Healers are on their toes
Medical professionals keep up with athletes by developing new techniques and equipment
When Patriots safety Rodney Harrison tore the anterior cruciate, medial collateral, and posterior cruciate ligaments in his left knee just three weeks into the 2005 season, it was potentially a career-ending injury. Harrison, however, refused to acknowledge that possibility. Facing major reconstructive surgery, he had faith in a higher power and in medical technology.
"I always felt like I had hope," said Harrison. "Everyone else was basically thinking that it was over for me."
If the injury had occurred 10 years earlier, Harrison said, there was no question his career would have been finished.
"An injury of that magnitude, never would you be able to play in the league again," he said.
Harrison knows his successful return is a testament to advances in sports medicine, many of which came in response to injuries suffered by football players.
Professional athletes are often at the forefront of sports medicine, presenting injuries and special circumstances (a return as quickly as possible) that can require medical professionals to develop better techniques, new instruments, and accelerated rehabilitation plans. A symbiotic relationship exists between sports medicine professionals (orthopedic surgeons, trainers, physical therapists) and athletes, each pushing the other toward new discoveries about how the body performs and heals best.
With sports medicine advancements, the more necessary for success it becomes for professional teams to have forward-looking medical service dedicated to innovative, all-around care.
"We have a lot of confidence in our medical people," said Red Sox manager Terry Francona. "They are very up-to-date and aware of what's going on with each player. So we can field the best team and win as many games as possible, not just in the short term, but in the long term."
Hub of the field
Drawing upon its immense academic and clinical resources, Boston has always been a leader in sports medicine. The establishment of the Massachusetts General Hospital Sports Medicine Center follows a longstanding local tradition of being at the forefront in treating athletes.
It is no coincidence that MGH Sports Medicine has become perhaps the country's preeminent all-around sports medicine center, and its doctors treat two of the most successful professional teams in the Red Sox and Patriots, as well as the Bruins, Revolution, and local college athletes. With its unique multidisciplinary approach, the center should produce the next generation of sports medicine breakthroughs.
"[Treating the Red Sox and Patriots] has had a huge impact," said Red Sox medical director and Patriots head team physician Thomas Gill, who led the campaign for the center that opened 15 months ago. "The expertise derived from taking care of professional athletes - minimally invasive techniques, rehab breakthroughs - gets translated directly to better surgery, better care for regular patients."
Gill said to hospital administrators, "If we are going to take care of the teams the way we should and give them proper care, we've got to build a sports center. We've got to be able to do it right. We have to get into the new millennium. We want to have the latest technology. We want to have a center for our research and education."
Gill called it "a totally new paradigm for patient care," and the response he got was, "You're right. How can we do it better?"
The answer turned into an approximately 20,000-square-foot facility on Cambridge Street, around the corner from the main entrance of Mass. General. Devoted to comprehensive care, the center houses specialists, clinicians, primary care doctors, and physical therapists. Gill is most proud of the integration among the medical professionals involved with the center, providing a more conducive environment for research, education, and innovation that will help all patients.
Early last December, the Red Sox pitching staff visited the center for a voluntary camp, with a wide range of services available - from performance testing to radiology to physical therapy. The players worked out in a room equipped with infrared motion-analysis cameras and a "force plate pit" designed to dissect throwing motions.
After testing for strength, flexibility, range of motion, and functional movement, the pitchers received individualized offseason training programs, addressing such issues as muscle imbalances to ensure smooth progression to throwing before spring training. This type of preventative care has been a well-documented help to pitchers Josh Beckett and Jonathan Papelbon, among others.
Long after the pitchers started their new workout regimens, Red Sox assistant trainer Mike Reinold performed some of the same testing on Bob Boermeester, a lanky, 40-year-old lefthanded pitcher in the Boston Men's Senior Baseball League. Boermeester, who underwent reconstructive shoulder surgery in 2004, wanted to pitch more effectively with more velocity and less recovery time. The testing revealed some muscle deficiencies. Reinold prescribed a series of exercises that should allow Boermeester to return to his presurgery form by the time the league starts this spring.
"The staff members at MGH who are with the Red Sox have researched baseball players so much that we know what normal players look like when healthy," said Reinold. "We also know what they look like when they're injured. So, we try to identify guys who have characteristics that will lead them to injury in the future and prevent that ahead of time.
"We want to make sure we don't see a guy Feb. 16 and say, 'Oh, boy. He looks weak.' It's too late at that point. Once they start playing baseball, it's a struggle just to maintain their status."
The beginnings
As Reinold evaluates Red Sox players, he also conducts and applies research, building upon the center's growing knowledge of baseball players and other athletes. By involving biomechanical experts, physical therapists, and doctors in planning year-round training programs, the model followed by the Red Sox and MGH Sports Medicine represents a noticeable departure from more traditional hands-off approaches to offseason baseball conditioning.
Then again, there is considerably more at stake treating today's multimillion-dollar professional athletes. The potential rewards for pioneering medical care are also greater for both professional athletes and other patients.
"With the pitching staff, we talk about two words all the time: health and production," said Francona. "One without the other is not really good. As the players learn, if they're willing to put a lot of work in, they're able to stay very healthy and very productive, where maybe 10 years ago they couldn't."
If taken decade by decade, the history of modern sports medicine would begin with the dangers of playing football and the action taken by Dr. Augustus Thorndike. As a general surgeon at MGH, Thorndike began treating Harvard athletes in the 1920s, developing protective padding, inventing casts and braces, and mandating that a physician attend every game of a contact sport. Still, by the 1950s, there was little interest in treating injured athletes, with the most common prescription being bed rest.
The true beginning of sports medicine came during the 1970s, with the development of arthroscopy. The minimally invasive technique was a natural fit for treating athletes who wanted quicker recovery from surgery. In the following decades, advances in arthroscopic techniques enabled athletes to return at even quicker rates and stay healthier for longer. Now, with more time and resources spent studying and treating athletes, sports medicine is headed toward new breakthroughs, such as refined ligament reconstruction techniques, biological replacement parts and noninvasive treatment options.
He's on the scene
When not performing surgeries, conducting research, reviewing offseason training programs, or consulting with team executives about the health of potential trade acquisitions, Gill can be found in the Red Sox or Patriots training rooms. He treats and evaluates players during the week, before and after games. Gill attends all Red Sox regular-season home games and all playoff games, as well as every Patriots game. And he'll be on the sideline at tonight's Super Bowl.
"You watch the game very differently," said Gill. "You're looking at the guy whose knee, ankle, or shoulder you operated on. If someone goes down, do they get up?
"I'm looking for mechanisms of injury. If the running back gets hit and stays down, it's an enormous help if you saw he got clipped from the side. You know what to look for, as opposed to going up to a player and saying, 'What hurts?'
"Let's say Tom Brady gets hit and he goes down. I want to see, was his arm out? Or was his arm tucked by his side? If he comes to me with shoulder pain, and his arm was by his side, there's only one or two things it can be. Whereas if his arm was out, there's a couple more serious things there could be.
"He might not remember exactly what happened if he just got hit by a 350-pound player. But it's an enormous help to know [what happened from watching on the sideline] if you don't have time to see the video again. So, that is your history."
A good history is essential. But Gill, and the rest of the doctors, researchers, physical therapists, and medical professionals working at the MGH Sports Medicine Center are eager to see what lies ahead, to fulfill the vision of bringing sports medicine into the new millennium.
Tomorrow: At MGH, physicians experiment with a better way to fix the knee. 