Sports Medicine

What does it mean to really be an Orthopedic Surgeon who has special expertise in Sports Medicine?

When I was a young surgeon, a more senior surgeon tried to tell me one day that “Sports Medicine” is nothing more than a patient “with a number on its back”. He could not have been more wrong.

Treating athletes, especially those with expectations of a professional career requires the treating physician to be the best of the best at what he or she does. Of course all physicians have a similar focus on being the best of the best or at least as good as the best. The difference in Sports Medicine is that the results of your work may be more visible than most. If I fix an ACL knee ligament injury and that athlete goes on to have a successful career at a professional level the results of my surgical skills are constantly on display. Likewise if that athlete fails to make it to the “big leagues” sometimes the surgeon is considered part of the problem.

Sports Medicine is considered a “glamor” career by many. Sometimes that is actually true.

A young athlete who appears to demonstrate skills or potential above and beyond those of his or her peers often provokes expectations of success in college sports or the professional arena which may be possible but sometimes unrealistic. Along with those expectations come dreams of scholarships, signing bonuses and multi-million dollar contracts.

A study interviewed Division I college football players. The results were held in confidence. The key question was: “Do you honestly believe that you will have a successful college career, be drafted in the NFL, receive a signing bonus and enjoy a successful NFL football career?” A shocking 92% answered YES! The real number is something less than 2%!

Is a “sports medicine” patient just another patient but this one wears a “number on it’s back”? Hardly! If that is what you think you will not enjoy as successful career taking care of “high demand” athletes.

In treating the young athlete it is imperative that the treating physician understand the importance of the sport to both the patient and the family.

As an example: What is one of the first questions I ask when taking the initial history of injury in a young gymnast or a dancer? It isn’t “how did you get injured” even though that is important as well. An initial question is “how many hours per week do you train gymnastics or dance? Sometimes the answer is two “one hour” lessons per week or even less. On other occasions the answer is “30+ hours per week”. Yes there are 12-14 year olds spending 30+ hours per week pursuing a career in gymnastics, dance or a similar focused individual sports. Unless you have this information there is no way you can appreciate the dreams and expectations of both the parents and the athlete and how devastated they might be by the prospect of a season or even sport ending injury.

Sometimes the appropriate treatment for a given sports related injury may be nothing more than “rest it for a few weeks”. Recommending that type of treatment to a “30 hour per week gymnast” will guarantee only one thing. They will find another doctor. To get an athlete better when “rest” is the desired treatment protocol may require that you allow the athlete to continue to perform 90% of their normal training routine while significantly restricting or modifying one or two particular exercises or maneuvers. In order to accomplish the treatment protocol the physician must not only understand the needs and expectations of the parents and the athlete but alsom must understand the nature and extent of the actual injury and the role the injured part plays in the sport or task that caused the injury.

So to be an effective and successful Orthopedic Surgeon who treats “high demand” athletes the physician must be on the “cutting edge” (yep that is a surgical pun) of his or her specialty.

A number of years ago I was participating in the annual meeting of the NFL Team Doctors Association. Part of the meeting included a panel discussion with two well known professional player Agents. Among the questions the agents were asked was “how do you decide who is the best Sports Medicine Orthopedic surgeon to treat your high profile professional athlete?

All professional teams have a “team doctor” however when the high profile athlete sustains a serious injury typically the first thing that happens is the player is on an airplane going somewhere for treatment from a surgeon selected by the agent.

Does the Professional Players Agents Association have a list of the “good” surgeons from which you choose? The answer was really interesting. First of all, Agents never talk to other agents and agents never share information. More often than not the surgeon selected to treat that high profile athlete might be the surgeon who most recently appeared on the cover of “Sports Illustrated”. Unfortunately that was really the answer!

As in most fields and businesses, reputation and experience defines the “expert”. Unfortunately in today’s arena of digital marketing the recognized “expert” may be more perceived rather than real. The best “marketer” may not be the best surgeon.

Now back to the discussion of the “cutting edge”. As the Team Orthopedic Surgeon for Brigham Young University I am often more of a “choir director” than a treating physician. Some conditions and injuries fall within my specific area of expertise and I may be in that group that is best prepared and experienced to treat that specific problem. In other situations I clearly am not that expert and my responsibility is to try to assure that I connect that athlete with an appropriate specialist well prepared and experienced in the given problem or condition.

One of the most difficult jobs of the sports medicine specialist is knowing when it is in the best interest of the athlete to stop being an athlete. Repetitive injury, multiple trauma related surgeries and especially accumulated joint trauma may force the issue of “hanging up” those athletic shoes and moving on to other adventures in life. That is a most difficult time.

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