“All these facets work in harmony to produce the fittest players with the best performance and the most efficient management of their injuries,” explains Dr. Altchek. “Without this kind of conditioning, there will most likely be a higher prevalence of preventable injuries such as muscle strains in the groin, hamstring, and calf.”
Medical attention isn’t limited to major league players. Whether the players have surgery at HSS or elsewhere, the team physicians, physical therapists, and trainers take care of the whole organization – from the farm teams to the major leagues.
Mickey stresses the importance of the constant presence of the team physicians: “Our goal is to have constant physician coverage for all of the players, both major leaguers and minor leaguers. There should always be doctors, physical therapists, and trainers available during every part of the season.”
“These professional athletes are trained at a much higher level baseline, and they’re gifted physically - not just in terms of talent, but in their biology,” explains Dr. Altchek. “Their body fiber is simply different. Sports are very Darwinian, and by the time you get to that level of competition, it has selected out other players with enormous talent whose bodies couldn’t withstand the constant trauma.”
Mickey agrees: “These professional baseball players are some of the easiest patients that I have, at least physically, because they have such body awareness and a high degree of experience doing these exercises to begin with.”
One major difference between professional and amateur athletes is the time they can devote to strength and conditioning training as well as rehabilitation. When combined with their advanced physical condition going into a rehabilitation program, a professional athlete’s rehabilitation efforts generally result in a much quicker rate of recovery.
“A lot of people think these athletes bounce back from injury at an astounding rate, and they sometimes expect to see those kinds of results for themselves,” notes Dr. Altchek. “But these athletes are able to spend eight hours a day doing what most people can only afford to do for maybe 45 minutes, two times a week.”
“The outcome measurement is very precise,” Dr. Altchek notes. “If these athletes fail to return at or above the same level as they were prior to injury, it’s a disaster, and it’s not acceptable.”
Regardless of the athlete’s condition, returning to play after an injury is a very graduated process. Mickey and his team introduce specialized therapy and functional exercises and constantly monitor the athlete’s progress and comfort level. After these steps, they practice at low levels, and eventually, they begin to play at low levels. Pitchers, for example, require extra caution, as they take a longer time to return to pitching at the same level in a game situation. “It’s much different than pitching in the bullpen,” Mickey remarks.
“You graduate them over a period of time, and you must rely on the process,” he adds. “Therapists in general, without our experience, may be intimidated by the pressure of getting these athletes off the DL. They might assume that you can’t push them because they might blow up. At the same time, they might think that the team’s management is pushing for the player’s return.”
“As it happens,” says Dr. Altchek, “the Mets management and ownership know that we have their interests – as well as those of the players – at heart, and they really do trust us to make the right decisions.”
Dr. Altchek describes his relationship with the Mets at length:
It’s a constant learning process, and it’s tremendous. Each decision requires you to be cautious and thoughtful – never flippant. Sometimes you have to make decisions in the training room, and it’s very chaotic. But the key is to slow it down, take a deep breath, and perform a thorough physical exam, consider their history, get whatever imaging tests you need, and gather all the information you’ll need to make the best decision. It’s a challenging environment, but when you make the right decision, you gain the player’s trust over time. They learn to trust you as they’d trust their family. When these players get hurt, they notice how interactive and attentive you are to them, and that’s what pays dividends for both the player and the physician as time progresses. The way we look at it, these guys are our patients. We have their best interests in mind - not just the short term interest of the team. But since many teams sign long term contracts with these players, our long term focus on the player ends up benefiting the interests of the team as well. Just today, I had a player from another team contact me to have a procedure done. His team doctor was going to send him to another physician, but the player chose to have it done here. That stems directly from the trust we’ve built.
Interview and summary by Mike Elvin