Behind the Sports Medicine

Episode 70: Erica Mulholland - Stop Blaming Her Hormones — The Real Cause of ACL Injuries in Female Athletes

The Real Reason Young Female Athletes Are Getting More ACL Injuries Adolescent girls are tearing ACLs at alarming rates, particularly in soccer, but the explanation most people reach for is wrong. According to strength coach and former All-American soccer player Erica Mulholland, the problem has far less to do with female anatomy or hormones than most people think. In this episode, Erica Mulholland joins hosts Andrew Rizza and Dr. Cameron Roth for a discussion on ACL injuries, strength training, long-term athletic development, and the growing pressures facing young female athletes. Drawing on her experience as a collegiate athlete, semi-professional player in Brazil, and author of the book Female Athlete, Mulholland explains why strength training remains the single biggest missing piece in a female athlete’s development. She challenges popular misconceptions around biomechanics and menstrual cycles, arguing that poor mechanics are often the result of fatigue and inadequate physical preparation, not the root cause of injury itself. The conversation also explores the role of parents and coaches in youth sports, the dangers of overscheduling young athletes, and why one well-designed strength session per week can completely change an athlete’s trajectory. MEET THE GUEST Erica Mulholland - Former All-American Soccer Player - Johns Hopkins University - Strength & Conditioning Coach - Author: Female Athlete TOPICS DISCUSSED - Why ACL injuries in girls are more about load management than anatomy - Why strength training is essential for adolescent female athletes - What a well-designed in-season strength programme looks like - The biggest myths surrounding menstrual cycles and ACL injuries - How coaches and parents can better support young athletes - Load management, recovery, sleep, and nutrition for injury prevention HIGHLIGHTS 00:00 – Intro 00:52 – Why ACL Injuries Are So Prevalent in Young Female Athletes 03:57 – Sponsor: Boston Orthopedics and Wellness | Beck Bode 05:29 – The Impact of Year-Round Youth Sports 08:24 – What Needs to Change: Parents, Coaches & Administration 14:47 – What a Typical Training Session Looks Like 17:33 – Are We Overcomplicating ACL Prevention? 21:54 – Getting Buy-In from Coaches, Athletic Directors & Parents 25:27 – American vs. International Approaches to the Weight Room 27:18 – What Separates a Good Strength Coach from a Bad One 28:48 – Training for Endurance in Soccer Athletes 30:11 – What Coaches Should Look for in a Strength Training 32:21 – When to Start Talking Nutrition and Sleep 34:28 – Nutrition and Supplements for Teens 38:05 – Best Technology Tools for Assessing Athletes 40:30 – Key Takeaways From the Female Athlete 45:06 – What Parents Should Prioritize & What Coaches Should Stop Overlooking 46:34 – Lightning Round: ACL Reconstruction, Load Management, etc 48:57 – Addressing Body Image Fears in the Weight Room 50:19 – Other Common Injuries in Young Female Athletes 52:45 – The Rise of Compartment Syndrome QUOTES: 01:04 - “We used to think it was just a female issue that, girls have wider hips or a larger Q angle and they had different mechanics than males, or there's hormonal factors at play — But it's really more a training load problem.” 06:40 - “I think parents fall into the trap that if they're not on the top team, they're not playing year round, they're not doing skill sessions year round, that their kid will fall behind, and they're not going to be on the top team when they hit puberty. Well, that's not the truth.” LINKS Erica Mulholland - https://ericasuter.com Female Athlete High Performance: Building Fast, Strong, and Powerful Female Athletes - https://www.amazon.com/Female-Athlete-High-Performance-Building/dp/B0CN8NJF2F PlayerPulse - https://playerpulseapp.com RELATED EPISODES The Surgeon Who Saved Sports - Meet Dr. Andrews - https://www.youtube.com/watch?v=tkvI56ZiabA&t SPONSORS - Boston Orthopedics and Wellness helps you recover faster, move better, and perform at your best with advanced orthopedic and wellness care. Get 15% off your first visit: https://www.bostonorthopedicandwellness.com/ - Beck Bode is a fee-only fiduciary firm that builds personalized roadmaps to keep your money aligned with your life goals. See what real planning looks like at https://beckbode.com DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. #FemaleAthlete #ACLPrevention #YouthSports #WomensSoccer #StrengthAndConditioning

Episode 69: Clinical Conversations - Tennis Elbow

Why "Just Rest It" Isn't Always the Best Advice for Tennis Elbow Tennis elbow (or “lateral epicondylitis”) is widely known as a "country club injury," but treating it can be more complicated than its casual nickname suggests. Beneath this common overuse condition lies a complex web of stubborn tendon pathology and what is usually a grueling 12-to-18-month natural healing timeline. In this episode, athletic trainer Andrew Rizza and orthopedic surgeon Dr. Cameron Roth launch their new, fast-paced Clinical Conversations series by breaking down how they manage tennis elbow and what actually works for long-term relief. The duo unpacks why treating this common overuse injury isn’t always as straightforward as “just resting it.” Dr. Roth explains how he diagnoses tennis elbow in the clinic and the importance of ruling out radial tunnel syndrome. Rizza challenges the "rest and wait" philosophy, advocating instead for targeted, slow-controlled eccentric exercises and manual therapies. The hosts also dive into the controversial role of cortisone injections, the mechanics of KT taping, and when surgery may be necessary. TOPICS DISCUSSED * Why tennis elbow can take months to fully resolve * How to differentiate tennis elbow from radial tunnel syndrome * Eccentric loading and rehabilitation strategies * KT taping, dry needling, cupping, and manual therapy * The pros and cons of cortisone injections * When surgery becomes an option for chronic cases HIGHLIGHTS 00:00 – Clinical Conversations Series Intro 00:54 – Symptoms & Presentation of Tennis Elbow (Lateral Epicondylitis) 03:19 – Rehab Philosophy & Treatment Approach 05:07 – Sponsor: Beck Bode | Boston Orthopedics and Wellness 06:38 – Expected Treatment Timelines in Physical Therapy 10:38 – The Benefits of KT Tape 12:13 – Surgical Candidacy 14:40 – Radial Tunnel Syndrome: Treatment & Surgery 17:50 – Cortisone Injections for Lateral Epicondylitis 19:38 – Topical & Oral Medications 21:03 – Outro QUOTES: 03:47 - “And we know that rest will ultimately make it better, but we know physical therapy will obviously help it improve at a little bit faster rate if you give it a better environment. But I always look at it as being slow and controlled, eccentric exercise. - Andrew Rizza 08:36 - There are things that can make you feel better temporarily, corticosteroid injections, bracing, dry needling, et cetera. But the thing that may shorten this 12 to 18-month timeframe is therapy. - Dr. Cameron Roth SPONSORS Beck Bode is a fee-only fiduciary firm that builds personalized roadmaps to keep your money aligned with your life goals. See what real planning looks like at https://beckbode.com [https://beckbode.com] Boston Orthopedics and Wellness helps you recover faster, move better, and perform at your best with advanced orthopedic and wellness care. Get 15% off your first visit: https://www.bostonorthopedicandwellness.com/ [https://www.bostonorthopedicandwellness.com/] DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. CONNECT WITH US Have a question or a specific topic that you want covered in an upcoming Clinical Conversations episode? Email: info@behindthesportsmedicine.com [info@behindthesportsmedicine.com] Check out our website and social media channels for video clips, episode updates, and more sports science insights. #SportsMedicine #TennisElbow #PhysicalTherapy #OrthopedicSurgeon #LateralEpicondylitis

Episode 68: Curt Schilling - Curt Schilling on Why Pitching is Broken (and the Real Story Behind the Bloody Sock)

Curt Schilling’s “bloody sock” became one of the most iconic images in sports history, but the real story behind it is far more medically complex than most fans realise. Beneath the legend was a career defined as much by medical adversity as athletic brilliance: misdiagnosis, pioneering surgery, a season-long ankle injury, and an experimental procedure performed on a trainer's table the night before one of the most famous starts in World Series history. In this episode, six-time MLB All-Star, three-time World Series champion, and postseason pitching legend Curt Schilling joins hosts Andrew Rizza and Dr. Cameron Roth for a wide-ranging conversation on elite pitching, sports medicine, and the changing landscape of Major League Baseball. Schilling speaks candidly about refusing to accept a rotator cuff misdiagnosis, seeking a second opinion that led him to pioneering shoulder surgeon Dr. Craig Morgan, and undergoing a SLAP repair in 1995 that was a decade ahead of its time. He explains how deeply understanding his own anatomy transformed his relationship with rehab, recovery, and the medical professionals around him. The conversation also covers the full story behind the bloody sock and the cadaver-tested suture procedure that allowed Schilling to take the mound in Game 6. Plus, his outspoken view on why pitching in today's game is broken, and why the people running baseball already know it. MEET THE GUEST Three-time World Series Champion Six-time MLB All-Star 2001 World Series Co-MVP TOPICS DISCUSSED The real medical story behind the “bloody sock” game The importance of taking ownership of your own medical care Biomechanical secrets of the pitching kinetic chain Why rotator cuff recovery takes longer than athletes are told Why the modern hunt for velocity has "broken" pitching The mentality required for a 3-0 comeback HIGHLIGHTS 00:00 – Intro 00:50 – Schilling's Career Journey 04:42 – Sponsor: Boston Orthopedics and Wellness 05:46 – The "Superstar Path" to the Major Leagues Explained 09:41 – Mental Toughness in Training and Preparation 11:32 – The Benefits of Curiosity 12:50 – When Sports Medicine Became Central to Schilling's Career 19:33 – Schilling's Post-Surgery Rehab Process 23:49 – The Importance of Taking an Interest in Your Health 25:54 – Why Schilling Believes That Pitching Is Broken 31:13 – How the Game Has Changed from a Pitching Perspective 33:17 – Shohei Ohtani: The Ultimate Pitcher–Hitter Unicorn 34:47 – Recovery & Preparation Across a Season 36:21 – Relationship with Pedro Martinez and Derek Lowe 37:06 – Importance of Starting Rotation and Team Chemistry 38:52 – Schilling's Role Models 40:48 – Connection to Phoenix & Boston 42:08 – The Bloody Sock: The Full Story 45:42 – How Schilling's Ankle and Shoulder Feel Today 46:41 – The Experimental Suture Procedure 51:46 – Coming Back from 3–0 Down 53:37 – Lightning Round: Five-Hour Pre-Game Routine & More QUOTES: 13:33 - “One, no one is ever going to care about my health more than I am, no matter how much somebody says they are. And number two, if the media is to be believed, no player has ever been misdiagnosed or operated on wrongly, because you don't read about those." 26:55 - “And they said, ‘Yeah, we know [pitching] is broke, but we're paid to win. We're not going to fix it within the window of time we have at this job. So we'll just use those guys and when they break, we'll move on.’” 37:13 - “I always tell people when they ask me for predictions, I always tell people that the pitching staff that gets the most starts from the opening day starting five is probably going to win the division.” RELATED EPISODES Treat the Human, Not the Hype: Dr. Thomas Gill on the Biology of Healing & the "VIP Medicine" Trap - https://www.youtube.com/watch?v=NPS45PrwnNs&t The Surgeon Who Saved Sports - Meet Dr. Andrews - https://www.youtube.com/watch?v=tkvI56ZiabA&t SPONSORS Boston Orthopedics and Wellness — helping you recover faster, move better, and perform at your best with advanced orthopedic and wellness care. Get 15% off your first visit: https://www.bostonorthopedicandwellness.com/ Beck Bode Wealth Management A fee-only fiduciary firm helping individuals, families, and business owners build long-term financial confidence through disciplined investing and personalized planning. https://beckbode.com/ DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. #CurtSchilling #MLB #SportsMedicine #Orthopedics #PitchingMechanics

Episode 67 Elspeth "Elly" Hart - How Many Did You Lose to Get One Olympian? The Hidden Cost of Elite Youth Gymnastics

The American Olympic gymnastics team is doing exceptionally well, but at what cost? With kids us young as 12 doing between 30 and 40 hours of training a week, gymnastics is easily one of the most physically demanding youth sports in the world. So what happens when training loads rise faster than growing bodies can handle? In this episode, Elspeth (Elly) Hart, Physician Assistant, Certified Athletic Trainer, and gymnastics medicine specialist at Boston Children’s Hospital, joins host Andrew Rizza to explore the unique medical realities of caring for young gymnasts. The conversation examines why gymnastics requires a sport-specific approach to injury diagnosis and treatment, particularly in young athletes with open growth plates and high repetitive loading. Dr. Hart explains why persistent back pain in gymnasts should never be dismissed, how spinal stress injuries can become lifelong problems if missed, and why early intervention can dramatically improve healing outcomes. The discussion also explores “gymnast wrist,” overtraining culture, mental health pressures, and the challenge of balancing elite performance with long-term wellbeing. Dr. Hart also clarifies why emerging AI technology is likely to help reshape injury prevention in the sport. MEET THE GUEST Elspeth "Elly" Hart, DScPAS, PA-C, MPAS, ATC, LAT - Physician Assistant & Certified Athletic Trainer - Micheli Center for Sports Injury Prevention, Boston Children's Hospital - Medical Staff, USA Gymnastics - Founder, Gymnastics Medicine: Education and Research TOPICS DISCUSSED - Why gymnastics medicine emerged as its own subspecialty - Training load, sports specialization, and when overuse injuries begin in gymnastics - Spondylolysis and the protocol for healing it - What “gymnast wrist” is and why it is often missed - How AI and wearables could finally bring evidence-based load management to the sport - Mental health as a clinical priority HIGHLIGHTS 01:29 – Dr. Hart's Journey into Gymnastics Medicine 04:51 – Sponsor: Boston Orthopedics and Wellness 05:55 – Gratitude for the Work of Dr. Micheli 07:41 – ATC and PA Dual Credentialing & Gymnast Experience 09:19 – Competitiveness in Athlete Care 12:00 – Gymnast Training Loads, Injury Risk, and Age 14:26 – USA Gymnastics Safety Criteria 18:11 – AI & Technology for Load Monitoring 23:31 – Common Gymnastics Injuries 27:24 – Spondylolysis Treatment Protocol 30:54 – Long-Term Risks of Untreated Injuries 32:45 – Gymnast's Wrist: Signs & Symptoms 35:54 – Implementing Off-Season Rests in Gymnastics 38:54 – Injury Prevention Strategies for Gymnasts 42:32 – Supporting Athlete Mental Health 47:28 – Key Tools for Clinicians Treating Gymnasts 51:35 – Lightning Round: Injury Prevention Exercises & Advice QUOTES: 17:52 – "My big question is, how many athletes did you lose to get that one athlete? And what are those athletes who didn't make it to the Olympics, how are they doing? How are their bodies? How are they recovering?” 13:19 - “My first age of where we're really seeing the repetitive overuse is starting around age 10, but usually maybe even up until 13 or 14. But I have yet to meet a gymnast who has not had an overuse injury before, or I should say after, the age of 14.” 17:38 - “But I think the trouble is that, to be totally honest, our team is doing so great. We have won so many Olympic games, so a lot of coaches don't want to change the way that they're coaching because it's successful, right? It's creating an Olympic athlete." LINKS Elspeth (Elly) Hart on LinkedIn — https://www.linkedin.com/in/elspeth-elly-hart-252b06150/ Boston Children's Hospital – https://www.childrenshospital.org Micheli Center for Sports Injury Prevention – https://www.themichelicenter.com Gymnastics Medicine Education and Research – https://gymnasticsmedicine.org “Common upper extremity gymnastics injuries and gymnastic specific return to play protocols” — https://pubmed.ncbi.nlm.nih.gov/40433250/ SPONSOR Brought to you by Boston Orthopedics and Wellness — helping you recover faster, move better, and perform at your best with advanced orthopedic and wellness care. Get 15% off your first visit: https://www.bostonorthopedicandwellness.com DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. #SportsMedicine #Gymnastics #YouthSports #InjuryPrevention #PediatricSportsMedicine

Episode 66: Dr. Adam J. White - Death by a Thousand Headers: The Subconcussive Reality of UK Football

Death by a Thousand Headers: The Subconcussive Reality of UK Football Concussion protocols in sport have improved dramatically over the past two decades, but what if the biggest threat to athletes’ long-term brain health isn’t concussion at all? In this episode, Dr. Adam J. White, Head of Brain Health at the Professional Footballers’ Association and co-founder of the Concussion Legacy Foundation UK, joins hosts Andrew Rizza and Dr. Cameron Roth to explore the evolving science of brain health in UK football (soccer). The conversation challenges conventional thinking around concussion, shifting the focus toward the cumulative impact of repetitive, subconcussive head injuries, particularly from heading the ball. Dr. White explains why modern football may pose even greater risks than the past, how new heading guidelines are reshaping training environments, and why prevention—not treatment—remains the only viable solution in the absence of a cure for neurodegenerative disease. The discussion also examines the cultural and commercial pressures that prevent athletes from reporting symptoms, the limitations of current concussion protocols in football, and the growing role of AI and data tracking in monitoring head impact exposure. Dr. White explains why meaningful change in sport requires not just medical advances, but a cultural shift. MEET THE GUEST Dr. Adam J. White, PhD, PGDip, PGCert, BA (Hons), FHEA Head of Brain Health, Professional Footballers’ Association (UK) Co-founder, Concussion Legacy Foundation UK Author of Sport, Theory and Social Problems TOPICS DISCUSSED Repetitive subconcussive impacts and long-term brain health risks Why modern synthetic balls and increased player torque have heightened impact forces The political battle with FIFA and IFAB over temporary concussion substitutions The legacy of Jeff Astle and the 1966 World Cup team's struggle with dementia The sociological reasons behind why athletes hide injuries SPONSOR Brought to you by Boston Orthopedics and Wellness — expert care to help you recover faster, move better, and get back to doing what you love. Enjoy 15% off your first visit: http://www.bostonorthoandwellness.com [http://www.bostonorthoandwellness.com] HIGHLIGHTS 00:53 – Dr. White's Role in the PFA and Brain Health 04:45 - Sponsor Message: Boston Orthopedic and Wellness 05:51 – Defining Brain Health Beyond Concussion 08:25 – Misconceptions About Heading and Subconcussive Impacts 11:04 – Linear vs. Rotational Forces in Headers 12:57 – In-Game Concussion Screening: USA vs. UK 18:50 – High-Profile Cases & The Legacy of Jeff Astle 22:29 – Brain Injury Stigmas and the Commercial Value of a Player 24:34 – Challenges of Monitoring Head Impacts in Soccer 28:50 – Long-Term Neurologic Care Post-Retirement 32:00 – Motivations Behind Sport, Theory and Social Problems Book 35:13 – Athlete Health: Biologic and Social Factors 37:23 – Shifting Norms: Athletes Advocating for Teammates 40:06 – Salary Guarantees and Injury Reporting in Soccer 41:57 – Lightning Round: Optimism for Brain Health in Football 42:32 – Eliminating Toxic Competition in Sport Culture 43:08 – The Number One Habit for Evaluating Head Injuries 44:31 – Exciting Research: Diagnosing CTE in the Living 45:07 – Redesigning Sports Systems Around Long-Term Health 47:05 – Success in 10 Years: Making Dementia History QUOTES: 06:21 - “It's the thousands of repetitive head impacts that are non-concussive, they're non-symptomatic, that players are sustaining every day in training that we think are leading to these — and the evidence is pointing towards — are leading to this long-term set of neurodegenerative diseases.” 06:39 - “Often we're couching it as Alzheimer's or Parkinson's, some motor neuron disease or ALS, as it is in the States, but for those that are studied postmortem, we're overwhelmingly finding that they're being diagnosed pathologically with CTE, chronic traumatic encephalopathy.” 42:11 - “Assume it's a concussion, always assume it's a concussion, and absolutely test that. If you've got any inkling or any worry, niggle, or you’re not sure, just say it's a concussion.” LINKS Dr Adam J. White - https://adamjohnwhite.co.uk Concussion & CTE Foundation UK - https://concussionandcte.org/ Sport, Theory and Social Problems - https://adamjohnwhite.co.uk/books.php RELATED EPISODES Inside the NFL Concussion Crisis with Former New England Patriot Ted Johnson - https://www.youtube.com/watch?v=01Opfvv5rY8 “Let No One Outwork You”: Isaiah Kacyvenski’s Journey From Poverty to the NFL & Venture Capital - https://www.youtube.com/watch?v=QkFHaeGbsn0 DISCLAIMER The opinions presented on Behind the Sports Medicine are those of the host and guests. They do not necessarily reflect the opinions of any affiliated institutions or partners. The content is for informational purposes only and does not constitute medical advice. Always consult a licensed medical professional before making any health or treatment decisions. Behind the Sports Medicine and its affiliates assume no liability for the accuracy or application of the information discussed. #SportsMedicine #BrainHealth #HeadInjury #CTE #ConcussionAwareness