BackTable Bone & Sports

What characteristics make bone biopsies unique in both presentation and procedure? In this episode of the BackTable Podcast, Drs. Junjian Huang and Majid Khan join host Dr. Neil Jain to break down the complexities of bone biopsy technique. They discuss key strategies for tackling difficult cases, from understanding referral patterns and pre-procedure planning to selecting the best guidance modality and anticipating complications.

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https://www.backtable.com/app

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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
08:06 - Referrals And Pre-Procedure Planning
12:35 - Triaging and Managing Difficult Cases
17:06 - Measuring and Improving Diagnostic Yield
18:58 - Knowing Boundaries Behind Difficult Cases
22:37 - Choosing the Best Guidance Modality
26:16 - The Future with Augmented Reality
28:11 - Tough Case Scenarios and Setup
41:27 - Preventing and Managing Complications
47:49 - Technical Tips for Future IRs
51:40 - Wrap-up and Credits

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More about this episode

The conversation covers how to triage complex cases, adjust technique for smaller or hard-to-reach lesions, and benchmark diagnostic success. Drs. Huang and Khan share their preferred imaging guidance, from CT to fluoroscopy, and explore new frontiers like augmented reality. Case scenarios highlight practical problem-solving, and the episode wraps up with technical pearls and complication-prevention tips gained from years of experience in targeted bone biopsy.

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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

How do you navigate the evolving science and controversy of concussion care in athletes and beyond? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Ryan Stempniak to break down the fundamentals and emerging advances in concussion management. They define concussion pathophysiology, highlight why most injuries occur without loss of consciousness, and discuss delayed symptom onset that can complicate diagnosis and treatment.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
07:16 - Who Manages Concussions?
12:21 - Defining and Understanding Concussions
23:31 - Injury Mechanisms and Pathophysiology
26:56 - Recognizing and Grading Symptoms
35:00 - Assessment Tools: SCAT6 vs. SCOAT
38:34 - Return-to-Play and Return-to-Learn
50:42 - Medications, Supplements, and Treatment Advances
57:10 - Concussion Subtypes and Individualized Care
01:02:01 - Helmets, Wearables, and Emerging Technology
01:10:11 - AI, Imaging, and Research Directions
01:13:01 - Myths, Facts, and Protocol Updates
01:16:57 - Closing Thoughts

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More about this episode

The conversation covers mechanisms of injury, symptom assessment, sideline and office evaluation, and the critical role of return-to-learn before return-to-play. Drs. Balle and Stempniak discuss concussion subtypes, medication and supplement limitations, and the latest on helmets, wearables, and AI-driven research. They also emphasize individualized care plans, the importance of school and work accommodations, and practical strategies for clinicians managing this complex and ever-changing condition.

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Resources
Dr. Ryan Stempniak
https://www.linkedin.com/in/ryan-stempniak-843545295/

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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

How have modern surgical techniques, pain management algorithms, and focus on rehabilitation transformed joint replacement outcomes? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. William Bryan of Houston Methodist to share his insights from decades of experience in orthopedic surgery and sports medicine. Dr. Bryan reflects on his journey from mentorship under Dr. George Lane and Dr. Michael DeBakey to serving as team physician for the Houston Astros, emphasizing the importance of restoring normal function and keeping patients active.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
04:55 - Praising Mentorship
11:59 - Evolution of Total Joint Care
18:44 - Optimizing Pain Control Post-TKA
30:42 - Discussing Operative Approach, Implants, and Emergence of Robotics
38:21 - Longevity of TKAs in More vs. Less Active Patients
41:58 - Knee Pain Eliciting Surgical Intervention
50:13 - The Balancing Act of Orthobiologics as a Conservative Modality
55:44 - Imaging Myths in Total Joint Surgery
58:02 - Sharing Surgical Pearls
01:03:42 - Advice for Non-Operative Colleagues
01:07:38 - Final Takeaways and Wrap Up

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More about this episode

The physicians explore the progression of arthritis, conservative treatment options, and the evolution of joint replacement, from early complications to advances that have improved implant longevity. They also discuss anesthesia advancements including periarticular nerve blocks, emerging calcium channel-blocker analgesics, and the use of the ROMTech home rehabilitation device. Curious about common misconceptions surrounding total joint replacement? Dr. Bryan and Dr. Balle address the role of orthobiologics, imaging myths, and other frequently misunderstood aspects of arthroplasty. Throughout the conversation, they emphasize the importance of ligament balancing, the unique challenges of treating ligamentously lax patients, and practical strategies for maintaining joint health through low-impact exercise and diet-driven weight loss.

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Resources

Dr. William Bryan
https://doctor-bryan.com/

ROMTech
https://romtech.com/

---

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

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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Get the BackTable app
https://www.backtable.com/app

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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/

---

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

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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Get the BackTable app
https://www.backtable.com/app

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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/

---

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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Get the BackTable app
https://www.backtable.com/app

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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.

---

Get the BackTable app
https://www.backtable.com/app

---

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

---

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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Get the BackTable app
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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Get the BackTable app
https://www.backtable.com/app

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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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Get the BackTable app
https://www.backtable.com/app

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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