What’s your game plan when heat illness strikes on the field? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes sports medicine physician Dr. Irvin Sulapas to discuss how clinicians and athletic trainers can use wet bulb globe temperature (WBGT) and other tools to improve athlete safety. They highlight best practices for communication with coaches, modifying training protocols, and recognizing the full spectrum of heat-related illness from heat rash to syncope and exertional heat stroke.

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Timestamps

00:00 - Introduction
04:12 - Defining Heat Stress and Its Risks
08:26 - Cooling Strategies in Sports and Mitigating Risk
17:11 - Wet Bulb Globe Temperature Explained
22:37 - Collaborating with Coaches and Trainers
26:02 - Identifying High Risk Athletes
30:57 - Heat Acclimatization Protocols
33:17 - Physical Exam for Heat Illness
39:12 - When to Activate EAPs and Call EMS
47:02 - Return-to-Play Guidelines
49:45 - Debunking Heat Illness Myths
54:11 - The Future of Heat Safety
57:13 - Key Takeaways and Wrap-Up

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More about this episode

The discussion covers risk stratification, early interventions like cold-water immersion and tarp-assisted cooling oscillators, and practical protocols for emergency response. Dr. Sulapas and Dr. Balle also address key physical exam findings, when to activate emergency action plans, and guidelines for returning to play after heat illness. They debunk common heat myths and look at future directions for improving heat safety in sports medicine.

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Resources

Dr. Irvin Sulapas
https://www.houstonmethodist.org/doctor/irvin-sulapas/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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Time is money, but when it comes to ACL rehabilitation, the calendar alone does not determine readiness for return to play. On this episode of BackTable Bone & Sport, host Dr. Larry Balle is joined by returning guest Dr. Andy Glidewell to discuss modern protocols for anterior cruciate ligament (ACL) rehabilitation. They cover the ACL’s role in knee stability, common injury mechanisms, and why moving beyond timeline-based milestones is crucial for optimal recovery. Glidewell emphasizes that while surgery reconstructs the ligament, rehabilitation is what restores true knee function.

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Timestamps
00:00 - Introduction
05:55 - Collaborative ACL Protocols
09:56 - Anatomy Review: The Role of the ACL
14:41 - ACL Rehab Misconceptions
19:04 - Rehab Goal Metrics: Time vs. Subjective Measures
28:55 - Early Post-Op Priorities
36:26 - Tweaking ACL Protocols Based on ACL Reconstruction Graft
42:30 - Use of Orthobiologics in Surgery
47:15 - Progressing BFR to ARPE to Hypertrophy in Rehab
56:38 - Incorporating Plymometrics and Agility Training in ACL Rehab
1:00:19 - The Mental Hurdles in ACL Rehab and Return to Sport
01:08:00 - Clinical Pearls in ACL Rehab
01:10:20 - Wrap Up

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More about this episode
The conversation explores early post-operative priorities, the importance of progressive strength and functional testing, and the need for closer collaboration between surgeons and physical therapists. Additional topics discussed include shifting from time-based to subjective and objective criteria for return to sport, and evolving approaches to open-chain knee extension to address persistent quadriceps deficits and reduce anterior knee pain.

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Resources
Dr. Andy Glidewell
https://www.trainrecovermove.com/andyglidewellpt
https://uamshealth.com/provider/michael-a-glidewell/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app

Ergogenics: supplements NOT substitutes. On this episode of BackTable Bone & Sports, host Larry Balle joins Dr. Ryan Rhodes, a sports medicine physician and Army National Guard flight surgeon, in a discussion about ergogenic aids and supplements in athletic and military populations. They distinguish supplements from substitutes and define ergogenics broadly, noting limited evidence for popular peptides and the “bro science” culture. The doctors review historical and modern pharmacologic performance enhancers including anabolic steroids, selective androgen receptor modulators (SARMs), growth hormone and hormone replacement therapy (HRT).

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Timestamps

00:00 - Introduction
04:03 - Ergogenics Overview
07:17 - A Brief History Lesson in Performance Hacks
14:54 - SARMs Explained
18:00 - Supplement Industry Economics
24:28 - Growth Hormone and HRT Nuance
34:50 - Stimulant Use in Sports
37:30 - The Hype Around Creatine
44:03 - Addressing the Renal Safety Myth with Creatine Use
46:02 - The Rundown on Protein Intake Basics
49:47 - Future Discussions on Ergogenic Aids
52:02 - Closing Key Point: Five Point Supplement Test
57:14 - Wrap Up

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More about this episode

This episode also features case discussion surrounding injury risks from exogenous testosterone use and nuances associated with hormone-replacement. Dr. Rhodes shares his appreciation for creatine, highlighting its strong evidence and safety profile. Key takeaways include the five-point framework for evaluating supplements: safety, claims, meaningful impact, correcting deficiency, and cost.

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Resources

Dr. Ryan Rhodes
https://www.ochsner.org/doctors/ryan-rhodes/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

A bone biopsy can reach the target and still miss the diagnosis. In this episode of the BackTable Podcast, host Dr. Neil Jain is joined by Dr. Peter Thurlow to discuss how lesion selection, imaging review, trajectory planning, and device choice determine whether a targeted bone biopsy produces a useful sample without compromising future treatment.

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This podcast is supported by
Varian OmniBone
https://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone

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Timestamps
00:00 - Introduction
04:17 - Approaching Focal Bone Lesions
06:17 - Differentiating Lesions and Pain Management
13:13 - Settling on Bone Biopsy Imaging
16:55 - Understanding Pre-Op Imaging from Lesion Characteristics
21:50 - Maintaining Communication Across Specialties
24:21 - Which Devices To Select and Navigating Challenges
32:28 - Trajectory Paths and Surgical Considerations
35:30 - How to Avoid and Mitigate Biopsy Complications
41:30 - Wrap Up

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More about this episode
The conversation begins with a systematic approach to evaluating focal bone lesions, including the likelihood of malignancy, lesion location, number of lesions, and selection of an appropriately sized sampling device. Dr. Thurlow reviews anesthesia and pain-management strategies for both superficial and deeper osseous targets, as well as the respective roles of MRI and CT in procedural planning. For challenging lesions, he explains why needle-guidance technology may be preferable to adjusting gantry tilt and outlines how imaging findings and biopsy strategy should be tailored to lesion type, with particular attention to the difficulties associated with blastic lesions.

The doctors also discuss the importance of communication with pathology, surgery, oncology, and other collaborating specialties before proceeding. Dr. Thurlow shares his preferred biopsy devices, considerations for selecting a safe trajectory, and ways to account for potential future surgical approaches. The episode concludes with practical strategies for avoiding complications, minimizing tissue injury, and obtaining an adequate diagnostic sample.

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app

Whole-body MRI is moving beyond diagnosis and into prevention, but is the technology ready and are clinicians prepared to interpret and act on what they find? On this episode of BackTable Bone & Sport Podcast, host Dr. Larry Balle welcomes back physical therapist/athletic trainer, Dr. Andy Glidewell to dive into the controversy of whole-body MRI screening for athletes and fitness-focused patients. They discuss how imaging has evolved from simple diagnosis to clinical mapping for rehab and performance planning, drawing on experiences like the NFL Combine’s extensive MRI use, and examine both the clinical opportunities and the practical barriers to broader adoption.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
04:57 - Athletes Hunger for Knowledge
13:22 - Preventive Care vs. Reactive Care
15:53 - Understanding Limitations and Liability
20:00 - Evolution of MRI Technology
34:53 - When to Order Whole Body MRI
44:24 - “If You Go Looking”: Addressing Incidental Findings
56:51 - Identifying Good Candidates for Whole Body MRI?
58:56 - Addressing Cost and Marketing Reality
01:05:24 - Vision for Preventive Care
01:07:18 - Final Thoughts and Wrap Up

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More about this episode

The conversation covers the latest in MRI technology, including how AI can improve image quality and reduce scan time, as well as typical whole-body protocols and their limitations. Dr. Glidewell shares personal stories about incidental findings and offers insight into issues like cost, radiologist expertise, and the importance of a single communicator for care. Together, they explore who might benefit most from whole-body MRI, how it could influence preventive care and long-term healthcare costs, and the challenges and opportunities that lie ahead.

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Resources

Dr. Andy Glidewell

https://www.trainrecovermove.com/andyglidewellpt

https://uamshealth.com/provider/michael-a-glidewell/

---

BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Genicular artery embolization (GAE) continues to gain traction worldwide, but is the evidence catching up to the hype? In this episode of BackTable Bone and Sports Podcast, host Dr. Kavi Krishnasamy welcomes Dr. Peter Minko, an interventional radiologist from Düsseldorf, Germany, to discuss GAE’s evolving evidence, techniques, and international practice patterns. Dr. Minko highlights forthcoming clinical trials and emphasizes the need for high-quality research to guide patient care.

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Timestamps

00:00 - Introduction
03:13 - The Embolization Landscape in Germany
07:25 - The Basics of GAE Patient Workup
13:49 - The Unideal Patient Candidate for GAE
16:55 - Measuring Outcomes Beyond Clinical Scores
23:14 - Procedure Specifics: Minko’s Choice
36:28 - Discussing the Future of Temporary vs. Permanent Embolics
43:47 - Collateral Flow Strategy and Procedure Wrap-Up
49:05 - Post-Procedure Rehab Guidelines
52:00 - Repeat GAE Treatment Algorithm
58:00 - Safety and Outcomes in Post-TKA Patients
01:04:11 - GAE and Associations with the Hospital Anxiety and Depression Scale (HADS)
01:09:40 - Call for Better Trials and Evidence in GAE
01:14:11 - Case Presentation: GAE Transpedal Access Case
01:21:05 - Case Presentation: “Three Stop Shop” Anastomosis
01:27:08 - Case Presentation: AV Fistula… Due to Arthroscopy?
01:32:03 - Case Presentation: Popliteal Agenesis
01:38:14 - Dr. Minko’s Perspective on the Future of MSK Embolization
01:40:55 - Wrap Up

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More about this episode

The doctors break down procedural specifics, including embolic materials, access site and catheter choices, and strategies for patient selection and contraindications. They discuss post-procedure rehabilitation, approaches to repeat GAE, and unique considerations for patients with prior total knee arthroplasty. The discussion also features interesting case presentations, explores the future of temporary versus permanent embolics, and examines the importance of robust study design in advancing MSK embolization. Dr. Minko shares his perspective on the direction of the field and the collaborative effort needed to move GAE evidence and practice forward.

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Resources

Dr. Peter Minko
https://www.researchgate.net/profile/Peter-Minko

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Lifestyle medicine isn’t new; it’s medicine’s original prescription, and it might be the most effective way to start treating your patients’ musculoskeletal health. In this episode of BackTable Bone and Sports, Dr. Larry Balle welcomes Dr. Megan Ferderber to discuss how foundational habits like nutrition, exercise, sleep, stress management, social connection, and avoiding risky substances can transform joint and tendon outcomes.

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Timestamps

00:00 - Introduction
07:02 - How Lifestyle Medicine is Incorporated into Practice
18:55 - Dr. Ferderber’s Definition of Lifestyle Medicine
23:15 - The Link Between Metabolics and Joint Health
29:15 - Physical Activity Prescription
35:06 - Risky Substances and Link to Cancer
39:50 - Sleep as a Pillar of Health
44:28 - Importance of Social Connectedness and Stress Management
49:43 - Discussing the Lifestyle Medicine Board Certification
53:06 - Life Hacks: Nutrition and Micro Habits
55:53 - Final Takeaways

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More about this episode

Dr. Ferderber shares how she incorporates the six pillars of lifestyle medicine into consults for musculoskeletal procedures such as PRP, prolotherapy, and TenJet. She highlights the evidence linking metabolic dysfunction and inflammation to osteoarthritis and tendon disease, and offers practical guidance for setting exercise targets, managing substance use, supporting sleep, and addressing stress. The episode also explores the value of board certification in lifestyle medicine, and how adopting these principles can bring credibility and long-term impact to sports medicine practice.

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Resources

Dr. Megan Ferderber
https://www.linkedin.com/in/megan-ferderber/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Are you truly understanding PRP and orthobiologics, or just following the latest trends in musculoskeletal medicine? In this episode of BackTable Bone and Sports, host Dr. Larry Balle and guest Dr. Jason Epstein explore the realities of platelet-rich plasma (PRP) and orthobiologics in non-operative musculoskeletal medicine. They highlight why successful outcomes start with honest patient counseling, clear definitions of the procedure, and addressing common misconceptions such as PRP being “stem cells.”

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Timestamps
00:00 - Introduction
09:02 - Exploring the Patient Definition of PRP
14:31 - Addressing Inconsistenties in the Literature for PRP
20:01 - Avoiding Stem Cell Terminology
26:24 - Encouraging Shared Decision Making
41:46 - Patient Selection, Dosing, and Post-Treatment Expectations
54:34 - Talking Cost of Treatment
58:07 - Choosing the Right Tool and Blood Draw Technique
01:01:31 - Personal Experience with PRP
01:05:35 - Discussing FDA Regulations and Marketing Myths
01:13:18 - Closing Remarks

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More about this episode
The discussion covers the lack of standardization in PRP studies, reasons for variable patient responses, and how to guide patients through shared decision-making and realistic expectations. Drs. Balle and Epstein emphasize building trust, avoiding marketing hype, and discussing FDA regulations, legality, and off-label use. Practical advice includes tracking outcomes and cell counts, clarifying costs, and choosing the right kits and techniques to integrate PRP responsibly into practice.

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Resources
Dr. Jason Epstein
https://www.linkedin.com/in/jason-epstein-27804a1a/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.
► https://www.backtable.com/app

It’s comeback season! What’s bringing lateral extra-articular tenodesis (LET) back to the landscape of ACL surgery? In this episode of BackTable Bone & Sports, Dr. Larry Balle joins sports orthopedic surgeon and knee specialist Dr. Kyle Borque to discuss the resurgence of lateral extra-articular tenodesis (LET) as an adjunct to ACL repair and reconstruction. They explore LET’s origins as a solution for rotation instability in the era of open ACL surgery, and examine how modern arthroscopic techniques, patient selection, and surgical evidence have driven LET’s renewed relevance in today's practice.

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Timestamps

00:00 - Introduction
02:36 - LET Origin Story
14:16 - Modern LET Technique Updates
23:13 - A Run-Down of the Procedure in the OR
26:54 - Patient Selection for LET
34:18 - Supporting LET with Published Evidence
38:43 - Rehab After LET
44:33 - Dismissing OA Concerns
50:10 - Case Example: ACL Revision
53:02 - Wrap Up

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More about this episode

The Drs. highlight the anatomy considerations, technical modifications, and the evidence that supports LET’s role in reducing graft failure, without changing rehab or increasing lateral OA risk. They compare LET with anterolateral ligament (ALL) reconstruction, emphasizing anatomy and technical approach. Dr. Borque details his modified technique using an iliotibial (IT) band strip fixed proximal and posterior to the lateral epicondyle of the femur. Furthermore, the doctors discuss selection factors for high-risk and revision patients, tactics to avoid overconstraint, and tips for patient counseling. They review the latest evidence, outline perioperative protocols, and address persistent myths about LET’s impact on recovery and osteoarthritis. The doctors highlight a real-world case example and the actionable insights for orthopedic surgeons to optimize ACL outcomes.

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Resources

Dr. Larry Balle
https://www.linkedin.com/in/larry-balle-ii/

Dr. Kyle Borque
https://www.drborque.com/

Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial
https://pubmed.ncbi.nlm.nih.gov/31940222/

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BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

“The athlete’s job is to stay consistent with rehab and to be hungry to get back on the field. I think our job as a sports medicine team is to make sure that they’re safe and that they can perform.” In this episode of BackTable MSK, guest host and sports medicine physician Dr. Larry Balle joins physical therapist/athletic trainer Andy Glidewell to discuss how “return to play” is defined and why it is often misunderstood among athletes, coaches, physicians, and rehab teams.

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Timestamps

00:00 - Introduction
04:25 - Return to Play from the Lens of Physical Therapy vs. Sports Medicine
12:11 - Evidence-based vs. Anecdotal-based Practice for Return to Play
21:18 - Is there an Appropriate Team Approach?
24:25 - Continuing Conservative Management vs. Surgical Intervention
34:01 - Notes on a High-Profile Sports Medicine Case
40:20 - The Influence of NIL on College Athletics
42:51 - Obtaining Objective Metrics for Clearance
52:38 - Influence of AI on Return to Play Algorithms
57:11 - Final Takeaways

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More about this episode

They emphasize that return to play is a milestone-based rehabilitation phase requiring clear communication, collaboration, and risk management, rather than rigid timelines or just “vibes.”

The conversation covers how evidence and objectivity have shaped protocols (notably ACL timelines), the role of prognostic indicators in operative vs. non-operative decisions, and practical use of functional strength and agility reassessment. They also address pressures of working with elite sport and NIL (Name, Image, Likeness) considerations. Furthermore, they expand on how AI may inform, but not replace, the humanistic and team-based components of decision making.

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Resources

Dr. Larry Balle
https://www.linkedin.com/in/larry-balle-ii/

Dr. Andy Glidewell
https://uamshealth.com/provider/michael-a-glidewell/

The Journal of Orthopedic and Sports Physical Therapy
https://www.jospt.org/

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BackTable Musculoskeletal (MSK) is the go-to podcast for musculoskeletal radiologists, interventional pain specialists, and orthopedic surgeons.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app