Brian Waterman, MD joins BestHealth for the April podcast. Dr. Waterman, Associate Professor for Sports Medicine and Orthopaedic Surgery talks about the start of baseball season, common sports medicine injuries and joint health.
Baseball Season and Common Sports Medicine Injuries
Speaker 2: 00:10 everyone. Welcome back to the best health podcast brought to you by wake forest baptist health. Uh, this is our April podcast and we're very excited to have a special guest with us this month. Dr. Brian Waterman. He is one of our orthopedic surgeons here at Wake Forest Baptist health and a, he's going to be talking to us about, um, all kinds of fun orthopedic topics and joint health topics. So welcome Dr Waterman. How's it going? Fantastic. Thank you so much for having me, Justin. It's an honor. Well, thank you for being here. Uh, Dr Waterman is fresh off a surgical case, so thank you for coming, coming over here out of the o r and hanging out with us on the podcast for a little while. Um, so Dr Waterman, just before we get into some of the orthopedic and Sports Medicine, um, topics that we'll get into here in a few minutes, just tell us a little bit about yourself. How the, how'd you find yourself at wake forest baptist and how did you find yourself an orthopedic surgeon? Yeah,
Speaker 3: 01:12 yeah. No, absolutely. It's a, it's an interesting story. I'm a little bit of a nomad, but a, had some roots as a part of a military family here in North Carolina and Virginia, uh, one for a year and played soccer at Elon, uh, before transitioning to University of Virginia. Um, from there, I, I kinda had that gravitational pull towards medicine. Uh, I ended up, um, doing a year of research and radiation oncology research and, and uh, then subsequently decided to, to take the full plunge in a medical school, went to eastern Virginia Medical School in Norfolk, Virginia Beach area. And, uh, and then from there, um, in order to pay for, for medical school, joined the service and it was through a program called health professional scholarship program. So it covers you, uh, financially, provides you with a stipend. And then in return, you serve in the U s army for a period of [inaudible]
Speaker 2: 02:09 time. Gotcha. So upon completion of medical school then you were an officer in the army.
Speaker 3: 02:16 Yeah. So then you go into active duty or six for the army at least there are six, uh, training sites and, uh, we, uh, were selected to come down to William Beaumont Army Medical Center in El Paso, Texas. So a region of the country I was otherwise unfamiliar with, but, uh, developed deep seated roots with, uh, with the greater southwest. It was a beautiful area. Very go. That's awesome. Some, some good, uh, food down there too. That's right. That's right. Green Chile. Yes. We'll ask. So how long have you been at wake Forest Baptist health? So about a year and a half to pushing up on two years now. It's, it seems like it's really flown by. Uh, I was really drawn by, uh, the potential to be at an training center with residents and fellows, uh, both within and outside of, of sports medicine, which is my specialty, uh, the capacity to take care of, um, uh, inner collegiate competitive athletes such as that at wake forest university in Winston Salem state. Um, and then ultimately being able to cover the local high schools and in Forsyth County, it's just an incredible honor and privilege. Uh, and not to mention, uh, just the, the wake forest baptist name and, and traditionally Bowman gray has really carried in an incredible reputation that that definitely [inaudible]
Speaker 2: 03:36 precedes it. Cool deal. Well, speaking of sports medicine, it is baseball season with April. So, uh, we just had a l Mel MLB kickoff here and, um, college baseball has been going on for a little while. And, uh, our local home team, that Winston-Salem Dash, they're opening a home, Stan is right around the corner. So if I'm not mistaken, you, uh, get to, uh, hang out with [inaudible] force athletics, Baseball team and the Dash Baseball team, correct? That's right. Yeah, that's right. So, uh, what's, what's, uh, some fun stuff you can tell us about hanging around and baseball team all the time?
Speaker 3: 04:18 Absolutely. Well, it kind of dovetails a lot with my interests. Um, from, from my training after the military, after I was done with my service obligation, uh, I ended up going to fellowship in, uh, and rush university in Chicago. And there the, uh, the team physicians for the Chicago Bulls, the White Sox, uh, the Chicago fire, uh, and several outlying programs. And so it was really a great time to cut my teeth on the injuries and issues that plague, um, really that elite, upper-level throwing athlete. And within that we were able to really parlay that into a broader, um, uh, area of focus here at wake forest. Uh, and one of the big draws was to, to be able to work with these teams. You know, the Winston Salem Dash is a, as a farm team, a and a, a affiliate for the, the white socks. So it's just a great opportunity to work very closely with a team and the trainers that have already been invested in and uh, be able to, to really nurture the, uh, the young developmental talent and see them go on to excel at the, uh, the next level. There you go. So bolt is the mascot for the Dash. Have you had to see him for any shoulder? No bolts doing OK so far? Yes, he is. He seems to be okay despite the jumping jacks and bat drills and everything.
Speaker 2: 05:39 Well that's good to know. Well, speaking of injuries, um, you know, you, you spread your, your time, uh, around a couple of different areas, um, including clinic time. So what are a couple of them were prevalent injuries, you're seeing this these days with um, adult active individuals
Speaker 3: 05:58 or, or youth athletes? Um, either one. What are some of the wear more common injuries you're seeing right now? Yeah. And when you think about sports medicine, oftentimes you're thinking about these elite or competitive athletes, but very often the people that we see are folks like you and I that are intermittently active and want to continue to stay active. Sure. Kind of that weekend warrior population. Sure. I would say a good portion of what we see is predominantly overuse type injuries. And uh, within that I generally focus on those issues related to the shoulder, elbow, and knee. And, uh, so as it relates to the shoulder, very common for us to see rotator cuff pathology doesn't always necessarily imply a tear, but may be an area of irritation, uh, or a soft tissue nagging injury like biceps tendonitis. Um, within the younger athlete population we can see shoulder instability, which is really a complex and, uh, interesting area of, of, um, up practice.
Speaker 3: 07:02 Um, as it relates to the elbow. Obviously, you know, spring boarding off the baseball topic, we do see a lot of overuse things in baseball, both as it relates to tendonitis of the elbow, um, the potential for, for injuries to the Ulnar collateral ligament or so-called Tommy John Surgery. Gotcha. Gotcha. Um, and, uh, a variety of different cartilage or overload type injuries in terms of knee, you know, really we see the full gamut a knee and uh, this can be ligament injuries, meniscal problems, uh, uh, cartilage injuries and uh, and what we often do is actually try to find ways to, to nurture people back to their, their functional state. And that, that very commonly involves nonsurgical treatment, which is kind of the fun part about what we do. It's meeting people where they are and trying to find the best, most expeditious pathway to get them back to function either with or without surgery.
Speaker 3: 07:58 Sure, sure. That, that's a great point. So for overuse, it's essentially just a lot of that is generated by the same repetitive motion over and over again on that single joint area. And that causes, uh, an array of issues related to overuse. Exactly. Kind of the way I put it is the miles on the tires and, uh, it doesn't necessarily think you're gonna throw those out and get a new pair of Michelin's. Um, very often it's just a targeted interventions to try to restore function. And that can involve physical therapy to improve mobility. It can involve injections or other pain-relieving measures to, to decrease that irritation and it precluding you from doing things. Uh, and then oftentimes it's just providing reassurance based on your exam and the things you find. Um, very often people are looking for permission to get back to doing the things they want to do without fear of this going into a further
Speaker 2: 08:56 worse position. Yeah. That, that's, that makes sense. Uh, so I think one of the cool things I recently was able to be a part of was, um, I really unique collaboration with wake forest baptist health and wake forest university. Um, and, um, I'm, I'm not a researcher. I just help get the word out word out about it, uh, when we did the grand opening here recently. Um, but you talk to us about the pitching live over at wake forest university at, uh, David Couch Ballpark, and, um, how that relates to overuse injuries and us doing research on, on how we can help improve the health of athletes.
Speaker 3: 09:35 Well, I really have to tip my cap to a several folks in this. Uh, it was definitely set in motion prior to me coming on board, but it's been a great opportunity to link up with, with those folks. Uh, tell them Walter, who's the head coach at wake forest baseball, really hadn't in his mind with one of my forebearers, Dr Mike Free Hill. And they envision a scenario where they could really target, um, motion analysis and biomechanics and see how that contributed to either the onset of injuries or, uh, trying to find ways that they can, uh, enhance athletic performance. Um, as a part of that, they were able to build a physical site as a part of their bullpen, uh, and then, uh, build the motion capture system out of a 16 camera, uh, set up that, uh, offers high def, uh, imaging, uh, tracker system and being little fall, not just the three dimensional flight of the ball, but the thrower as they engage in this very intricate and almost, uh, unhuman motion that they put themselves in.
Speaker 2: 10:40 Yeah. So instead of a motion capture for developing a movie or video game, you guys are doing the three d motion capture for research on, on how the body is used in that scenario.
Speaker 3: 10:53 Yeah, and you know, the, the, the person that really ties it all together is Dr. Coach Kristen Nicholson. Um, she was a phd, a bio mechanistic is what it's called. Okay. Uh, in, uh, she was hired among a large group of interviewees coming down from Delaware and she is just specifically trained on the athletic motion and evaluating the risk factors that might contribute to injury. What we know is, is that, uh, um, athletes particularly throwing athletes are increasingly encountering fatigue and potentially overexposure to this throwing motion, which can not only contribute to core and muscle injuries of the trunk and lower extremities, but also overload to the shoulder and elbow. And so within that, what we're trying to see is a couple of different things. How are specific bio mechanics or arm, shoulder, scapular, shoulder blade position, how do those contribute to the onset of injury?
Speaker 3: 11:51 What are the forces across that joint and you know, ultimately, how can we affect change on that? How can we move the needle to decrease the risk of that? You have? That's, I'm glad you said that. That's a great segue. So how can we, uh, help, uh, of avoid injury in the future? So I think that's one of the cool things about being a part of a academic medical centers. We can take all this knowledge we're gaining through really unique situations like the pitching lab and then if we learn, um, learn pieces about, uh, patients that we can potentially take across the board to all of our patients. They don't have to be a collegiate baseball player. Um, but they can be, um, like you said, a weekend warrior or an active individual in our community, um, where we can apply that knowledge as well if they come into one of our clinics. Correct. Yeah. Yeah. And I would say it's, it's kind of about broader cow coalitions of folks. So it's us working with physical therapy, working tightly with the trainers, analyzing data from the biomechanics department. Um, and then our, our also our non-operative sports colleagues, our primary care sports medicine folks. Uh, I think when we look at ways together collectively both for research and otherwise, um, I think we can really effect change on trying to, to decrease risks of injury or problems that are leading to, to time loss, to, um, to, um, pathology. So,
Speaker 2: 13:20 you know, I'm, I'm, hopefully, I'm not unique in this sense, but I've been known to be a little stubborn. So if I've, uh, had a knee pain or an ankle pain in the past, I'm like, oh, owl, it'll be all right in a couple of days or a few days. I'll just walk it off. Um, and, and, uh, sometimes in my past it hasn't gotten better right away or after a couple of days. And, um, I've had to reach out to, to a doctor. So if, um, we have a, a patient or potential patient listening on the podcast, you know, what, how would you recommend, uh, the timing of when they need to see an orthopedic doctor or one of our sports medicine doctors here at Wake Forest Baptist? If their shoulders bothering them or their knees been bothering them, you know, what would, what would you recommend as far as reaching out to a doctor?
Speaker 3: 14:09 Yeah. Yeah. And I, I think that uh, very often we find ourselves putting it on the back burner cause it's an inconvenient time to be injured. Uh, I would say generally speaking, uh, if given a short period of rest, uh, activity modification, potentially some oral anti-inflammatories, a a period of stretching and it's not getting better, then that's perfectly reasonable to either reach out to your primary care provider or seek, uh, an appointment to be evaluated. Very often we can provide the reassurance you need that indicates that this is not a serious problem and usually get you involved with either one of our physical therapy colleagues or a targeted rehabilitation program that's to your condition. Um, it doesn't always imply that it's a bad problem. And the other thing is, is that folks that can present with what they think is either hip or back pain, knee pain or shoulder pain can often be attributable to other causes. And so you can really rule out the back is a contributing factor, um, something coming from the abdomen or hip, uh, a nerve problem or potentially a vascular problem. Um, it's just a matter of getting that expert and trying to delineate further what's going on so that you can design a treatment.
Speaker 2: 15:26 Sure. So I'm glad you brought up, um, expert. So we, uh, I think are very fortunate here at wake. So we have a whole, um, team of providers and doctors that specialize in different areas of, of the body and different joints. So, um, you do a fair amount of work in the shoulder area, correct. Um, but then some of your other colleagues focus on different joints. So, um, with your powers combined, it's really kind of an expert team approach to what no matter what part of the body it might be hurting for one of our patients. Correct.
Speaker 3: 16:02 Yeah, and that's right. I think that that's the nice part about our team is we're all humbled to work within this system. And to have somebody that's a subject matter expert in a given area, um, is really nice. Uh, I always go down to my, uh, my colleague and friend, Dr Al Stubs, who's a really a hip guru and he's dedicated his life to hip preservation. Dr Kristin Ferguson really focuses on that, uh, young athletic patient, you know, even as low as four to five and trying to restore them back to, to their activities. Um, you know, my partner John Hubbard really does this entire spectrum of, uh, of knee care. Dr Coats and I help take care of a lot of throwing athletes together. Uh, and, and really underneath that also we have our leaders like Dr Gary Paling and Dr. David Martin, who have served in these senior leader roles and mentor to us throughout, uh, at least my presence here. Um, so it's, it's, we're just quite fortunate to have such a great team.
Speaker 2: 17:07 That's, that's awesome. So, uh, we're getting close to wrapping up here. Oh, just got a minute left. And, um, so I just wanted to, to, I guess reemphasize the point that Dr. Waterman made a minute ago. If you're, if you have, um, one of your joints is alien you, um, it doesn't automatically mean surgery. We have a full suite of, of medical options that are available to patients. Um, but if, um, surgery is required for some sort of repair or joint preservation. Um, can you talk real quick, Dr Waterman about, um, I guess the team approach for a surgical procedure as well. So you have people walking a patient through that entire correct?
Speaker 3: 17:50 Yeah. So, um, the, you know, it starts with, with getting an appointment, one of our facilities, he can certainly gain same day access. We also have special offerings with either extended hours, um, and potentially on a Saturday at a, some of our locations. Uh, one of the best ways to get in touch with, with our team to coordinate an appointment is contacting us at three, three, six, seven one six wake w a Q, a, m, w, a, m. K, e. Uh, you can also access online wakehealth.edu, uh, in coordinate care with a, the patient care portal if that's your preferred method. Um, but really it's getting in and being evaluated by either us or one of our primary care colleagues or physician extenders. Uh, and then trying to decide what that next evaluation step is and from there, um, uh, designing a treatment plan. Awesome. Dr Waterman, I know you've been busy so far today, so I appreciate you taking time out to chat with us about sports medicine and joint health here at the best health podcast.
Speaker 3: 18:59 So a as base policies and gets underway. Are you, uh, are you waiting for the white sox? I will. I mean, obviously they've got a lot of, uh, great athletes and the developmental pipeline. I just hope they can translate it to the next level. In the interim. I'm a huge dash fan and, uh, you know, coach Walter has an incredible program. Uh, and when you're embedded with the guys as we are, it's, uh, it's hard not to love them. So go Deacs. There you gotta go. Duke's yes on the road to Omaha, hopefully aren't. Well, thanks everyone for listening to the April edition of the best health podcasts. Uh,
Speaker 1: 19:33 a reminder, you can find out more information about best health at wakehealth.edu/besthealth and listen to our full array of podcasts so far. We hope you have a great month and we'll talk to you again next month. Thanks for listening to this episode of the best health podcast brought to you by wake forest baptist health. For more wellness info, check out wakhealth.edu and follow us on social media, wake forest baptist health, the gold standard of healthcare.