As reported by the AAMC Newsletter, March 27, 2007.

Basketball Docs Lead March to Performance

By Gregg Siegel

Pete Indelicato's boys are not sitting easy this year.

"We've got targets on our backs this season," said Indelicato, M.D., the team physician of the University of Florida Gators men's basketball team, which just happens to be the defending Division I champion. "We know that every team we play is going to give us their best shot. There's a lot more pressure on us than last year, when we weren't even ranked, but I know our guys are up to the challenge."

But if he has any say in it—and he does—his team will be up for it. Team physicians are vital to their squad's success. Even if fans rarely see them on the basketball court, the contributions of team physicians are evident in the players, who bounce back to full health—and game action—after injuries and conditions both major and routine thanks to the physician's presence on the sidelines and in the training room.

"I sit a few rows up during the game, behind the bench on an aisle," said Tim Taft, M.D., team physician for the University of North Carolina Tar Heels. "In 30 years, I've probably been needed on the court less than a dozen times during the actual game."

According to both Taft and Indelicato, their work with basketball teams tends to happen behind the scenes more often than it does for, say, their work with football teams (team physicians often handle multiple sports), where team physicians hit the field once or twice each game to evaluate an injury or make a "play/no play" decision following a vicious tackle or other impact.

"I'll see basketball players all week as needed, and then before a game I'll check in with the trainer and coach to see if there's anyone who needs my attention," Indelicato said. "During the game, I'll keep a careful eye on players who are coming back from injury. Sometimes the coach will ask my opinion if a player looks fatigued or is favoring an ankle. And I'll follow up again with the trainer and coach after the game."

"Game time, I'm primarily there as a fan," Taft said. "Although one who's paying a little bit less attention to the ball than the rest of the crowd and more attention to the kid who just stumbled to make sure that he's running and doing OK."

Diverse Doctoring
Although basketball is a game of chronic rather than acute injuries, most team physicians treat their share of fractures and dislocations, and have also put in a stitch or two over the years.

"Because of this job I tend to do a lot more primary medicine than most other orthopedists," Taft said. "I'm on the road with college kids, and they get colds, gastrointestinal problems, other common ailments. And conversely, our primary-care guys are probably more comfortable than most in dealing with musculoskeletal injuries. So I think working with the teams really helps us expand our skills."

Truer to their specialty, most orthopedists in college sports are also called upon to perform surgeries, including, fairly commonly, repairs to the anterior cruciate ligament (ACL), which, as a stabilizing factor in the knee, often demands immediate surgical intervention in a competitive athlete.

"I played basketball in college and tore my ACL, and that whole process is what sparked my interest in going into orthopedics," said Matt Matava, M.D., team physician for Division III Washington University in St. Louis, who recently performed ACL surgery on one of his players. "I understand what they're going through. I can commiserate about how I felt about missing a lot of games during recovery, and I can tell them how I successfully came back to play, and that helps put them at ease. Also, the ACL procedure has changed a lot over the years, and there's only a small incision now. So, I show them my 12-inch-long scar from 1982. They get a kick out of that."

The Intensity of March
For many fans, March Madness—college basketball's annual season of "one and done" elimination tournaments that determine the champions in each of the NCAA's divisions—is one of the most exciting times in American sports. For similar reasons, it can be one of the most stressful on young athletes.

"March is a very different time," said Bob Arciero, M.D., team physician for the University of Connecticut Huskies.

"Intensity is quadrupled, everyone is on a razor's edge, and there's a very frenetic type of energy. Players are extremely motivated, and the stakes are high. Does that mean a greater chance of injuries? I don't know if there's a connection, but I know I've treated at least two ACL tears during recent championship play," Arciero said.

Robin West, M.D., team physician for the University of Pittsburgh Panthers, has had a slightly different experience.

"Injuries are usually steady and predictable throughout the year, but March Madness comes and suddenly everyone is 100 percent injury-free," West joked. "They see me and hide. No one wants to take the risk of being benched and they'll play through almost anything. Of course, right after the tournament, my phone starts ringing again."

West, who also works with the NFL's Pittsburgh Steelers, is one of the few female team physicians in Division I sports or professional football.

"Orthopedics is only about 8 percent women, so it's not surprising I see so few other women doing this," she said. "But I don't think gender makes much difference. The players and I have very good rapport, and, if anything, they're even more respectful to me."

Team Professors
Most team physicians fulfill multiple roles at their universities, often serving on the faculty of the institution's medical school or as a university physician in addition to caring for men's and women's teams across many sports. "The fact that we're dealing with young people who are so motivated to overcome injuries tests our skills to the ultimate and pushes us to develop more innovative approaches," said UConn's Arciero, who has helped develop a new surgical approach for first-time acute shoulder dislocation.

Washington University's Matava noted that, in his relationships with some athletes, the classroom is never truly closed.

"We have players on our team who are engineering students, pre-law, and pre-med, and with the latter especially, conversations off the court will often turn to what I do," he said. "After the season is over, I'll often invite students to spend the day with me in the clinic or in surgery to explore orthopedics to see if they like it. And I've also seen some players go on to the WU School of Medicine and have had the pleasure of working with them in their post-basketball careers as well."

The Tough Parts
Just as much of their work is behind the scenes, so are some of team physicians' biggest challenges hidden from general view.

"We have kids who sustain career-ending injuries, and having those discussions with them and their parents is very, very difficult," said UNC's Taft. "If someone has had too many concussions or developed a heart condition or had a cervical spine injury, it's unsafe to let them continue, and they have to be disqualified. It's not fun telling them that, and, unfortunately, I've gotten more experience in that regard than I'd like to."

Sometimes the most vexing challenges come from off the court.

"Our basketball program is high profile, and the media calls and wants to know every detail about an injured player," said UConn's Arciero. "Sometimes it seems that they don't understand that these kids are protected under patient privacy laws; so, for legal as well as ethical reasons, I'm not going to talk to them without permission. Sometimes they respect that, but sometimes they go ahead anyway and print speculation, which can create anxiety for the players and their families."

Other challenges can be more mundane, such as the difficulty of scheduling family time around a busy road schedule, especially with the "unknowns" of the March Madness elimination tournament period, in which Florida, Pittsburgh, Connecticut, and North Carolina are expected to contend on either the men's or women's side (or both).

But overall, many team physicians said theirs is an easy job to love.

"It's a real treat to get to know these players personally, traveling with them, living with them, and when someone is injured, it's very gratifying to be able to help them get back quickly to what they love to do," said Florida's Indelicato.

"You can't help but fall into this team camaraderie thing, and, I have to admit, I get ecstatic when they win and a little despondent when they lose."