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Dr. William Meyers - 08/2014

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3DPT interviews Dr. William Meyers about core muscle injuries

Vincera Institute
1200 Constitution Avenue
Philadelphia, PA
(267) 592-3200
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Dr. William Meyers is a world renowned surgeon, specializing in sports hernias or athletic pubalgia. He has evaluated and performed procedures on top athletes in the National Football League, National Hockey League, National Basketball Association, Major League Baseball, Major League Soccer, Professional Tennis, Professional Golf, Professional Bull Riding, Swimming, Olympic Track and Field, as well as collegiate and recreational athletes. He practices and performs surgeries at the Vincera Institute at the Naval Yard in Philadelphia. 3D had an opportunity to discuss sports hernias, rehabilitation, and prevention with Dr. Meyers.

3DPT: Where are you from and where did you go to medical school?

Dr. Meyers: I am from Lawrence, Massachusetts. I went to medical school at Columbia College of Physicians and Surgeons in New York and completed my surgery residency at Duke University.

3DPT: There is a lot of talk in sports and medicine about a sports hernia. What exactly is a sports hernia?

Dr. Meyers: The term “sports hernia” is misleading. For many years, the pelvis remained a mysterious anatomical region, but we now have so much greater understanding of the workings of the core. I encourage the use of the term “core muscle injuries” to describe any of muscular injuries in the core. A core muscle injury is a tear or a series of micro-tears of the muscles or tendons that attach to the pubic bone. The pubic bone is the center of activity for the core with multiple soft tissue attachments connected to it. Core muscle injuries can involve any of these structures, but the most common involve the rectus abdominis, and/or the adductor muscles that attach to the pubic bone (adductor longus, adductor brevis, pectineus).

3DPT: Are there particular sports that make an athlete more susceptible to a core muscle injury?

Dr. Meyers:We tend to classify the injuries in following way: severity, variety (which combination of muscles, etc), and type (acute or chronic). Within those classifications here are some examples:

Severity: bull riders and bronco riders get the most severe core muscle injuries, with evulsion of many muscle attachments.

Variety: We call one of the variants of the injury "Baseball Pitcher / Hockey Goalie Syndrome". From the name you can tell it occurs most frequently in baseball pitchers and hockey goalies. It primarily involves a muscular hernia through the fascia or epimysium investing the belly of the adductor longus muscle. Tennis players get a specific type of rectus abdominis injury. Within each sport, we see common injuries based on position. For example, in football, quarterbacks will get a different variety of injury than receivers.

Type: Football and soccer players tend to get acute injuries from cutting or twisting quickly, (hyperextension of the abdomen and hyperabduction of the thighs). Basketball players and marathon runners can have chronic injuries from constant pounding to the area.

3DPT: Do all core muscle injuries require surgery or does rehabilitation alone work for some? What types of exercises are most effective?

Dr. Meyers:Not all core muscle injuries require surgery. Treatment plans are based on many factors including the variant and severity of the injury, level of performance, and risk of altered mechanics. Conservative treatment can include anti-inflammatory medication, core stability and physical therapy, heat/ice therapies, massage therapy, steroid or PRP injections, and simply rest.

3DPT: If an athlete does require surgery, what will a return to play timeline look like?

Dr. Meyers:Recovery from surgery can be anywhere from 10 days to 12 weeks depending on the type and severity of the injury.

3DPT: Is there anything that an athlete can do to "prevent" a core muscle injury?

Dr. Meyers: Prevention of core muscle injuries involves consideration of the two scenarios within which the injuries occur; overuse and acute injury.

To avoid injury based on overuse, players needs to strengthen all muscle groups equally and design exercises to maximize core strength to avoid wear-and-tear.

For prevention of acute injuries that involve unusual movement or contortion, a realistic approach is to train for the “transition” scenarios within a specific sport. For example, in baseball, train for transition of pitching and batting. There may be ways to incorporate training and practice techniques to train the body, minimize these huge force shifts, and at the same time improve performance.

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     -      Dr. Kathryn Gollotto, DO - Orthopedic Reconstruction Specialists