Brian Middleton: Welcome back, Jacksonville, happy Saturday to you all. We’re glad that you are joining us for the conversation with Dr. Ali Kasraeian. I am not Danielle Leigh, hopefully you can tell by the voice. I’m Brian Middleton. I’m actually filling in for Danielle this weekend. She’s taking a much-deserved mini-vacay. Dr. Kasraeian, thank you for letting me fill in and, to all the listeners, if you have a question for Dr. Kasraeian at any point in today’s show you can always call into our phone lines at 904-340-1045. Again, that’s 904-340-1045.
Doc, what are we talking about today?
Kasraeian: Today we are talking about sports and then we’re gonna segue to actually a very interesting and unfortunately controversial topic of stem cells, but we’re gonna kind of make it basically a discussion of truths and myths and actually how you can very interestingly use the stem cells in positive ways if you think about it in appropriate way and to help me have these conversations is Dr. Kevin Kaplan, who is an orthopedic surgeon at the JOI here in Jacksonville, Florida, but he’s also the head physician for the Jacksonville Jaguars. I’ve known Kevin probably since high school. He graduated a few years earlier than me. I was friends with his brother probably a little bit, he was a year under me, he’s a very successful actor now-
Kevin Kaplan: That’s right.
Kasraeian: … who has also been on this show. He actually had a very successful play called Bully that actually came through Jacksonville, in fact, many years ago now. He’s continuing to do work along that line, but today we’re gonna talk about some of the medical issues that are emerging and growing in the way that the NFL manages the medical issues within the world of football, in professional football and how that translates not only to professional athletes but professional sports and the segue to sports for people from youth football and youth sports in general and then we’re gonna talk about, like we spoke about, stem cells and how that applies to not just orthopedic medicine but other medicine. There are a couple of articles in the New England Journal of Medicine that got some attention last month and we’ll talk a bit about that.
So it should be a very interesting, broad show, so call us if you have any questions but we’re excited to have this conversation. Kevin, thanks for joining us.
Kevin Kaplan: It’s great to be here. It’s been a little while.
Kasraeian: So it’s been way too long, I think it’s been about two years.
Kevin Kaplan: Is it, two years, yeah?
Kasraeian: We keep wanting to do this but the schedules, you’re busy, you’re traveling a lot. But now’s actually a quiet time before it becomes very, very busy.
Kevin Kaplan: It’s the calm before the storm, you know. We did the combine and then the combine re-check, and now obviously the draft is this coming week, which is an exciting time. You know, once the draft happens they bring in, obviously all the rookies come in. We do their physicals and then hit the ground running. Schedule came out. So it’s an exciting time and there’s a lot of new things happening over at the stadium, so it’s a good feel.
Kasraeian: So let me ask you this. So over the past couple years, you know, we hear in the media there’s a lot of different things going on which are not necessarily bad but they are more comprehensive in the way that sports are attended to from a medical standpoint. So we’re paying attention to a lot of things and that translates into both professional sports but it translates into the way youth sports and high school sports and club sports look to the possibility of injury and safety.
Kevin Kaplan: Yeah, you know, there’s always this trickle-down effect, I think. The NFL is in the forefront of the way we treat things like concussions, the way we manage injuries from ACLs to hamstring strains to tendon tears. You know, everything kind of trickles down. Obviously the big thing now is concussions and it’s interesting I remember in residency learning about concussions and there was an algorithm, CAN 2 classification of concussions. The rules were if you were concussed for, you know, less than five minutes and you cleared all your signs, you could go back into the game. Now you fast-forward a number of years and now, if there’s any sign of a concussion at all or even the bell rung, I got my bell rung, then you are immediately taken out of game.
That’s just because of the research that’s been done in the NFL and around the country, around the world really, in determining that these hits to the brain and these impacts on the brain are obviously not good from a short-term perspective and a long-term perspective. That trickles down. You look at, you know, even my son who’s way too young to play football, you start thinking about these things and whether or not these guys playing, you know, Biddie Ball and football at a young age, if that’s gonna have a long-term effect on brain function.
So these things are on the forefront of medicine. Anytime you read an ESPN article about concussions, it’s something that’s right in front of us, so-
Kasraeian: So let me ask you, you know, one of the interesting things about that is looking back. So now you have a lot of people who are in their later years as retired NFL players or people who played football, and you may have just natural wear and tear cognitive decline and things of that nature.
How does one look at this both as a physician looking at young men who are at the beginning of their career and as we are looking at the data from people who have played who now we really see interesting, emerging data that we couldn’t have had then because the science is just emerging at such an amazing pace and it’s interesting. We kind of looked at some stats and some facts that we discussed on the show, I don’t know, about six months ago from that standpoint. I apologize if the date is incorrect, but the rapidity with which medical information moves now compared to it did even five years ago is mind-boggling and how quickly it’s gonna continue to emerge is beyond comprehension for us now. You know, it’s just moving at such a blistering pace.
When you look at this, how do you comprehend that both in terms of you mentioned your son but looking at other sports, like soccer, where, you know, I look back at how many hits I took to the head diving for headers-
Kevin Kaplan: Right.
Kasraeian: … and they’re constantly using their head to manipulate the ball, you know, in headers and things of that nature. How do you take that into consideration when you’re evaluating how you’re gonna do things tomorrow?
Kevin Kaplan: Yeah, I think a lot of these sports, NHL, soccer, lacrosse, I was just covering a lacrosse game at JU today. I mean, even those guys are wearing helmets, you know. They may impact each other, hit their heads. I think, you know, obviously looking, a retrospective look, you know, at 20 years ago, it’s easy to say, “Oh, man, you know, how did we not see this?” But we really didn’t have that. You’re right, we didn’t have that data. I think the equipment’s improved. You know, you look at guys that were wearing helmets in football back years and years ago, they had these little leather helmets they were wearing. They weren’t these nice, padded helmets that protected the train from these decelerations, accelerations, so I think we learn from things.
You know, if we just said, okay, a concussion’s a concussion, don’t worry about it. That’s not realistic. Now we’re starting to learn and as we learn we try to make things better. You know, do I think that there’s a possibility to eliminate risk and eliminate concussions from happening? No, I don’t. I think concussions happen in all sorts of different sports. I mean, do you remember in high school, did you ever have or remember having a concussion?
Kasraeian: Yeah, that’s funny. You know, I remember, kind of looking back, I had this one episode where we were playing Bishop Kennedy in the district game and I went for a diving header and I hit the ball before the goalkeeper punched me in the face. He missed the ball and it was great. We got the goal, we won the game. My entire team decided to pile on top of me. I, you know, came up with that and, you know, you talk about getting your bell rung, it was, I felt like my nose was probably three times the size of my face and anyone who knows me my nose probably should not be any bigger than it is already. So, one could potentially argue did I have a concussion? Probably, but, you know, I didn’t come out of the game. You know, everyone pushed me back in there and probably my entire team falling on my face and my head and jumping on top probably didn’t help anything at that point, but you didn’t come out of games unless you really had to. Then I, you know, looking back at that, who knows, you know?
Kevin Kaplan: Yeah, and now the other thing in the NFL that we’re doing our injury database is enormous. You know, all the teams keep track of their injuries. You know, for me, obviously, the concussions are within the medical side and, you know, for us looking at rotator cuff tears and ACL injuries and meniscus injuries and, looking at it, it’s interesting, even shoe wear. I mean, there is an entire foot and ankle subcommittee in the NFL of physicians looking at shoe wear and how that translates to high ankle sprains and Achilles injuries. So every aspect of the game medically we have to look at. You know, we look at our injury rates every year. How many guys had ACLs? Why did they have ACLs? Where did they tear? Was it on turf? Was it on field? Was it pre-season, regular season, post, you know, so we look at all these variables in trying to determine what these injury patterns are. We know you can’t eliminate. You can’t make N zero. You can’t say there are gonna be zero injuries.
Kevin Kaplan: It’s impossible.
Kasraeian: How quickly does that translate into changes in equipment? Like how often do helmets change?
Kevin Kaplan: I think that the style of the helmets change. You know, they are trying to figure out what’s the best-padded or what’s the best equipment. The NFL Physicians’ Society, we all get together at the combines every year and come up with recommendations for things like helmets or shoe wear. You know, there is a list of shoes that they say you shouldn’t wear because of x risk factor. So every year there’s different recommendations based on these studies and the studies are ongoing. Every year there are more and more studies based on the injury data that we collect.
Kasraeian: And how does that translate-