“Most studies would say that we reach our peak muscle mass around age 30 to 40. Then there is a very slow decline until you hit about age sixty. Once we hit age sixty, there is a steeper decline of about one percent per year. Strength training can mitigate that. You can get stronger almost no matter how old you are," said Dr. DiFiori.

This segment aired on broadcast on April 1 and 2 and is available at cnn.com. 

Dr. DiFiori explained, "Vaccines, and especially with the Omicron variant, boosters, remain the best weapon we have against COVID-19. They are certainly not perfect and people can still become infected, but they continue to perform well in preventing severe illness, including hospitalization and death.”

He continued, “Data shows that people who are fully vaccinated and boosted by one of the mRNA vaccines are the most protected against COVID-19. For the Omicron variant, boosters are particularly important. We continue to work closely with the players' association to inform them about the latest information regarding vaccines and boosters, as well as all measures needed to maintain health and safety during the pandemic.”

Read the full article at Sports.yahoo.com.

Dr. DiFiori emphasized that keeping players safe and healthy is the priority, and that more information is needed before considering making changes to the current protocols for COVID-positive players in the NBA.

“If a player is unvaccinated, we don't want to put them at risk. We are still of the mind that we want to keep everyone healthy and safe as much as we can,” said Dr. DiFiori.

Dr. DiFiori explained some of the unknowns: “We don't know yet how the virus will affect someone if they continue to train and compete immediately after they become infected. We don't know, if they do, if it worsens the overall illness. And in addition, we don't know if it increases the risk of complications.”

He added, “We have to be able to answer those questions, or have some level of reassurance that athletes would not run any increased risk that would be otherwise avoidable.”

Read the full article at Yahoo.com.

Read the full article at Washingtonpost.com. This article also appeared in print on April 20, 2021. 

Dr. DiFiori provided insight on what the past year was like for the NBA from a medical perspective. It’s more a sense of relief than triumph. Satisfaction through mitigation. So much progress from where things were a year ago, however Dr. DiFiori noted, “We were by no means experts.”

When the NBA emerged from the bubble, Dr. DiFiori and his counterparts had a trove of data, information that helped inform the guidelines for the bubble-less 2020–21 season. They learned that the bubble’s success came not just from affecting the behavior of the players, but from altering their own behavior to place an emphasis on communication. As for the science, Dr. DiFiori and others explained the more time that goes on, the more information that is gathered, the deeper and longer the data sets become.

The pandemic requires the public to recalibrate how canceled games are viewed. They aren’t signs of the sport failing, but signs of the preventative measures working. “We knew we were going to have positive cases moving forward, but how do we handle that?” cited Dr. DiFiori. “How do we prevent the campfire from becoming the forest fire?” he continued. “We're always, very, very conservative, very concerned that it could change at any time. [So if] player health and safety cannot be achieved, we're not playing.”

Read the full article at SI.com.

Additional coverage: Start Your Day With Sharon And Mike on March 22, 2021 at 8am. 

Drs. DiFiori (who is the director of sports medicine for the NBA), McElheny (who is the associate team physician for the New York Mets) and Kinderknecht (who is a team physician for the New York Giants), highlight the protocols for testing and quarantines in the respective leagues, and how these leagues are approaching play going forward during the pandemic.

Watch the discussion at Medscape.com.

According to John P. DiFiori, MD, FACSM, chief of Primary Sports Medicine at HSS and director of Sports Medicine for the NBA, while exploring the causes of the spread, the league found common transmission points included car-pools without masks and shared meals. “Our players and team staff all have families,” said Dr. DiFiori. “Some of them have children. Some of them go to school. And they go out into the community. We’re all subject to the same sorts of potential risks that anyone else is.”

“What we’ve learned and it’s not a surprise is that the pandemic affects everyone associated with the NBA just like it affects the U.S. population and the world,” added Dr. DiFiori.

Read the full article at Nytimes.com.

Dr. DiFiori and others converse about the importance of testing and the types of tests their leagues have been using, how they are analyzing results and the role of contact tracing in mitigating risk.

Watch the full event at Playsmartplaysafe.com.

While each case will be handled based on its own needs, Dr. DiFiori said the timeline for any player to return from a confirmed positive case is at least two weeks. "Everyone needs to understand that if someone were to test positive, it's quite likely that they won't return to the court for a minimum of two weeks - minimum," he noted. “It may be even a little longer than that, depending on the individual circumstances, and then you need some time to get reconditioned.”

Dr. DiFiori continued, "Anyone who's been out of training for two weeks is going to need time to recondition. These things are important for everyone to understand. The players, the coaches, the medical staff, understand that if a player tests positive, they're going to need time to clear the infection management, they need additional time to recover, and then to begin reconditioning for their sport.”

Dr. DiFiori said that much of what the league and its partners have learned about how the virus affects the heart is derived from studies of patients who have been hospitalized with COVID-19. "That data does show that there are probably two different ways that the virus can affect the heart," he explained. "One of those is a direct effect of the virus itself on the heart muscle and the heart function, and the other is sort of an indirect response where the virus stimulates a massive inflammatory response, and that inflammatory response can affect heart function." However, there is no reason to believe that any athlete is at higher risk for cardiac complications related to COVID-19 than anyone else. "There's no reason that we know that would suggest that right now,” said Dr. DiFiori.

Read the full article at ESPN.com.

John P. DiFiori, MD, FACSM, chief of Primary Sports Medicine at HSS, explained how the use of urgent care clinics has been further expanded by orthopedic practices and hospitals that see orthopedic walk-in clinics as way to increase access to comprehensive musculoskeletal care. “As opposed to a typical urgent care where the providers are trained in a number of different areas, including to some extent musculoskeletal care, [patients] are getting a higher level of care for a musculoskeletal condition because all of the physicians and providers at that location are specifically trained in musculoskeletal care.”

Since April, HSS has opened eight urgent orthopedic care clinics at existing HSS locations. According to Dr. DiFiori, HSS Urgent Ortho Care clinics provide services for urgent musculoskeletal injuries that cannot wait to be scheduled for an orthopedic office visit, including onsite x-ray or musculoskeletal ultrasound, as well as splinting, casting or bracing. Although the clinics do not offer surgical treatment, DiFiori noted some sites are equipped to perform outpatient procedures, such as ultrasound-guided injections. “If it was thought that [patients had] a surgical injury, they would be appropriately managed and then care with a surgeon who had expertise in that particular injury would be facilitated either that same day or within the timeframe that is needed to treat that injury appropriately,” he cited.

Dr. DiFiori concluded that urgent care and walk-in clinics are a way orthopedic practices can expand care throughout their communities, and are meant to complement and not replace the care provided by a primary care physician or an orthopedic specialist.

Read the full article at Healio.com/news/orthopedics.

These centers will act as emergency rooms for serious orthopedic injuries that require immediate medical attention.

“HSS Urgent Ortho Care is available to people with an acute injury or orthopedic issue that needs to be evaluated promptly for the proper diagnosis and treatment, and to avoid a bigger problem later,” John P. DiFiori, MD, FACSM, chief of Primary Sports Medicine at HSS said. “Under the current circumstances, the centers offer essential care for a new injury or orthopedic issue. If an individual has a longstanding or chronic problem, we offer telehealth consultations.”

Read the full article at DailyVoice.com/Connecticut/Stamford.

Additional Coverage:

• Nassau Daily Voice
• Stamford Patch
• Becker’s Spine Review
• Stamford Hamlet Hub

Listen to the full podcast episode at DYANetwork.org.

GE.com spoke to John P. DiFiori, MD, FACSM, chief of Primary Care Sports Medicine Service at HSS, about musculoskeletal injuries that are clinically challenging for pro basketball players. “When bone stress injuries occur, they typically result in a significant loss of playing time,” said Dr. DiFiori. “And certain injuries can be difficult to diagnose, leading to the end of a career on the court for some players. It’s why better research is so important to detect and treat these injuries early on,” he added. Plans are being developed to incorporate imaging techniques to gain further insight — on how to improve bone stress injury prevention, explore early-diagnosis techniques and develop innovative treatment protocols.

Read the full article at GE.com.

The guidelines were influenced by a group led by John P. DiFiori, MD, FACSM, chief of Primary Care Sports Medicine Service at HSS, who has been studying youth sports and overuse injuries for more than 25 years. However, the lack of a national governing body for youth basketball makes a uniform system of rules difficult.

ESPN.com spoke to Dr. DiFiori, who said the concerns have only grown more persuasive in the age of specialization. In basketball, overuse can lead to chronic ankle injuries, development of joint and cartilage issues, even spine problems. "I don't think people realize how common back problems are, among NBA athletes," said, Dr. DiFiori. “That sort of accumulation of the injuries, or the development of asymmetries, muscle tendon dysfunction, etc. That certainly can shorten a career span,” he added.

Read the full article at ESPN.com.

“I think the focus should be less on the chronologic age, but the overall physical development maturation, and also what we call ‘sport readiness’, or the ability to understand the role, the requirements of the sport, and to be able to understand instructions for sport safety. I think it’s a combination of those things that are most important," explained Dr. DiFiori. "Typically, children will begin to physically mature and develop as they go through that adolescent growth spurt, which is usually the age of 12 ½ for girls and 13 ½ -14 for boys."

“The main concern is injury that is a result of improper supervision or unfamiliarity with the techniques and the equipment,” said Dr. DiFiori. He added, “More commonly the concern is about open growth plates and the effect of chronic stress on an open growth plate which can be a problem. That’s much less of a concern in a well-designed, well supervised well-structured program.”

Dr. DiFiori emphasized the importance of understanding what the goals of the athlete are. “If the goals are to improve general fitness and conditioning then we would suggest a number of different alternatives. Bodyweight exercises are a great alternative. They can be very helpful to building general strength and conditioning. There are also more dynamic techniques, movement oriented techniques, and pulley systems that are more functional. If they are well supervised, they can achieve the goals most people are interested in – large muscle group strengthening and general dynamic conditioning and synchrony of movement. Those are important for injury prevention and we think that a properly implemented overall strength and conditioning program can help to reduce injury. That’s an important goal – to prevent injury. The second goal is being fit for your sport, and that can be more sport specific depending on the sport.”

Listen to the full interview at LeagueApps.com.