Sports medicine advances to enhance injury treatment from World Cup to Olympics.

“Kentaro Onishi, an assistant professor of physical medicine and rehabilitation at the University of Pittsburgh School of Medicine and an International Olympic Committee doctor, stated that modern sports medicine is still in its early stages. Leveraging ultrasound technology for less invasive surgeries, Onishi seeks to revolutionize injury treatments. Despite advancements, common injuries like tendon problems are primarily managed symptomatically. Onishi, along with other researchers, is striving to introduce innovative technologies.

Funded by the Department of Defense, he is working on a lotion targeting the molecule responsible for tissue scarring, which could alleviate conditions like tendonitis. This approach could eventually become as easy as applying sunscreen before workouts, transforming the treatment landscape. Onishi believes that these solutions could even prevent injuries.

In a discussion with STAT, Onishi touched on his use of technology to assist elite athletes and the state of sports medicine as a field. Here are the highlights of that conversation:

Q: How do you assess the World Cup’s handling of injuries?

A: The World Cup has made significant progress. Previous tournaments saw players returning on the same day after suffering concussions, which stirred controversy. However, in the recent World Cup, I didn’t notice any glaring issues. It appears that the medical staff is performing admirably.

Q: Could you share your experience from the 2021 Summer Olympics in Tokyo?

A: Tokyo is my hometown, and being an Olympic doctor was a childhood dream. Six years after completing my sports medicine fellowship at Mayo Clinic, I had the opportunity to return to my homeland and serve as an Olympic doctor, collaborating with the IOC research team. It was a remarkable way to fulfill my childhood dream in my own city.”

“My role was to introduce portable ultrasound technology, which now conveniently fits in a jacket pocket. It enables on-the-spot diagnosis of injuries like fractures and tendon muscle tears by peering through the skin. Surprisingly, the Olympics had never offered this as a standard service to athletes at the competition venues. Traditionally, they relied on a centralized Polyclinic for medical services, where Olympians reside, eat, and receive care from a multidisciplinary sports medicine clinic. However, things were different at the actual venues.

What made the Tokyo Olympics unique was that it was the largest sporting event ever and the first mega event held within a Covid-19 bubble. Moving athletes from one place to another posed the risk of infections. Dr. Freddie Fu, the former Chair of the Orthopedic Department at the University of Pittsburgh, suggested bringing ultrasound to the athletes instead of moving the athletes to imaging facilities.

We initiated the IOC Venue Ultrasound Program at the Tokyo Olympics, providing formal ultrasound services at seven different venues, including basketball, three-by-three basketball (a new sport in Tokyo), rugby sevens, BMX, indoor men’s and women’s volleyball, and handball. These choices were based on data from the Injury Illness Surveillance Program during the Tokyo Olympics, which helped identify high-risk sports requiring robust medical support. Having ultrasound at the venues enabled doctors to make more informed decisions with imaging information, as opposed to relying solely on clinical exams.

What sets ultrasound apart from other imaging technologies?

Consider a conventional X-ray machine or an MRI machine; they require dedicated rooms to prevent unnecessary radiation exposure or interference with devices like pacemakers. Ultrasound, on the other hand, is pocket-sized and can be used on the field. However, it requires a skilled physician to operate. This project was uniquely suited for Japan, where doctors have high ultrasound proficiency. Of the 14 injuries assessed using ultrasound, the diagnostic accuracy, when compared to clinical gold standards like MRI, was an impressive 100%.”

“How do you employ ultrasound for injury diagnoses?

Clinical examinations, as you’re aware, aren’t infallible. Doctors manipulate limbs, but no matter how skilled the examination, it’s never foolproof. Thus, we need to supplement it with tools to enhance diagnostic accuracy. Misdiagnoses could lead to critical decisions, especially in the context of the Olympics, where it could determine an athlete’s participation in a gold medal match. Timely diagnosis is of paramount importance in sports medicine.

As athletes continually push the boundaries of human physical capabilities, is sports medicine keeping pace with these developments?

Yes, we can, but we must evolve. Many sports medicine practitioners adhere to what they were taught, which often stems from their mentors’ teachings. This perpetuates habits not necessarily grounded in scientific evidence. If we persist in this approach without change, we’ll lag behind athletes attempting extraordinary feats.

We’re exploring the notion that humans might one day achieve a sub-two-hour marathon. To attain such a goal, athletes will need to train intensely, likely covering longer distances. Such training may lead to an increase in issues like tendon problems. When dealing with tendonitis through palliative care, we might hinder the tendons’ functional recovery. Instead, we should delve into the biological, and even genetic, underpinnings of tendon injuries and seek ways to reverse them, rather than adhering to traditional methods like steroid injections.

It’s crucial to question the ‘why’ behind our practices. We should create independent research topics that aim to comprehend the biological basis of injuries. Research isn’t always glamorous; it’s time-consuming. Yet, it’s necessary to innovate treatment options that help athletes achieve their performance goals.

Is there a conflict between the pressure on athletes to return to the game and the need to treat their injuries?

Yes, there can be. I adhere to the fundamental principle of medicine: the patient’s well-being comes first. I don’t engage with coaches unless athletes express a strong desire to expedite their return. Even if an athlete’s primary aim is to resume playing, I make it a point to ask if their goal is to return to training promptly. Surprisingly, some athletes might prioritize recovery over an immediate return to sports. I’ve treated Olympic-level tennis players who’ve said, ‘I’m okay with this season; I have a few months to recover.’ It’s essential to ask because the aggressive interventions that hasten an athlete’s return can carry greater risks than less invasive options. Ensuring alignment with athletes’ goals is paramount.”

“What have been some of the most rewarding moments in your career?

I may not be extending life expectancy, but I’m certainly enhancing the quality of life. Medicine has been quite successful in saving lives, but the focus on improving the quality of life has been relatively limited. It’s equally gratifying to witness elderly individuals affected by arthritis whose aspirations include holding their grandchild’s hand and enjoying a peaceful beach hike. Stories like this are just as fulfilling to me as those of top Olympic athletes competing on the global stage.

One of the world’s premier decathletes has sought treatment for various injuries from me over the years. Watching him lead the world at the World Track and Field Championships while I was presenting at a conference in Japan was an anxious moment. I hoped that the injuries I had treated wouldn’t hinder his performance. However, when he crossed the finish line as the world’s top competitor, it was incredibly fulfilling. It’s a tangible testament to the impact of your work, beyond merely extending someone’s life. In some cases, it can completely transform their life. For instance, when a high school athlete receives timely treatment, makes it to the state championship, wins, and earns a college scholarship, you’ve played a small but significant role in shaping their future.”


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