit more biomechanical strength. Those seem to be, that seem to be a pretty reasonable surgery, um, for people who are candidates and a little faster return to play times. We don't know the long-term outcomes in terms of longevity yet, but overall it's looking pretty good.
Mike:Mm-hmm.
Chris:the problem is not everybody's a candidate for, for the repair. You know, guys that have massive tears, chronic attenuation, tears at multiple sites of the ligament, which to be honest, by the time they're getting up in the minor league, major league type level, that's usually what these look like. You know, they, they look like. Pretty beat up low quality ligaments. So I do still think there's room and need for some innovation in the reconstruction space, which is reconstruction, which is what we think of as traditional Tommy John, when you're actually adding a ligament in that, that we do need to evolve there. And I think that adding the internal brace to those reconstructions, what a few of us are starting to do now, and we're seeing some promising results.
Mike:That's.
Chris:And, and I think that, that, that is sort of the current status of things. People are finding that, yes, if there's a way to reliably add an intern brace to a reconstruction, that seems to help. What I think though, is gonna be the next big breakthrough, and some of the things that we're working on is. improving the biomechanical strength with addition of an internal brace. But what we really need to think about is also improving the biology of the construct and the surgical technique to improve the healing rate. And it gets really complicated really quickly. But I think that. In order to have something that's successful, that allows for a quick return to play time, number one, and number two is robust for the long haul. We need to marry both the biomechanical strength and the biological activity, and if we can find the way or find the, the reconstruction technique that best optimizes both biomechanical. and the biology for healing, that's when we're really gonna be able to make some, some inroads in improving these return to play, uh, times and lowering revision rates. Um, and there's several of us that are working on that. We, we have some, uh, I've been doing a, a newer technique now for the last three years, um, which, which does that, and I'm really excited about it. We're gonna be publishing that. Uh, this year. So I, I think that there's, there's a lot of exciting things coming down the pike for, uh, for UCL reconstruction that I think could be some potential game changers for us.
Mike:That's great. That's great. And, and I do think we're, we're probably gonna have to take a step back from our perspective, from the rehab perspective too, and reanalyze a little bit of our, our rehab procedures as we start to transition to the hybrid. Um, you know, but. My limited experience with these hybrid reconstructions are, you know, they're, they're a little tighter. Um, they, they feel tighter with range of motion. We don't want'em to lose motion. And, and they almost have this, um, you know, this, this, this tightness period in the throwing program that so far is resolved and every, you know, people are doing great, but it's different, right. And, you know, I've, I've seen so many of these that I know what to expect. So when somebody's like, ah, I just. Tight and they point like almost to like, like the proximal end of their ligament. And you're like, oh, ah, we'll just, we'll, we'll ignore that. right?
Chris:Right. Yes.
Mike:But, but you know, for us, we're, I think we're gonna have to start, uh, I think we have to do the same thing. We have to evolve our thoughts and our techniques as, as we see new, new surgical improvements from yourself. So, um, that's, that. That's awesome. Um, what else, what else besides, uh, elbow, what else are you.
Chris:You know, one of the things that I think is interesting and it we're gonna find as a big contributor to, um, injury risk and trends is that we are starting to measure more things. That players can follow. So, lemme lemme explain that. So obviously pitch velocity has been measured forever and there's always been a metric of success for baseball players, whether you're little league, high school, college pro, that's something easy to look at. You know, it translates to success and everybody is sort of obsessed with pitch velocity and that has probably, um, driven some of the entry trends that we've. Now we're starting to do some similar things in other areas, uh, of the sport. So now any high school player or college player has access to, to different labs and, uh, facilities they can go into and they can get their exit velocity for a hitter or they can get their sprint speed and, and I think, and they can get spin rates and, and so I. These metrics are incredibly helpful for us in improving performance and predicting performance, but they're also gonna start to give us values. That players, coaches and other, and parents will chase. And if they start to chase those things similar to how they've chased pitch velocity, I think that that will probably be driving some injuries, uh, for some of these athletes. So I think that, and, and some of this will be other soft tissue injuries that we see in hitters. Some shoulder injuries. We know, you know, there's a lot of force in the shoulder during the swing. A lot of rota rotational components to this. So BLE type injuries, hip injuries, low back injuries. So I think we're gonna see all of those start to evolve as we start to give hitters numbers that they can chase, just like pitchers that have been chasing velocity, uh, for many years.
Mike:And, and I, I, I couldn't agree more. I would say the last two, three years I've seen an uptick again of, of, you know, what we call batter shoulder. But it's, you know, y you know, there's, I guess, numerous ways you could define that, but it's, um, you know, that that posterior instability of, of the shoulder and, and. You know, at, at, you know, in my head I'm trying to figure out, okay, what, why is this ticking up a little bit? And we, we do see it in aggressive fielders, right? So like middle in fielders, center field, you know, that probably have a history of diving and subluxations and stuff like that. Um, but then you look at. All of these kids, like you just come to my facility any evening at 5:00 PM and look at all the kids Then in the winter that are just working on max intent, exit velocity and launch angle and just like grinding, grinding, grinding, uh, you know, on top of, of, of fielding. And, and it's, it's interesting to see. So, um, have you noticed that at your level? I, I have started seeing it in our pro guys too. Um, but how, how much of this batter shoulder. Is, is this just in my hands? Is this a New England thing or are you guys seeing that too?
Chris:We're, we're seeing it, and honestly, it's, it's sort of following similar experience to Tommy John. Uh, you know, we're, we're starting, we, we've always known about it in high level hitters and professional hitters, but I'm, I'm seeing it in college hitters and I'm seeing it in high school hitters, and I'm even seeing it in some youth. I've, I've had some 12, 13, 14 year old, uh, kids enter their shoulders while batting, and so it's definitely, it's starting to, to trickle up and we're starting to see more.
Mike:That's, that's, I, um, I'm glad you brought that up because, you know, we, we always talk about pitching injuries, right. And I feel like the position players don't get enough. But, um, you know, I, I'm definitely seeing batter shoulders. Uh, uh, what, what else in position players, you know, I, I know the data shows, you know, hamstrings, obliques, huge. Um, are you seeing any trends in that? Are we getting better at hamstrings?
Chris:Yeah, I think so. It's starting to look like it, so we're actually looking up the MLB data again, uh, just to see how it's going. But it, it seems like we're starting to do that, you know, especially at the, at the higher levels in the, in the major league levels. Interestingly enough, if you. If you look back at some of the older data, the, the most common, uh, position for hamstring injury was pitcher and the most common mechanism was sprinting to first base. And so you gotta wonder, you know, going to universal DH may help that, honestly. Um, so that, that may, you know, cause our hamstring numbers to go down. But I think people are getting tuned into it, whether it's doing different. Um, eccentrics or Nordic hamstring exercises are more sprinting, timing, uh, timing, gauge jumping, those type of things. People are getting clued into it. And, and honestly, I think the hamstring is sort of a great success story of what epidemiologic research can do for you. You identify, Hey, this is a common problem. In fact, it's the number one problem. Um, and it's not catastrophic. They're usually not season ending, but still, and these guys are missing three to four weeks on average for these types of injuries. And there's a lot of'em. Let's see if we can fix it. And then there are actual interventions you can take to try to improve hamstring plasticity and string and explosiveness and, and I, and I think it actually is making a difference. So I think that's one of the success stories, uh, that, that we're having. And now I think we're gonna see the same thing in other areas. You know, we know that oblique injur. Core abdominal abdominal muscle injury. So sort of the sports hernia, the abductor, the rectus, that whole area. Um, we're, we're seeing that very commonly. So I think those are probably going to be the next area that we're gonna really have to try to intervene on and, and reduce injury numbers for.
Mike:And call me crazy. Same thing as bad or shoulders. It's, it's probably because of the increased volume and intensity of swinging that, you know, we're getting in these sport hernia type like situations in low back and spies. I mean, we're, we're, you know, we're seeing the, the kids with the stress. Reactions. It's, it's crazy how much we're seeing these things nowadays. So, um, you know, uh, super interesting. Um, all right. Random question about this then. So hamstrings, obviously we're seeing ticking up a little bit. You still take hamstring graft for Tommy John's, or, or have you started to, uh, you know, is that, do you, do you care? Is that, is that something that crossed your mind? Do you try to go Polaris more or does that impact your decision?
Chris:That's a, that's a great question. I do my go-to graft, so I, I definitely prefer autograft over allograft for, for UCL surgery. So always, always, always, if possible, use the patient's own graft, uh, just because there's better handling properties, more biologically active, um, improved healing, all of those sort of things. So for me, the Paul Marris is still the go-to graft and the vast majority of players have a Paul Mar. Um, for that 10 to 15% that don't, then I will go to hamstring and typically the gracilis, which is the smallest of the hamstring tendons, there's some debate whether or not you should use the landing leg or push leg, and we've tried to study it. Don't really, you know, have, have a great answer. I tend to use the landing leg rather than the push off leg. But, um, we don't have any good data to support that. So Paul Meis is still a graft of choice for 90%, uh, but then ham hamstring for the rest. The thing that's interesting though is that oftentimes players are now coming in with a very strong bias to what they want. So they may say, wait, I know you did this guy's surgery and used a hamstring, and he's throwing. I want, I want to use my hamstring. And then you gotta sort of say, all right, let's back this up a little bit. Let's unpack and talk about that. Um, but in reality, if they have such a strong bias, you know, towards something, it can be often hard to overcome. So I am finding that more so than ever in the past, players actually have a bias towards what they want to use, which is important. You know, you wanna inform'em, ultimate's, everybody though, we, we've gotta, um, do do what they want, uh, but try to give'em all the information they need to make those decision.
Mike:That's funny. Uh, y y you know, we did the same thing with hamstrings and, and kind of our subset of people, and I would say with the pitchers, I, I feel like we get. Much, you know, lead leg is trail leg, hamstring injuries, to be honest. And, you know, that kind of, that, that impressed me a little bit too. I thought there would be more of a pattern, but it, it, it seems like they injure them both fairly frequently. Um, and I wonder again, if the next evolution in baseball pitching hamstrings here is, you know, all the biomechanical people, the pitching coaches, everybody's talking about lead leg block. Everybody's talking about this. And, you know, I, for, for us from the medical side, we've, we know what. Lead leg block is, and how it's a b biomechanical conclusion almost, right? But we, we literally now have kids like jamming their knee into hyperextension, trying to, trying to work on lead leg block instead of just getting their force of momentum over their front side. But, um, I, I wonder if that's gonna be, you know, one of those next things with, with the pitchers is the hamstrings on the, on their front side from just worrying too much about the wrong.
Chris:Yeah, I think, I think it's a great point and, and you bring up a, an interesting concept here, Mike, and I think, you know, we've seen how obsessed people have come become with velocity because it's a great predictor of performance or it correlates with performance. And I've always wondered, is there a way we can do the same thing for sound mechanics? So can we have some sort of numerical score or um, ability to grade or judge sound mechanics. That will reduce injury risk. And is there a way that we can make that measurable and appealing to our young athletes? You know, is there, is there a way we can start getting them to, they're always gonna chase velocity. We can't prevent that and that's okay. But can we also find some ways to get them to become obsessed with and start chasing. Sound mechanics, good strength, and, you know, good injury prevention principles, that's hard. You know, it's like teaching kids to eat vegetables. They don't wanna do it. It's gonna be tough. You gotta find a way to make it appealing. But I think that that is something that we need to be doing as a, as a, um, professional group.
Mike:Yeah. And, and it's funny though, you, you brought up the, the perceptions here, and I was just looking at this in a slide, but a study from cross last year in, in 2022 that talked about weighted balls and, um, uh, what, what was it? Uh, 86% of of people responding. Thought that weighted balls would increase their velocity, and 85% of them thought they would increase their injury risk, but they, they did it anyway.
Chris:Right. And, and we, we have to recognize that as medical providers, you know, we, we tend to be very, um, injury risk averse. Much more so than our players are. And that's okay because we're offering a unique perspective that they don't have. But we also have to recognize that if, if we just say, Hey, do you know these things are gonna increase? You know, such and such is gonna increase your risk of injury? They'll probably say, yeah, I don't care. I'm gonna do it anyway. And so we, we have to be prepared to understand that, have that conversation and, and meet'em in the middle and also recognize that. You know, some, except we all have to accept some risk of injury or we wouldn't be playing sports at all. And so we just have to sort of work through what our threshold is for injury risk and put and, and kind of marry that to the injury risk threshold of the player and try to get on the same page and help them and know that, you know, it's never gonna be exactly what we want. And it's never, maybe never fully what they want either, but we gotta try to work together to find that that happy medium, it gives them the balance of optimal performance and minimal injury risk.
Mike:Yeah, and I think I struggled with that a little bit earlier in my career where. you know, that I think that would bother me a little bit more. But man, I, I'm so much more humble about that whole experience with the players now, where I was like, look, I, I'm just here to educate you and then you hired me to help you. Right? That's how I kind of think of you, even though we're medical right? You, I, I'm here to help you. I, I'm not gonna also advise you. But I'm also gonna help you. Right? And that's the whole goal. And, and even within baseball, sometimes sport science gets that, that, you know, bad rap sometimes. Um, but it's, it's about maximizing your play between those white lines and not limiting it. Right? We're not trying to limit you, we're trying to get you as prepared as we can and get your capacity as high as we can. Um, and I think as a medical community, we have to embrace that more so that way we get better buy-in from, from everybody. Right. And, um, heck, I've, I've definitely. I'm probably labeled on Twitter as like a anti weighted ball kind of guy. And I'm not my, all my athletes like use weighted balls to, in extent, but we do it as, uh, intelligently as we can. Um, you know, just because our data showed some negativity doesn't mean that there isn't a way we can apply it. We just have to dose it correctly. And that's just a concept that most people don't.
Chris:Mm-hmm. And, and I think it's true and, and our tolerance for risk as medical providers is relatively low, but we have to recognize that for some of our players, you know, you, you've. 38 year old veteran who's still wanting to play and is struggling and they're saying, listen, if I don't pick up three miles an hour, I've gotta retire. So, and I say, I may say, Hey, this is really high risk for you. And they may say, if I don't do it, I'm done. You know, my chance of playing are 0% if I don't do it. So you're telling me, yeah, is a high risk of injury, but this is the only way I can keep my career going. Okay. We have to understand that and be okay with this. All right, we're gonna do it. Let's talk about how we can do it the right way, the smart way, and try to try to get you better without getting you hurt. So we, we, that is often very difficult for us to do, but ultimately we have to recognize we're here for them. We're not here for ourselves. We're, we're here for them. And so we have to know what their.
Mike:That's, that's awesome. That's a great way of thinking of it. And yeah, we could, we could talk for hours. This is amazing. Um, I know you gotta get, uh, probably you're reconstructing some ucls this afternoon at some point, so, um, uh, we, we could keep going for hours. Uh, before I let you go though, uh, we'd like to end with a quick high five. Where Five quick questions, five quick answers. Um, I, I love hearing this, especially from such well established people like yourself, just to show everybody that you still have a growth mindset and all this great stuff. But, um, five quick questions. First one is, what are you currently working on for your own professional development? Like your, what are you reading? What are you learning for
Chris:yeah. Great question. Yeah, so for me, actually, every Jan, I have a list of January books that I reread every January. So I'm, I'm a big reader, right? And right now on the list, I'm, I'm going back through Marcus Aurelius's, uh, meditation. It's one of my favorite, I think I read it four or five times, but I reread it every January. It's, uh, A lot of wisdom. Every time I reread it, I pick up new, new things.
Mike:Is that, is that,
Chris:I highly recommend it.
Mike:I was gonna say, is that, is that your, is that your number one book recommendation for somebody that's, that's, that's trying to work on self-improvement?
Chris:No, that wouldn't be my number one. Um, that, that one is usually it. It's better sort of once you're, uh, partially down the trail and you've sort of already done a little soul search and you have a little bit of an idea. Um, cause it takes a little bit to, to put that one into practical use. Um, but in terms of like best book recommendations, a couple, you know, you mentioned a growth mindset. I'm a, I'm a huge Carol Dweck fan, uh, growth mindset. I think Atomic Habits, uh, is, is a fantastic one for developing systems and processes, uh, grit. Fantastic. Uh, peak and Owned by Anders Erickson. All of those are good. I think it is sort of establishing yourself on a pathway towards expert performance.
Mike:That's awesome. Great stuff. Uh, what's one thing that you've recently changed your mind?
Chris:Yeah, I'd, I'd say, um, I've always historically been a very, very much a goal-oriented person. Um, but I've actually sort of abandoned that in recent years. Uh, and I really think that systems and processes, Trump goals. Um, every time. Every time. And so I, I have. Essentially eliminated almost all goals, uh, from my life. And I've worked to develop systems and processes that are gonna help me get to the place I want to be and be the person I wanna be. So, uh, systems and processes over goals every, every day of the week for me.
Mike:That's awesome and I'm maniacal about that as well. You can ask everybody I work with, right? We have. So many, uh, uh, standard operating procedures for everything written up. Uh, once it starts blending into your personal life though, and you have a system for like making coffee in the morning, that's when, when your wife starts to get, uh, agitated with you, but but, uh, but yeah,
Chris:my wife could definitely, uh, could definitely share that frustration. Yeah,
Mike:Once you, once you start thinking systems, you can't think anything else. Right? Even you go to a restaurant and you're like, the, the, all the systems are all broken here. I can't, I can't
Chris:This is how they should be doing this. Yeah. This, this.
Mike:That's why, that's why you're a leader. Um, all right, next question. What, what's your favorite piece of advice that you give residents?
Chris:Yeah. So my, my key, I, I try to make it as simple as possible, and I tell'em, always stay humble, hungry. Those are the two. If you, if you needed two adjectives to describe yourself, humble and hungry. And I think that's true of any young, professional or older, professional, uh, in the world. If, if you're humble, you're a person who's got, An open mind, you're responsive to criticism. You've got a growth mindset. You're gonna be a better team player. People are gonna enjoy being around you, and your ceiling is much higher. And obviously, if you're hungry, you're gonna, you're gonna have the energy, you're gonna be motivated, you're gonna do the things you need to do, you're gonna be doing, you're gonna do the stuff that others are not willing to do. You're gonna do the hard work, you're gonna have the high tolerance for boredom. And I, and I think that's something for younger people to think about, especially if you're trying to get into baseball. Oftentimes you think you're gonna come in and it's gonna be glitzy and, and, and it's gonna be a lot of glamor. And in reality it's not. And, and nothing in life is, and, and I think it's the people who have the high tolerance for boredom. Are the ones that can be extremely successful. So can you keep doing the right things every single day, day in, day out, over and over and over and over and over again, and stick with it. Um, those are the people that are gonna be successful. And I, I think that, so staying hungry, humble, uh, would be my two pieces of advice for any, any young professional or somebody that's been at it for a while and needs to freshen things up a little bit.
Mike:I like. I like it. And then follow up with that me. I think you're, you're in a good spot right
Chris:Exactly. Exactly. Yeah. Yeah.
Mike:Alright. What's coming up next for you?
Chris:Yeah, so spring training's right around the corner, so always excited about that. Um, so we got that coming up. And then also a couple new things in the, in the research world that I'm pretty excited about. We're, we're gonna start, you know, people have seen, uh, marker based motion capture of the pitching motion. Uh, we're starting some studies doing it for the baseball swing. We, we talked about that earlier with the obsession with ex exit velocity things. So we need to figure out more about the, the forces that are happening throughout the body, through the swing. Got that coming up. And then another thing that I'm really interested in, and we're starting to, to use in some of our research is using different machine learning and artificial intelligence approaches to try to sort out some of these issues around risk prediction, uh, risk mitigation for injuries and those types of things. So those are the few of the things coming up that I'm, I'm really excited about.
Mike:That's awesome. I, I'm really looking forward to learning from that, from you. So. Awesome. Um, where can people learn more about you obviously go to PubMed. Type in your name and, and that'll give you a, a few months of reading. But, uh, where, where else is, is there a place that they can find you if, if they wanna send a patient to you or anything? Where, where can people find more about you online?
Chris:Yeah, a couple spots. Um, so yeah, all, all our research is on, uh, PubMed. Uh, our website is, uh, sports medicine dot mayo clinic.org. So if you wanna just go to the Mayo Clinic Sports Medicine, uh, Google that you'll find it, that sort of tells you all about our clinic and how to get patients in and what we have to offer, those sort of things, if you wanna do that and. I'm also moderately active on Twitter, trying to share baseball injury research and surgical techniques and things like that. So at Chris Camp md, uh, is the Twitter handle. So either of those spots will work.
Mike:Yeah, and I will say you are a great Twitter follow, um, cuz you're. Posting really good stuff and you're active. Right. And it's, it's, um, you know, I I think sometimes people, uh, don't, uh, appreciate that enough, right? To, to be able to interact with somebody like yourself on Twitter is, is priceless. So, uh, so take advantage and follow'em and, and ask questions and, um, it's, it's a great experience. So, um, well, thank you so much Dr. Camp. That was amazing. Um, good luck this season. I, I hope, hope to, to see you, uh, at some point during the year. But thanks so much for coming on the show and giving so much of your perspective. Is amazing.
Chris:You got it, Mike. Really appreciate it. I, I enjoyed it. As always, enjoy listening to your podcast, so it's an honor to be a part of it.
