Tennis , a pulled , or an . We’ve all dealt with common sports in an attempt to get in shape. Faculty at Georgia Tech’s College of Engineering are laser-focused on providing for even the most common . Past that, extracellular matrix therapies, regenerative medicine and wearable sensory technology are just a few of their more advanced focus areas. Sports medicine today has become a specialized field with many facets. No longer just a study of orthopedics, sports medicine now encompasses new therapies and technologies that tackle all sorts of sports-related injuries and diseases, leveraging predictive analytics and wearables to keep athletes performing at their best.

by Georgia Parmelee

30 31 ROB FELT Robert Guldberg

Tech’s sports medicine research program continues to grow, led by faculty such as Robert Guldberg, Omer Inan, Michelle LaPlaca and Johnna Temenoff, all leaders at the top of the field.

Each of these engineers has made impactful for rotator cuff injuries, tears contributions to sports medicine research, and osteoarthritis. Guldberg has recently and their work is already seeing real-world worked with the likes of Dr. Gary Lourie, application today. Each one of them is driven head physician for the Atlanta Braves, by a common desire to enhance the quality of whose focus is to keep athletes safe and life of athletes, both on and off the field. And healthy. Lourie will deliver a keynote talk on even the occasional exerciser can reap the regenerative medicine at the Major League benefits. Baseball annual meeting in December. This close collaboration with Tech brings cutting edge sports medicine therapies to baseball Robert Guldberg // Executive players across the nation, keeping athletes Director, Parker H. Petit Institute for performing at their peak. Bioengineering and Bioscience and Mechanical Engineering Professor Much of Guldberg’s research can be applied to athletes, like baseball or football players, Baseball players today may soon benefit who have early onset osteoarthritis from from Robert Guldberg’s work on treatments trauma to their and . Guldberg

32 Georgia Institute of Technology, College of Engineering has recently focused on extracellular matrix loading in the healing process is crucial for a (ECM) therapies for sports injuries and speedy recovery of functional performance.” using stem cells to reduce inflammation and stimulate healing. More than 200 prohealing When asked about the future of biomedical proteins make it one of the latest treatment engineering, Guldberg points to predictive options to help manage sports injuries. modeling and data analytics.

“Injured athletes just want to get back to the “I think the next frontier will involve playing field faster, as well as prolong their working with health data analytics,” said career,” said Guldberg. “In collaboration Guldberg. “The future for healthcare is with MiMedx, Inc. in Marietta, GA, we have understanding all the data and using it to shown that an injectable form of micronized predict injuries and identify the optimal ECM can slow down and partially reverse personalized medicine approaches to quickly post-traumatic arthritis in preclinical studies. return patients to full health.” We believe this will have a positive impact on athletes in the near future.” Soon, there will be predictive models for diseases like arthritis, creating the Guldberg is also interested in biomaterials opportunity for doctors to intervene early and bio-printing for injuries to cartilage and stop the damage. Guldberg hopes to be like the meniscus. Bio-printing involves 3D on the front lines of returning athletes and printing but with living tissues. Currently, others to full health. there is no real solution for a damaged meniscus. But in the future, a living meniscus could feasibly be printed. In the meantime, Omer Inan // Assistant biomaterial hydrogels are used to replace Professor, Electrical and cartilage tissue and speed recovery. Computer Engineering

Working with biomaterials leverages Omer Inan was a college Guldberg’s work in both BME and ME athlete in track and field at Georgia Tech, and he’s interested at Stanford when his in understanding how the mechanical passion for sports medicine environment in the body relates to the began. As a discus thrower, healing process. Guldberg sees a natural he became interested in interface between mechanical engineering quantifying the health of joints and the biosciences. His research helps to enable higher performance and answer questions such as, ‘if an athlete has a influence training regimens. , what is the optimal rehabilitation protocol for them to be up and moving Today, Inan is developing sensor- again?’ based technologies to aid the road to recovery in athletes. With pro In research published in the prestigious athletes, training is occurring Proceedings of the National Academies of at a very high level, and Science, Guldberg’s lab recently showed the stress on the joints that stressing an injury site too early can is substantial. disrupt revascularization and healing, while Monitoring a delayed mechanical loading protocol athletes’ stimulates more robust tissue repair. “We bodies, want to wait until the right moment to encourage blood vessels to grow and for tissue to start reforming, so timing is everything,” said Guldberg. ”Mechanical

Georgia Tech Engineers, Fall 2017 33 “Healthy and particularly the joints and , In the future, Inan is interested in can help coaches make better training looking at overuse injuries, which he damaged joints decisions. Objectively-driven decisions predicts to be the next big thing for joint guided by data reduce the chance of re- health monitoring in sports medicine. sound very different. injury and optimize recovery. Inan believes data analytics will help This wearable researchers study overuse injuries by Inan has developed a Wearable Knee quantifying injury risk with wearable joint sensor helps Health System (WKHS) that listens to sensors. Analytics are helping Inan build the sounds a joint makes to determine better sensors to gather more accurate evaluate joint injuries its health. The WKHS can be used data. and create healing during rehab to monitor swelling and structural stability improvements. It’s “Leveraging data and technology helps regimens." creating a much more objective level of us sense and modulate,” said Inan. “It’s monitoring. And it’s not just for . not just the physical hardware, but also – Omer Inan the processing and interpretation of the “Healthy and damaged joints sound data that comes from the sensors. Data very different,” said Inan. “This analytics is a big component of our lab wearable knee joint sensor helps and helps us extract information from evaluate joint injuries and create healing the data that we sense.” regimens. It also has preventative applications. Pitchers for example can Inan hopes to use analytics for overuse potentially listen to their rotator cuff and injury detection to help athletes avoid decide how much pitching they should further damage and create a healing do based on the sounds.” regimen to get them back to playing, and fast. When Inan was throwing discus in college with his sights set on the Olympic trials, he over extended Michelle LaPlaca // Associate himself, cutting his career short. If his Professor, Coulter Department of coaches had possessed technology like Biomedical Engineering this, it is likely he could have competed much longer and at a higher level. Michelle LaPlaca recently gave a TEDx talk on concussions, bringing her Inan’s work also takes him to College research and viewpoints to center stage of Sciences Professor Mindy Millard- for a large, engaged audience. In her Stafford’s lab at Georgia Tech, where he talk, she makes the case for personalized measures heart function in a high heat health to transform the way doctors treat environment, like a summer ball field or concussion injuries. For each athlete that football stadium. Many athletes suffer suffers a concussion, LaPlaca argues you from dehydration in these conditions, have to take into account any number and Inan is looking for a way to measure of personal health factors, such as the body’s reaction based on cardiac and preexisting conditions. response. Doctors can then make more objective decisions about concussion treatment “If an athlete is performing when it’s and more accurately predict outcomes. hot, and the coach is worried about loss of fluids, we can potentially monitor “Each of us has a brain fingerprint changes in cardiovascular performance based on how many times you’ve hit and decide when to rehydrate and your head in the past, what rest,” said Inan. “We are measuring you’re on, your medical history, diet, cardiovascular performance with etc.,” said LaPlaca during her TEDx talk. wearable sensors, and the overall “We can take all these data points and solution may be a great way to prevent use algorithms to create personalized heat exhaustion in athletes.” prints that allow us to tailor

Right: Omer Inan and student.

34 Georgia Institute of Technology, College of Engineering FITRAH HAMID 35 taking the guesswork out of diagnosing a concussion during a game. So no more ‘how many am I holding up?’

“Every concussion is different, and we are really trying to understand the complexity of the data coming out of DETECT,” said LaPlaca. “The device allows us to test , motor function, reaction time, neurocognitive function and oculomotor function. After you test across all these different domains, you can then make the call whether the player should go back in the game.”

LaPlaca believes the next phase for DETECT is to leverage the data analysis to make concussion therapy even more personalized and predictive. Ideally, she would also like athletes to have access to the tools on a personal device, like a smartphone.

“We want people to have more control over their health and diagnoses,” said 01101011001011010011 LaPlaca. “We want to empower them 01010101010 with information so they can be aware of 0110110110100101010110100111010 their health. It would be great if we could 011 GARY MEEK turn DETECT into a point-of-care device 0101111010110010 Michelle LaPlaca and athlete. that is convenient for athletes, as well as 10101010101001010101001 inexpensive.” 10010101010100101 01001010100101 diagnosis and treatment plans just for LaPlaca finds the brain intriguing and 010011010110101010 you and your brain. So this is a data- challenging, and every day she leverages 100 driven approach, and we can create her bioengineering background to 01101110101010111010111 individual plans for each athlete.” problem solve for the most efficient, yet 01101010101 complex, machine on earth: the human LaPlaca advocates for personalized brain. healthcare to diagnose and treat concussions. She’s leveraging technology Johnna Temenoff // Co-Director, and systems thinking from her Regenerative Engineering and engineering background to uncover Medicine Center and Biomedical the simplest solutions to address Engineering Professor concussion issues. LaPlaca developed DETECT (integrated Display Enhanced Johnna Temenoff is passionate about TEsting for Cognitive Impairment making people’s lives better. And and mTBI) alongside David Wright at she does that with her research into Emory University as a rapid concussion regenerative therapies, which involves assessment tool for sideline evaluation injecting cells or proteins into tissue of concussions. It’s an immersive tool to aid healing and stimulate repair. As that uses virtual reality to objectively athletes age and put more stress on their detect deficits from several different bones, joints and ligaments, degeneration neurological domains in just 20 minutes, occurs, which leads to tears to the

36 Georgia Institute of Technology, College of Engineering and ligaments. Temenoff because of the tightness is hoping to identify degeneration of the . Temenoff and stop it in its tracks, before a tear has a solution in mind: to occurs. completely regenerate the tendon and avoid “We are trying to better understand surgery all together. what causes the pathology that leads to tears, so we can develop a “Ideally, we will biomarker or imaging technique to develop regenerative monitor and intervene before the therapies that mitigate damage occurs,” said Temenoff. “We the need for suturing,” have a National Institutes of Health said Temenoff. “And our injectable muscle (NIH) grant to fund the degeneration therapy could reduce degeneration in the first place to research, which is really well suited improve the potential for earlier rehabilitation and return to athletes who are monitored closely to function.” anyways.” Temenoff’s hope is that eventually the regenerative Starting this fall, a new NIH grant will therapies will completely prevent the need for tendon enable Temenoff to focus on the idea reconstructive surgeries or at least provide alternatives to of intrinsic healing. She’s proposing an allow the body to regenerate if a tear does occur. injectable material that would recruit the body’s own stem cells to injured Temenoff is collaborating with Emory Orthopedics and muscle to stimulate regeneration. their physician team to validate her studies. The doctors The cells would then prevent further at Emory lend a unique perspective to the research by degeneration and potentially promote providing patient tissue samples. Emory also gains an future regeneration. Temenoff suspects engineering team who is focused on regeneration that this research will be very useful for they can eventually use to treat their patients. Temenoff sports injuries like rotator cuff tears, expects this synergy to grow as her research continues. ▪ a common condition among athletes derived from overuse.

Temenoff’s rotator cuff research has also detected early changes to the cartilage, so she’s looking to target cartilage, as well as tendons for those who may be susceptible to injury. Baseball and football players, swimmers and throwing sport competitors in track and field can benefit from cartilage monitoring. The regenerative therapies being developed would treat the cartilage with an injection, preventing negative changes to the joint.

If a tendon tear does occur, the next question is how best to treat it. Standard procedure is to suture the tendon back to the . The biggest issue for athletes in this situation is the inability to return to full function because the muscle is too weak. It is also very easy for re-injury to occur ROB FELT Johnna Temenoff

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